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US NETWORK The All-Wales User and Survivor Network |
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US Network, Suite 3, 1 North Parade, Aberystwyth, Ceredigion, SY23 2JH Telephone: 01970-626-230 Steve is also the development worker for Ceredigion Advocacy Network of Aberystwyth, one of our own members in Wales: tel: 01970-626-229 |
ELECTRIC SHOCK TREATMENT
"SWITCH IT OFF" CAMPAIGN
THE CASE AGAINST ECT
CONTENTS click below to view section
THE CAMPAIGN
THE CASE AGAINST ECT
1. The Royal College of Psychiatrists Audits and Reports
1.1 The 1981 Pippard Report
1.2 The 1992 Pippard Report
1.3 The Third Audit 1996
2. Survivors of Shock Treatment
3. The Research Literature
FOOTNOTES:
BIBLIOGRAPHY
The US Network "Switch it Off" Campaign against the continued use of Electro-Convulsive therapy in Psychiatric practice, has its origins in a Campaigns Questionnaire distributed to US members in 1997. Analysis of the returned questionnaires revealed that ECT was an issue of overwhelming concern to US Members, who mandated the US Management Committee to campaign against its continued use in mental health care.
In September 1997, at the US Network Annual General Meeting held at the University of Swansea, an AGM resolution calling for a "complete suspension" of shock treatments was unanimously approved. This AGM resolution was subsequently reaffirmed by no less than three separate resolutions, at the most recent US Network Annual General Meeting held at the University of Bangor in September 1998.
Thus far, the campaign has involved joint working with other national user/survivor organisations including: ECT Anonymous; Reclaim Bedlam; Survivors Speak Out; as well as individual representatives from a host of UK User/Survivor organisations, including: MINDLINK; UKAN.; SHOCK; The Federation of UK Mental Health Agencies and so on.
The campaign has hosted a major conference on ECT. (Aberavon Beach Hotel - Port Talbot, 21 July 1998); plus an ECT Workshop involving a debate with two participating Consultant Psychiatrists (Ystrad Mynach, 27 November 1998). In addition, the Campaign has involved users/survivors in direct action to raise awareness of the debates and issues. Direct action has included vigil and letters to MPs - Cardiff City Centre, 19 June 1998; Demonstration - Royal College of Psychiatrists (London), 19 June 1998; Demonstration and march to Downing Street, 7 October 1998; "Survivors on the Street" - World Mental Health Day, Queen St. Bandstand, Cardiff, 10 October 1998. The US Network has also co-ordinated the writing of over 120 letters to 22 different members of Parliament which has provided a significant lobby and influenced two private members bills during the Parliamentary year 1998.
The US Network has also co-ordinated a petition sent to the Royal College of Psychiatrists and to Wyn Griffiths MP. Moreover, press and radio/T.V. coverage of the "Switch it Off' Campaign has been extensive and, so far, the US Network has received over 420 letters and faxes of support from users and members of the general public. The fact that the Campaign has been successful in raising awareness is revealed by reference to the letters of support from the general public. The US Network Aberystwyth office has on file many letters and faxes from people made aware of the Campaign through local and national press coverage. These letters reveal that members of the public are generally unaware that Shock Treatment is still in use in Psychiatric practice.
The Campaign has also provided a platform for membership recruitment, in part as a consequence of the extensive national and local media coverage of the issues. Articles have appeared in the Independent, Daily Express, Time Out, Nursing Times, Community Care and the Big Issue. Local coverage includes the Cambrian News, South Wales Echo and the Western Mail, as well as a whole range of local publications and mental health journals and newsletters.
The case against ECT may be derived from three main sources of evidence: firstly, the Royal College of Psychiatrists' own internal audits and reports; secondly, the growing literature of personal testimonies from Survivors of Shock Treatment; and thirdly, the currently available academic research literature. It is worth examining, briefly, each of these sources of evidence in turn, in order to establish a coherent case against Shock Treatment.
1. The Royal College of Psychiatrists audits and reports
The Royal College first published guidelines on the use of Electric Shock Treatments over twenty years ago (1). The first set of guidelines appeared largely in response to scandal and controversy, following the death of a woman patient, in a hospital in Kent, who had been given ECT against her will. The guidelines were followed, in 1980, by a survey of ECT use in Britain. The published results of the survey were summarised in the headline of an editorial that appeared in the medical journal, the Lancet. The headline read:
" ECT in Britain a shameful state of affairs", (Lancet, November 28 1981).
The 1980 survey carried out by John Pippard and Les Ellam of the Royal College revealed a chilling catalogue of blundering and dangerous incompetence. Out of 100 clinics visited by the Royal College team, only 22 met the standards set out by the Royal College guidelines. Approximately a quarter of clinics were using obsolete machines, which did not even meet the requirements of the 1976 safety code for Electro-medical apparatus. Some of the machines dated back to the 1940s and 1950s. According to the report, the inspectors saw: "Obsolete machines which deliver an unnecessarily large electric charge" and ... "consultants who did not even know where the ECT room was, and left everything to junior doctors who showed each other how to work the machines, often incorrectly". 'The report also revealed how: "Stimulus with an old machine is continued for several seconds, the button being stabbed nervously" and how... "Whether a fit had occurred was often in dispute among team members, sometimes none of whom had learned to recognise one.
'The Pippard Report maintained that few clinics took any measures to minimise the damage done by ECT and many patients received excessively large doses of electricity. In some clinics equipment and practice had not changed in 25 years and staff made comments such as: "old is gold" or "none of your soft psychotherapy here". A few clinics admitted to the occasional use of ECT without anaesthetic. Many psychiatrists - one third always, one quarter sometimes - did not follow the advice of the Royal College guidelines - that patients who realised ECT should only be treated under a section of the Mental Health Act, (Pippard and Ellam 1981; Kemsley 1998). The 1980 Royal College survey also revealed just how much of a lottery ECT use was. There were massive variations in the amount of ECT being given in different hospitals by different consultants. The highest-using regions used more than five times as much ECT as the lowest-using regions. Since hospitals had only agreed to participate in the survey under guarantee of anonymity, users of services had no way of knowing if their area was one of the highest-using regions, or whether their ECT Unit had been condemned as "substandard" by the report. In 1989 the Royal College again issued ECT Guidelines which were followed by a second audit.
John Pippard of the Royal College was commissioned to undertake the survey. Eleven years after the publication of his original report, Pippard's survey once again revealed that, "little has changed in the unsatisfactory administration of ECT. Fifty percent of clinics are still using obsolete machines". Pippard also found that the work of the ECT clinics was still being left to rotas of junior psychiatrists and trainee GPs who frequently had little training or supervision. Some clinics were still using the most obsolete machines despite the fact the Department of Health had recommended their replacement ten years earlier. Perhaps more disturbing was Pippard's revelation that nearly all clinics were using a standard stimulus dose, instead of adjusting the setting on the ECT machine for individual patients.
"Cognitive function is liable to be impaired the more the stimulus exceeds the minimum needed to cause a fit which can vary 40 fold between patients... It is beyond the capability of clinics to determine individual levels. It will require great changes in practice and newly designed equipment if even intelligent estimates are to be used. The dose of electricity is given by habit rather than by rational strategy, and routine instrument settings differ fourfold between clinics. A routine setting may be many times too big for some and too small for others". (PIPPARD REPORT 1992)
Despite the evidence suggesting that unavoidable brain damage ("cognitive impairment") has resulted in an unknown number of patients, the Royal College published its third set of ECT guidelines (2) and continued to maintain that, "ECT is safe and effective, it has no long term effect on memory or intellect". Following the publication of the ECT Handbook in 1995 the Royal College instituted a third audit of Electro-convulsive therapy.
The findings of the third Royal College survey of ECT clinics duplicated those of previous audits. Although there were some improvements in overall standards, the vast majority of clinics were rated as "deficient" or "poor". Despite the failings revealed by the 1981 and 1992 reports, the problems of outdated equipment, inadequately trained or unsupervised staff and absentee or apathetic consultants persisted (Duffett and Lelliot 1998; Benbow et al. 1998) Surveying the Royal College of Psychiatrists' own audits and reports, Susan Kemsley (1998) concludes:
"Twenty years, three guidelines, three audits and half a million patients further on, the Royal College still can't ensure decent standards of care in all (or even most) ECT clinics. Since the Royal College have shown themselves unable, or unwilling, or both, to put the situation right it is time for the government to heed the calls for action" (Kemsley 1998: p44).
Not only did the most recent Royal College audit reveal continued failings in the supervision and administration of ECT, but perhaps more disturbing was the revelation that one in four psychiatrists surveyed had experienced patients dying or becoming "dangerously ill" during shock-treatment (Benbow et al. 1998). The report concludes that:
"Twenty years of activity by the Royal College of Psychiatrists and three large scale audits have been associated with only modest improvement in local practice"
(Duffett and Lelliott 1998: p401)
Perhaps it is the stark conclusions of the Royal College's own audits and reports which have finally led the opposition of Psychiatric Nurses to Shock Treatments. A recent forum of ECT Nurses found that an overwhelming majority felt that the Royal College had failed to protect patients (3). A further study shows that a third of Mental Health Nurses in Wales would not want to receive ECT, even if actively suicidal. Two thirds wouldn't want it if "very depressed" and 95% wouldn't want it if "moderately depressed" (4). If Mental Health Nurses would not want to receive ECT, what does that say about its, so-called, "safety" and "effectiveness"
2. Survivors of Shock Treatment
The second, and perhaps most important, source of evidence against the continued use of ECT comes from the vast body of literature and testimonies written by Survivors of Shock Treatment. From US Network files, the huge caseloads of ECT Anonymous, and the written testimonies of the campaign group SHOCK, can be gleaned a frightening catalogue of damage and distress. Iris O'Mara is just one of many Survivors who have spoken out:
"Never again will I have this barbaric outdated treatment. I highly recommend that people such as trainee nurses read some of the inhumane horror stories surrounding ECT and how it has wrecked people's lives. These days I still get flashbacks: I suddenly lose my breath for a few seconds and have a similar sensation as when I had ECT. This almost breaks me and I lose my confidence. It's a very frightening experience".
(Iris O'Mara)
As well as being an effective Campaign organisation ECT Anonymous are also a clearing house for the personal accounts of Survivors of Shock Treatment, their files are:
"Bulging with stories of shattered lives and ended careers. Some have spent 20 years trying to recover from ECT. Some are wheelchair bound".
From a random check on 140 files from Shock Treatment correspondents, ECT Anonymous has produced a terrifying checklist of damage as a consequence of receiving Shock Treatment. This includes permanent memory loss; suicidal tendencies; Lupus; Motor Neurone Disease; Parkinson's Disease and so on. The ECT Anonymous checklist is supported by the correspondence we, at the US Network, have received since the "Switch It Off" Campaign began; here are just some of the comments made:
US Network activist Don O'Donoghue, has made similar claims in a local press campaign organised to air local opposition to a proposed "ECT Suite" planned by the Derwen and Pembrokeshire NHS Trust
"They knocked me out with drugs for several weeks and gave me ECT at the same time. The only thing I remember about ECT was being given the anaesthetic....I still had all the same problems and it was like facing them afresh every time I came round."
(The Cambrian News, front page, Thursday 21 May 1998).
Despite the determination of the local Trust to build a new ECT Unit the "Switch It Off" Campaign was successful, as the Cambrian News has reported:
"Shock Therapy plan is dropped at Psychiatric Unit"
(The Cambrian News, Thursday 30 July 1998 p.3)
Aside from the thousands of reports, letters and personal stories provided by the Survivors of Shock Treatment, Cameron (1997) has compiled over 200 cases of permanent memory loss from first person accounts. One of the respondents makes the following comments about ECT and the principle of informed consent:
"There is no such thing as informed consent.... They do not explain the possible risks and damages.... Believe me, depression is easier to live with than brain damage".
In recent years ECT Anonymous have collated evidence from hundreds of ECT Survivors and begun to institute legal proceedings as test cases. In Shropshire, for example, Andy Bethel of ECT Anonymous, has been granted legal aid to pursue his claim for damages against Shropshire Mental Health Trust. Manchester Legal Aid Board has granted a number of legal aid certificates that will allow the practice of ECT to be examined. In Scotland, the Grampian Health Board has recently settled a claim for damages "out of court" as a result of legal actions by a Survivor of ECT. The newspaper Scotland on Sunday (16 August 1998) reported that the Grampian Health Board had agreed to pay legal costs plus damages (believed to be thousands of pounds). Alex Doherty, a leading Scottish ECT activist, described the judgement as a landmark victory that would open the floodgates for people who had been wrongly subjected to Shock Treatment. Mental Health campaigners have sought to make available resources and information to those seeking legal redress for damage caused by ECT. The US Network is one of several organisations who are able to provide information and support to those wishing to pursue claims through the Courts.
There are literally hundreds of academic papers in a host of medical and psychiatric journals, which point to the damage caused by Shock Treatment. The literature is extensive and there are too many references to cite in this review. Selected at random are just a few of the papers to demonstrate the weight of evidence against the continued use of ECT in Psychiatry.
Studies have reported that:
In a review of the data Peter Breggin (1979) presents epidemiological evidence which suggests that ECT can cause confusion, global disruption of intellectual function, impaired judgement and insight and shallow emotional reaction. Breggin's book reviews evidence from animal research, human autopsy studies, brain wave and neurological investigations, clinical reports and the anguished observations of patients themselves. Dr. Breggin also documents that permanent and serious brain dysfunction - especially short and long-term memory loss - is a common result of Shock Treatment. In a paper presented to the American Psychiatric Association and eventually published in the American Journal of Psychiatry, John Friedberg (1977) similarly concluded that,
"From a neurological point of view ECT produces a form of brain disease... Many psychiatrists are unaware that ECT causes brain damage and memory loss because numerous authorities and a leading psychiatric textbook deny these facts".
(Friedberg 1977 p.1011)
With regards to the issue of informed consent, in an unusually frank statement, Dr. Friedberg argues that:
"Assuming free and fully informed consent, it is well to reaffirm the individual's right to pursue happiness through brain damage if he or she so chooses. But we might ask ourselves whether we, as doctors sworn to the Hippocratic Oath, should be offering it."
Many of the research papers quoted above are presented in specialist medical or psychiatric journals. The language is often obscure and difficult to decipher, however Templer and Veleber in the Journal of Clinical Neuropsychology simply ask the question: Can ECT Permanently Harm the Brain? One doesn't have to be a Clinical Neuropsychologist to understand their conclusions
"Our position remains that ECT has caused and can cause permanent pathology"
(Templer and Veleber 1982 p.
BENBOW, S.M., TENCH, D. and DARVILL, S.P. (1998) Electro-convulsive Therapy practice in
Northwest England. (In Psychiatric Bulletin, Vol.22, p.226 - 229).
BREGGIN, R. (1979) Electro-shock: Its Brain-Disabling Effects. USA, Springer.
CAMERON, D.G. (1997) Electro-Convulsive Therapy: 200 Cases of Permanent Memory Loss from First Person Accounts. USA, Psychee.
DUFFET, R. and LELLIOT, P. (1998) Auditing Electro-convulsive Therapy: The Third Cycle. (In British Journal of Psychiatry, Vol. pp4O1 - 408
FRIEDBERG, J.M. (1977) Shock Treatment, Brain Damage, and Memory Loss: A Neurological Perspective. (In American Journal of Psychiatry, Vol.134 (9), September 1977, pp. 1010 - 1013).
KEMSLEY, S. (1998) ECT - Are Guidelines and Audits Enough? (In The Survivor - Newsletter of the Survivors of Mental Health Services in West Suffolk, Issue 12, April 1998, pp39 - 44)
'THE LANCET (1981) November 28 Editorial
PIPPARD, J. and ELLAM, L. (1981) Electro-convulsive Treatment in Great Britain 1980. London, Gaskell
PIPPARD, J. (1992) Audit of Electro-convulsive Treatment in two National Health Service Regions. (In British Journal of Psychiatry, Vol.160, pp621 - 637)
TEMPLER, D.I. and VELEBER, D.M (1982) Clinic al Neuropsychology 4(2):62 - 66