Maudsley ECT debate: two questions for each side

(See also my highly critical piece on John Read posted 10 days later)

‘Electroconvulsive Therapy (ECT) has no Place in Modern Medicine’

I have a ticket and will be voting against, because I know that many people have ECT on a voluntary basis, and it would cause them distress if it were withdrawn overnight.

However, I am quite sceptical about ECT: in ten years as a higher trainee and consultant in Learning Disability (LD) Psychiatry I only ever heard of one person with LD needing it in the UK. I went to national LD conferences regularly and often asked about ‘treatment resistant depression’, partly because as a student in 1984 part of my psychiatry placement was at the Brook Hospital, which was the last major centre for psychosurgery in the UK.

Two Questions for John Read (proposing to abolish ECT):

  1. You have compared ECT to ‘lobotomy and the rotating chair’:  This seems close to the Scientologists who say that ECT is a deliberate form of torture, and point to early twentieth century history to support that view. As a psychologist, would it not be more honest to acknowledge that your profession has a dark history just as psychiatry does? Intelligence testing was central to eugenics (including deliberate killing in its most extreme form) in the early twentieth century, and more recently American psychologists have designed torture techniques for the US government:
  2. You have recently stated that you want a larger, better quality, randomised controlled trial (RCT) for ECT. You have also stated that you do not accept the concept of diagnosis, and propose an ‘alternative’, but as diagnosis (including a notion of severity) are necessary for an RCT of a treatment for severe depression how is this possible?

Two Questions for Sameer Jauhar (against abolishing ECT):

  1. As a Maudsley Hospital consultant psychiatrist, and a researcher at the ‘world-leading’ Institute of Psychiatry, Psychology & Neuroscience, is not your professional and academic credibility undermined by an apparent culture of minimising ‘bullying, harassment and misogyny’ in those organisations?
  2. Given that the previous RCTs of ECT showed a significant placebo effect, do patients deserve more honesty about this to be able to give proper ‘informed consent? And is there a case for offering randomised sham or real ECT in clinical practice?

About Dr Neil MacFarlane MRCPsych

Independent Psychiatrist providing culturally informed mental health opinion, advice, and a few new facts. Based near London, UK. Main qualifications: BA MBBS MA MRCPsych.

2 responses to “Maudsley ECT debate: two questions for each side”

  1. Sue Cunliffe says :

    I am the brain damaged speaker from the event. The Royal College ECTAS patient perspective survey 2014 identified 63%patients having memory loss and 18% had severe permanent memory loss. That’s 18%,of lives destroyed.
    ECT practices today are variable and put patients at risk. These are the changes that need making to improve patient safety whilst research is done that is accepted by both sides and more importantly can be used to provide patients with fully informed consent. NICE 2003 guidelines have been ignored…. This is what causes patients like me brain damage:
    1) all patients must be under the joint care of a psychologist. They must have good quality talking therapy before ECT is given. This doesn’t happen every where which is evidenced by John Reads audit which shows eg Worcestershire uses ECT 12 times more than other areas…. That exposes us to 12 times the risk. Other units are using ECT as a last resort.
    2) adequate consent. Information leaflets provided by units over estimate effect and under play side effects. Yes these units are accredited. NICE had not checked that these have been improved.
    3) psychologist must monitor all patients before each shock is given. As per NICE ECT must be stopped if brain damage occurs. ECTAS does not make monitoring an essential requirement for accreditation of units… But you can’t be accredited if you don’t have a toilet in the waiting room…
    4) all brain damaged ECT victims must be given neuro rehabilitation support.
    5) psychiatrists need to accept brain damage occurs and take responsibility…
    6) patients who had inadequate consent and ended up brain damaged.. Like me… my notes consent me as ECT being safe and no long term effects.we need compensation and support.
    7) the royal college need to review all past ECT patients and set up support groups. This is what the MESH enquiry has done.
    8) an independent monitoring agency should accredit units and ALL units must be accredited.. They aren’t.
    9) all incidents of brain damage must be reported
    10) all psychiatrists giving ECT should listen to a victim speak so they know the consequences of poor ECT practices….I met a woman at the debate who finished her ECT 12 months ago… She has the same symptoms of damage as me. It still happens
    The MESH enquiry is the gold standard for injured patient care and prior to being banned produced an excellent information leaflet.
    Mental health patients deserve that same level of safety and consent.

    • Dr Neil MacFarlane MRCPsych says :

      Sue…I have just caught up with this. Having not been involved with ECT for 20 years I am a bit rusty. I had been a medical student at the Brook Hospital’s psychosurgery unit in the mid 80s, and a friend of mine later worked there, so while I was a specialist in LD psychiatry for 10 years I used to ask my colleagues all over the UK how much ECT they were giving: I only ever heard of one case. Therefore I am a sceptic.

      I will do what I can to encourage people to link up with your campaign (as I hope I did the other night on Twitter). Best wishes.

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