A shock that can save your life
01 November 2001
Many people, when they think of electric shock treatment, think of Jack Nicholson’s character in “One Flew Over the Cuckoo’s Nest”. Nicholson, interned in a psychiatric hospital, is strapped to a table and effectively tortured in the film, not to improve his condition, but in an effort to break his spirit.
By James Tapsfield
Many people, when they think of electric shock treatment, think of Jack
Nicholson’s character in “One Flew Over the Cuckoo’s Nest”. Nicholson,
interned in a psychiatric hospital, is strapped to a table and effectively
tortured in the film, not to improve his condition, but in an effort to break
his spirit.
However, the image and the modern reality are very different: electric shock
therapy, or ECT, used to be brutal and employed too often, but now it saves
lives.
That, at least, is the opinion of Dr Majid Al Yassiri, a consultant psychiatrist
with South West London & St Georges Mental Health Trust.
According to Dr Yassiri, ECT is used with success for thousands of patients
every year in the UK, and most hospital trusts have facilities and staff trained
to carry out the procedure. Electric shock therapy is a mental treatment for
those who are at risk of further deterioration, such as severely depressed
people who stop eating and drinking, or people with psychotic delusions who will
not take their medication.
Although previously the treatment was widely used and quite violent for
patients, who would often suffer seizures during the procedure, advances in
psychiatry and the introduction of anaesthetic and muscle relaxants mean that
things have changed, says Dr Yassiri.
“It’s completely painless. When the patient wakes up they won’t feel
anything apart from slightly muddled and confused.”
Dr Yassiri estimates that 90 per cent of the profession agree that ECT is
beneficial for patients, and says that what differences there are generally
arise over when rather than whether the treatment should be applied.
“If we had a seriously depressed patient, I think that everyone would agree
that ECT is the treatment to be used, but the possible disagreement would be
over what stage [in the illness] to give the treatment.”
He says that on rare occasions patients will lack “insight”, and must be
forced to accept ECT treatment, but insists that there are very strict rules
governing when this can happen.
“The only way we could [give treatment by force] is to use the mental health
act, where we have to put patients on section 3 – a legal document which
allows us to give patients medication against their will. There is a thorough
and rigorous procedure to go through before we can get to that stage.”
Dr Yassiri laments what he sees as the public’s misunderstanding of ECT,
saying that it is based on the “stigma and fear of mental illness” and ideas
picked up from popular culture.
“And then there are some voluntary organisations who provide information not
based on scientific knowledge, but on more what I call ideological [grounds]. It
is all well meant, but I think they are scientifically not correct.”
He does not name names, but perhaps one of the groups to which Dr Yassiri refers
is the mental charity Mind. In March Mind released research that claimed that
ECT patients were not being given enough information, and were often not allowed
the chance to “opt out” of the treatment. According to the charity 40 per
cent of 400 patients they surveyed suffered permanent loss of some of their
memories and a further 36 per cent had difficulty in concentrating.
“We accept that some people find ECT helpful, and we don’t think that those
people should be prevented from having the treatment. But we don’t know who
will be adversely affected,” says Melba Wilson, policy director for Mind.
“People don’t know that they can refuse it and aren’t given all the
information about it,” she adds.
There are other groups, including so-called “survivor” groups of former
patients, who also have their doubts about the side effects of electric shock
treatment, but very few even of these say that the treatment is not effective
for some people. It seems that, while the public perceive ECT as violent brutal,
for some it is their only hope.
© Health Media Ltd 2001
http://www.health-media.net