ECT

Electro-convulsive therapy (ECT) is a cunning punishment devised for the mentally disordered that enjoyed a spell of widespread popularity in the middle of the twentieth century, and is *still* administered to 12000 patients in the UK every year. Patients are strapped to a couch with electrodes attached to either temple. A 100 volt belt of electricity is then zapped through their brain, straightening out their mentally disordered wiring and making them better again, after they’ve convulsed a bit. Anyone who’s seen One Flew over the Cuckoo’s Nest will know that it’s an ace film based on the book that Ken Kesey ever wrote in which a basically sane but slightly unruly Irish American called Randall McMurphy gets banged up in a mental hospital and there’s his friend called ‘Big Chief Broom’ who’s a big chief in the Indians and he never speaks but sweeps the floor all day even though it’s clean already (nowadays of course they wouldn’t be able to say ‘Indians’ because Native Americans are not from India, in exactly the same way as the Innuits are not from Esquim, and Mr. Broom should probably more properly be addressed as ‘Tribal Affairs Co-ordinator’ or something, but this was back in the seventies when life was a lot simpler, but probably no less fair to minorities). The inmates have to take drugs, but McMurphy doesn’t, he only pretends to take them and spits them out later. He also says he’s going to put a betsy bug up the butt of nurse Ratched in charge because she’s such a manipulative control-freak who wants the patients to remain passive and obedient to her many wicked whims. Anyway they play basketball which Chief Broom doesn’t really know how to do because they don’t do that in the Indians, but because he’s so tall McMurphy just gives him the ball which he holds up in the air and walks from one end of the court to the other with and puts in the net and scores a goal without really trying. And one day they steal a bus and go on a fishing trip in a stolen motor launch which is very funny, and McMurphy teaches them all how to bait hooks and steer the boat so he can go down below and do some canoeing with this lissome babe who came along except it wasn’t canoeing, it was canoodling, (I was still thinking about the Indians). Then when they nearly get found out they have to pretend the inmates are all very eminent doctors, which they’re not of course otherwise they’d be able to cure each other with electroconvulsions. Later on when he’s waiting for some electro- “therapy” of his own McMurphy gives Chief Broom some chewing gum, and Chief Broom says ‘Thank-you’ and ‘Juicy Fruit’ (because they have both good manners and that particular brand in the Indians). McMurphy thinks this is really neat because Chief Broom really could speak all along, and probably chew gum too, and later he holds a party with some good time girls he’s smuggled in, and young Billy Bibbit gets some oats but has to kill himself because he gets in such bad trouble with the nurse who makes him feel very guilty, so McMurphy has to attack the nurse so badly that he ends up having a frontal lobotomy which makes him go soft in the head so Big Chief Broom smothers the unruly Irish American with a pillow and kills him dead (which even Native Americans aren’t supposed to do in this day and age). Had he used a different item of bed coverage, he could have been convicted of mattresside and been killed dead by the American government (who, unlike the Native Americans, ARE allowed to do that sort of thing in this day and age). So Chief Broom throws the washstand right through the window and out of building and strides off towards the mountains happily ever after without the slightest regard for the other inmates who won’t be able to clean their teeth at bedtime as a result of his wanton vandalism.

ECT is *still* administered to 12000 patients in the UK every year.  Yes, I know I’ve repeated that sentence.  And I’ll repeat it again: is ECT *still* administered to 12000 patients in the UK every year.

Shocking?

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6 responses to “ECT

  1. Florence Nite Owl-ingale

    I suppose you consolidated your research by watching Return to Oz, starring Fariza Baulk. That is where the sensationalism of fiction lives in all its misleading glory.

    OK, maybe the edwardians version of ECT was dark & full of fear, but in modern times, it is nothing like that. The majority of patients are older people who have been having the treatment for years. Their long suffering partners usually bring them & take them home again. A person having a ‘maintenance’ course of treatment will usually function at a much higher rate for about 75% of the time between treatments. I ought to add that most elderly patients become medication intollerant & could not handle doses needed to maintain them at a level achievable by ECT.

    Patients are not STRAPPED to a bed. They are given a short acting general anaesthetic & are usually up & about consuming tea & toast in about 30 minutes.
    There are no electrodes clamped anywhere; simply 2 paddles are coated in a contact gel & placed against the temples. A short burst of low current is applied & a print-out shows any increase in brain activity. This is repeated if necessary at a higher voltage, until the patient convulses. This is nothing like Sam Spoons in the Bonzo’s Monster Mash video, merely a curling of the toes. Following treatment, the patient’s baseline obs. & oxygen levels are monitored until they wake up ready for the aforementioned tea & toast. I hope this clarifies matters.

    Next week: The effects of the moon on the brain. now read on dot dot dot.

  2. I stand corrected…

    …but only up to a point. Maybe patients no longer receive the treatment reported (and experienced) by Ken Kesey back in 1960’s America (‘One flew over the cuckoo’s nest’ was partly autobiographical). If so, good.

    And maybe ECT is no longer imposed against a patient’s will; if so, even better… (Is it always voluntary now? I’m not sure.)

    But I think you are splitting hairs to say people are not wired up to electrodes, but ‘paddles’. According to the OED an electrode is ‘a conductor through which electricity enters or leaves an electrolyte, gas, vacuum etc.’ Unless electricity no longer enters or leaves, I’d say a paddle is an electrode.

    What remains unchanged is the object of the treatment: ie., to induce a convulsion. In the whole of medicine, this is the one intervention that has no theoretical justification. When you give an antibiotic, say, or carry out surgery, the ‘before’ and ‘after’ states can be physically charted, monitored and explained. With ETC, the before and after states are black holes. You have only behavioural or self-report measures of ‘success’ – both of which can be highly unreliable. And there are many cases of people being traumatised by their experience. (My late brother-in-law received ECT against his will back in the 1980’s and said it not only messed his head up, but damaged his memory long-term.)

    So I don’t understand what you mean by ‘maintain them at a level’. ECT is not medicine – nor is it analgesia or anaesthesia. Any effect reported (apart from side-effects such as memory impairment and disorientation) is purely psychological. And this causes problems of interpretation when a patient reports that they feel a benefit. As ECT is used a treatment for depression, and depression is often associated with feelings of guilt, patients sometimes view it as an appropriate punishment. Theoretically, the shrinks are still just blundering in the dark.

    Then there is always the placebo effect – which can show benefits for pretty well any so-called treatment (but doesn’t justify channelling public money that way). And even the ‘informed consent’ argument is suspect, IMO, if the patient automatically assumes it must work, as the NHS otherwise wouldn’t be offering it. And if ECT were a new intervention that had just been developed, it would probably fail to get endorsed by NICE who nowadays insist on evidence-based outcomes. From what I’ve seen, the evidence for ECT is ambiguous at best, dangerous at worst.

    I’m not being unsympathetic to cases like those you mention, where elderly people are medication intolerant and partners are long-suffering etc. But what does ‘an increase in brain activity’ actually mean? – the brain is always active, and some activities are no doubt more beneficial than others. But I don’t see how one can guarantee which way it will go when you zap the frontal cortex indiscriminately into a more animated state. And if a convulsion is a bodily reaction to something going wrong in the nervous system, it looks a pretty unhippocratic for the docs to be deliberately inducing them.

    That’s my tuppenceworth – though I’m willing to be persuaded otherwise…

  3. An increase in brain activity usually shows that the synapses are connecting & the person is able to communicate & function better. Low brain activity tends to indicate a vegetative state. ECT is only used (here anyway) where nothing else works. If you want to compare, look up the side effects of Olanzapine, Clozapine, Lorezepam etc. & ask yourself what you would prefer your psychotic granny to have. Unless of course you would leave her unmedicated. I know it doesn’t sound nice, but I have worked on the wards in psychiatric hospitals for 14 years & have worked as recovery nurse with countless patients having ECT & I know what I would choose.

    Information is not knowledge…contact your local psychiatric unit & go out there & see for yourself

  4. ps. The object is not to induce a convulsion. The convulsion merely shows that the treatment is working. It is a means to an end, not the end.

  5. I realise that for some people ECT can ‘work’, without anyone understanding how or why it might. But from a theoretical perspective, it is still the medical equivalent of thumping your telly when it goes on the blink (in the old days of valve sets). You might get the picture back for a bit, you might not, or you might make things worse. The fact that ECT is only ever used as a last resort suggests that the docs themselves are not comfortable with the procedure. And personally I wouldn’t want ECT administered to any family member just because the alternatives are unpleasant or unavailable.

    But with a bit of luck, in a few years time, advances in neurosurgery or pharmacology will make the procedure (and this discussion) redundant.

  6. It sounds like you will be replacing granny with a flat screen model then.

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