Shocking news: ECT is pretty safe and effective

But good luck moving the dial of public opinion.

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Electroconvulsive or “shock” therapy is somewhere up there with lobotomy on the list of psychiatric public relations nightmares.  

Ever since One Flew Over the Cuckoo’s Nest scooped Best Picture and the other four big Academy Awards in 1976, ECT has been widely seen as a sinister, inhumane method of controlling and pacifying the mentally ill at cost to their cognition, individuality and liberty.  

It’s probably fair to say that the public fear of ECT, found in survey after survey, largely derives from that fictional case of rampantly inappropriate use from a particularly paranoid era.  

Besides that film, a range of prominent 20^th-century artists and writers underwent the procedure and enshrined it in unforgiving art, leading to a legacy of misrepresentation in popular culture.  

While it’s in quite widespread use, has an almost century-long CV, and is regarded by clinicians as a generally effective and safe way to treat intractable forms of depression, you wouldn’t open with that on a first date.  

You don’t want them to look into your eyes and see Randle McMurphy – especially if their memory, like the Back Page’s, faultily associates the final catatonic image of him with ECT instead of lobotomy (which as far as your scribe knows is still genuinely sinister).  

A paper like this one from the University of Glasgow, presented at the European Congress of Psychiatry conference last month, isn’t likely to move the stigma dial at all, even though its results are quite impressive.  

It’s a survey of ECT use across Scotland from 2009 to 2019 using data from the Scottish Electroconvulsive Therapy Audit Network – what they call a “naturalistic” study, with no controls – that assessed efficacy and side effects when used for depression, bipolar, schizophrenia and mania.  

They compared scores on the seven-point Clinical Global Impression Scale (CGI-S) of illness severity where befores and afters were available (nearly 3000 cases) and found the mean went from 5.03 down to 2.07 – a “borderline” score, meaning you almost don’t have the illness.  

A third of cases reported either confusion or cognitive side effects or both. The next most common side effects were muscle aches (12%), nausea (7%) and cardiovascular complications (2%). Serious side effects of anaesthetic complications and prolonged seizures occurred in less than 1% of treatment episodes.  

Co-author Dr Julie Langan Martin commented: “Our findings from this large naturalistic study across Scotland from over an 11-year period reinforce the widely held, but nonetheless underexplored view, that ECT is both a safe and effective treatment when delivered to appropriate groups of people with severe mental illness. Monitoring of side effects, especially cognitive side effects should be undertaken carefully and rigorously in all patients receiving ECT.” 

According to EPA secretary-general Dr Julian Beezhold the study “challenges common misconceptions and stigmas associated with ECT, providing valuable insights that can reshape public perceptions and stimulate informed discussions among healthcare professionals”.  

Patient selection would seem to be key. Transient confusion and retrograde amnesia may not be nice things on their own, but they seem a reasonable price to pay for relief of debilitating illness if all else has failed.  

Which brings us back to Randle McMurphy, who, you may remember, isn’t mentally ill to begin with. He’s faking it to get out of the hard labour to which he’s been sentenced for the statutory rape of a 15-year-old.  

Now if ECT could cure that, the publicity would write itself.  

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