It is one of the most dramatic techniques used in modern psychology. An electric shock is delivered directly to the brains of persons suffering from depression.
But electroconvulsive therapy (ECT) is controversial among some psychologists and is now at the center of a huge row — which broke out last week — over claims it can cause brain damage, guidelines for its use are weak and it’s being used disproportionately in women. and the elderly.
However, other psychologists and psychiatrists disagree. They say that while ECT causes mild seizures and can also cause significant memory impairment, it is a valuable tool for treating severely depressed individuals with suicidal tendencies and for whom all other treatments and medications have failed. Relief can be caused by ECT which, they say, has been approved by the National Institute for Health Care and Excellence in the UK and by the Food and Drug Administration in the US.
“Many people who need ECT have psychosis,” said Sameer Jauhar of the Institute of Psychiatry, King’s College London. “They hear voices telling them that it is bad and horrible people who should die. They are in danger by themselves. Other treatments may fail and you cannot expect the episode to pass. That is where ECT comes in.”
ECT was developed more than 80 years ago and its use peaked in the UK in the 1970s and 1980s, when more than 50,000 treatments were administered per year, said Prof John Read of East London University. “Today there are about 2,500,” added Reed, a leading critic of the use of ECT.
“We know it causes brain damage,” he told the… Observer† “However, we don’t know how much damage is being done, or in how many patients, and until that is the case, there is no ethical or scientific justification for its use.”
Supporters, however, reject the idea that it causes brain damage. It can lead to amnesia that can last for months, but they insist the impact isn’t permanent.
Both sides also disagree about the efficacy of ECT. Opponents argue that their studies provide little evidence to indicate that the technique works as well as claimed. “However, if you look at those studies, you see that they have major methodological flaws and are inherently biased,” said Robert Howard, a professor of psychiatry of old age at University College London. “There is ample evidence to show that ECT is effective.”
Then there is the issue of the prevalence of women among patients receiving ECT. A recent study indicates that they are twice as likely to receive the treatment as men. This suggests significant bias on the part of psychologists, opponents of ECT say.
But supporters point out that women are more likely to be treated for depression because they are more likely to be diagnosed with the condition, more likely than men to seek psychological help, and they tend to age when the risk is greater. on depression will increase. In other words, more women are getting ECT because there are more prone to depression.
“I also resent the suggestion that we’re a patriarchy that does horrible things to women because we don’t like them,” Howard said. “We care about all people who suffer from severe psychotic illness. And it’s good that we can give them a treatment like ECT that can help them.”
But this explanation is rejected by Read. “Yes, women are usually slightly more depressed than men, but not twice as much. Women tend to be more depressed because they endure more violence and abuse, while older people are more depressed because of loss and loneliness. The question is, how on earth can electricity solve those problems?”
This point is supported by other ECT opponents. It’s not clear how electric shocks, albeit mild ones, affect the brain, they argue, so we shouldn’t administer them.
Howard disagrees. “There are many medical procedures whose exact course of action is not fully understood, but we still use them because they work. Many of my patients – who are often very distressed – have been on antidepressants, antipsychotics and psychological therapies, and none some have worked. ECT can make all the difference.”