Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) continues to provoke arguments. For some it represents little more than a haphazard and degrading technique not fit to be termed a treatment. For others it represents an alternative and highly effective treatment that does not deserve the bad press it sometimes receives. So why does ECT remain so controversial - surely the facts should speak for themselves?
ECT involves passing an electrical current through the brain for a brief period of time. This results in the person having a convulsion, the purpose of which is to improve their existing mental state. Quite how ECT works remains unclear but it appears to have an effect on neurotransmitters that are implicated in both depression and schizophrenia.
Early attempts to induce seizures involved the use of camphor injections. It was a highly risky practice and resulted in several deaths. Not until two Italian doctors discovered that a seizure could be more safely and reliably induced by an applying an electrical current directly to the head was the practice overtaken. In these early days the term ‘safely' was something of a relative concept. With no muscle relaxants and no anesthetic available the procedure frequently resulted in joint dislocations and broken bones.
Mainly because of the lack of any alternatives, ECT reached its high point during the 1950s. The procedure involved placing electrodes on each temple and passing a current of up to 140 volts into the brain for maybe a second or less. The resulting seizure could last a few seconds to a few minutes. Modifications in the form of muscle relaxants meant bones remained intact. Subsequently, the introduction of anesthetics meant the procedure could be carried out whilst the patient was unconscious.
Apart from moral concerns about the use of a technique that is poorly understood, there have always been concerns about the use of ECT as a form of behavioral control. These fears were exemplified in the movie One Flew Over the Cuckoo's Nest, which is still shown to psychology students today. One notable exponent of the anti-psychiatry movement, Thomas Szasz, argues that any psychiatrist who prescribes ECT sacrifices his or her position both as thinker and moral agent.
Psychologists also tend towards a negative view of ECT. Some condemn the practice totally. Others adopt a view which essentially recognizes that whilst ECT can have a significant therapeutic effect with major depressive disorder, it can also damage other mental processes, most notably memory. ECT does not cure depression, but it can alleviate the worst of the symptoms for a period of time. Risks are associated with the use of anesthetics and patients generally go through a phase of acute confusion for about 10 minutes following the procedure.
There has been a shift away from the bilateral use of ECT, partly because of the association with loss of memory. The preferred technique is to apply the electrodes (paddles as they are sometimes called) to one side of the head (unilateral) on the non-dominant side. Evidence seems to suggest that this reduces some of the problems associated with memory loss.
And my position on this? I can certainly attest to observing the therapeutic effectiveness of ECT with depression. As a young student I vividly recall meeting a patient who suffered depression so profound that she had stopped eating, drinking, was hallucinating and could no longer effectively communicate. After just two or three treatments with ECT the effect was both dramatic and impressive. The person had put on some weight, was talking eloquently and expressing very positive thoughts about her current state and what the future held in store. Faced with this situation and the apparent lack of any alternative treatments, I found myself persuaded that ECT has its place. Then again, I have seen patients arrive for what seems to be their umpteenth treatment who, to my mind, appear little different afterwards than they did before.
I'm certainly aware of other views but I have concerns about people being described as ‘ECT survivors'. Sure, ECT has wrongly been applied, and this is acknowledged by psychiatrists as well as psychologists. I also have every sympathy with people who believe they were damaged as a result of ECT, because I do believe this is possible. However, this is something of a cost/benefit issue. We know that ECT has benefits and we know there are costs. I continue with my belief that unless and until suitable alternatives can be made available, circumstances still remain where the benefits appear to outweigh the costs.