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Why I believe ECT is unlawful

Sarah Panton, who was herself given ECT, explains why she believes the treatment should no longer be used.

- paper presented at the UK Advocacy Network 2000s annual conference

.....

Dangerousness to self is a key concept by which psychiatrists are empowered to force ECT on unwilling recipients, to save their lives. However, the reverse side of the coin is that ECT arbitrarily kills the treatments inherent dangerousness suggesting at best a balance between benefit and harm.

Details of the available evidence which led the U.K. Department of Health to declare that ECT can save lives are supplied in a letter written by Minister for Health, John Hutton, MP, who stated,

There are a number of studies which support our view that ECT can be a life-saving therapy. Based on the literature and their own research, Prudic and Sackheim (1999) conclude that ECT has a profound short-term beneficial effect on suicidality. The positive effect is often swift. ECT reduces ratings of symptoms of suicidality as rapidly as other depressive symptoms, and there is no evidence of an increase in suicidality in those patients who do not respond to ECT. (19.4.2000, to Tom Levitt, MP)

The claim is, ECT saves lives by preventing suicide in an emergency situation, where the law dictates treatment must be given. Section 62 of the Mental Health Act 1983 sanctions administration of emergency ECT without the patients consent, and a second opinion can likewise be dispensed with. Although under U.K. law an individual of sound mind has a right not to be treated without their consent, the Doctrine of Necessity (see below) negates this right where patients lack capacity.

Actually, the doctrine is so central to psychiatrists right to treat it is small wonder the determination exists to hang on to ECT to save lives in an emergency, particularly the lives of the second-class patients whose capacity is readily ignored. Mr. Hutton is on record as telling the Health Select Committee, I am not sure anyone knows why, but it can be a life-saving treatment. (Hansard, 24.5.2000) The assumption of a supposedly unknown but straightforward action between ECT and suicide prevention is erroneous, however. As the lawfulness of treatment depends on whether or not that treatment is in the patients best interest, this makes the way ECT works, in an emergency or otherwise, of critical import.

Following their statement (made against the recommendation of the Richardson Committee set up to advise on reforms to Mental Health legislation) that, on the available evidence we are satisfied that it can save lives in cases of very severe, generally psychotic, depression. (Reform of the Mental Health Act 1983: Proposals for Consultation, p. 57) the Department of Health was informed that ECT is a silent killer, but has failed to act. Just as crucially, the mode of action of ECT is such that if ever the facts are brought before a judge in Britain, s/he would very likely rule ECT unlawful. It is of tremendous relevance that the study which so impresses the Department of Health looked at ECT and suicidality rather than ECT and suicide, the authors stating,

&ECT is specifically recommended for patients with mood disorders in whom suicidality is an important feature&. (Prudic and Sackeim, 1999)

A beneficial effect on suicidality is not the same as a beneficial effect on suicide. Prudic and Sackeim acknowledge this and attempt to get around the problem by stating,

Although ECT is not considered a treatment for suicidal behavior per se, it may decrease or prevent suicidal behavior, presumably due to its effectiveness in treating the illnesses characterized by suicidal symptoms. (Emphasis added) (Joan Prudic and Harold Sackeim (Electroconvulsive Therapy and Suicide Risk, J. Clin. Psychiatry 1999:60 (supple. 2))

The reference to ECTs effectiveness in illnesses characterised by suicidal symptoms is a red herring. Suicidality means thinking about killing oneself - and ECT given to impact on suicidality, or ideation, constitutes treatment to brainwash the patient of wrong thinking. This directly contravenes Article 3 of the European Convention, even where unacceptable thought processes do include contemplating suicide. What we are looking at, ultimately, is behaviour modification, the justification being that behaviour in this case, acting to take ones life will be affected. Clearly, Prudic and Sackeim conceded as much; what they have omitted to make apparent is a key stage in the process that an ECT alteration of thinking is what will give rise to altered behaviour. Although the professional literature of earlier times openly describes ECTs cardinal action, use of its known impact on thinking to modify behaviour is nowadays performed surreptitiously. Ask yourself why! The claim of a reduction in ratings of suicidality symptoms is not contested, though the ethics of eliminating thought to change behaviour is. Basically, it is contended that the implications of just how ECT operates to achieve the stated ends and thus the whole business of ECTs status as a medical treatment requires serious deliberation:

- Insofar as it de-patterns by brainwashing, or dysregulating cognition, ECT works in suicidality. Because it reduces thinking it decreases suicidality - even if the patient is being treated for something else - and even, as Prudic and Sackeim noted, in non-responders. ECT always acts to dysregulate mental and physiological processes, and the dysregulation effects compromise mentation and ultimately affect behaviour (and health).

- Accepting that ECT de-patterns, the rationale behind the de-patterning of suicidal ideation is nonetheless flawed, and is totally unacceptable given findings that, together with those by Prudic and Sackeim, appear in a professional journal supplement devoted to suicide. Kay R. Jamison and Ross J. Baldessarini clearly state,

"&proof remains elusive that any medical intervention, including the recent developments of safer antidepressants that are not lethal on acute overdose, has produced a measurable impact on suicide rates&. (Effects of Medical Interventions on Suicidal Behavior. J. Clin. Psychiatry, 1999:60 (supple. 2))

There exists NO proof that any treatment prevents suicide, so it should be evident that so-called life-saving ECT does not operate precisely as one might expect, or as the doctors ostensibly require, and nor could it.

- Not only are risks denied, there is even denial of what psychiatry is really up to. Clearly, the ethics of dysregulating thinking are remarkably flawed. ECT has its alleged beneficial effect on suicidality in Nazi-style secret, by violating human rights principles in ways that would not be permitted in other circumstances and in the absence of voluntary, informed consent, or with consent obtained by stealth and deception.

Informed consent is a vital issue in all forms of medicine, yet genuine consent to ECT is non-existent. After all, where the compulsion on psychiatrists to obtain truly informed consent? The standards for nonconsensual treatment for physical disorders dont apply. In practice this means capacity, rarely absent, is disregarded in favour of dangerousness to self or others and best interests. Superficially, under the rules, emergency ECT given to save lives nicely side-steps the consent dilemma. Nevertheless, it is an inescapable fact that although a patient may well be told that ECT will save their life, they are never told it will do so by changing their thinking. Therefore, in truth, the whole concept of consent is violated.

The Doctrine of Necessity

This doctrine has been established by UK case law, and enables doctors to provide treatment in emergencies. It is also relevant to the provision of treatment to individuals who lack capacity. The court does not have the authority to approve, or disapprove, the giving of medical treatment to someone who lacks capacity. The lawfulness of treatment depends on whether or not it is in the patient's best interest. See Re F.

Re F states, Under UK law an individual, of sound mind, has a right not to be treated without their consent, even if they are being unreasonable. Forcible treatment could result in liability under the civil and criminal law. Re F (Mental Patient: Sterilisation) [1990] 2 AC 1 (from 'Human Rights & Mental Health Law,' Central Law Training)

Via contraction of the available knowledge and intentional corrupting of the science in order that ECT might appear to be other than what it is, psychiatrists are in possession of a body of knowledge which they keep from most people. Why? Well, the Convention for the Protection of Human Rights in Europe forbids brainwashing. Hence the necessity to speak out and argue that brainwashing is the secret ingredient to saving lives with ECT, to which nobody gives valid consent as patients are not told about the impact on thinking (brainwashing). A very important consideration is that the lawfulness of treatment depends on whether or not it is in the patients best interest a value-laden concept. Yet as brainwashing is never perpetrated for the benefit of recipients, it is inconceivable that treatment which alters thinking and/or the personality is in any persons best interest.

The AIRE Centre (Advice on Individual Rights in Europe) has proposed that ECT is of questionable legality in many cases. However, it is likely ECT is of questionable legality in ALL cases due to its mode of action. Erroneously called medical treatment, because it brainwashes, changing thinking and the personality, ECT is more aptly termed torture. No matter how great the insistence that ECT is genuinely therapeutic, brainwashing is never in the recipients best interest, so ECT cannot be lawful.

ECT is extensively used in the present day, yet a treatment which saves lives by its effect on suicidality as the Prudic and Sackeim (1999) study (heavily depended on by the Department of Health) says ECT does indeed that de-patterns thinking whether or not the thinking is unhelpful, must not be lawful under current U.K. law. (It is stressed that brainwashing is a major active ingredient of all ECT and not just ECT given for suicidality.)

The existence of serious doubts about the lawfulness of ECT provides the core reason why the provisions of section 57 of the Mental Health Act 1983 (which must be applied where there are doubts), should guide the use of ECT. That ECT is unlawful is even more central to the issue than are violations of rights as set out in Articles 2 and 3 of the European Convention on Human Rights. But if further justification is wanted, as stated at the start ECT is inherently dangerous. Not only does it infringe Article 3 of the Convention, which guarantees freedom from torture (including brainwashing) or inhumane or degrading treatment or punishment, it also breaches Article 2, which guarantees the right to life.

ECTS VIOLATION OF ARTICLE 2 EXPLORED

ECT violates Article 2 because it arbitrarily kills, both acutely and in the long term.

Death Over Time

Supposedly, nobody knows why there is a sizeable increased mortality risk with ECT. Specifically, the probability exists that the ECT recipient will die sooner than recipients of treatments for depression other than ECT. Since it is over 25 years since Babigian and Guttmacher (Epidemiologic Considerations in Electroconvulsive Therapy, Arch. Gen. Psychiatry, Vol. 41, 1984) remarked the mortality risk, failure to seek clarification represents extraordinarily bad clinical practice. A quarter of a century is a ridiculous amount of time to let a finding of increased mortality gather dust, especially as

...if death occurs as the result of a treatment which is not for purposes of urgently saving life it is a dramatic and irreversible complication which no one can disregard as being of minor importance. (Hon. W. S. Maclay (Death Due to Treatment, Proceedings of the Royal Society of Medicine, 1953)

Of note is the strength of the evidence that ECT kills. A study which informed the Richardson Team was a paper by Gregory et al. (The Nottingham ECT study: A double-blind comparison of bilateral, unilateral and simulated ECT in depressive illness, Brit. J. Psychiatry (1985) 145). Strangely, for a group asked to advise on the appropriateness of reforms, it seems the Scoping Study Team remained unaware of a follow up to the Nottingham study, which also, and recently, drew attention to the increased mortality outcome. OLeary & Lee (Seven Year Prognosis in Depression: Mortality and Readmission Risk in the Nottingham ECT Cohort, Brit. J. Psychiatry (1996), 169), reported that in the under-65s, the death rate was nearly five times normal. Research having warned of a major risk to recipients of ECT of dying sooner than would otherwise be the case, one must wonder why it isnt a requirement for properly-conducted follow-up studies to examine long term outcomes.

Death Occurring Acutely

Benbow, Tench and Darvill, in a survey of ECT practice which brought in 122 responses from consultant psychiatrists, reported that,

Twenty-five per cent of respondents had experience of death or major medical complications occurring during ECT and 9% had had personal experience of a defibrillator being used, although only 3% had seen it save a patients life.

(Electroconvulsive therapy practice in north-west England, Psychiatric Bulletin (1998), 22)

The availability of a limited number of actual figures makes it plain the true acute death rate is many times higher than patients or the public realises and suggests that the position, in Britain, is being misrepresented. Freeman and Kendell, the former an advisor on ECT to the government, reported that of 183 persons given ECT in 1976 in Edinburgh, two women, aged 69 and 76, died twenty-four and forty-eight hours respectively after each had received her thirteenth dose of ECT. Autopsies revealed myocardial infarction in both cases. (Freeman & Kendell, ECT: 1. Patients experiences and attitudes, Brit. J. Psychiatry (1980), 137) This is a death rate of 1.1%; and it has been worked out that, With an estimated death rate of 0.06% one must assume that one patient dies every 5 to 6 days under ECT. (Jackson, Freedom is the right to know, The Individual, August 1995) Does the rate suggested by the Freeman and Kendall death figure indicate that the reality is an acute death every three days?

The Relationship of ECT to Suicide

There is yet another facet to the mortality issue, and this is the increased probability recipients of ECT will kill themselves. Psychiatrists are attempting to save lives with a treatment that is associated with an increased risk of suicide meaning electroconvulsive brainwashing may change behaviour for the worse. Survivors of the immediate aftermath usually find that when the treatment session is over they become depressed, even those who werent depressed prior to ECT. ECT never cures depression; indeed, it is likely so-called treatment-resistance equates with a chronic damage cycle caused by treatment, as post-ECT occurrence / recurrence of depression may take place because depression is common during recovery from brain damage. (Aggleton, 1997) Currently, there is no admission ECT damages the brain, but what does that mean when there is no admission it brainwashes!

But, psychiatric treatment itself is known to be an important variable in suicide. A paper by Roy contains the fruits of a controlled study of 90 psychiatric patient suicides, and Roy proffers the information that,

Significantly more of both the male and female suicides than their controls had a history of both past psychiatric treatment and psychiatric admission.

Roy fails to record ECT given in earlier admissions / contacts with psychiatrists, but does report of the deceased,

Nine of the 90 patients [who died]&received ECT for depression in their last episode of contact&.

(Alec Roy, Risk Factors for Suicide in Psychiatric Patients, Arch. Gen. Psychiatry, 1982)

Knowledge Curtailed: The Established, but Suppressed, Brainwashing Effects of ECT.

Traditional brainwashing has two components; a tearing down of the structure of the mind, and its subsequent rebuilding using a new architecture. Dr. Cameron of Canada used a technique he named psychic driving to input a whole new personality, following the virtually total destruction by de-patterning with ECT of the sick personality. He utilised confusion, a prominent feature of a form of electroxplexy (ECT) known as the Page-Russell treatment. To Cameron (with Pande), The objective of the electroshock therapy is to produce&a condition of confusion which we term complete depatterning.

Camerons de-patterning treatment and the Page-Russell Method are described in the following articles:

Treatment of the Chronic Schizophrenic Patient, D. Ewen Cameron, M.D. and S. K. Pande, M.D., Canadian Medical Association Journal, Jan 15, 1958, vol. 78

Intensified Electrical Convulsion Therapy, L. G. M. Page and R. J. Russell, The Lancet, 17.4.1948

Intensified Electroconvulsant Therapy: Review of five years experience, R. G. Russell, MRCS,

L. G. M. Page, MRCS. and R. L. Jillett, MB, The Lancet, Dec. 5, 1953

Blacks Medical Dictionary (1987) describes an ament as an idiot or mentally deficient person one having no mind. In a nutshell, the outcome of de-patterning is that the patient afterwards is mentally deficient. S/he has trouble understanding things that require assembling a mental pattern&. (Karom, Introduction to Electroshock: the case against, R. Morgan (ed.), IPI Publishing Ltd., 1991) An authority on ECTs full-blown idiocy outcome stated,

&the best clinical results are often obtained when the patient is shocked into amentia&. &Moderate improvement means that the patient shows conduct improvement and a general lessening of& symptoms&

(Myerson, Further Experience with Electric-Shock Therapy in Mental Disease, New England J. Medicine, 1942)

One aspect of amentia is amnesia, or the de-patterning of memory (as in the patient forgets what was bothering them, including the desire to die) and what could be clearer than:

In the electro-shock procedure, we have a means of producing graduated amnesia, and it is of interest to note that there is a proportional relationship between the number of electroshocks given within a period of time and the extent of the amnesias. It is quite possible, for instance, to produce a long-lasting, probably permanent, amnesia by setting the number of electroshock treatments to be given within a predetermined period

(D. Ewen Cameron, The Process of Remembering, Brit. J. Psychiatry (May 1963)).

Of course, these are the extremes of de-patterning, but although patients are not so obviously de-patterned now as they were in the past, it remains the case that the confusion which was known to be a key aspect of brainwashing is still a recognised side effect of ECT. It is intensity of electrical energy which equates with excessive confusion and memory loss and in the present day the plumped for scientific theory of ECT centres on the absolute necessity for dosage to be at a level whereby the risk of cognitive impairment and of confusion are maximised in parallel. This ordinarily means stimulation at up to 2 times the patients seizure threshold.

In a case report, Edwards described how ECT was &given in the hope that it would disrupt established patterns of abnormal cerebral activity and, by wiping the slate clean so to speak, make the patient more accessible and responsive to suggestion and relearning. (Electro-Convulsive Therapy in the Treatment of Bizarre Psychogenic Movements, Brit. J. Psychiatry (1968), 114)

By rights, when the patient has had their symptoms of suicidality wiped, decreased or prevented, s/he ought to be receiving appropriate suggestions as to what to think. But training in right thinking, the re-educative aspect of treatment, has long been neglected. Generally, full brainwashing is too ambitious and time-consuming; besides which experience has shown that ECT damages genuine therapy. Going to the trouble of trying to re-educate the ECT de-patterned brain actually makes this evident, as was shown by Mitsos (Learning in the post-ECT period, J. Clin. Psychology 16, 1960), who found that ECT-damaged patients are resistive to re-educative or psychological therapy. By brainwashing, therefore, is meant the first part of the traditional process, i.e. de-patterning.

ECT aments, no matter how subtle the imposed mental deficiency, are less able to think or mentate so they think less about suicide and everything else. Prudic and Sackeim (1999) found an ECT-engendered decrease in the suicide item (i.e. indicating wishes or thoughts of death) on the Hamilton Rating Scale for Depression, leading those authors to claim that when patients respond to ECT they are extremely unlikely, at least in the short term, to manifest suicidal ideation or intent. (Italics added) Of enormous significance is their finding that, both ECT responders and nonresponders had a large decrease in scores on the suicide item&. (Emphasis added)

In short, the post-ECT scores of patients who were judged not to have responded to ECT (used for depression and not as life-saving treatment) nevertheless indicated decreased suicidal ideation. This, then, is the significance of Mr. Huttons no evidence of an increase in suicidality in those patients who do not respond to ECT. Shouldnt the Department of Health be making clear that ECT can even save the lives of people who are not suicidal?

Copyright Psychminded Ltd, 2001

2001 Psychminded Limited. All rights reserved