Electroconvulsive therapy (ECT)
Electroconvulsive therapy, or shock therapy, is enjoying somewhat of a
comeback after falling into disrepute in the 1970s. Every year in
Britain, 20,000 people are on the receiving end of 100,000
treatments—that is, at least five shock treatments apiece. In the US,
100,000 patients are subjected to more than half a million treatments a
year. But perhaps the most astonishing of all these statistics is the
number of cases of shock therapy that are still administered
involuntarily. In the UK, some 3000 patients—or a sixth of all those
treated with ECT—still receive the treatment against their will.
It is primarily used to treat severe depression. It involves the
passage of electricity through the human brain. In bilateral ECT,
electrodes are placed on the patient’s temples. With unilateral ECT,
the electrodes are placed over the front and back of one side of the
head. The applied voltage can be anywhere from 70 to 170, and the
current from 500 to 100 milliamperes—the power consumed by a 100-watt
bulb flashed for one-half to one second. The result is similar to a
grand mal epileptic seizure, and that is its purpose.
It is believed that the induced seizure causes chemical changes to the
brain that normalize moods and alter pain perception. But since nobody
really fully understands how ECT works, its efficacy has been likened
to kicking a malfunctioning TV set. If you do it long enough and hard
enough, you may just produce the desired result.
Overall, ECT appears to have immediate, though temporary, beneficial
effects where depression is characterized by psychotic features, or an
individual has lost the will to live, doesn’t sleep and is refusing
food.
ECT emphatically doesn’t work for Parkinson’s disease, Alzheimer’s
disease, violent behaviour, obsessive–compulsive disorders and
depressed individuals who do not respond to drug treatment. ECT should
not be used for cases of mania, schizophrenia, epilepsy, autism or
dementia.
While the medical profession believes ECT is a ‘life-saving option’,
there is no evidence for this. Although we know it can kill, there are
few figures to show how often it does. Risk of death from ECT is
underreported all over the world. In the UK, there is no audit of ECT
use. In the US, no national records are kept (except in the state of
Texas), so it is impossible to quote accurate figures.
While psychiatrists constantly reassure us that patients are happy with
the results of ECT, surveys of users suggest that many recipients are
deeply divided. In a 1993 survey by MIND, the UK’s leading mental
health charity, 43 per cent of patients said they found ECT helpful, 37
per cent said it was unhelpful and 20 per cent said it made no
difference. In plain language, this means that more than half of those
treated found ECT did not help their condition or made it worse. A
survey by the United Kingdom Advocacy Network (UKAN) two years later
was even more revealing since less than a third of respondents found
ECT helpful. Two-thirds regarded their experience as unhelpful, and
half of those believed themselves to be damaged by the procedure.
Psychotherapy
So-called ‘talking cures’ are probably the oldest form of modern
treatment for depression. Begun by Sigmund Freud in the 19th century,
and later adapted by Carl Jung and others, psychotherapy is
characterized by in-depth assessment of the patient’s problem, usually
provided by extensive interviews with the patient himself. The
psychotherapist usually confines himself to a listening mode,
encouraging the patient simply to talk—frequently about childhood and
family relationships.
The theory is that talking through the ‘root of the problem’ may help
to resolve it. Frequently, however, the therapist will try to analyse
the patient’s difficulties, often according to a theoretical construct
of unconscious human behaviour. The theories may well differ even
within one school of therapy.
Today, given the plethora of different psychoanalytical theories,
modern psychotherapists often need to rely on a blend of theories,
according to personal preference and experience. Most psychotherapy
tends to be a long drawn-out affair, continuing over as many as two or
more years and involving literally hundreds of separate sessions.
For half a century, no studies were done to assess psychotherapy’s
effectiveness. It was only the ‘heretical’ psychologist Hans Eysenck
who, in the 1950s, dared to question the orthodoxy by seeking out
clinical evidence for psychotherapy. He compared the outcome reports of
24 studies of ‘talking-cure’ treatments with two control studies
involving patients who had received no treatment whatsoever.
Eysenck found that two-thirds of the patients improved substantially
within two years, whether they had been treated or not. Looking closely
at the figures, he concluded that psychotherapy was not only completely
useless, but that it was also marginally harmful.
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