Electroconvulsive Therapy

Electroconvulsive therapy (ECT), and the psychiatrists who use it, are under attack. A sustained campaign is being waged by a loose alliance of scientologists, aggrieved patients, patients' rights organizations, and maverick psychiatrists with doctrinaire objections to physical treatments. In the USA two states, California and Alabama.. have passed laws placing serious limitations on psychiatrists' freedom to use ECT and in this country unfavourable comment in the media has aroused considerable disquiet. Four fairly distinct charges are levelled: that there is no scientific evidence that ECT is effective; that psychiatrists have no idea how it works; that it is a frightening and sometimes dangerous treatment which often produces permanent impairment of memory; and that psychiatrists use it indiscriminately, sometimes in flagrant violation of their patients' legal rights. The available facts do not support these accusations. The claim that ECT is ineffective rests partly on the fact that its efficacy has never been established by double-blind trial, and partly on an anecdote about an anonymous hospital whose staff failed for two years to realize that their new ECT machine was not working. There are cogent reasons why ECT has never been subjected to the double-blind trials now regarded as mandatory for new drug treatments. It came into widespread use, and convinced psychiatrists of its efficacy, before the days of clinical trials and there are always ethical difficulties in withholding a long established treatment for a serious illness. The central problem, though, is that for a trial of ECT to be double blind it would be necessary not only to withhold a treatment most psychiatrists are convinced is more effective than any alternative, but also to administer, without any possibility of benefit to the patient, a potentially dangerous general anaesthetic on several occasions. For similar reasons the value of appendicectomy, or indeed that of most surgical procedures, has never been tested under double-blind conditions. However, ECT has often been compared with drug treatments under random allocation conditions and has almost invariably proved to be more