Electroshock Therapy: From Research to Action
UK patients, clinicians and researchers call for independent enquiry into ECT.
Posted August 24, 2020 | Reviewed by Kaja Perina
In my first blog, I reported on my early personal encounters with electroconvulsive therapy (ECT), and on a review of the ECT research literature that I had just published, with Professor Irving Kirsch of Harvard Medical School.1
The review found very little evidence that ECT was better than placebo during the treatment period and no evidence at all beyond the end of treatment. There was also no evidence that ECT saves lives or prevents suicides, as often claimed. On the other side of the cost-benefit equation, there is a slight but significant risk of death, and between 12 and 55 percent of ECT recipients suffer brain damage in the form of permanent memory loss.
In this second blog, I will describe some of the reactions to, and consequences of, our review, to demonstrate what can be accomplished when some of the diverse sectors of our 'mental health community' come together to work for a more humane, evidence-based approach to mental health services.
Having been delighted that our review received so much attention from the mainstream media in the UK, we were equally pleased to see it being covered, accurately and in considerable detail, by Medscape,2 an important source of information for doctors in the USA and around the world. Most (but not all) of the psychiatrists commenting on Medscape were critical of our work, or of Medscape or the journal for publishing it. This was in contrast to most (but not all) of the ECT recipients on social media liking the review, usually because it reflected and validated their own personal experiences.
But one's postion in this often polarised, and sometimes heated, debate is not entirely determined by whether you are a psychiatrist or a patient. Some ECT recipients tweeted that it had helped them, and one or two even reported that they thought it had saved their lives. Meanwhile one psychiatrist, Dr Sandra Bink, who had two courses of ECT herself, wrote:
"Today I resent myself for agreeing to receive ECT. My long-term memory was destroyed. Memories of childhood friends, memories of major events I attended, memories of my training as a psychiatric registrar, academic memories etc. I started struggling with simple spelling and calculations. I basically cannot recall an almost entire 3 years (2004-2006), including the relationship I was in at the time. I never told colleagues about this, as I felt ashamed. But I started talking to other people who had ECT and realized I am not alone. . . . I can understand some of the negative responses by colleagues to this article, but I have to admit that I welcome their argument."
Meanwhile, back in the UK, a sympathetic mental health organisation interviewed Professor Kirsch and myself to help publicise our review and its implications for the future of ECT in the UK. I strongly recommend readers listen to Irving's explanation of how placebo works with ECT, and why more intrusive procedures produce more powerful placebo effects. He is arguably the world's leading expert on placebo effects in psychiatric treatments.
Forty experts (including researchers, psychiatrists and other mental health professionals, and ECT recipients and family members) have now written to our Minister for Health calling for an independent Enquiry into how ECT is administered and monitored in the UK. The letter includes:
“Most of us have been campaigning about this issue for many years. We have received no official acknowledgement of our serious concerns, let alone action on the numerous failures of clinical practice, informed consent, governance, and sound evidence for the use of ECT. As a result, the ECT recipients among us have been left with severe psychological trauma and lifelong impairments to their cognitive functioning."
The letter highlighted the fact that most people given ECT are women and older people. It also emphasised that any Enquiry must be independent. This is crucial because the use of ECT is currently monitored by the Royal College of Psychiatrists who may be less likely to pick up on the sorts of irregularities and failings identified by our own independent audit.3
The lead signatory on the letter is Dr Sue Cunliffe, who had been a pediatrican until having ECT rendered her incapable of working. I had the honour of debating alongside Sue at the 57th Maudsley Debate, at the Institute of Psychiatry in London, in 2018,4 where we proposed the motion 'This House Believes ECT has No Place in Modern Medicine.' The arguments from the two psychiatrists opposing the motion, and the absence of any apparent empathy for Sue's alarming personal story, seem informative.
Our call for an Enquiry has now been endorsed by several key UK organisations, including the National Counselling Society, the Association of Clinical Psychologists and the Council for Evidence-Based Psychiatry. Importantly it has also been supported by the UK's largest, and widely respected, mental health charity (NGO), Mind:
"At Mind, we back calls for a comprehensive review into the use of Electroconvulsive Therapy (ECT), a potentially risky physical treatment that is still used to treat mental health problems in rare cases. We know that some people have found it effective for improving symptoms of mental health problems – particularly depression – when nothing else has worked. However, we still don’t know why it works or how effective it is. Some people who have had ECT may have found they experience adverse side effects that are worse than the symptoms of the problem they’re trying to treat, including short term or longer term memory loss".
It is equally important that our call for an Enquiry is also supported by a smaller organisation, Headway, the brain injury association . Their support is an acknowledgement that ECT can indeed cause damage to the brain. Further validation of this, beyond the research itself,1 comes in the surprising form of an ECT machine manufacturer in the USA, Somatics, following the out-of-court settlement of a class-action law suit on the eve of trial, issuing a Regulatory Update adding "permanent brain damage" to the list of risks.
Finally, in possibly the most significant step towards bringing about real changes (given that research is not always sufficient to change minds), the English Law firm Freeths has announced that, following media coverage of our review of the research, it received ‘dozens’ of enquiries from ECT recipients about joining the UK's own class-action lawsuit that they are preparing. The lawsuit is focussed less on the fact that ECT causes memory loss and brain damage and more on the fact that people are not told about that when being offered ECT.
Hopefully, patients, carers, mental health professionals, academics and lawyers working together will hasten the inevitable eventual demise of this largely ineffective and extremely dangerous procedure. In the meantime our coalition of many colours aims to ensure that the dwindling number of psychiatrists who still believe ECT is safe and effective will use it ever more sparingly, will monitor properly for memory loss, and will offer compensation and referral for cognitive rehabilitation when brain damage occurs.
Of course there will be opposition, from a small number of caring, well-intentioned people. There was probably similar, honourably motivated, opposition in the dying days of surprise baths, rotating chairs, standing patients next to cannons, and, more recently, lobotomies. Our alliance of concerned parties is determined, however, to apply today's principles of evidence-based medicine, and human rights, in order to succeed in the UK. We hope that others will follow our lead.
1. READ, J., KIRSCH, I., McGRATH, L. (2020). Electroconvulsive Therapy for depression: A Review of the quality of ECT vs sham ECT trials and meta-analyses. Ethical Human Psychiatry and Psychology, doi:10.1891/EHPP-D-19-00014 https://connect.springerpub.com/content/sgrehpp/21/2/64
2. VLESSIDES, M. (2020). Experts call for immediate suspension of ECT, others push back. Medscape, July 24th. www.medscape.com/viewarticle/919533
3. READ, J., HARROP, C., GEEKIE, J., RENTON, J. (2018). An audit of ECT in England 2011-2015: Usage, demographics, and adherence to guidelines and legislation. Psychology and Psychotherapy: Theory, Research and Practice, 91, 263-277.