Why is ect controversial

Electrodes are then attached to the patients scalp and an electric current is applied which causes a brief convulsion. Minutes later, the patient awakens confused and without memory of events surrounding the treatment. This treatment is usually repeated three times a week for approximately one month. The number of treatments varies from six to twelve. It is often recommended that the patient maintain a regimen of medication, after the ECT treatments, to reduce the chance of relapse.

The risks and side effects involved with the use ECT are related to the misuse of equipment, ill-trained staff, incorrect methods of administration, persistent memory loss, and transient post-treatment confusion. After 60 years of use, ECT is still the most controversial psychiatric treatment.

Much of the controversy surrounding ECT revolves around its effectiveness vs. Because of the concern about permanent memory loss and confusion related to ECT treatment, some researchers recommend that the treatment only be used as a last resort.

He dragged out a table on wheels with a machine on it and rolled it behind the head of the bed. The nurse started swabbing my temples with a smelly grease. Doctor Gordon was fitting two metal plates on either side of my head. He buckled them into place with a strap that dented my forehead, and gave me a wire to bite. I shut my eyes. There was a brief silence, like an indrawn breath. Then something bent down and took hold of me and shook me like the end of the world. Whee-ee-ee-ee-ee, it shrilled, through an air crackling with blue light, and with each flash a great jolt drubbed me till I thought my bones would break and the sap would fly out of me like a split plant.

I wondered what terrible thing it was I had done. Later in the s, doctors began administering general anesthesia and giving patients muscle relaxers before the treatment. I felt surprisingly at peace. But those new modifications were not practiced everywhere, and took a while to catch on.

As a child, I watched this scene and shuddered. At the time, I had no idea that my great-grandmother had probably experienced something similar. One is the gender concern, given that the majority as much as 67 percent of people treated with ECT are women. Some have questioned whether ECT falls into this category as well. Maybe not. But by the s , ECT was making its way into mainstream psychiatry again, because many severely depressed people were not responding to medication.

Scientific studies of the treatment proliferated as well. And doctors developed better ways to apply electricity to the brain — such as using electrodes on only one side, instead of both — which reduced cognitive side effects like memory loss. They also started using brief-pulse ECT instead of sine-wave ECT, which used the type of electricity that comes out of a regular socket. As psychiatrists developed a better understanding of different types of depression, it became clear that where antidepressants failed, ECT could help.

The American Psychiatric Association defines depression as a common, serious illness that has a negative effect on how a person feels, thinks, and acts, and causes feelings of sadness. There are various types, like major depressive disorder which can be mild, moderate, or severe and secondary depression, which results from another underlying medical problem. No one knows exactly what causes depression, but it has been linked to brain chemistry, genetic makeup, personality, and environmental factors, like violence or abuse.

Severe depression can be incredibly stubborn, and people with this form of the disease may not respond at all to medications or talk therapy. For some patients who have tried everything else and failed, several experts told me, ECT could very literally save their lives.

Michael Dukakis described to me how for 17 years, beginning in her 40s, Kitty, for no apparent reason, went through recurring cycles of depression. About every eight months, she would fall into a slump, he said. She wrote that it brought her back to being herself — and that it saved her life. After her first round of ECT, she received treatments every eight months, when her depression typically returned.

She now has a short treatment about every six weeks, which she said takes about 20 minutes, to keep her symptoms under control. Her doctor calls it maintenance ECT. The clinic was white and clean, and six gurneys were set up where doctors prep patients by giving them an IV and monitoring their vital signs. ECT was also physically dangerous when first developed. Now there are ways to mitigate those dangers.

Current practice, known as modified ECT, uses muscle relaxants to avoid the physical dangers of a seizure and anesthesia to avoid pain from the electricity.

These modifications were learned early, but it took a while for them to become standard practice. He would have been able to witness all of this. This was not a major part of ECT practice, but this is not a comfort to gay people who received the treatment, for whom it could be traumatizing.

But it survived in the social memory of the therapy. By the s, the evidence that ECT was very effective for treating depression was robust. But there were also good reasons for patients to fear ECT. These reasons, combined with widespread revolts against authority and conformity that flourished in the s, also gave rise to a revolt against medical authority — the anti-psychiatry movement. In its most extreme versions, the anti-psychiatry movement rejected the very idea of mental illness.

But physical treatments, and most especially ECT, aroused its strongest rejections. Most advocates of anti-psychiatry — even those who questioned the very reality of mental illness — were supportive of talk therapy. This provides another clue about why ECT occasions such deep divides. It evens raises questions about who we are, and what a person is. ECT use declined in the s and s, but revived starting in the early s.

Now, psychiatrists estimate that about , Americans receive ECT. Many efforts are being made to find a more elegant and less distressing treatment, and it may not be long before ECT is replaced by an equally effective and less controversial treatment. As long as ECT has an evidence-based superiority over other treatments, however, it should be utilized for the benefit of patients.

Proper use not only assures patients of an effective treatment but is considerate of health care costs.

The widespread noncompliance with the principle of justice in the practice of ECT means a violation of the U. Declaration of Human Rights, which states that human beings are equal in dignity and rights. XI, 5th ed. New York: Oxford University Press. Encephale 27 2 J Clin Psychiatry 60 3 Schizophr Bull 22 1 New York: Cambridge University Press.

Am J Psychiatry 6 Am J Psychiatry 7 Italian Journal of Psychiatry and Behavioral Sciences J ECT 15 4 Merskey H , Ethical aspects of the physical manipulation of the brain. In: Psychiatric Ethics, 3rd ed. New York: Oxford University Press, pp Am J Psychiatry 2 [see comment]. J ECT 17 4 Eur Psychiatry 17 1 J Clin Psychiatry 60 suppl 2 [see discussion]. J Clin Psychiatry 59 1