On 3 August 2022 The New Statesman (UK edition) ran an article on electroconvulsive therapy (ECT): “We need reasoned debate on ECT, not polarisation”. The authors are two psychiatrists, Rebecca Lawrence and Stephen Lawrie, who both work in Scotland. Lawrence works in the field of addiction and has herself had several courses of ECT. Lawrie has had a career in neuroimaging.
So how do they go about starting this reasoned debate? Their chosen words are not ones you particularly associate with reason: hideous, awful, unbearable, brutal, terrible, anguish, desperate, discombobulating, clinging fears.
The first three – hideous, awful, unbearable – are used to refer to depression, the disorder for which ECT is most commonly used as a treatment.
As for brutal and terrible, the article says:
“When first used, it was brutal – often given on a daily basis without anaesthetic or muscle relaxant. This caused terrible harm and broken bones were common.”
This shows a lack of knowledge of the history of ECT. Although most hospitals were using mainly modified ECT (that is, with anaesthesia and muscle paralysing drugs) by the late 1950s, unmodified ECT (without anaesthesia and muscle paralysing drugs) continued to be used occasionally in the United Kingdom into the 1980s. And is still used in some other countries. In the 1940s and 1950s there were a few psychiatrists who experimented with intensive ECT on a daily basis, but most patients had courses of treatment given two or three times a week.
As for anguish: “But now there is no pain, and any anguish experienced is due to the underlying depression”. I am not sure what the authors mean by this. Are they referring to people’s very understandable anxiety about undergoing a medical procedure? Or their concern that they will be left with memory loss? But in any case it is common for psychiatrist’s to blame patients’ depression for anything untoward.
Desperate refers to the psychiatrists’ attempts to save lives with ECT. “There are worse experiences in medicine, many desperate attempts to save lives that hurt more, but are thought worthwhile.” The authors do not mention any evidence to support this view.
Discombobulating? It is a word that was invented in America in the 1820s when it was fashionable to make up Latin sounding words for humorous effect. Apparently it means confusing or disconcerting. The authors say:
“Having ECT is frankly discombobulating – during the course of treatment you can feel bewildered and, afterwards, many people will have memory holes for that period – or even for previous memories.”
So, having acknowledged that “the memory problems linked to ECT have been underestimated and understated, with little support provided”, they then go on to describe them with a joke word.
What then, do the authors suggest for those who have suffered memory loss? Bizarrely, they say:
“A subsequent visit to the ECT suite could brush away clinging fears, and peer support, which one of us has given informally, can help. Above all, people should be taken seriously.”
It is not however taking people seriously to dismiss memory loss as “clinging fears” that can be brushed away by a visit to the ECT suite.
This is hardly the “balanced coverage” the authors call for.