ECT shocks to the health system

Is electroshock therapy a real lifesaver or a mind thief?

Two electrodes were placed either side of Denise's head. Up to 200 volts of electricity pulsed through her brain and, within seconds, nearly two years of memory were wiped out. "Great black holes now exist where once I had memories," she says. "They say you are the sum total of your memories. Losing them is like a bereavement, part of you dies."

Denise was treated 10 times with electroconvulsive therapy (ECT), the psychiatric treatment made famous by Jack Nicholson in the film One Flew Over the Cuckoo's Nest. But Denise was not treated in America in the Sixties. Denise was treated here, in England, last year.

Denise is one of the 20,000 patients who are given ECT each year for the treatment of psychiatric disorders, mainly severe depression and some types of schizophrenia. Of these, around 2,000 are given ECT without their consent, putting the UK in contravention of an EC ruling. This Friday (June 19), ECT `survivors' will demonstrate outside the Royal College of Psychiatrists in London.

Denise cannot remember giving her consent for treatment. All she knows is that in the past she has always stated her objections to ECT. An attractive redhead in her early forties who lives in Camberwell, south London, she describes how she ended up in the ECT room: "I studied fine art at Goldsmiths College in south London into my mid twenties. Soon after graduating I suffered a bout of depression. I was treated with anti-depressants and after about two difficult years, the depression lifted.

"For the next 10 years, I worked at odd jobs, trying to support myself while I continued to paint. I then suffered two terrible bereavements: two of my sisters died, from illness, within a few months of each other. I became severely depressed and was treated at the Maudsley Psychiatric Hospital in Camberwell with anti-depressants. Although I suffered from delusions - at times I believed people were being gassed by the Government - at all times during my treatment I stressed I did not want ECT. Never once did I make an attempt to end my life. I eventually pulled through and continued life as normally as possible. I started a job selling investments in the City.

"Things start to get hazy about two years ago. I became depressed again at the end of 1996 and a friend, acting with the best intentions, took me back to the Maudsley. Apart from a three-week break, I was at the hospital until May last year. It says in my records that I was treated with ECT on 10 occasions between March and May. I am informed by the nursing staff at the hospital that, during the tenth episode, I `overconvulsed' and for several weeks following that final bout I was manic. Totally high." During this manic period, Denise wanted to kill herself: "Not because I was depressed, but because I was so high I wanted to release my spirit from my body."

Like many ECT patients, Denise remembers little of the actual treatment. "All I remember is quite a pleasant, floaty feeling. They give you a general anaesthetic and a muscle relaxant before treatment, to prevent you breaking your ribs. So for a period of about six weeks I was barely there. It was a nice, sleepy feeling." Denise is still on anti- depressants and she has not painted since being given ECT.

Another ECT `survivor', Andy Bithell, describes the shock treatment as being "Rather like arson - it destroys its own evidence". Andy was treated with ECT in 1994, against his will and even though his solicitor was actually at the hospital with him. Andy has ongoing memory impairment. "It's horrible. Like walking through a long, dark tunnel with only a weak torch to guide you. When you look back, you can only see about six months into the past. One advantage is that I can read the same book over and over again and never remember the plot." A former management consultant, he became depressed after losing his job and his wife after suffering from a prolonged bout of post-viral syndrome.

Andy, 32, is a member of the patient protest group ECT Anonymous, which is organising the lobby this Friday. Along with other mental health user groups such as Reclaim Bedlam and Survivors Speak Out, the group wants ECT to require both consent of the patient and a second opinion. The mental health charity MIND is backing them. Psychiatric nurses within the Royal College of Nursing believe that ECT is over-prescribed by some psychiatrists and alternatives such as cognitive therapy should be offered.

It is 60 years ago this year that two Italian psychiatrists, having observed pigs being stunned before slaughter, decided to see whether electric shocks would produce convulsions in humans. Previously, drugs had been used to induce convulsions which, it was claimed, inhibited schizophrenia. Psychiatrists claim that ECT, by changing the balance of neurotransmitters in the brain, is an effective treatment for depression, particularly where urgent treatment is needed. Professor David Goldberg, Director of Education at the Institute of Psychiatry in London, says ECT is effective for patients suffering from depressive illnesses, and where a patient is suicidal, ECT can be life saving. "Some-times people are suffering intensely and would like to have a quick treatment to relieve their distress," he says. The last time he ran an ECT unit he would have prescribed the treatment no more than 10 to 20 times a year. He also says that the administering of ECT without consent is a "vanishingly rare phenomenon" and the difficulty some former ECT patients have in memory retrieval is subjective. "Research does not support claims of long term memory loss," he says.

But some psychologists and psychotherapists argue that ECT has no long- term beneficial effects, and can actually cause psychological and neurological damage.

Consultant clinical psychologist Craig Newnes says that one of the difficulties in assessing the benefits of ECT is that the Department of Health ceased collecting data on usage a few years ago, because it was so difficult to obtain reliable figures. "The last time the figures were collated, about three years ago, there was a wide variance of usage from region to region and unit to unit, suggesting there is no uniform standard of when it is appropriate to use ECT. Rather, it is used according to the whim and preference of individual psychiatrists."

Mr Newnes, who works within the NHS in Shropshire, says that he would only feel the administering of ECT was justified if all other treatments have been tried. "Psychiatrists treat depression as an illness, whereas in psychology there is the belief that it is caused by external events, and that finding coping mechanisms is the way to treat it."

He dismisses the claim that ECT can be the only way to save the life of the desperately suicidal: "God knows how many suicidal patients I have treated. I have electrocuted none of them."

He adds that one of the reasons why very few psychologists speak out against ECT is that very often they are working alongside psychiatric colleagues in hospitals, and do not want to be seen to be criticising or undermining colleagues. "If ECT were given only in cases of extreme depression, then it would not be controversial," says Mr Newnes. "But ECT has been given to very young children - the youngest was 34 months old - and even to diabetics. I think some psychiatrists do not help the case for ECT."

Lucy Johnstone, lecturer in clinical psychology at the University of the West of England in Bristol, has recently conducted research into the psychological effects of ECT. "From the outset, I would stress that not everyone finds ECT to be a negative experience," she says. "But for people who had found it distressing, I found that people felt abused, that ECT was given to them as a punishment for being bad. They feel worthless and terrified - the ECT reinforces a lot of the negative feelings they already had. The results can be a lasting dread of ECT and a lasting distrust of professionals."

The Department of Health says that there are some cases of depression, in which all other treatments have failed, where ECT remains the only safe and effective treatment and that it is safely regulated by the Royal College of Psychiatrists. MIND wants ECT regulated by an independent body.

Last week, however, Paul Bradley, MP for The Wrekin, who has been raising concerns about ECT with the department, received notice that Paul Boateng, Parliamentary Under Secretary of State for Health, is prepared to meet and discuss his concerns - something he has until now refused to do.

"This is a good first step," says Andrew Bithell. "Maybe in future depressed patients will not be treated with the same cavalier attitude as I was. But for me it is already too late. The whole experience has wrecked my life."