[ELECTRO-convulsive therapy (ECT) is a fairly common treatment…]

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ELECTRO-convulsive therapy (ECT) is a fairly common treatment of some forms of mental disturbance. It is often used, for instance, when other treatments for depression have failed.

Seizure

The therapy consists of applying an electrical shock to the brain of anaesthetised patients, in order to induce a convulsive seizure (fit). For reasons which are almost completely unknown, the seizure can help to overcome the depression, though most psychiatrists accept that there is a high rate of relapse.

A problematical side-effect of the treatment is confusion in the hours following a seizure, and the loss of memory, which lasts several months. Current thinking attributes the beneficial effects of ECT to the convulsion, while the confusion and memory loss are due to the electrical current.

The idea, then, is to give as little current as possible, especially to the 'memory side' of the brain, while still producing the fit.

The public (i.e. you and me) have long viewed ECT with suspicion and distaste, an opinion which has been encouraged by suggestions that ECT has been given as punishment to uncooperative mental patients and to political dissidents in Russian so-called psychiatric clinics.

Class

It is also said that ECT is more likely to be given to working-class patients suffering from depression than to depressives who are middle class. The general suspicious attitude towards ECT has also given rise to stories, such as that in the magazine World Medicine of a hospital whose results from ECT were so successful that the staff didn't realise for two years that their brand new ECT machine hadn't been producing any shock!

In view of the public disquiet about ECT, and its only too real side-effects, you might think that clinicians who prescribe the treatment to patients would be cautious and painstaking in its application. Not so, a recent report shows.

In their investigation for the Royal College of Psychiatrists, Drs J Pippard and L Ellam found that up to 98% of British psychiatrists favour ECT, and that in 1979 some 200,000 applications of ECT were made.

Despite the fact that many, many studies show that unilateral ECT (to one side of the brain only) causes less confusion and memory loss, but is equally effective in combatting depression, 80 per cent of British clinics use the more severe bilateral treatment.

Over a quarter of the clinics use out of date machines, with no control over the amount of electricity passed through the patient's head. The machines are rarely overhauled, and most ECT treatment is given by doctors with no training in the technique.

The report describes ECT being given in large open dormitory wards with rows of patients lying in unscreened beds and the ECT and anaesthetic machines being wheeled from one bed to the next. Patients awaiting treatment, or recovering from it, can see and hear the others undergoing convulsions.

Of the staff involved, the report rates only one third of the psychiatrists and two thirds of the nurses as competent.

Nursing staff were found to be bored, apathetic, or hostile to ECT. In some cases, the fact that treatment did not result in a fit (the only aspect of ECT thought to be beneficial) was ignored by the medical staff involved.

In a review of the report, the medical journal Lancet says, 'The picture painted is one of ECT being given in many clinics in a degrading and frightening way, with little consideration for patients' feelings, by bored and uninterested staff, with obsolete machines, operated by ignorant or uncaring psychiatrists"

Whether ECT is an effective treatment for certain mental disorders is beyond my competence to judge. DAVY JO LOOKS AT E.C.T.

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