The Seanad will tonight debate a private member's Bill seeking a partial ban on ECT - electroconvulsive therapy. This "therapy" must be done away with, writes Michael Corry.
A YOUNG WOMAN called Sarah lies strapped to a table. Without the general anaesthetic 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."
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 "well-being". 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 retraumatises 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 brain damage 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 doors on the psychiatric dark ages it represents.
Dr Michael Corry is a consultant psychiatrist at the Institute of Psychosocial Medicine in Dún Laoghaire, Co Dublin. He is co-author, with Dr Aine Tubridy, ofGoing Mad? (Gill Macmillan) andDepression: an Emotion, not a Disease (Mercier Press). Drs Corry and Tubridy are creators, with Basil Miller, of the websiteswww.depressiondialogues.ie andwww.wellbeingfoundation.com , dedicated to ECT abolition. If you would like to share your experience of ECT as part of a research study, please contact the Institute via 01-2800084 or ipmed@eircom.net