ECT in the 1970s

Two weeks ago the Guardian newspaper published an article about psychologist and writer Dorothy Rowe, who had worked in Lincolnshire in the 1970s. At that time, the article said, the “conventional wisdom of the time”  was that what depressed people needed “was drug treatment and, in extreme cases, electro-convulsive therapy (ECT).”

Thanks to a generously funded survey in 1980, we know more about how ECT (electroconvulsive therapy) was used in the 1970s than at any time since. In 1979 about 200,000 ECT treatments were given in England, Wales and Scotland. That represents about 30,000 courses of ECT and slightly fewer people – about 27,000 – as some people had more than one course during the year. The authors of the study estimated that the use of ECT had fallen by about one half during the decade. So, on average, about 40,000 people a year in the 1970s were given ECT.

Even taking the lower figure of 27,000 from 1979, it is hard to argue that such a large number of people can all have been extreme cases.

But perhaps some people would argue, that even though ECT was being used on large numbers of people, it was still being reserved for people who were in some way different to other psychiatric patients. So, here are a few facts and figures about ECT in the 1970s which show that its use was not just widespread and routine but also fairly random.

If ECT was reserved for extreme cases you would expect its use to be spread fairly evenly between psychiatrists. But in fact a small number of psychiatrists were responsible for a disproportionate amount of ECT.

ECT wasn’t reserved either for those people who hadn’t been helped by drug treatment – thousands of people were being given ECT as treatment of first choice.

Or perhaps extreme case is simply a euphemism for psychotic? Again this isn’t the case: ECT was being used for all types of depression – neurotic or reactive, as well as psychotic or endogenous (as the classification of the day went).

Analysis of the prescribing of individual consultants in the 1970s shows that the majority of ECT was given where the majority of psychiatrists would not have considered it appropriate. For many people, treatment was decided not by the fact that they were an extreme case but by the fact that their psychiatrist happened to have extreme views on ECT.

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