The debate about ECT continues. This time in Ireland where an amendment to the Mental Health Act 2001 was proposed in order to enable psychiatrists to help their most severely depressed patients with this life saving treatment. The Irish Medical Times published our Chairman's response which highlights the Society's views and anxiety over the matter.
ECT is not ‘barbaric’
I read Aoife Connor’s report (Controversy on ECT proposal 1st April, Irish Medical Times) with astonishment and alarm. These feelings were induced by Senator Niall O Brolchain’s Neanderthal pronouncement that ECT is “barbaric”. (As it was mentioned in the context of the Mental Health Act 20011, let me first say that I support the amendment under debate).
If one were to accept the Senator’s statement it would necessarily follow that decades of physicians in the specialty of psychiatry from the 1930s onwards have systematically inflicted barbaric assaults on severely mentally ill persons over that time. How can he reconcile this with the position of ECT to this day as a legally accepted medical treatment?
I would not deny for a moment that a number of thoroughly decent (and would assume that the Senator is one such person) find fault with perceived imperfections of ECT as indeed a life-saving therapy. In large part the negative emphasis has been promoted by Hollywood fictional ECT depiction of such as the film of Ken Kesey’s novel One Flew Over The Cuckoo’s Nest. Another, and perhaps related influence, has been an understandable public sensitivity with such ‘crude’ interference with that specially revered organ, our brain. But let us be clear that when we suffer say a subdural haematoma a neurosurgeon may evacuate that blood by first boring a hole or two in the skull: crude indeed but can be essential to save life. Alas, only Doctor McCoy of Star Trek has the luxury of saving injured life by magical hand movement and plastic toys. We are not there yet. But we are trying.
The only reason that ECT continues to be used is because as we still stand today, in the treatment of the most disabling and life-threatening mental illnesses, patients at death’s door can be restored to full health in numbers as no medication or surgery can yet equal. This is not to say it never fails. No, only that it can and does succeed where all other measures have failed.
The battle to retain ECT in its rightful place as a truly remarkably effective treatment for certain mental illnesses took a further step forward in a large US 13-centre study, Bifrontal, temporal and right unilateral electrode placement in ECT: randomised trial, Kellner CH et al Br J Psychiatry(2010), 196, 226-234. This was preceded by a commenting editorial in the same journal issue on Electrotherapy, practice and evidence (Scott AIF, 196, 171-172). The last two sentences of the editorial state unequivocally, “The patients in the present study had already been ill for an average of 2.4 years. Why did they have to wait so long to be offered such efficacious treatment?” The likelihood is that 20 years ago those patients would have received their ECT within days or at most weeks of diagnosis of similar illness development: a 2-year plus saving of suffering patient time and with it the common improvement leading to hospital discharge in weeks. The people responsible for that avoidable patient suffering are careless, hopelessly ill-informed people who do not feel constrained by lack of evidence for their flawed and vaunted anti-ECT opinions.
Dr Dermot J Ward FRCPI FRCPsych DPM