Sunday 30 October 2011

ECT is barbaric and should be banned. Right?

ECT is barbaric and should be banned. Right?  That's what someone said to me last night on Twitter.
It’s a no-brainer (to coin a black humour pun), isn’t it?  ECT (electroconvulsive therapy) involves putting an electric shock through someone’s head to trigger an epileptic seizure. The psychiatrists can’t even say for sure how it might work.  Totally unproven. 

Cut and dried, huh? 

Except no.  Not really. 

I know more than I should about ECT.  I have trawled websites; I have studied academic papers; I have read interviews with those for it and those vehemently against it.  

Would I ban it?  No.

Why? Because I was put in the invidious position of having to decide if someone I loved should have it.  I made that decision – not remotely lightly – and it, quite literally, saved her sanity and her life.
This is a difficult subject for me, as some of you will know.  I can’t use names because – last time I tried to talk about the circumstances that led up to this – it caused a huge rift with people I love. So.
Let’s just say someone close to me – let’s call her Josephine – developed severe psychosis. As in, she thought she'd killed people. She thought she was being tortured. She thought she was being crucified, for pity's sake.  Over and over again.  
She tried to kill herself in hospital.  When she was transferred to a mental health unit, she tried to kill herself again. And again. When she ran out of the means and strength for quick active suicide attempts, she stopped eating and drinking and tried to kill herself that way. Medication did nothing. Therapy? Don’t be stupid. She thought anyone who talked to her was a devil. The devil.
Basically she was running out of time.  Let me be very clear here. I have nothing but praise for that mental health unit. They were superb.  Her psychiatrist was the most humane, intelligent and downright kind doctor I’ve ever met. Somewhere I still have all his phone numbers – yup, home and mobile included.
When he suggested ECT as a ‘last ditch option’, he put it like this. ‘You won’t like the idea. Nobody does. I don’t. I only suggest it as I think, right now, it’s the only way to save her life.’ He went on to say. ‘We don’t know how it works. Not really.  But sometimes it does.  Will it work for her?  I don’t know but, frankly, it’s all we’ve got.’
Let’s get a few things straight. ECT is given under general anaesthetic, with a muscle relaxant. When 'Josephine' was able to talk about it, she said there was no pain.

And, yes, she was able to talk about it because, to cut a long story short, it worked.  It brought her back.  How? I dunno. But I do think that sometimes our brains develop sheep-tracks...synaptic pathways which become hard-wired through constant use.  What ECT seems to do is to switch the train tracks (to mix my metaphors quite appallingly) so the brain stops using that particularly dark synaptic pathway.  Once she realised what was happening (after three sessions) she chose to continue with the ECT – her own choice.  There was some short-term memory loss but we all accepted that as a small price to pay for her peace of mind and sanity.

Yes, it’s a very crude treatment. Yes, it’s distasteful.  And yes, I’m sure, in some cases it is used inappropriately, just as many drugs are given inappropriately; just as many things are done inappropriately. I am quite sure there are some terrible abuses. But just remember, before you ban it…things are rarely black and white.  It is so damn easy to judge.  So so easy. Because, let’s be honest, it makes life a lot simpler, huh? 
One thing, however, is very clear to me.  Without ECT ‘Josephine’ would have died in mental torment.  I can’t stress that enough – she believed she was in hell – real living Hell.  She was existing in mortal terror and bitter despair every moment of the day.  This ‘barbaric’ treatment brought her peace. 

Black and white? Cut and dried? 

For an informed overview of ECT I’d suggest you look at the MIND website here. 


Henry Dunn said...

I too know someone close to me that had a course of ECT - about 12 in all, and it made a huge difference, getting her out of the mire she was stuck in. There are many things in life we don't understand, and in mental health things are rarely clear. When I trained as a music therapist we had a psychiatry module. The first thing the psychiatrist did in the first lecture was to go to the piano (brave in the circumstances). He played us various pieces of music and then asked us to come up with words to describe the mood of the music. We all had slightly different interpretations. He then said that mental health diagnosis is like that - it's more to do with intuition - after all there are no medical tests for this type of diagnosis. I found this really helpful.

Rob-bear said...

Yes, ECT is kinda ugly. But like so many things, it works well for some people.

Not the place to start in dealing with mental illness. But if nothing else works at all, might be worth a try.

Sage advice, m'lady.

Anonymous said...

I too have experience of this. Nothing like portrayed in the film cuckoos nest and it did work. Immediately afterwards wasn't a pleasant thing to witness in the patient as there was a loss of memory and things seemed to be the exact opposite of the original symptoms. Chinese whispers eh?

Anonymous said...

This was in 1976 btw so I would imagine some things have changed a tad.

Exmoorjane said...

Thanks, guys... Hey, two Jazzmen and a Bear.. :)

JazzmanH - yup, very little is clear in the mind...and in this case, one could argue that it was actually a therapist who had triggered the psychosis with inappropriate 'inner child' work. We thrash around when we try to heal minds... I thought long and hard about posting this so am very glad you found it helpful.

Bear: Yup, I think it's last-ditch. Not sure anyone would choose to go that route if something else were available. Though, having said that, many anti-psychotic drugs are pretty grim.

JazzmanB: Sorry you had experience of this too - wouldn't wish it on anyone.. And yup, the aftermath of first few sessions were tough to watch...and I had severe doubts. But cannot describe the sheer joy when 'she' (whatever that was/is) 'came back'.

Anonymous said...

I wasn't the patient, but I was 22 and had to witness the full blown breakdown and recovery. Great to say that the person in question has been on top form for many years and so confident it's unreal. The body and mind will always heal itself if you only allow it to.

To those out there who are in a dark place at the moment - you are a lot stronger than you think and there is a medicine cabinet right there within you that supplies everything you need at just the right dosage xxx

Anonymous said...

As an epileptic who has been in and out of hospital after suffering seizures, had my driving licence taken away 3 times, had MRI's, ECG's and varies other scans to rule out brain tumours, I'm honestly not too sure what to say.

If someone could cure my epilepsy then I might think about giving it a try. But I wouldn't wish an epileptic seizure on anyone. And as I don't know enough about ECT to make any further comments, I shall bow out and say once again, great post, Jane.

CJ xx

Exmoorjane said...

Bud: That's good news about the patient.
It's an interesting point though about the body and mind the case I'm talking about, mind clearly didn't want to heal or had gone too far to pull itself back. What then? Left to itself mind would have killed body. Which, of course it did anyway - just later and under different circumstances.

Exmoorjane said...

Crystal: thank you for commenting.. As you know I have close people with epilepsy - and so I can understand your feelings. The person is not conscious during the seizure, however. They never found lesions on your scans then? Interesting.

Tattieweasle said...

Oh Jane! It does work for soe people. In fact it does work for a lot of people and no I have never heard of anyone saying that they know why.
They tried to section me so I could have it when I was 24 but my Mum couldn't do it.
Having had to cope with serious depression since then would I have wished that she had had the courage?
I don't honestly know. Part of me says not on your life; the other part says...well it could say a lot of things. Amazing post.

Exmoorjane said...

Tattie, oh Tattie - it's a gamble, particularly at such a young age as (as Bud points out) you can get side effects. I kinda think I'd have been with your Mum actually... xxxx

Ruthytoothy said...

This is an excellent post, very well written.

I suffered puerperal psychosis after the birth of my son two years ago, followed by the deepest depression I've ever experienced (I'd been depressed to varying degrees for most of the previous 18 years). When my consultant suggested ECT I was extremely wary, especially when he told me about the potential for memory issues, as such issues had played a major part in my psychosis. However, I'd reached the point where I massively regretted having my son, because (a) I knew I was utterly incapable of parenting my child in this state, and (b) the only thing stopping me committing suicide was the thought of what my son would feel growing up knowing his mum killed herself when he was still a tiny baby. So, I went ahead, had a full course of ECT, and can honestly say it was the most effective treatment I've ever received for my depression.

I have some significant gaps in my memory, and it took a few months for my short-to-medium term memory to fully recover, but I got my life back, so that seems a small price to pay. For most of the intervening 18 months I've been more well than I can remember ever being before, and I've already told my consultant that if I am ever that unwell again, ECT would be my treatment of choice.

The hospital where I received my ECT is no linnet able to offer the treatment, as they cannot afford to provide the necessary staffing levels, not just for the treatment itself, but for all the associated red tape. This means that if I need to receive the treatment again, I would have to be an inpatient at a hospital 50 miles away. This would pose major difficulties, but if I ever reach desperation point again, I would rather have ECT than be stuck in the depths of despair indefinitely.

So no, I don't think ECT should be banned. However I do think there should be further research into how/why it works, and I also think there should be efforts made to change the public perception of the treatment, so that it doesn't prompt quite such a horrified reaction when a person says they have undergone ECT.

Ashen said...

In the early days ECT replaced exorcism, and was abused in the wrong hands. Indeed,spiritual exorcism can have the same dramatic effect, because (I like your description)
... sheep-tracks ... synaptic pathways that become hard-wired through constant use ...
And they often resemble the experience of being possessed by a soul hungry for revenge. Some shamanistic practices are successful in such cases. There is no funding to research wisdom methods that need subtlety, time and commitment. ECT is quick and cost effective. I know a lot of its abusive history and wished there was a more spiritual approach to psychotic episodes, which are often a sign of some deep spiritual emergence.

Exmoorjane said...

Ruthy: thank you so much for sharing your story here...I'm very honoured you feel you could. Yes,I think there needs to be more research for sure and I hadn't realised about the funding issues.

Ashen: interesting take. I did try shamanic healing/soul retrieval for her, and all manner of NCT mirroring in attempts to reach into that state and tug her back, but I think (TBH) I wasn't in a centred enough space and time really wasn't on our side. Exorcism, yes...a psychic jolt off the sheep track... if you believe it. This is a fascinating subject - would love to talk about it with you sometime.

the veg artist said...

I witnessed a friend of mine go through ECT about 30 years ago. Apart from the immediate short-term memory problems, she recovered well, and was able to function. She could not function before. It was a simple choice for her family and doctos.

English Mum said...

Fascinating. I'd never really thought about it - or, to be honest, knew what it was.

It seems to me that you're right - somehow, sometimes, something seems to click, and that something saves people. What's wrong about that?

Thanks for sharing x

Anonymous said...

My husband had two courses of ECT. He recovered well from both with the predicted short term memories issues that have lessened since his last treatment 3.5 years ago. While it didn't work as well with him as it has with others, I would *absolutely* tell people to look into it. It is not barbaric-- it's a truly viable option when you are on the edge of losing everything.

For those who need a better perspective on ECT and it's REAL effect on real people, there are two books I would recommend: by Kitty Dukais- "Shock". She lays it all out about her ECT treatments.
Also: "Morning Has Broken: A Couple's Journey Through Depression" by Emme and Phillip Aronson

Thanks for standing up for ECT... Maybe someday we'll understand how it works, and make it even more effective!

The bike shed said...

My father was severely - REALLY SEVERELY - depressed, and he was offered ECT or its equivalent back then. He feared it greatly, resisting the treatment with with every sinew of his body - he then used those same sinews to beat me and my brothers so badly and so regularly that it took me 30 years to face up to what had happened. Astonishing brutality that might just have been avoided had he been better informed and taken sensible counsel.

I have no idea if ECT would have worked. What matters I think is that we have informed choice. Society accept all sorts of unproven practices - in clinical as well as alternative medicine, in religion, in cultural norms. ECT is no different - we need information and reasoned advice. And we need to remember that others are affected too.

Exmoorjane said...

Veg: Thanks for commenting - good to hear that outcome.

EM: It's not something that is talked about really, so I'm not surprised you hadn't heard of it and, to be honest hon, I'm heartily glad you haven't had any experience of it. xx

NQJ: Sorry to hear it didn't work so well for your husband. Did anything else work? I so hope so. Huge HUGE thanks for sharing the books - they sound like great resources for anyone going through this particular brand of hell. x

Mark: thank you so much for putting this perspective. We often forget the other people who are affected by mental illness, the families and friends. I am so sorry, so very sorry.
My father also suffered from severe depression but (luckily for us, if not for him) he turned his hatred within and died of cancer. His father had a lobotomy (!) and his brother hanged himself. All through depression.

Joanna Cannon said...

When I was at medical school, I had very strong feelings about ECT. I thought, as many do, that it was barbaric and outdated and the fact that no one really knows how it works didn't really endear it to me.

However, I met so many patients who lead a much improved quality of life, thanks to ECT. In fact, I met several who simply wouldn't be here without it. Unfortunately, however, not only do they have to deal with the stigma of mental illness, they also have to deal with the stigma of the very treatment which saved them.

I remember one woman in particular, who became very tearful when she explained to me how ECT had changed her life. I sat there and felt very humbled and ashamed and angry at myself for such a knee-jerk reaction.

Posts like this go a long way to helping people make an informed choice in their treatment. For those who are fortunate enough not to suffer mental health problems, I hope it makes the path to understanding a little easier.

Mike Gloady said...

Your article is spot on. These days ECT is very controlled and carried out with thought and care to the patient's comfort and dignity. It wasn't always the case sadly.

Some people here have said that the reality of ECT bears no resemblance to the novel and film of "One Flew Over The Cuckoo's Nest" - and it doesn't these days, but there was a time when it was very close and that was an important book because it raised awareness of these practices. In order to explain I'm going to have to share a personal story.

My mother, shortly after I was born, was suffering from Post Natal Depression, I was premature by nearly a month, my brother was going blind and my father had suffered a crippling industrial accident which his employer had wriggled out of paying out on. Lots of problems on her plate and she had to the be one to get us through visiting three separate hospitals every day for months. Eventually she collapsed and was sectioned (and then raped repeatedly by several staff members (including doctors of both sexes) in the hospital she would, until she died last year, refer to as "that prison".

While she was there, before therapy and drugs were really considered she was just signed on for (we would later discover) 20 seperate ECT treatments. No anesthetic. No relaxants. No attempts to explain things to her. No care for her dignity. No consent forms from her family. No care taken to clean the excrement from her if she was to evacuate her bowels in fear at another "torture session" She would suffer from night terrors until the day she died. Nobody seemed to have any interest in actually helping her and she would suffer from a pathological fear of hospitals and medical professionals for the rest of her life. I would say taht "barbarism" is too kind a term for what happened to her.

This was the early 70s in Britain. It's now 2011 and things have changed. I know people who work in mental health and have some experience of serious long term depression of my own sadly. Nobody would WANT this. But now, were it to someday, somehow be an option for helping me I don't have to FEAR it. It's also probably worth mentioning that my mother slowly learned to trust individual doctors and nurses, even if she instinctively flinched from their uniforms. And that, despite the night terrors, she lived a mostly happy life after her brief (but serious) brush with psychosis.

I've cut out large portions of the story as it's already quite long enough. Thanks for your time everyone and thank you Jane for allowing me the opportunity to share my mother's story. I'm sure my mother would have read it, nodded and agreed with your points.

Lisa Scullard said...

Hi Jane. A fellow patient in the same psychiatric unit as me a number of years ago had ECT, for crippling depression and bi-polar - and yes, it was effective. I wasn't offered it. I knew about synaptic 'pathways' already, and in spite of the relapse, it was just a matter of time practising other thought processes based on only dealing with what was in front of me, for the self-reinforcing illusions to disappear. Sometimes I wonder if being able to recall psychotic episodes does more harm for me personally in the long run, because it blocks other things like social confidence returning, and the ability to form relationships. Unfortunately counselling doesn't work for me in that sense, as I haven't had any relationships yet to recall how they're supposed to work, or to know what personality will emerge if I ever have one. It'll be something new that I've never done, psychotic or otherwise - that's the most I can be confident about! :) xx

M. A. McRae said...

I was appalled when a friend told me that her elderly mother, bedridden and deressed (and no wonder) had been given ECT against her wishes and against the wishes of her family. Apparently the psychiatrist told the family she could do it without permission. (Yes, the psychiatrist was female.) The old woman continued to worsen and then died, as old people do. The psychiatrist made money.
I read somewhere that it is mainly old women who are being treated with this, especially old women without a strong defender. I very sincerely hope that no-one ever attacks me like this.