jones and baldwin 1992

ECT shock~ lies andpsychiatry YvonnEpJones and Steve Baldwin

t

A Ithough Cerletti is often attributed with the introduction of ECf t1(1938) references are available which highlight earlier use In England in 1872 Oifford Allbutt used the passage of electric current through the head for the treatment of mania brain wasting dementia and melancholia (Strabeneck 1986) It was however the independent practices of Meduna and Sakel who set the precedents for the induction of epileptic fits as a form of treatment In 1938 Cerletti supplied the electricity

The first electro shock was given to an Italian man known only by his initials as SE He had been arrested by the police department for vagrancy

and was referred to hospital for observation After a diagnosis of v-- schizophrenia he was identified as a first subject in the study Although

Cerletti sought permission to experiment on hogs he did not pursue the same procedure when conducting this human trial He administered the~ first shock which failed to induce a convulsion because the voltage had been ~ too low Whilst Cerletti discussed with colleagues how to proceed

~ SE (who had been listening to this conversation) stated N Not another one Its deadlymiddot (Berke 1979) Despite this mans expressed wishes Cerletti

b proceeded with his experimentation and using a higher voltage induced a convulsion

Today psychiatrists claim to administer modified ECfIt is presented as a safe treatment far removed from Cerlettis crude experiments In fact modifications do little to increase the safetyof ECTand are more damaging For example there have been major changes in the way that psychiatrists now view the administration of ECf First they consider the useof a muscle relaxant essential TIUs is now given routinely with all ECf to prevent the orthopaedic complications of dislocation and breakages which were common side effects associated with ECf in the past Muscle relaxants sedate the brain and it is much more difficult to induce a seizure Therefore the voltage has to be increased even higher than with unmodified ECf to reach the threshold necessary to produce a convulsion The result of this improved procedure is a higher degree of damage to the brain

Another modification is the administration of unilateral rather than bilateral ECf This procedure assumes that one side of the brain is less valuable than the other Humanistic psychologists would not agree Instead they might argue that the non-dominant side is essential to creativityThe placing of electrodes unilaterally increases the concentration ofcurrent in one part of the brain and the damage to this part is more severe than in bilateral ECf (Breggin 1989) EEG results one month after unilateral

Yvonne Jones is Deputy Unit Occupational Therapist at Bangour Village Hospital West Lothian Steve Baldwin is Senior Lecturer and Course Coordinator of the MSc in Public Health at the University of Aberdeen UK

CHANGES (An International Journal of Psychology and Psychotherapy) June 1992 Sub $36 (4 issues) L Erlbaum Assoc 27 Palmeira H~nsectiQna Chv+cn Rg Hove ~a~t gU~gX DNJ ~FAf UK

------

bullECf SHOCK UFS AND PSYCHIATRY 127

ECf confirm that it is possible to detect which side of the brain is damaged (Weiner 1980)

Modified ECf is not scientifically proven Psychiatrists claim that it is a safe technique in an attempt to control popular opinion In general many psychiatrists have insufficient regard for the brain For example Pippard and Ellam found that some clinics did not give their clients oxygen thus risking anoxic brain damage and that nearly a quarter ofclinics were using obsolete shock machines These delivered an untimed shock resulting in clients receiving excessive amounts of current (Pippard and Ellam 1981 Editorial 1981) The most recent update confinns that not much has changed (Pippard 1992) The Royal CoJlege of Psychiatrists guidelines also recommend bilateral ECf (Freeman 1989)

howECTworks ECf is presented in current psychiatric literature in an edited form The rationale for ECf is often that the electrical current rearranges brain chemistry positively Another explanation given has its roots in psychoanalytic terms suggesting that individuals benefit when they get in touch with their need to punish themselves Current psychiatric literature highlights that most of these theories are without supportive data and identifies that the mechanism of ECf is unknown The rationale for the continued use of ECf is that many medical treatments havebeen essentially helpful despite the medical professions lack of knowledge about the way in which they work

The truth about how ECfactually does work is always omitted in current psychiatric publications Electro-convulsive therapy is effective by damaging the brain Advocates of ECT were the first to identify this It is only more recently that this has been presented in a positive way by the insistence that this damage is negligible and transient a concept which is hotly disputed by many people who have undergone ECf

ECfhasbeen repackaged ina manner designed to censor pubJicopinion Empirical research based on adequate methodological data does not exist to back up its continued use However psychiatrists continuetoquote from obsolete and inaccurate studies misrepresenting the original outcomes to suggest positive conclusions

psychiatryandECTmaintenance Many psychiatric treatments for example major tranquillizers lobotomy and ECT reduce an individuals potential to experience emotion it is acceptable to stuporise people rather than to enable them to get in touch with their own distress

For some people long term treatment can become a reality although not a necessity In an overstretched staff team the frustrations of managing a difficult self-middotdestructive or impulsive individual can often lead to the introduction of an aggressive Eer regime This renders the person passive docile predictable and easily manageable Staff can misinterpret this lack

feT shock lies and psychiatry YvonnEpJones and Steve Baldwin

t

A Ithough Cerletti is often attributed with the introduction of ECT i1(1938) references are available which highlight earlier use -In England in IBn aifford Allbutt used the passage of electric current through the head for the treatment of mania brain wasting dementia and melancholia (Strabeneck 1986) It was however the independent practices of Meduna and Sakel who set the precedents for the induction of epileptic fits as a form of treatment In 1938 Cerletti supplied the electricity

The first electro shock was given to an Italian man known only by his initiaJs as SE He had been arrested by the police department for vagrancy and was referred to hospital for observation After a diagnosis of

y schizophrenia he was identified as a first subject in the study Although Cerletti sought pennission to experiment on hogs he did not pursue the same procedure when conducting this human triaJ He administered the~ first Shock which failed to induce a convulsion because the voltage had been ~t too low Whilst Cerletti discussed with colleagues how to proceed

~ SE (who had been listening to this conversation) stated U Not another one Its deadly (Berke 1979) Despite this mans expressed wishes Cerletti proceeded with his experimentation and using a higher voltage induced a convulsion

Today psychiatrists claim to administer modified ECT It is presented as a safe treatment far removed from Cerlettis crude experiments In fact modifications do little to increase thesafety of ECTand are more damaging For example there have been major changes in the way that psychiatrists now view the administration of ECT First they consider the useofa muscle relaxant essential This is now given routinely with aJI ECT to prevent the orthopaedic complications of dislocation and breakages which were common side effects associated with ECT in the past Muscle relaxants sedate the brain and it is much more difficult to induce a seizure Therefore the voltage has to be increased even higher than with unmodified ECT to reach the threshold necessary to produce a convulsion The result of this improved procedure is a higher degree of damage to the brain

Another modification is the administration of unilateraJ rather than bilateral ECf This procedure assumes that one side of the brain is less vaJuable than the other Humanistic psychologists would not agree Instead they might argue that the non-dominant side is essentiaJ to creativityThe placing ofelectrodes unilaterally increases the concentration ofcurrent in one part of the brain and the damage to this part is more severe than in bilateral ECf (Breggin 1989) EEG results one month after unilateral

~

Yvonne Jones is Deputy Unit Occupational Therapist at Bangour Village Hospital West Lothian Steve Baldwin is Senior Lecturer and Course Coordinator of the MSc in Public ieUth at the University of Aberdeen UK

CHANGES (An International Journal of Psychology and Psychotherapy) June 1992 Sub $36 (4 issues) L Erlbaum Assoc 27 Palmeira Manmign~ Ch~TGh Rd Hove Ea~t p~esectx PNJ ~fA UK

ECf SHOCK UES AND PSYCHIATRY 127

ECT confirm that it is possible to detect which side of the brain is damaged (Weiner 1980)

Modified ECT is not scientifically proven Psychiatrists claim that it is a safe technique in an attempt to control popular opinion In generaJ many psychiatrists have insufficient regard for the brain For example Pippard and Ellam found that some clinics did not give their clients oxygen thus risking anoxic brain damage and that nearly a quarter of clinics were using obsolete shock machines These delivered an untimed shock resulting in clients receiving excessive amounts of current (Pippard and Ellam 1981 Editorial 1981) The most recent update confirms that not much has changed (Pippard 1992)The Royal College ofPsychiatrists guidelines also recommend bilateral ECT (Freeman 1989)

howECTworks ECT is presented in current psychiatric literature in an edited form The rationale for ECT is often that the electrical current rearranges brain chemistry positively Another explanation given has its roots in psychoanalytic terms suggesting that individuals benefit when they get in touch with their need to punish themselves Current psychiatric literature highlights that most of these theories are without supportive data and identifies that the mechanism of ECT is unknown The rationale for the continued use of ECT is that many medical treatments havebeen essentially helpful despite the medical professions lack of knowledge about the way in which they work

The truth about how ECT actually does work is aJways omitted in current psychiatric publications Electro-convulsive therapy is effective by damaging the brain Advocates of ECT were the first to identify this It is only more recently that this has been presented in a positive way by the insistence that this damage is negligible and transient a concept which is hotly disputed by many people who have undergone ECT

ECT has been repackaged ina manner designed to censor publicopinion Empirical research based on adequate methodological data does not exist to back up its continued use However psychiatrists continue to quote from obsolete and inaccurate studies misrepresenting the original outcomes to suggest positive conclusions


For some people long term treatment can become a reality although not a necessity In an overstretched staff team the frustrations of managing a difficult sef-destructive or impulsive individual can often lead to the introduction ot an aggressive Eer regime TIUs renders the person passive docile predictable and easily manageable Staff can misinterpret this lack

of affect as an improvement in the persons psychological state It is at a great personal cost to the individual that psychiatric teams oftenmeet their own goals

Eer is a way in which psychiatrists families and sometimes clinical teams deal with challenging and troublesome people It is surely wrong to add force to theadministration of Eer though sectioning people under the Mental Health Act remains an option People who are about to undergo Eer receive an abundance of information based on psychiatric literature which fails to acknowledge the risks involved They are often not given a clear picture of the risk of death permanent brain damage and loss of memory (Hughes Barraclough and Reeve 1981) With this information people are coerced into taking a voluntary decision to receive Eer

the lepackagingoffer Although many studies have been undertaken to evaluate Eer few have reached the minimal requirements necessary toestablish scientific validity With the limited material available to support the therapeutic use of Eer the underlying basis for the widespread use of this intervention should be explored

One explanation is that the way in which Eer is documented presents an irnbaJanced view Although clinical evidence exists to demonstrate that Eer damages the brain For example Generalised EEG-slowing both regular and irregular in morphology is the most prominent electro-physiological correlate of Eer It is a non-specific abnormality consistent with dlffuse cortical and sulHortical impairment (Weiner 1980) Weiner concluded thatalthough theslowinghad usually returned to baseline levels by three months in some people it can persist for longer This information is rarely quoted

In contrast leading texts promote Eer as a safe treatment devoid of serious side effects The uniform view is dismissive of many specific case histories in which extensive side effects are noted For example a survey (Freeman and Kendall 1980) found that 30 per cent of shock victims reported permanent memory impairment following treatment

In another example (Frank 1990) Each shock treatment was for me a Hiroshima The shocking destroyed large parts of my memory including the two-year period precedlng the last shock In addition alternative literature which suggests that Eer is harmful is either ignored or dismissed as a campaign by a minority group with extreme views

Significantly an overview of psychiatric literature demonstrates that the method of presenting Eer has changed Early texts included many references to the incidence of brain damage associated with Eer For example Bini (1938) suggested that the favourable transformation of the morbid psychic picture in schizophrenia was broUght about by very severe and iaever5ible alterations in the nervous system Fink (1958) wrote that the biochemical basis for convulsive therapy is similar to that of cranial cerebral trauma Hirsch Gordon achieved in plain English imbecility replacesinsanitymiddotll948

Many articles documenting long-term impairment personality changes and brain damage following Eer appeared in psychiatric journals in the 1940sand 1950s In the 19605 the neurologist Symonds stated after a series ofbi-weekly treatments the clinical picture is like that of a more severe head injury (Symonds 1966) In addition Lewis admitted that electro shock certainly produced tissue damagein thebrainand concomitant impairment of mental functions including perception and capacity to learn (Lewis 19(7) Neither Symonds nor Lewis were anti-psychiatrists

An example of the change in the way that Eer is promoted is the Mdisappearing memory loss trick In the first (1946) edltion of Psychiatry theory and practice for nurses this quote ap~ There is a possibility of damage to the brain substance Furthermore convulsions not only result in amnesia for the fits but also enlargememory gaps which may extend far back into the past By the fif1l edltion of the same book in 1962 the possibility of damage to the brain substance had become remote- and a discJainler had beenadded Mmost of thesememory gaps areeventuallyc1osed (Becc1e 1946)

Advocates of Eer introduced the contra-indications of brain damage and many sources refer to the need for careful consideration when deciding upon Eer as a treatment for clients who rely on their memory for employment Herskovitz writing in the PhilildtlphiD PsydJiDtric Socrety Joumal in 1943 reported finding memory deficits among 174 people treated with Eer to be rather general and prominent Therefore patients whose occupation requires intellectual ability are selected for treatment with caution (quoted in Frank 1990) Current texts often fail to report the negative consequences of Eer although adequate research to dismiss the possibility of permanent memory loss does not exist

Eer results in acute brain syndrome Sament a neurologist published his views on the brain-damaging effects of Eer in a letter to the editor of a professional journal M have seen many patients after Eer and have no doubt that Eerproduces effects identical to those of a head injury (quoted in Frank 1990)

Salzman (1947) investigated what he termed the umalignant effects of shock therapy on the personality of the individual He discovered that the most persistent impression obtained is that shock patients show a picture resembling the post lobotomy syndrome McOelland 1988 believes that the changes Salzman observed in shock patients-disinhibition euphoria and blunting are the classic signs of injury to the frontal lobes of the brain

The debate remains about whether the damage is permanent and if so what is the incidence and severity Anderson noted that every psychiatrist has seen such (post shock) amnesia last for years after treatment (l951) Memory impairment is a recognised side effect of Eer (Freeman 1989) Valentine (1968) gave the following description of memory loss a patient with marked Eer amnesia is likely to have substantial memory loss for the sequence of events immediately prior to treatment and also a very partial and scattered amnesia particularly for names peopleand events extending backwards in time for many months Current psychiatric literature frequently does not address if this damage is permanent

of affect as an improvement in the persons psychological state It is at a great personal cost to the individual that psychiatric teams often meet their own goals

Ecr is a way in which psychiatrists families and sometimes clinical teams deal with challenging and troublesome people It is surely wrong to add force to the administration of Ecr though sectioning people under the Mental Health Act remains an option People who are about to undergo Ecr receive an abundance of information based on psychiatric literature which fails to acknowledge the risks involved They are often not given a clear picture of the risk of death permanent brain damage and loss of memory (Hughes Barraclough and Reeve 1981) With this information people are coerced into laking a voluntary decision to receive Ecr

the lepackaginf1offer Although many studies have been undertaken to evaluate Ecr few have reached the minimal requirements necessary to establish scientific validity With the limited material available to support the therapeutic use of Ecr the underlying basis for the widespread use of this intervention should be explored

One explanation is that the way in which Ecr is documented presents an imbalanced view Although clinical evidence exists to demonstrate that Ecr damages the brain For example NGeneralised EEG-slowing both regular and irregular in morphology is the most prominent electro-physiological correlate of Ecr It is a non~pecific abnormality consistent with diffuse cortical and sub-cortical impairment (Weiner 1980) Weiner concluded that although the slowing had usually returned to baseline levels by three months in some people it can persist for longer This information is rarely quoted

In contrast leading texts promote Ecr as a safe treatment devoid of serious side effects The uniform view is dismissive of many specific case histories in which extensive side effects are noted For example a survey (Freeman and Kendall 1980) found that 30 per cent of shock victims reported permanent memory impairment following treatment

In another example (Frank 1990) Each shock treatment was for me a Hiroshima The shocking destroyed large parts of my memory including the two-year period preceding the last shock In addition alternative literature which suggests that Ecr is harmful is either ignored or dismissed as a campaign by a minority group with extreme views

Significantly an overview of psychiatric literature demonstrates that the method of presenting Ecr has changed Early texts included many references to the incidence of brain damage associated with Ecr For example Bini (1938) suggested that the Nfavourable transformation of the morbid psychic picture in schizophrenia was brought about by very severe and irreversible alterations in the nervous system Fink (1958) wrote that the biochemical basis for convulsive therapy is similar to that of cranial cerebral trauma Hirsch Gordon achieved in plain English imbecility replaces insanity- (1948)

Many articles documenting long-term impairment personality changes and brain damage following ECT appeared in psychiatric journals in the 1940sand 1950s1n the 19605 the neurologist Symonds stated after a series ofbi-weekly treatments the clinical picture is like that of a more severe head injury (Symonds 1966) In addition Lewis admitted that electro shock certainly produced tissue damagein thebrainand concomitant impairment of mental functions including perception and capacity to learn (Lewis 1967) Neither Symonds nor Lewis were anti-psychiatrists

An example of the change in the way that Ecr is promoted is the disappearing memory loss trick In the first (1946) edition of Psychiatry theory and practice for nurses this quote appears There is a possibility of damage to the brain substance Furthermore convulsions not only result in anmesia for the fits but also enlarge memory gaps which may extend far back into the pastn By the fifijl edition of the same book in 1962 the possibility of damage to the brain substance had become Nremote and a disclainler had beenadded mostofthese memory gaps areeventually closed (Beccle 1946)

Advocates of Ecr introduced the contra-indications of brain damage and many sources refer to the need for careful consideration when deciding upon Ecr as a treatment for clients who rely on their memory for employment Herskovitz writing in the Philadelphia Psychiatric Society ountlll in 1943 reported finding memory deficits among 174 people treated with Ecr to be rather general and prominent Therefore patients whose occupation requires intellectual ability are selected for treatment with caution (quoted in Frank 1990) Current texts often fail to report the negative consequences of Ecr although adequate research to dismiss the possibility of permanent memory loss does not exist

Ecr results in acute brain syndrome Sament a neurologist published his views on the brain-damaging effects of Ecr in a letter to the editor of a professional journal I have seen many patients after Ecr and 1have no doubt that Ecr produces effects identical to those ofa head injury (quoted in Frank 1990)

Salzman (1947) investigated what he tenned the malignant effects of shock therapy on the personality of the individual He discovered that the most persistent impression obtained is that shock patients show a picture resembling the post lobotomy syndromen McOeiland (1988) believes that the changes Salzman observed in shock patients-disinhibition euphoria and blunting are the classic signs of injury to the frontal lobes of the brain

The debate remains about whether the damage is permanent and if so what is the incidence and severity Anderson noted that every psychiatrist has seen such (post shock) amnesia last for years after treatment (1951) Memory impairment is a recognised side effect of Ecr (Freeman 1989) Valentine (1968) gave the following description of memory loss a patient with marked Ecr anmesia is likely to have substantial memory loss for the sequence of events immediately prior to treatment and also a very partial and scattered anmesia particularly for names peopleand events extending backwards in time for many months Current psychiatric literature frequently does not address if this damage is permanent

-

130 YVONNE JONES amp STEVE BALDWIN

Such selective reporting invites the interpretation that ECf has been repackaged and is now strategically promoted in a manner designed to avoid the censure of critical public opinion lhis misrepresentation of data is created by the existence of poor standards to monitor ECfIn the absence of accurate data results from invalid studies are now quoted indiscriminately as fact

For example a study completed by Freeman and associates in 1978 is frequently quoted to support ECf The study involved 40 clients who were randomly assigned to two groups One group had the first two treabnents of a course of ECf replaced by placebo Despite the design protocol of this study Freeman then administered ECf to both groups The study cOncluded that ECf is more effective than placebo in the treabnent of depression In reality this clinical trial is invalid because Freeman felt it ethically unjustified to withhold for a complete course a treabnent generally regarded to be effective (Freeman Basson and Crighton 19781

Lamboum and Gill (1978) completed one of the first contemporary trials to evaluate ECf They concluded that in this group of patients suffering from depressive psychosis six brief pulse unilateral ECfs did not produce a significantly therapeutic effect when compared with a simulated procedure Gangadhar et at (1982) completed the only trial to give the controls an antidepressant drug in conjunction with a simulated shock At the end of the trial there was no difference between the shock or the control group Psychiatrists have taken thesenot wholly impressive results as proof of the effectiveness of ECf

Evaluations which are valid suggest that ECT is of value in the treabnent of severe depression which is characterised by the risk of suicide (Leicester trial 1984 Nottingham trial 1985) The Northwick Park double blind study in 1980 (regarded by many as the most thorough investigation of ECT yet) measured follow-up improvement in relation to the effectiveness of ECT It concluded that although people receiving ECf were significantly better in the short tenn no differences were shown between thecontrol group and the ECfgroup at one month and six month intervals Analysis of the results confirmed that with intensive nursing and medical care people can recover from the most severe depression without receiving ECf

Qaims in mainstream psychiatric literature that ECfcan prevent suicide are quoted as fact Statistical evidence to support this is unavailable Furthennore admission to psychiatric institution can increase the risk of suicide (Frank 1990)

useofECT Many psychiatrists try to convince people that abuse or overuse of ECf is a thing of the past that today there is agreement among psychiatrists regarding its use and that it is only used as a treabnent for severe Ndepressive illness This is not the case

The averagenumberoftreabnents in a course is about 65 (although there are still some people getting maintenance shock) so about 20000 people a year were getting ECf in the 1980s Since the Department of Health

ECf SHOCK UES AND PSYCHlA TRY 131

started keeping a record in 1979 the total number has fallen by about 30 per cent However these figures are for NHS patients only and do not include the people getting ECf in private hospitals (In some countries for example USA and Italy ECf is used more in private hospitals than in state hospitals)

Although modem texts refer to ECf as the standard treabnent for depression in the 1950sn

a psychiatrist at that time estimated that ECf was being given to about 20000 people a year Uarvie 1954) approximately the same number as today This may well have been an underestimate as he was counting only the number of new admissions but even so it raises an awkward question Why didnt the introduction ofantidepressant drugs at the end of the 1950s do more to reduce the use of ECI

The figures for the Regional Health Authorities show wide variation between regions from 125 treatments per 100000 population in Oxford to nearly 400 in Wessex (198788) and figures for the districts within the RHAs show even greater variation In the absence of any demographic explanations these figures confirm that there is still wide disagreement about the usefulness of shock

A study of individual consultants in one region (Gill and Lambourne 1981) demonstrated that approximately one third of shock is given where 85 per cent of consultants would not use it Further 15 per cent of consultants are responsible for 40 per cent of shock Gill and Lamboum concluded that their survey ~throws up some very embarrassing questions which remain to be answered

What is the difference between psychiatrists who use shock more than 20 times a month and those who use it less or not at all One survey (pallis and Stoffelmayr 1973) found that psychiatrists who favoured physical treabnents tended to have conservative social values and be tough-minded They concluded that their findings raised two important issues (which like Gill and Lamboums embarrassing questions have been ignored ever sincel

Firstly psychiatrists should reDlise that there is an association between the social attitudes they hold and the treDtment they recommend for their patients Secondly statements which are frequently nuuie with some ideologiCilI fervour about the wlue of different treDtment should perhaps be viewed with moreCilution It is likely thiltif trmtment orientation is embedded in general social attitude discussion about the advantages of the various treDtments will not be guided by factUllI arguments

There are very few psychiatrists in Britain who never use shock Pippard and Ellam (1981) completed a study where only one per cent were wholly opposed to the use of ECf and 97 per cent of clinical consultants working at least partly in adult psychiatrypsychogeriatrics regarded ECf as at least occasionally useful As ECf is always prescribed by senior doctors (consultants and senior registrars) but usually administered by junior doctors psychiatrists will give a lot of people ECf before they can make decisions about whether or not to prescribe it RA Johnson a psychiatrist who publicly criticised shock in the 19705 described the problems he faced

130 YVONNE JONES amp STEVE BALDW1N

Such selective reporting invites the interpretation that ECT has been repackaged and is now strategically promoted in a manner designed to avoid the censure of critical public opinion This misrepresentation of data is created by the existence of poor standards to monitor ECT In the absence of accurate data results from invalid studies are now quoted indiscriminately as fact

For example a study completed by Freeman and associates in 1978 is frequently quoted to support ECT Thestudy involved 40 clients who were randomly assigned to two groups One group had the first two treatments of a course of ECT replaCed by placebo Despite the design protocol of this study Freeman then administered ECT to both groups The study concluded that ECT is more effective than placebo in the treatment of depression In reality this clinical trial is invalid because Freeman felt it ethically unjustified to withhold for a complete course a treatment generally regarded to be effective (Freeman Basson and erighton 1978)

Lamboum and Gill (1978) completed one of the first contemporary trials to evaluate ECT They concluded that in this group of patients suffering from depressive psychosis six brief pulse unilateral ECTs did not produce a significantly therapeutic effect when compared with a simulated procedure Gangadhar et al (1982) completed the only trial to give the controls an antidepressant drug in conjunction with a simulated shock At the end of the trial there was no difference between the shock or the control group Psychiatrists have taken these not wholly im pressive resul ts as proof of the effectiveness of ECT

Evaluations which are valid suggest that ECT is of value in the treatment of severe depression which is characterised by the risk of suicide (Leicester trial 1984 Nottingham trial 1985) The Northwick Park double blind study in 1980 (regarded by many as the most thorough investigation of ECT yet) measured follow-up improvement in relation to the effectiveness of ECT It concluded that although people receiving ECT were significantly better in the short term no differences wereshown between the control group and the ECT groupatone month and six month intervals Analysis of the results confirmed that with intensive nursing and medical care people can recover from the most severe depression without receiving ECT

Claims in mainstream psychiatric literature that ECT can prevent suicide are quoted as fact Statistical evidence to support this is unavailable Furthermore admission to psychiatric institution can increase the risk of suicide (Frank 1990)

useofECT Many psychiatrists try to convince people that abuse or overuse of ECT is a thing of the past that today there is agreement among psychiatrists regarding its use and that it is only used as a treatment for severe depressive illness This is not the case

Theaveragenumber of treatments inacourse is about 65 (although there are still some people getting maintenance shock) so about 20000 people a year were getting ECT in the 1980s Since the Department of Health

Ecr SHOCK LIES AND PSYCHlA TRY 131

started keeping a record in 1979 the total number has fallen by about 30 per cent However these figures are for NHS patients only and do not include the people getting ECT in private hospitals (In somecountries for example USA and Italy ECT is used more in private hospitals than in state hospitals)

Although modern texts refer to ECT as the standard treatment for depression in the 1950s a psychiatrist at thattime estimated that ECT was being given to about 20000 people a year Uarvie 1954) approximately the same number as today This may well have been an underestimate as he was counting only the number of new admissions but even so it raises an awkward question Why didnt the introduction of antidepressant drugs at the end of the 1950s do more to reduce the use of ECf

The figures for the Regional Health Authorities show wide variation between regioDS from 125 treatments per 100000 population in Oxford to nearly 400 in Wessex (198788) and figures for the districts within the RHAs show even greater variation In the absence of any demographic explanations these figures confirm that there is still wide disagreement about the usefulness of shock

A study of individual consultants in one region (Gill and Lamboume 1981) demonstrated that approximately one third of shock is given where 85 per cent of consultants would not use it Further 15 per cent of consultants are responsible for 40 per cent of shock Gill and Lamboum concluded that their survey throws up some very embarrassing questions which remain to be answered ~

What is the difference between psychiatrists who use shock more than 20 times a month and those who use it less or not at all One survey (Pallis and Stoffelmayr 1973) found that psychiatrists who favoured physical treatments tended to have conservative social values and be tough-minded They concluded that their findings raised two important issues (whichlike Gill and Lamboums embarrassing questions have been ignored ever since)

Firstly psychiatrists should reJlIise that there is an association between the social attitudes they hold and the treatment they recommend for their patients Secondly statements which are frequently made with some ideologiCilI fervour about the value of different treJltment should periraps be viewed with moreCJlutionlt is likely thiltiftreatment orientation isembedded in general social attitude discussion about the advantages of the various treJltments will not be guided by factuol arguments

There are very few psychiatrists in Britain who never use shock Pippard and Ellam (1981) completed a study where only one per cent were wholly opposed to the use of ECT and 97 per cent of clinical consultants working at least partly in adult psychiatrypsychogeriatrics regarded ECT as at least occasionally useful As ECT is always prescribed by senior doctors (consultants and senior registrars) but usually administered by junior doctors psychiatrists will give a lot of people ECT before they can make decisions about whether or not to pleSCribe it RA Johnson a psychiatrist who publicly criticised shock in the 1970s described the problems he faced

~ ~-- _ r ~ ~

when he refused to preCribe Eer When eventually I was in a position to refuse to give any more I was blacklisted from further promotion in a psychiatric career and was obliged to transfer to general practice If

The Royal College guidelines (Freeman 1989) endorse Eer as a treatment not only for severe depressive illness but also for less severe depressive illness and as having a place in the treatment of mania anorexia and schizophrenia (research to support the guidelines does not exist nor are they a legal document)

In 1984 the medicaJ newspaper Pulse reported that a Dr Woodland had for years used Electroconvulsive Therapy on his patients in general practice According to the report he had given more than 10000 treatments to his patients in Paignton Devon and then in London At some point one in seven of the patients on Dr Woodlands list were receiving Eer as treatment Dr Woodland claimed it helped patients suffering from arthritis indigestion irritable bowel syndromeand aphthous ulcers He admits that he did not always obtain informed consent from his patientsmiddotCan these actions be justified Many doctors think not Dr Woodland has addressed meetings wheie audiences walk out He has described his work as research and claims that stricter controls on research would limit basic freedoms to practisemedidne Onecanconclude that psychiatry presently is beyond the law

elderly people There has been a dramatic increase in the number of elderly people who receive Eer In the 1940s only four per cent of people given Eer for depression were over 66 (Karagulla 1950) today half are over 65 years of age Doctors claim that this group respond well to Eer and do not tolerate antidepressant drugs

Is Eer-incurred brain damage then to be termed senili~

ethnic minorities People from ethnic minorities appear to be over-represented among people who have received Eer when the diagnosis is schizophrenia but not among people being treated for depression (Fernando 1988)

women Women form the majority of shock patients with a ratio of 1 227 (Pippard and Ellam 1981) Professor E Paykel (Daily Telegraph 31 January 199O) states that women suffer from depression more than men because life is more difficult for women If this is so then Eercan be viewed as a punitive oppressive rather than curative intervention which stops women complaining about their difficult lives

I L nvUgt Litgt ANJJ tUilAlRyen 133

worldwide Eer is administered to people in Great Britain Scandinavia and many third world countries It is less available in France Germany Holland and ltaJy (Fink 1984)

in conclusion In a changing heaJth care system all professional services are required to demonstrateeffecti veness This isa major changefor the medicaJ profession which has historicaJly enjoyed autonomy and not been subjected to such intense scrutiny Society places tremendous pressure on doctors to provide cures for all illsw and it is difficult for the medicaJ profession to disclose a lack of advanced techniques in some clinicaJ areas

Within psychiatry if is not surprising that with the introduction of clinicaJ audit some psychiatrists are now being confronted with their own lack of adequate training and professional skills to deaJ with complex human dysfunction Psychiatrists threatened by their own professional limitations feel out of control and can often resort to using machinery and invasive physicaJ techniques to achieve results In some instances as the psychiatrists personal power is restored even bad results seem better than no results at all Advocates of Eer will give many explanations to rationalise its continued use Eerhas been so strategicaJly repackaged that other professionals often tolerate and Condone the useofEer even with the most controversial client groups Recently some of the most radical and frightening ideas to surface have been expressed by Max Fink (Fink 19901 His recommendations have no scientific basis but appear in mainstream literature Fink recommends the use of Eer not only in major depressive disorders but especially in those disorders marked by psychosis melancholia mania catatonic states and Parkinsonism He dismisses the medicaJ risks associated with Eerand claims it is now safe to administer it with people previously considered to be in a high risk category For exampIe peoplewith heartlungconditions osteoporosis brain pathology such as tumours multiple sclerosis and even in pregnancy As previously noted the same Fink in 1958 wrote that the biochemicaJ basis for convulsive therapy is similar to that of cranial cerebral trauma Today he completely ignores that Eer works by damaging the brain and recommends maintenance Eer for people who relapse quickly In fact Fink is also of the belief that manufacturers of Eer devices should design a machine with higher energy levels thus advocating more damage to the brain

Little has changed since 40 years ago when one psychiatrist wrote about constantly seeing

patients who havesome serious trouble some constant anxiety orjellr who have been given insulin convulsions (shock trelltment) prolonged IUJrcosischildren or what not yet no-one has taken them aside and treated them as human

Some psychiatrists administer Eer to children This has constituted beings These physicil1ns who rush to apply mechaniCilI trflltments without criminaJ assault (Baldwin and Jones 1990) The youngest child reported to proper psychologiall investigations are demonstruting their own ignorancehave received Eer was 345 months old (Bender 1974)

~ ~ ~-J-- ~o-J oJ ~ ~middot

when he refused to precribe ECf When eventually I was in a position to refuse to give any more I was blacklisted from further promotion in a psychiatric career and was obliged to transfer to general practice

The Royal College guidelines (Freeman 1989) endorse ECf as a treatment not only for severe depressive illness but also for less severe depressive illness and as having a place in the treatment of mania anorexia and schizophrenia (research to support the guidelines does not exist nor are they a legal document)

In 1984 the medical newspaper Pulse reported that a Dr Woodland had for years used Electroconvulsive Therapy on his patients in general practice According to the report he had given more than 10000 treatments to his patients in Paignton Devon and then in London At some point one in seven of the patients on Dr Woodlands list were receiving ECf as treatment Dr Woodland claimed it helped patients suffering from arthritis indigestion irritable bowel syndrome and aphthous ulcers He admits that he did not always obtain informed consent from his patients Can these actions be justified Many doctors think not Dr Woodland has addressed meetings wheie audiences walk out He has described his work as Mresearch and claims that stricter controls on research would limit basic freedoms to practise medicine One can conclude that psychiatry presently is beyond the law

elderly people There has been a dramatic increase in the number of elderly people who receive ECf ln the 1940s only four per cent of people given ECT for depression were over 66 (Karagulla 19501 today half are over 65 years of age Doctors claim that this group respond well to ECf and do not tolerate antidepressant drugs

Is ECf-incurred brain damage then to be termed senilio

ethnic minorities People from ethnic minorities appear to be over-represented among people who have received ECf when the diagnosis is schizophrenia but not among people being treated for depression (Fernando 1988)

women Women form the majority of shock patients with a ratio of 1 227 (Pippard and Ellam 19811 Professor E Paykel (Daily Telegraph 31 January 1990) states that women suffer from depresSion more than men because life is more difficult for women If this is so then ECfcan be viewed as a punitive oppressive rather than curative intervention which stops women complaining about their difficult lives

children Some psychiatrists administer ECf to children This has constituted criminal assault (Baldwin and Jones 19901 The youngest child reported to have received ECf was 345 months old (Bender 1974)

111 nuu- Wtl rlNU tYUilAflyen 133

worldwide ECfisadministered to people in Great Britain Scandinavia and many third world countries It is less available in France Germany Holland and Italy (Fink 19841

in conclusion In a changing health care system all professional services are required to demonstrate effectiveness This isa major change for the medical profession which has historically enjoyed autonomy and not been subjected to such intense scrutiny Society places tremendous pressure on doctors to Mprovide cures for all ills and it is difficult for the medical profession to disclose a lack of advanced techniques in some clinical areas

Within psychiatry it is not surprising that with the introduction of clinical audit some psychiatrists are now being confronted with their own lack of adequate training and professional skills to deal with complex human dysfunction Psychiatrists threatened by their own professional limitations feel out of control and can often resort to using machinery and invasive physical techniques to achieve results In some instances as the psychiatrists personal power is restored even bad results seem better than no results at all Advocates of ECf will give many explanations to rationalise its continued use ECf has beenso strategicall y repackaged that other professiOnals often tolerate and condone the use of ECf even with the most controversial client groups Recently some of the most radical and frightening ideas to surface have been expressed by Max Fink (Fink 19901 His recommendations have no scientific basis but appear in mainstream literature Fink recommends the use of ECf not only in major depressive disorders but especially in those disorders marked by psychosis melancholia mania catatonic states and Parkinsonism He dismisses the medical risks associated with ECfand claims it is now safe to administer it with people previously considered to be in a high risk category For example people with heartlungconditions osteoporosis brain pathology such as tumours multiple sclerosis and even in pregnancy As previously noted the same Fink in 1958 wrote that the biochemical basis for convulsive therapy is similar to that of cranial cerebral trauma Today he completely ignores that ECf works by damaging the brain and recommends maintenance ECf for people who relapse quickly In fact Fink is also of the belief that manufacturers of ECf devices should design a machine with higher energy levels thus advocating more damage to the brain


patients who havesome serious trouble someconstant anxiety or fear who have been given insulin conuulsions (shock trmtmentJ prolonged narcosis or what not yet no-one has taken them aside and trtilted them as hutnan beings These physicians who rush to apply mechaniad treJJtments without proper psychological investigations are demonstrating their own ignorance


and maltreating their patients Man (sic) is worthy of better treatment than a ror or wireless set and those who do not give it to him are betraying their trust (Allen 1949)

Today psychiatrists accounts of ECf seldom deviate from the standard safe-and-effective-life-saving version but early commentators were more candid

This method of treatment has several aduantages which are generally agreed upon It is cheap It can be administered with limited help within a short time and many cases can be treated concurrently which may make it possible to continue it even in wartime results are usually obtained qUickly if not I4stingly (Nussbaum 1943)

Nussbaum went On to point out that even if patients benefited little from shock the treatment nevertheless brought relief to nursing staff and gratitude from relatives

references Alien C (1949) Modem discoverllS in m~dical psychology London Macmillan Anonymous (1872) A review of Jc Browne cd) The West Riding Lunatic Asylwn

Medical Report 1872 raetitiontT 9 362-364 Anderson EW (1951) Mental diseases physical methods of treatment Medical Annual - 173-183 Baldwin S and Jones Y (199O) ECT and children OIanges 8(1) 30-39 Becde HC (1946) Psychiatry thtoryand practice for nuTSIS London Faber Bender L (1974) One hundred CllSes ofchildJlood schizophrenia treatment with electric shock

Transactions of the American Neurological Association 72nd annual meeting Berke J (1979) I halJtnt had to go mad hert Harmondsworth Penguin Bini L (1938) Experimental researches on epileptic attacks induced by electric current

American Journal of Psychiatry 172-174 Breggin P (1989) As stated in paper given at Advocacy Confmnct New York Cerletti U (1956) The great physiodynamic therapies In AM Sadder et aJ (eds)

Psychiatry an historical rmppruisal New York Harper Fernando SJM (1988) R4ceand culture in psychiatry London Croom Helm Fink M (1958) Effects of anti-iholinergic agent diethazine on EEG and behaviour

significance for theory of convulsive therapy Archives ofNeurology and Psychiatry 80 380-387

Fink M (1984) MedWla and the origins of convulsive therapy American Journal of Psychiatry 141 1034-1041

Fink M (1990) Electro convulsive therapy Current Opinion in Psychiiltry 3 58-61 Frank LR (1990) Electroshock death brain damage memory loss and brainwashing

Journal of Mind and Beh4viour 11(3-4) 489-512 Freeman CPL (1989) Tht practiaJl administration of tlectroconvulsive therapy London

Royal College of Psychiatrists Freeman CPL Basson JV and Crighton A (1978) Double-blind controlled trial of

ECT and simulated ECT in depressive illness Lancet 1 738-740

ECT SHOCK UE AND PSYCHIATRY 135

Freeman cPL and Kendall RE (1980) ECT 1 Patients experiences and attitudes British Journal ofPsychiatry 137 8-16

Gangadharetal (1982) Comparison of ECT with Imipramine in endogenous depression a double blind study BMtish Journal of Psychiatry 141367-371

Gill D and Lambown J (1981) The indications for ECT a profile of its use In RL Palmer (Ed) EIectro-convulsive th~PIan appraisal Oxford OUP

Gordon HL (1948) Fifty shock therapy theories Military Surgeon 103 397-401 Hughes J Barraclough BM and Reeve W (1981) Are patients shocked by ECT Journal

of the Royal Society ofMedicint 74 283-285 Jarvie HF (1954) Prognosis of depression treated by electric convulsion therapy British

MediadJDurnal 132-134 Johnstone et al (1980) The Northwick Park ECT trial Lancet 20127 December KaraguJla S (1950) Evaluation of electric convulsive therapy as compared with

conservative methods of treatment in depressive states Journal of MentDl Scienct 1060-1091

Lambourn J and Gill D (1978) A controlled comparison of simulated and real ECT British JouTTlllI of Psychiatry 133 514-519

Lewis A (1967) Disorders of nervous system integration and adaptation In PB Beeson and W McDermott (eds) uril Loeb Textbook of Medidnt Philadelphia WB Saunders

McClelland RJ (1988) Psychosocial sequaelaeof head injury anatomy of a relationship British JouTTlllI ofPsych iD try 153 141-146

The Nottingham ECT Study A double blind comparison of bilateral unilateral and simulated ECT in depressive illness British Journal of Psychiiltry 146 520-524

Nussbaum K (1943) Observation on electric shock treatment Die Psychiatric Quarterly 17327-336

Pallis DJ and Stoffelmayr BE (1973) Social attitudes and treatment among psychiatrists British Journal ofMedical Psychology 46 75-81

Pippard J (1992) Audit of electro convulsive treatment in two National Health Service regions British Journal of Psychiatry 160 621-637

Pippard J and Ellam L (1981) Electroconvulsive treatment in Great Britain British Journal of Psychiatry 139 563-568

Salzman L (1947) An evaluation of shock therapy AmmcanJournal ofPsychiatry 103(5) 669-679

Strabaneck P (1986) Convulsive therapy a critical review of its origins and value Irish MedicaIJournal79(6)157-165

Symonds CP (1966) Disorders of memory Brain 89 625-640 Valentine M et aI (1968) A comparison of techniques in electfCHonvulsive therapy

British JouTTlllI of Psychiatry 114 989-996 Weiner RD (1980) The persistence of ECT induced changes in the

e1ectroencephalogramJournal of Nerwus and Mental Disease 168224-228

Acknowledgement Wann thanks to Sue Kemsley and Jan Wa11craft without whom this article would not have been possible


and maltreating their patients Man (sic) is worthy of better treatment thon a C1lr or wireless set and those who do not give it to him are betraying their trust (Allen 1949)

Today psychiatrists accounts of ECT seldom deviate from the standard safe-and-effective-Iife-saving version but early commentators were more candid

This method of treatment has several advantages which are generally agreed upon It is cheap It can be administered with limited help within a short time and many cases can be treated concurrently which may make it possible to continue it even in UXlrtime results are usually obtained quickly if not lastingly (Nussbaum 1943)

Nussbaum wentnn to point out that even if patients benefited little from shock the treatment nevertheless brought relief to nursing staff and gratitude from relatives

references Alien e (1949) Modern discoveries in mtdiazl psychology London Maanillan Anonymous (1Sn) A review of Je Browne (cd) The West Riding Lunatic Asylum

Medical Report 1872 PraClitionu 9 362-364 Anderson EW (1951) Mental diseases physical methods of treatment Mediazl Annual bull 173-183

Baldwin S and Jones Y (1990) ECT and children OIanges B(l 30-39 Beede He (1946) Psychilltry thtoryand practice for nurses London Faber Bender L (1974) One hundred CilStS ofchildhood schizophrenill trmtment with electric shock

Transactions of the American Neurological Association 72nd annual meeting Berke J (1979) I haven had to go mad here Harmondsworth Penguin Bini L (1938) Experimental researches on epileptic attacks induced by electric current

ArneriaznJounud of PsychiJltry tn-174 Breggin P (1989) As stated in paper given at AdlJOazcy Confumce New York Cerletti U (1956) The great physiodynamic therapies In AM Sackler et al (cds)

Psychilltry an historiazl rmppraiSili New York Harper Fernando SJM (1988) Race and culture in pSljchiatry London Croom llelm Fink M (1958) Effects of antiholinergic agent diethazine on EEG and behaviour

significance for theory of convulsive therapy Archives of Neurology and PSljchiJltry BO 380-387

Fink M (1984) Meduna and the origins of convulsive therapy Ameriazn jou17lQ1 of Psychilltry 141 1034-1041

Fink M (1990) Electro convulsive therapy Current Opinion in Psychilltry 3 58-61 Frank LR (1990) ElectrOShock death brain damage memory loss and brainwashing

jou17lQ of Mind and Behaviour 11(3-4) 489-512 Freeman CPL (1989) The practiazl administration of electroconvulsive therap London

Royal College of Psychiatrists Freeman CPL Hasson JV and CrightOIl A (1978) Double-blind controlled trial of

ECT and simulated ECT in depressive illness ulllcet I 738-740

ECT SHOCK UES AND PSYCHlA TRY 135

Freeman CPL and Kendall RE (1980) ECT 1 Patients experiences and attitudes British Jou17lQ1 ofPSljchilltry 137 8-16

Gangadhar etal (1982) Comparisonof ECT with Imipramine inendogenousdepression a double blind study British Jou17lQ1 of Psychill try 141367-371

Gill D and Lamboum J (1981) The indications for ECT a prOfile of its use In RL Palmer (Ed) E1ectr~onvulsive thrnlplj an appraisal Oxford OUP

Gordon HL (1948) Fifty shock therapy theories Military Surgeon 103 397-401 Hughes J Barraclough BM and Reeve W (1981) Are patients shocked by ECT jou17IQ1

of the Royal Society of Medicinl 74 283-285 Jarvie HF (1954) Prognosisof depression treated by electricconvulsion therapy British

MediadJou17lQI 132-134 Johnstone et al (1980) The Northwick Park ECT trial Lancet 20127 December Karagulla S (1950) Evaluation of electric convulsive therapy as compared with

conservative methods of treatment in depressive states jou17IQ1 of MentD1 Scienct 96 1060-1001

Lamboum J and Gill D (1978) A controlled comparison of simulated and real ECT British Jou17lQ1 of PSljchiJltry 133 514-519

Lewis A (1967) Disorders of nervous system integration and adaptation In PB Beeson and W McDermott (eds) Cecil Loeb Tatbook of Medicine Philadelphia WB Saunders

McClelland RJ (1988) Psychosocial sequaelaeofhead injury anatomy of a relationship Britishjou17lQ1 of Psychiatry 153 141-146

The Nottingham ECT Study A double blind comparison of bilateral unilateral and simulated Ecr in depressive illness British Jou17lQ1 of Psychiatry 146 520-524

Nussbaum K (1943) Observation on electric shock treatment TIle Psychilltric Quarterly 17327-336

Pallis DJ and Stoffelmayr BE (1973) Social attitudes and treatment among psychiatrists British Jou17lQ1 of Mediazl Psydology 46 75-81

Pippard J (1992) Audit ofelectro convulsive treatment in two National Health Service regions British Jou17IQ1 of Psychiatry 160621-637

Pippard J and Ellam L (1981) Electroconvulsive treatment in Great Britain British jou17IQ1 of Psychilltry 139 563-568

Salzman L (1947) An evaluation of shock therapy American Jou17IQ1 ofPsychilltry 103(5 669-679

Strabaneck P (1986) Convulsive therapy a critical review of its origins and value Irish MedicalJou17lQI 79(6) 157-165

Symonds CP (1966) Disorders of memory Brain 89 625-640 Valentine M et aJ (1968) A comparison of techniques in electro-convulsive therapy

British Jou17IQ1 of Psychilltry 114989-996 Weiner RD (1980) The persistence of ECT induced changes in the

eJectroencephalogramjou17IQ1 of Nervous and Mental Dise4St 168 224-228

Acknowledgement Wann thanks to Sue Kemsley and Jan WaJlcraft without whom this article would not have been possible

feT shock lies and psychiatry YvonnEpJones and Steve Baldwin

t

A Ithough Cerletti is often attributed with the introduction of ECT i1(1938) references are available which highlight earlier use -In England in IBn aifford Allbutt used the passage of electric current through the head for the treatment of mania brain wasting dementia and melancholia (Strabeneck 1986) It was however the independent practices of Meduna and Sakel who set the precedents for the induction of epileptic fits as a form of treatment In 1938 Cerletti supplied the electricity

The first electro shock was given to an Italian man known only by his initiaJs as SE He had been arrested by the police department for vagrancy and was referred to hospital for observation After a diagnosis of

y schizophrenia he was identified as a first subject in the study Although Cerletti sought pennission to experiment on hogs he did not pursue the same procedure when conducting this human triaJ He administered the~ first Shock which failed to induce a convulsion because the voltage had been ~t too low Whilst Cerletti discussed with colleagues how to proceed

~ SE (who had been listening to this conversation) stated U Not another one Its deadly (Berke 1979) Despite this mans expressed wishes Cerletti proceeded with his experimentation and using a higher voltage induced a convulsion

Today psychiatrists claim to administer modified ECT It is presented as a safe treatment far removed from Cerlettis crude experiments In fact modifications do little to increase thesafety of ECTand are more damaging For example there have been major changes in the way that psychiatrists now view the administration of ECT First they consider the useofa muscle relaxant essential This is now given routinely with aJI ECT to prevent the orthopaedic complications of dislocation and breakages which were common side effects associated with ECT in the past Muscle relaxants sedate the brain and it is much more difficult to induce a seizure Therefore the voltage has to be increased even higher than with unmodified ECT to reach the threshold necessary to produce a convulsion The result of this improved procedure is a higher degree of damage to the brain

Another modification is the administration of unilateraJ rather than bilateral ECf This procedure assumes that one side of the brain is less vaJuable than the other Humanistic psychologists would not agree Instead they might argue that the non-dominant side is essentiaJ to creativityThe placing ofelectrodes unilaterally increases the concentration ofcurrent in one part of the brain and the damage to this part is more severe than in bilateral ECf (Breggin 1989) EEG results one month after unilateral

~

Yvonne Jones is Deputy Unit Occupational Therapist at Bangour Village Hospital West Lothian Steve Baldwin is Senior Lecturer and Course Coordinator of the MSc in Public ieUth at the University of Aberdeen UK

CHANGES (An International Journal of Psychology and Psychotherapy) June 1992 Sub $36 (4 issues) L Erlbaum Assoc 27 Palmeira Manmign~ Ch~TGh Rd Hove Ea~t p~esectx PNJ ~fA UK

ECf SHOCK UES AND PSYCHIATRY 127

ECT confirm that it is possible to detect which side of the brain is damaged (Weiner 1980)

Modified ECT is not scientifically proven Psychiatrists claim that it is a safe technique in an attempt to control popular opinion In generaJ many psychiatrists have insufficient regard for the brain For example Pippard and Ellam found that some clinics did not give their clients oxygen thus risking anoxic brain damage and that nearly a quarter of clinics were using obsolete shock machines These delivered an untimed shock resulting in clients receiving excessive amounts of current (Pippard and Ellam 1981 Editorial 1981) The most recent update confirms that not much has changed (Pippard 1992)The Royal College ofPsychiatrists guidelines also recommend bilateral ECT (Freeman 1989)

howECTworks ECT is presented in current psychiatric literature in an edited form The rationale for ECT is often that the electrical current rearranges brain chemistry positively Another explanation given has its roots in psychoanalytic terms suggesting that individuals benefit when they get in touch with their need to punish themselves Current psychiatric literature highlights that most of these theories are without supportive data and identifies that the mechanism of ECT is unknown The rationale for the continued use of ECT is that many medical treatments havebeen essentially helpful despite the medical professions lack of knowledge about the way in which they work

The truth about how ECT actually does work is aJways omitted in current psychiatric publications Electro-convulsive therapy is effective by damaging the brain Advocates of ECT were the first to identify this It is only more recently that this has been presented in a positive way by the insistence that this damage is negligible and transient a concept which is hotly disputed by many people who have undergone ECT

ECT has been repackaged ina manner designed to censor publicopinion Empirical research based on adequate methodological data does not exist to back up its continued use However psychiatrists continue to quote from obsolete and inaccurate studies misrepresenting the original outcomes to suggest positive conclusions


For some people long term treatment can become a reality although not a necessity In an overstretched staff team the frustrations of managing a difficult sef-destructive or impulsive individual can often lead to the introduction ot an aggressive Eer regime TIUs renders the person passive docile predictable and easily manageable Staff can misinterpret this lack



























-


































~ ~-- _ r ~ ~





































































































































-


































~ ~-- _ r ~ ~












































































































































~ ~-- _ r ~ ~











































































































jones and baldwin 1992

Documents