Barbaric age of electric shock must vanish
It
is amazing how many people think that Electro-Convulsive 'Therapy', or
Electro-shock, to give it its true name, is no longer used. But it is,
and far too widely. Michael
Corry says ECT must be banned
A YOUNG WOMAN called Sarah lies strapped to a table. Without having had the general
anaesthetic which was just administered to her, she would still be
resisting. The procedure taking place is against her will. Electrodes
are attached to Sarah’s head. A switch is thrown. Up to 400 volts of
electricity surge through Sarah’s brain. They cause an electrical
brainstorm of such magnitude that its exponential energy is released in
a series of spasmodic outbursts involving her entire nervous system.
Sarah’s breathing is interrupted, her blood pressure rises, stress
hormones are released and her muscles go into a rhythmic series of
violent contractions.
The
psychiatrist overseeing this session of ECT keeps the current on until
he sees her toe twitching. This is a sign that his patient, despite
muscle relaxants, is convulsing, and a grand mal seizure is taking
place. The desired outcome has occurred. The session is over.
Sarah was prescribed ECT for psychotic post-natal depression. After
treatment, while she no longer exhibits psychotic behaviour, large
tracts of her memory — including the experience of holding her newborn
baby for the first time — have been permanently lost. Lacking her
previous “memory map”, Sarah finds herself confused about her identity
and personal history, and plunges into a state of fear and
vulnerability. Her family notice that since ECT, Sarah has shut down
emotionally and lost her ability to empathise. She gets disorientated
in once-familiar surroundings. Worst, since the treatment Sarah has
suffered two epileptic fits.
In
my psychiatric practice, I come across individuals of all ages who,
like Sarah, have been damaged intellectually and emotionally by ECT.
Memory loss is the first obvious result. Other factors compromised
include problem-solving ability, processing of new information,
concentration, planning, decision-making, self-awareness, imagination,
creativity, abstraction and reflection. The damage is similar to that
resulting from a violent head trauma, with one notable difference:
after head injury, brain damage would be expected; but after a
“healing” session such as ECT, it comes as an unpleasant surprise.
Unfortunately, the effects are permanent, because brain cells, once
damaged, cannot be replaced. There is a particular “deadness” about
people hurt by ECT: a tiredness, as if they are living in a twilight
zone. Their spirits seem broken.
Some
of the younger people I have encountered are unable to complete
second-level education or engage in further studies, so compromised are
their cognitive abilities. Many of the elderly frequently report
becoming disorientated in their own homes. Many survivors of ECT, in
particular the elderly, are left docile, with brainwave recordings
showing a predominance of delta wave activity, usually
sleep-associated. Notably absent are normal levels of beta waves seen
when a person is alert. Electric shocks to the brain induce epileptic
fits that are much more violent than those experienced in the medical
disorder itself. In this way a double impact is administered to the
brain — the destructive force of electric shock and the secondary grand
mal seizure.It has been demonstrated that successive electric shocks
create an excitability in the brain that increases the potential for
future grand mal seizures to occur after ECT. It is broadly accepted
that the apparent effectiveness of ECT results from the long-term brain
damage it causes.
In a
1941 paper entitled Brain-Damaging Therapeutics, Dr Walter Freeman —
the psychiatrist who introduced ECT to America — wrote: “The greater
the damage, the more likely the remission of psychotic symptoms . . .
Maybe it will be shown that a mentally ill patient can think more
clearly and more constructively with less brain in operation.” In 1942
another US psychiatrist, Dr J Stainbrook, wrote: “It may be true that
these people have . . . more intelligence than they can handle and that
the reduction in intelligence is an important factor in the curative
process . . . Some of the best cures one gets are in those individuals
who one reduces almost to amentia.” 'Amentia' means having virtually no
mental activity.
Before the use of muscle relaxants and general anaesthesia in ECT, evidence abounds that bones were
broken, teeth cracked, and damage rendered to muscles and ligaments due
to the convulsions. If the heart’s system is overwhelmed by the
electric storm nearby, abnormal rhythms lead to cardiac arrest and
death, particularly in the elderly. Some elderly people die from
strokes and pneumonia in the days and weeks following ECT.
Many
individuals have been administered hundreds of electric shocks and thus
have experienced hundreds of seizures during treatment. It must be
understood that the grand mal seizure in the brain is believed by
psychiatrists to be the mechanism of cure. It is speculated that a
seizure triggers a compensatory surge of “well-being” neurotransmitters
and hormones, and that this chemical cascade soothes the symptoms of
the distresses being targeted — such as depression, schizophrenia,
mania, obsessive compulsive disorders and anorexia. A
chemically-induced transient euphoria can occur, particularly in the
depressed population, immediately after ECT, creating the illusion of a
breakthrough.
This can
occur after any head injury or physical trauma, even a natural one such
as prolonged labour. When the target is eradication of symptoms,
treatment can involve shocks stretched over months at a time, at the
rate of two to three per week. If symptoms diminish, and return later,
further treatment is prescribed, and to prevent any further relapse,
maintenance ECT is administered each month. These 'top-ups' are deemed
necessary when treatment does not “take” sufficiently. This is
particularly so in the elderly. The classical “revolving door” patient
is created. Left floundering, many feel estranged, a burden, riddled
with fear, panic, shame and guilt — needing an ECT machine to sustain
their equilibrium.
The
brain is shielded from injury by a thick bony skull within which it
floats in a buffering fluid. A protective blood-brain barrier,
functioning as does the placenta in relation to the foetus, screens off
toxic materials from entering the brain’s fragile organisation.
Post-ECT brain autopsies have revealed micro-haemorrhages and rupturing
of the protective barrier. It is inconceivable that anyone in their
right mind would sanction such a procedure for a developing foetus as
it floats in fluid within the uterus, with the goal of improving its
“wellbeing”. Is the brain any less fragile? It is universally agreed in
medicine that occurrence of seizures is always harmful to the brain.
Within neurology, every effort is made to prevent seizures. Psychiatry
is the only branch of medicine that specialises in deliberately causing
them. Psychiatry seems blind to the possibility that after an electric
shock to the brain, it is the state of confusion, sometimes tinged with
a mild euphoria, that obscures the individual’s original symptoms. This
temporary obscuration is classified by psychiatrists as an
“improvement”.
In this way, a powerful physical intervention is used to jolt dysfunctional
metaphysical thoughts and feelings into alignment, as if they were cogs
in a machine requiring a kick-start.
Such
interventions lack scientific rigour. Mental distress does not emanate
from a malfunctioning, diseased brain, but from problems of living:
family breakdown, school and work pressure, bullying, financial
difficulties, relationship dilemmas, fear, loss, a broken heart, grief,
sexual abuse, violence, trauma, drug abuse, physical illness,
loneliness, abandonment, lack of meaning, ageing and that titanic sense
of being overwhelmed that sensitive children and teenagers experience.
Using
ECT is the equivalent of sending the TV or computer for repair if
programmes are not to one’s liking. ECT is frequently given
involuntarily, forced against patients’ wills, and repeatedly so. Those
receiving it are emotionally vulnerable, and may have already suffered
bullying, coercion and violence. ECT re-traumatises them, with the
additional burden of brain damage.
No
branch of medicine except psychiatry has prompted such terror, stress
and condemnation from those at the receiving end. The literature and
the internet tell story after story of lost personal histories and
ruined lives. Anti-psychiatry movements abound, populated by survivors
who want their opinions respected and to protect those who may come
after them. How has psychiatry been allowed to place itself beyond
accountability? Where is the logic? The truth is that there is no logic
when it comes to mental distress. There appears to be a collective
denial of its validity, its rightful place in the human condition.
Mental distress is considered something to be feared, denied, condemned
and driven out like a demon, at any cost.
People suffering from mental distress are not taken seriously, and are rarely given the luxury of being
understood. Their objections to ECT, and their reporting of its side
effects, often go unheeded, rationalised away as a manifestation of the
disease process itself, a possible side effect of medication, delirium
or paranoia, or a coincidental relapse rendering them non compos
mentis. Psychiatric patients historically have been segregated in
dehumanising, unhealthy environments. Many have been detained against
their wills, warehoused, forgotten by relatives and friends, and left
without advocates, professional or otherwise.
No
other minority group, and certainly no patients in any other medical
speciality, continue to suffer such ordeals — utterly abandoned by the
normal societal impulses towards reason, dignity and compassion. A
psychological apartheid towards the mentally distressed exists, with
stigmatisation and the collective blind eye central to the process of
denial. This lack of vision also allows worldwide use of lobotomy, a
surgical procedure that involves the severing of nerve pathways in the
frontal lobe of the brain in order to cure “intractable mental
disorders”. ECT and lobotomy both use a traumatic physical intervention
to dislodge non-physical phenomena.
This
might be compared to applying a defibrillator to interrupt cardiac
electrical rhythm in the hope of easing the pain of a broken heart.
Trained proponents of ECT believe they are doing the best for patients,
and rigorously defend this position. Most endorse it in the belief that
the relief of symptoms in the short term is worth whatever secondary
disabilities occur as a “side effect”.
In
this modern era of psychiatry, with its access to such a vast array of
medications claiming to treat patients safely, a reasonable person
would exclaim: “How can an outdated procedure like ECT still be in
use?” Where repeated use of medication has failed, and with their
arsenal now depleted, an attitude of “things can’t get any worse”
develops in the psychiatrist’s mind. ECT is therefore often seen as the
the last stop. The risk of secondary disabilities is thought to be
worth the possible benefit. It can be argued that if psychiatrists were
to do an about-turn and condemn ECT, they would be opening the door to
loss of power, possible litigation and moral indignation.
The
fact that ECT is common practice does not make it right, or the best
therapy for patients. Proponents of ECT write about “modified” ECT,
devised to “minimise” brain damage. Instead of giving a shock to both
brain hemispheres, a shock is given exclusively to the non-dominant
hemisphere. But a serious question has to be raised about this: what is
the difference between one or two fast or slow moving bullets
travelling through the brain?
There
is little information on use of ECT in Ireland. Research is badly
needed. Most recent figures reveal that in 2003, 859 persons had
treatments in the South, and 628 in the North of Ireland. Among other
problems, there is no information on gender breakdown, age
distribution, numbers to whom ECT was forcibly applied, and, most
importantly, numbers of fatalities.
It
is very difficult for psychiatrists who have given ECT to acknowledge
the true risk of death and the real extent of the brain damage which is
caused. The magnitude of their error is too great and the consequences
so enormous and far-reaching that most find it impossible to admit they
may be wrong. The imperative to believe in the efficacy of their
treatment appears to negate objective judgment.
We
can no longer sit on the fence. Use of ECT is archaic, irrational and
barbaric. It is a Holocaust of the brain: a brutal Final Solution. We
must abolish it, and close the doors on the psychiatric dark ages it
represents.
This article first appeared in the Irish Times on Wednesday 25 June 2008. For online IT readers, the piece appeared here. If you wish to read it or download it from our website, go here
Until his untimely death in February 2010, Dr
Michael Corry was a consultant psychiatrist at the Institute of
Psychosocial Medicine in Dún Laoghaire, Co Dublin. With Dr Aine Tubridy, he co-authored Going Mad? (Gill & Macmillan) and Depression: an Emotion, Not a Disease (Mercier Press).
Drs
Corry and Tubridy, together with Basil Miller, created the original website
depressiondialogues.ie, now amalgamated with www.wellbeingfoundation.com
