Madam, – The letter from Dr Pat Bracken (August 30th) in response to the recent study of the side-effects of electroconvulsive therapy (ECT) (Clare O'Connell – HEALTHplus, August 24th) made the relevant point that this study did not look at the phenomenon of retrograde amnesia. I would like to endorse what he stated, as this lapse in the study is highly significant, because, as he said, numerous studies in the literature report that this is the most significant problem reported by recipients of this treatment. ( Models of Madness, Ed. John Read, Loren R Mosher, et al).
What is frankly surprising is that, in this day and age, psychiatrists are still debating the question of the side-effects of this intrusive and damaging intervention. This “treatment” should have long since been consigned to the waste bag of punitive procedures such as the bleedings, swinging-chairs, freezing baths and more recently – lobotomies and deep insulin coma therapy, which have, one after the other, been shown to be highly damaging and therapeutically ineffective.
In 2008 I wrote a letter, published in The Irish Times, in response to a diatribe from the official voice of psychiatry, speaking on behalf of the Irish College of Psychiatrists, entitled: "ECT still a valuable treatment". I stated then, referring to what happened early in my career: "I began to have deep reservations about the efficacy of ECT and the long- term damage which can ensue from this procedure. I was becoming increasingly uneasy about these crude forms of physical intervention, my feeling was growing that there must be a more humane way to work in psychiatry. As I gradually reached the 'use of reason' as to the true nature of mental health, I came to a decision. This was not an ideological position; it has always been my view that the ultimate priority is that we do whatever we can to help the person we are dealing with. But I decided that I would only countenance giving ECT to a patient if I could find no better alternative and if their very survival was at stake".
That was 40 years ago and I have never had to give anyone ECT since that time, even though over all those years I have dealt with the full range of psychiatric disturbance. There were occasionally very difficult situations where, for example, someone was refusing food and in danger of dying, but I always managed to find an alternative.
Over many years, studies of the efficacy of electroconvulsive therapy have shown no long-term benefit, only a temporary relief of symptoms, mainly due to confusion and memory loss. Some early studies utilised a simulated ECT control group and found no significant difference between the two groups. In more recent years simulated ECT control groups have not been used in clinical trials. The justification for this is that it is considered unethical to withhold a treatment “which is known to be effective”, thus “begging the question”. That is, using the assumption that ECT is effective to justify not investigating whether it is effective.
When will psychiatrists finally accept that we are dealing with sensitive human beings, not machines to be tinkered with. The very definition of what it is to be alive is to be self-organising and to manage oneself. The only real change happens when we help a person to bring about the painful work of change within themselves. – Yours, etc,