ECT in Worcestershire: over 90 per cent of patients are women

When I wrote about electroconvulsive therapy (ECT) in Worcester, United Kingdom, two years ago I was unable to find any publications on the treatment from psychiatrists, etc., working in Worcester. However, an article about ECT in Worcester has now been published. The articlePatients’ experiences of and attitudes to ECT, by Latha Guruvaiah, Karthikeyan Veerasamy, Muhammad Naveed, Swami Kudur, Farah Chaudary and Ann Paraiso appeared in the April – June edition of Progress in Neurology and Psychiatry. As the title suggests, people who had undergone ECT were asked to fill in a questionnaire about their experience. The people who were asked to fill in the questionnaire had all been treated by the Worcestershire Health and Care NHS Trust in 2013 and 2014. The lead author is a psychiatrist at the 2together NHS Foundation Trust in Gloucestershire, the others are psychiatrists at Worcestershire Health and Care NHS Trust.

The questionnaire was based on one used by Scottish psychiatrists for a similar study in the 1970s. The authors say: “Since its publication in 1980, we could not find any similar published literature in the UK highlighting the experience and attitudes of patients and carers towards ECT” which is surprising as several such studies have been published. People who had undergone ECT were asked questions about their experience and, based on their answers, the authors concluded that “It is clear from this study that the overall experience and attitude of patients and carers were positive”. For example:

  • 15 out of 27 consenting patients said they had signed a consent form (the others could not remember);
  • 4 out of 27 consenting patients felt forced or pressurised to have ECT (19 did not and four could not remember);
  • 22 out of 30 patients said a member of staff accompanied them to the ECT clinic (2 said no and six could not remember);
  • 28 out of 30 said the clinic was clean and comfortable (2 could not remember);
  • 17 out of 30 rated the recovery period for a few hours after ECT as “pleasant”, 5 as “neutral”, 4 as “unpleasant” and 4 as “do not know”.

Of 29 patients, 24 said they experienced memory loss after treatment, and 13 said they experienced confusion. The authors suggested that the high incidence of memory loss might be explained by the fact that all the patients had been given bilateral treatment. (The survey did not ask participants if they had been given a choice of bilateral or unilateral treatment.)

The researchers found 30 people who were willing to take part in the survey, out of 60 people who had completed a course ECT during 2013 and 2014. The trust came up with a slightly different figure when I put in a Freedom of Information request – 69. Perhaps the difference is explained by people who did not complete a course of treatment. The interviews were conducted in early 2015, that is from immediately to just over two years after treatment (I am going to say on average one year). Six people could not be traced, five people could not take part due to significant cognitive impairment, 11 refused to take part and eight had died. The authors made no comment about those with cognitive impairment or whether it was caused by ECT, and they said that the deaths were “not related to ECT” but due to either “old age or physical ailments”.

But should eight people, out of 60, have died within, on average, a year of ECT? The average age of the people in the final sample of 30 was 62 years (ranging from 20 to 81). The trust told me that the average age of all people who received ECT in 2012 and 2013 was about 63 (64 in 2013 and 62 in 2014). A woman (and nearly all those who received ECT were women) in her early sixties in England can expect to live over twenty years more, so that appears to be a high death rate. It is something that at least deserves more explanation than a vague comment about old age.

Almost all – 28 out of 30 – the people taking part in this study were women. When I read the study I assumed that that must be because women were more willing to participate in the study. But the trust told me that, astonishingly, 63 of the 69 people who underwent ECT in 2013-2014 were women. Over 90 per cent of their ECT patients were women. Again, the authors are unconcerned, saying that depression is more common in women than men. Possibly – but certainly not in the ratio of 9 to 1.

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5 Responses to ECT in Worcestershire: over 90 per cent of patients are women

  1. Gillian Dennis says:

    There is something very strange going on here, why are women, elderly women too, given more ECT then men?

    • Welton says:

      For one thing, there are more elderly women than there are elderly men because women on average live longer than men — demographics. But actually, I think it is because the shock doctors can get away with it and because of various levels of misogyny in western society. Sort of like back in the middle ages and renaissance, more female witches were burned, drowned, tortured than male. Elderly women are often vulnerable (often widowed) and ageism is also a factor — an older woman is no longer considered conventionally “pretty” and ageism plus misogyny devalues women when they are no longer able to have children (often an unconscious devaluing, but not always). So, ageism and misogyny are what I think are the main reasons.

      Some friends of mine here in the USA were asked if they would approve ECT for the husband’s 91 year old mother who was in cognitive decline and was stubbornly resisting being in a nursing home, protesting about the level of care, etc. etc. Fortunately for the mother, my friends refused to grant permission. In her case I think the doctors wanted to medicate her and shock her to get her to shut up and stop causing trouble for the staff.

  2. Welton says:

    Outrageous once again. This damaging and harmful treatment should be stopped. And once again women are the most numerous victims. Back in the 1970s in the USA, after I was no longer being shocked, one of my psychologists said that he thought the reason they shocked the wives and the daughters was that if they shocked the fathers and the husbands, they would lose their jobs and no longer have insurance with which the shock doctors could be paid. We don’t have NHS here in the States, so back then private insurance had to pay for ECT. I suppose that psychologist (one of the good ones — he was outraged that I had been shocked so many times) today might have added “mothers” to his list: wives, daughters, and mothers being shocked, but not husbands, fathers, and sons. Now elderly women are particularly at risk for being shocked, it seems to me.

  3. Sheila Smith says:

    My mother had ECT 42 years ago. The impact on her and our family was horrendous. We visited her in the conservatory at the mental hospital after treatment. The patients were all put in there to recover. She was sat there two red marks on her temples, dazed didn’t know us. All the others were in a similar state. We never knew if she consented to this barbaric, intrusive treatment. I still do not understand how any one in this day of supposed enlightenment could use this on people. Particularly aged, depressed mental Health sufferers.
    Later on she had significant memory loss. I cannot vouch it ever did anything for her depression. The route causes were never discussed,

  4. Welton says:

    Yes. In many cases women of my generation, I believe, were subjected to ECT for depression in order to get the women to shut up and stop complaining, or to stop crying, stop being depressed and get with the program. I had ECT 53-49 years ago (4 years of ECT), so I must be of your mother’s generation. I was only 17 when it began; 21 when they stopped. I am one of the lucky ones — managed to have something of a life after all, although still suffer from PTSD fears of being shocked. ECT did nothing good for me, just gave me trauma symptoms and wrecked my life for many many years. I was not depressed — just the “identified patient” in a dysfunctional family but no one would listen to me when I begged for counseling.

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