ECT in the i

Last week was Mental Health Awareness Week and on Tuesday 8 May 2017 the i newspaper ran an article under a headline about debunking common mental health myths. I thought the headline was a bit misleading as the article was more of an opportunity for six psychiatrists to write about something that interested them, for example the president of the Royal College of Psychiatrists saying that more money should be spent on psychiatric research. But, anyway, the on-line version of the article, published the previous day, had featured an additional “myth” in the form of Raj Persaud writing about electroconvulsive therapy (ECT). I wonder why Raj Persaud’s piece had been left out of the print edition. Perhaps an editor recognised it as a particularly banal and cliche-ridden piece or perhaps there simply wasn’t enough room on the page.

Raj Persaud used to be a media psychiatrist but about ten years ago he ran into trouble with plagiarism and was suspended from the medical register for three months. Persaud’s piece starts, as so many newspaper pieces about ECT do, by saying that it is not like its portrayal in the film One Flew Over The Cuckoo’s Nest. Why should it be? That was a film, made about forty years ago, based on a book written in the 1960s. Even for that era the use of ECT (without anaesthetic, to control behaviour) shown in the film was unusual, though not unheard of.

Then there is a bit about a “mild electric charge” that leaves people feeling “a bit groggy” but with “minimal” side effects. At first sight Persaud appears to have turned to the Royal College of Psychiatrists’ information leaflet on ECT for inspiration. The Royal College leaflet for example talks about patients feeling “muzzy-headed” after ECT, and mentions a 1 in 10 figure in connection with memory loss. The Royal College leaflet says: “Memory problems can be a longer-term side effect. Surveys conducted by doctors and clinical staff usually find a low level of severe side-effects, maybe around 1 in 10.” Persaud though has changed the “severe” to “mild”: “There is risk of mild memory loss, which can happen in around one in 10 people.” If the risk-benefit balance begins to look precarious, just throw a few “milds” onto the risk side and “severes” (as in symptoms to be treated) onto the benefits side. True to this approach, as if he didn’t quite believe his own claims about the mildness of the electric charge and of the memory loss, Persaud launches into a stigmatizing description of an ECT patient:

“Patients for whom ECT is recommended can be catatonic. They are in grave danger of dying as a result of not being able to eat or drink. They might be experiencing crippling hallucinations and could be actively suicidal”.

Well, yes, they might be. But they might also be someone with moderate depression that has not gone away with drug treatment.

Persaud concludes by saying that ECT is used as “a last resort treatment” (although in fact it is used as a second-line treatment) and then, without apparent irony, says that there is a stigma attached to it.

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