The Royal College ECT lecture: don’t mention its history!

The Royal College of Psychiatrists has created a template for a lecture on ECT. The lecture is designed to be given to a target audience which would include “Trust Boards, Clinical Commissioners, medical psychiatric trainees and associated health professionals new to psychiatry, general hospital staff, general practitioners, medical students, patients and interested public groups.” Its stated aim is to both educate and promote ECT. (Are education and promotion necessarily compatible?) Lecturers are told not to mention the history the ECT as it might engender “a negative mind-set in the audience”.

Turning to the template, the lecture starts off with lists of symptoms of depression (evidently, as well as ignoring history it is also going to ignore the use of ECT in conditions other than depression, or, indeed, its use as a treatment for moderate as well as severe depression) and with an attempt, with the help of lots of bright colours, to convince the audience that it is all down to malfunctioning circuits in the brain. Having set the scene and hopefully engendered a positive mind-set in the audience, ECT itself is introduced and lecturers are told to play a few minutes from a BBC video. Then there are a couple of diagrams which show lines going in the direction of improved following ECT. One of the diagrams, confusingly, is from an American study comparing right unilateral, bitemporal and bifrontal electrode placement. In the UK nearly all ECT is given with bitemporal (that is, bilateral, electrode placement). A little further on there is a discussion of this article, although it is of little relevance to British practice. Perhaps the idea is to convey the impression that interesting research is being done. Meanwhile the audience has been given a list of mechanisms of action of ECT (normalisation of ventro-lateral PFC, reduction of CBF and CMR in PFC, etc.) all very scientific sounding.

There follows, under ECT procedure, another list: diagnosis, consent, etc., work up, anaesthetic, treatment, recovery and review. Is the lecturer given free rein here? Are they supposed to mention the fact that about forty per cent of ECT patients in England are treated under the Mental Health Act without their consent because they are deemed to lack capacity? Or is that, along with history, another unmentionable? After a picture of an ECT machine and an EEG recording, comes a section on risks/adverse effects of ECT. When it comes to long-term risks, lecturers are prompted with: “Long term, ?Auto-Biographical ?? None. Other causes (depr, meds, organic brain dis.)” The lecture ends with a plug for TMS (transcranial magnetic stimulation).

I find it slightly worrying that psychiatrists can’t be trusted to compose their own lectures. Hopefully when they deliver their lecture they will at least tell their audience that it is based on a template by the Royal College ECT Committee. And what is that quote about those who ignore history…?

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3 Responses to The Royal College ECT lecture: don’t mention its history!

  1. It concerns me as well, that they dont trust psychiatrists enough to make up their own lectures as well, to be honest. Advice, yes, virtually planning down the whole lecture for them, no.
    I can understand the desire not to overstate the early usage of ECT, it was pretty awful back then, in the days before anaesthesia, and muscle relaxants, it wasnt a pretty sight, and very different now. But the more modern history, yes, why not? Could accentuate the positive changes, even?
    Consent issue, I hate. I dislike the idea of using ECT on unwilling patients, when capable of making the decision for themselves. Obviously this doesnt work in 100% of cases, but surely most must have a record of pro, or anti by then? Just work from that?
    Me, I would have it, if I needed it, or indeed if I could benefit by it, but thats just my view. Those who are strongly against shouldnt be forced to have it, simple as that

  2. Welton says:

    It seems to be something of a cliche that “early” ECT supposedly did not use anesthetic or “muscle relaxants.” But it is rarely specified what is meant by “early” ECT. In actuality, anesthetic and muscle relaxants were used as far back as 1965 (at least at Hillcrest Hospital in Birmingham, Alabama), when I was subjected to my first ECT. Of course I was not really a willing patient, having been coerced and threatened (at age 17) into signing the “consent” form, which I signed only once before being subjected to 66 ECTs over a period of 3 years and 10 months. The consent form did not specify how long the treatments would continue, and in fact, did not even mention ECT. It merely said that I consented for the psychiatrist to “treat” me. I hope that consent forms are more explicit these days.

    • I think by the end of the 1950s most hospitals in England were routinely using anaesthesia and muscle paralysing drugs for ECT. But there were some who were not and some hospitals where both methods were used. Even in 1980 ECT was occasionally given in unmodified form.

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