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Electroconvulsive Therapy: A Second Opinion
Note: The information on this
website is not a substitute for
diagnosis and treatment by a qualified, licensed professional.
o "ECT was originated in Italy in 1938 by Bini and Cerletti who observed the effects of electric current in rendering slaughter house pigs into a state of unconsciousness. That the electrical shocks did not actually kill the pigs led the doctors to try it on human beings. The first human subject understandably feared that he was indeed about to be slaughtered. When the first shock did not render him unconscious, he beseeched the doctors, "Not again, it's murderous!". Cerletti himself translated the victim's plea as "Not another one! It's deadly!""
Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.
Doctors frequently respond to complaints about ECT treatment by deciding that the patient is in need of more treatment. Increased exposure to the brain-damaging effects of ECT can almost always be relied on to eventually put an end to the patient's protests ("complaints").
Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.
o "Twenty people who reported having found ECT upsetting were interviewed about their experiences in detail. A variety of themes emerged, including feelings of fear, shame and humiliation, worthlessness and helplessness, and a sense of having been abused and assaulted. This had reinforced existing problems and led to distrust of psychiatric staff. Few had felt able to tell professionals of the strength of their reactions, implying a possible hidden pool of trauma."
Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o "Doctors who give ECT have shown remarkably little interest in their patients' views of the procedure and its effects on them and only recently has this topic received any consideration in the literature."
Abrams, R. (1997). Electroconvulsive Therapy. 3rd edition, Oxford/ New York: Oxford University Press; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o "What is never discussed in the literature is the profoundly damaging psychological effects ECT can have."
Lindow. V. ( 1992). A service user's view. In H. Wright & M. Giddey (Eds.), Mental Health Nursing: From First Principles to Professional Practice. London: Chapman & Hall; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o "Conscious attitudes towards ECT are `time and again', in long-term therapy, succeeded by feelings that it was cruel and destructive. There is 'a revival of threatening and punitive parental figures' who are often, like the physician, initially credited with good intentions."
Johnstone, L. Adverse psychological effects of ECT. Journal of Mental 8(1). Feb 1999; citing Abse, D.W. & Ewing, J.A. (1956). Transference and countertransference in somatic therapies. Journal of Nervous and Mental Disease, 123, 32-40.
o "The procedure may evoke unconscious meanings in both doctor and patient; for example, G. J. Wayne writing in the Psychoanalytic review observed that `It has all the characteristics of an overwhelming assault...and this can be documented by the reactions of some patients who have had this treatment.'"
Wayne, G.J. (1955). Some unconscious determinants in physicians motivating the use of particular treatment methods. Psychoanalytic Review, 42, 83-87; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o In a study of the conscious and unconscious attitudes towards ECT in 30 psychotic patients, the authors concluded that 'the majority of patients found electric shock to be a traumatic experience.'
Fisher, S., Fisher, R. & Hilkevitch, A. (1953). The conscious and unconscious attitudes of psychotic patients towards electric shock treatment. Journal of Nervous and Mental Disease, 118, 144-152. Cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o "Psychological reactions to ECT often compound patients' difficulties and defences; for example, obsessional people might need to become even more controlled."
Winnicott, D.W. (1947) Physical therapy of mental disorder. British Medical Journal, May 17, 688689; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o Interviews with ten women admitted to a state hospital in California between 1957 and 1961 and their relatives revealed a uniform confusion and bewilderment at the loss of memory in everyday life. Sometimes their forgetfulness, for example of previous hostile outbursts, was welcome to their husbands. Fear of future ECT stopped some women from confiding emotional upsets, and family relationships were subtly altered on all levels.
Warren, C. (1988) Electroconvulsive therapy, the self and family relations. Research in the Sociology of Health Care, 7, 283-300; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o "Most people who have had ECT are profoundly ignorant about the whole procedure, and say that they were given no or inadequate explanations."
Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999. o "Sixty-nine per cent did not know that ECT involved a convulsion."
Hughes, J., Barraclough, B.M. & Reeve, W. (1981). Are patients shocked by ECT? Journal of the Royal Society of Medicine, 74, 283-285.
o "Only 21% said they were given a good explanation of the procedure."
Freeman, C.P.L. & Kendall, R.E. (1980). ECT: patients' experiences and attitudes. British Journal of Psychiatry, 137. 8-16. Cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o In one survey by an organization of former ECT recipients, 35.1% of respondents described ECT as 'damaging' with another 16.5% saying it was `not helpful.' Those who were dissatisfied were likely to express very strong views against it, using words like 'brutal', 'barbaric' and 'degrading'. Psychological after-effects included loss of confidence, dignity and self-esteem; fear of hospitals and psychiatry; anger and aggression; loss of self; and nightmares.
UKAN (United Kingdom Advocacy Network) ( 1996). ECT Survey. The Advocate, Issue I, Spring/Summer, 24-28. Cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o Interviews with 516 psychiatric patients revealed a large minority (37.1 %) who said ECT was unhelpful or very unhelpful, with a high proportion of the latter group strongly condemning it. Psychological effects included fear, flashbacks and nightmares.
Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999; citing Rogers, A., Pilgrim, D. & Lacey, R. (1993). Experiencing Psychiatry: Users ' Views of Services. London: Macmillan.
o "The recently formed organization ECT Anonymous has collected several hundred reports from people who say that ECT has had a variety of disabling physical and psychological effects on them."
Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
o In interviews with 20 ECT recipients who found treatment upsetting, nearly everyone reported that explanations of treatment and its effects had been completely inadequate or nonexistent, and that there had been little or no opportunity for discussion of treatment options.
Ibid.
o Patients consented to ECT despite inadequate explanations and the fact that many of them already had doubts based on the experiences of relatives or other patients. This is explained by their feelings of extreme desperation and powerlessness. Patients felt they could not risk alienating the doctors, on whom they were dependent for any hope of a cure.
Ibid.
o Nearly all participants insisted that their apparent agreement was from being fully informed consent: 'I wasn't physically taken to the suite or anything, I walked there on my own, but I felt it was forced on me,' said one former patient.
Ibid.
o Fourteen out of twenty participants reported a very high level of fear.
Ibid.
o "When asked what was the most frightening aspect of receiving ECT, participants most commonly mentioned feelings of being helpless and out of control, and worries about long-term damage."
Ibid.
o For several, ECT was a confirmation that they were truly mad, and had reached the last option.
Ibid.
o "Fear is the only psychological reaction to ECT that has been investigated to any extent. However, these participants described a complex range of emotional responses including feelings of humiliation, increased compliance, failure, worthlessness, betrayal, lack of confidence and degradation, and a sense of having been abused and assaulted."
Ibid.
o "…the perception…that ECT is an intervention reserved for the extremes of madness, produced a strong sense of shame and stigma. According to one patient, 'I was deeply, deeply ashamed of having ECT...this was real serious stuff, this was a mad person'. "
Ibid.
o " ECT was experienced by several participants not just as a sign of madness, but also as a punishment for and confirmation of badness."
Ibid.
o "…ECT had left some participants with a lasting distrust of mental health professionals and hospitals: 'When I was in hospital last time I was terrified that they were going to give it to me again. They promised they wouldn't, but can I trust them, can I trust them ? I was terrified, I hated walking across the room where they did it.'
Ibid.
o "Nearly all participants were convinced that ECT and all its disadvantages could have been avoided had the right kind of counseling and support been available instead."
Ibid.
o "All the participants except one were very clear that they themselves would refuse ECT if they were ever offered it again. The exception was a man who said that he would consent as a `very, very last resort' if he ever became ill again."
Ibid.
o "…the study does confirm that for a certain proportion of patients, ECT is a deeply and lastingly traumatic experience."
Ibid.
o "we must be careful not to discount the possibility that some of [the patients'] concerns also have a factual basis; for example, that ECT does cause definite cognitive impairment, and anxiety about brain damage is not just a psychological phenomenon but an understandable response to a real danger."
Ibid.
o "ECT may be undermining therapeutic work in ways that professionals are unaware of. One woman appreciated her psychiatrist's sensitive attempts to build a relationship with her, but lost all trust in him when he subsequently prescribed ECT. Another was encouraged to direct her anger outwards, while simultaneously being forced to undergo a treatment that increased her anger and self-blame to the point of self-harm."
Ibid.
o "…ECT may actually exacerbate existing psychological problems."
Ibid.
o "ECT may be leaving some people with a distrust of psychiatric services that undermines any future attempts to form therapeutic relationships. They may be both unhelped - perhaps even in a worse state and at the same time harder to reach."
Ibid.
o "If up to a third of people will suffer psychological trauma after ECT, and if there is no way of identifying these individuals in advance, the ratio of costs to benefits may begin to seem unacceptably high."
Ibid.
o "In a review of the literature on the well-known ECT complication of epilepsy, researchers calculated that the age-adjusted incidence of new seizures after ECT was fivefold greater than the incidence found in the non-psychiatric population."
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Devinsky, O. and Duchowny, M.S. Seizures after convulsive therapy: A retrospective case survey. Neurology 1983;33:921-5.
o "Persistent brain wave disruption to the point of status epilepticus has been reported to occur following ECT. Individual reports by Drs. Weiner and Varma on different patients both describe acute disorientation and deterioration of intellectual function immediately following ECT. This was found to be due to ongoing epileptic brain wave forms that was initiated by the ECT."
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Weiner, R.D. Prolonged confusional states and EEG seizure activity following ECT and lithium use. Am Journal Psych 1980;137:1452-1453. Varma, N.K. et al. Nonconvulsive status epilepticus following ECT. Neurology 1992;42:2263-264.
Babigian, H., et al. Epidemiologic Considerations in ECT. Arch Gen Psych 1984;4:246-253.
o There is no conclusive evidence that ECT is better than antidepressant treatment.
A. Rifkin, ECT versus tricyclic antidepressants in depression: A review of evidence, Journal of Clinical Psychiatry 49 (1988)3-7.
o "A review of controlled studies of ECT efficacy found that both ECT and sham ECT were associated with "substantial improvements" and that there was little or no difference between the two. The authors concluded, "Whether electrically induced convulsions exert therapeutic effects in certain types of depression that cannot be achieved by other means has yet to be clearly established."
Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing T. Crow and E. Johnstone, Controlled trials of electroconvulsive therapy, Annals of the New York Academy of Sciences 462(1986), 12-29.
o "At the Consensus Conference on ECT…advocates were unable to come forth with a single controlled study showing that ECT had a positive effect beyond 4 weeks. Many studies showed no effect, and in the positive studies, the improvements were not dramatic."
Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing Consensus Conference: Electroconvulsive therapy, Journal of the American Medical Association 245(1985), 2103-2108.