Electroconvulsive Therapy (ECT) Today
As a neurologist and electroencephalographer, I have seen many patients after ECT, and I have no doubt that ECT produces effects identical to those of a head injury. After multiple sessions of ECT, a patient has symptoms identical to a retired, punch-drunk boxer'After a few sessions of ECT the symptoms are those of moderate cerebral contusion, and further enthusiastic use of ECT may result in the patient functioning at a subhuman level. Electroconvulsive therapy in effect may be defined as a controlled type of brain damage produced by electrical means.
When I discuss ECT (electroshock) at seminars, many Practitioners express surprise that this "treatment" is still being carried out, and most appear to think that it has been "banned". Most beliefs about the practice of ECT appear to stem from the movie, "One Flew Over The Cuckoos Nest" where three central characters are fried punitively.
Whilst Kesey accurately portrayed many aspects of psychiatric treatment that are still relevant today, some 40-50 years after the period in which the story was set, the film's portrayal of ECT is accurate yet misleading.
Modern day ECT is not a rarity not has it been "banned" as many people believe. According to a survery by the UK Department of Health, in the three month period of January to March 1999, 2800 patients were shocked with 16,000 individual administrations of electroshock. Of 700 of these patients detained against their will during this time, 59% were given ECT against their will.
The UK Code of Practice on the Mental Health Act suggests that, "patients treated with ECT should be given a leaflet which helps them to understand and remember, both during and after the course of ECT, the advice given about it's nature, purpose and likely effects." This condescension would be laughable if it wasn't for the dangerous effects to the memory parts on the brain undergoing such "treatment".
Possibly as a demonstration of the patriarchal aspect of psychiatry, 900 of these patients were male, compared to the 1,900 that were female. The difference is explained by the over representation of females in the over 65 age group - the elderly population being the most commonly shocked.
Marketed by psychiatry as an essential and life saving treatment, it is believed to be safe, rapid in effect and most of all - cost effective.
In most countries that still kill people in government sanctioned death chambers - following public trial jury and legal conviction - the execution is carried out in public so that sentence is seen to be executed in a proper fashion.
Here in the UK, forcible ECT is carried out routinely and without fuss. In 1990, 106,000 treatments were carried out in England alone. The sentence is not sanctioned by a court nor does the "patient" possess the most basic rights afforded to a convicted prisoner and no independent person is permitted to be present during the 'treatment.'
In 1995, I wrote to various psychiatric institutions requesting permission to attend a compulsory ECT treatment that was to be carried out on a "formal" patient. Not a single institution replied. Telephone contact with one Consultant Psychiatrist in charge of the "Electroconvulsive Therapy Suite" informed me that this silent refusal was to protect the patient
A typical ECT treatment is not a single shock. "ECT Treatment" typically refers to 6-10 shocks, given at a rate of 3 shocks a week.
The shock is given in order to produce an epileptic convulsion, which these days is "modified" by the administration of a light anaesthetic and muscle relaxant. Normal EEG waveform function takes approximately two to four weeks to return to normal after such an assault. The muscle relaxant and anaesthetic mean that a higher voltage is required to overcome the raised seizure thresholds.
A schizophrenic of about 40, whose condition was organically sound, was chosen for the first test. He expressed himself exclusively in an incomprehensible gibberish made up of odd neologisms, and since his arrival from Milan by train without a ticket, not a thing had been ascertainable about his identity.
Preparations for the experiment were carried out in an atmosphere of fearful silence bordering on disapproval in the presence of various assistants belonging to the clinic and some outside doctors.
As was our custom with dogs, Bini and I fixed the two electrodes, well wetted in salt solution, by an elastic band to the patients temples. As a precaution, for our first test, we used a reduced tension seventy volts) with a duration of 0.2 second. Upon closing the circuit, there was a sudden jump of the patient on his bed with a very short tensing of all his muscles; then he immediately collapsed onto the bed without loss of consciousness. The patient started to sing at the top of his voice, then fell silent. It was evident from our long experience with dogs that the voltage had been held too low.
Dr. Ugo Cerletti.
Rather extraordinarily at an NLP seminar I met an "NLP Trainer" who told me of her own ECT experiences. An active advocate of her own treatment, she regularly booked herself into a private clinic for an annual course of electric shocks. Evidently, not all recipients complain about the effects, but then, not all NLPeople are necessarily human..
Typically, two forms of ECT exist: Bilateral and Unilateral.
In bilateral ECT, the current is passed across the frontal lobes, with an electrode being placed on either side of the head. With unilateral ECT, the electrodes are only placed on the right side of the head, to pass the current primarily through the right frontal lobe. Even though ECT is "safe", passing the current through the 'non-dominant' hemisphere is "safer" - unless of course, you happen to be an artist, musician etc and depend on the right hemisphere for your creativity.
Typical physiological side effects of ECT are memory loss, permanent epilepsy, dyskinesias, tics and twitches and death. Physiological effects are easy to quantify, the psychological effects are a different matter and often overlooked.
The "NLP Trainer" previously mentioned believed her treatment was an "electronic purging of guilt"; some of the patients I have seen carted off by a team of strong armed nurses felt that their 'treatment' was an outright assault and humiliation. One army psychiatric nurse I worked with felt that ECT was a good threat to use against "hopeless depressives" in order to motivate them to change their attitudes.
One of the problems facing psychiatrists is the very fact that ECT exists at all. If they don't use it and the patient dies from suicide, they face being accused of being negligent. If they do use it and the patient still goes and ahead and kills themselves, well, legally the psychiatrists "did everything they could". A similar situation faces obstetricians with the decision whether or not to use a caesarian section delivery during complicated labor.
Many patients will view ECT as the last resort. Given the hopelessness and helplessness of the depressive condition, if other treatments have failed, then ECT may be accepted willingly. Unfortunately, longitudinal studies of ECT recipients demonstrate no long-term benefits in the relief of depression. From experience, these patients demonstrate secondary adaptation to their depression and continue to accept madications despite inefficiency and are forced to build a lifestyle around their depression. Much of the organic treatment will serve to reinforce secondary adaptation from the inside by the nature of their action, as illustrated by Peter Breggin:
Verbatim dialogues with [H.C] Tien [a self styled 'family psychiatrist'] and a married couple dramatise how the wife believes, before her shock treatment, that she wants to leave her husband. She doesn't love him, he is never home, and he beats her in front of the children. Under the threat that her husband would try to get custody of the children in a divorce, the wife, Peggy, agrees to undergo the treatment. After each ECT Peggy regresses to a childlike state and is 'reprogrammed' by her bottle feeding husband to believe that her past personality was bad and that her new one is 'good.' She assumes a new first name, Belinda, to signify the change. Incidentally, Tien tells us, she became 'paranoid' during the first treatment, accusing those around her of harming her; but then she submitted to a second series of shock. Afterwards: 'Belinda is more balanced, more mature and adaptable in social situations than Peggy was. Now, as Belinda, her marriage is reasonably stable.' Tien calls this method ELT, explaining that E is for electricity, L is for love, and T is for therapy.
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