It is fair to say that Electroconvulsive therapy (ECT) is a controversial treatment that many people do not realise is still prescribed in contemporary medicine
In my experience, the usual response of friends, family and colleagues when I say I have been working in an ECT clinic is widened eyes and a grimace. This is followed by questions about the ethics of the treatment, statements about it being invasive and wondering how it actually works.
These are similar reactions to the feelings I experienced the first time I heard I would be accompanying a patient to ECT. I was apprehensive of what I would actually be seeing and partaking in; the idea of a physical treatment for an intangible illness did not sit well with me.
“The actual process of ECT I saw was not how the film industry portray it - frazzled patients screaming and violently jerking around the table”
However, the actual process of ECT I saw was not how the film industry portray it - frazzled patients screaming and violently jerking around the table with ten muscle-bound men restraining them. ECT is no longer used to subdue or control patients as it has been in the past.
Today, the patient must present with severe depression, resistant mania, treatment resistant schizophrenia or catatonia.
What I saw during my weeks on placement were patients being informed, reassured, comforted, anaesthetised and the electric current administered. They were then taken through to a recovery room where trained ECT and recovery nurses monitored their vital signs, provided airway management and cared for them until they regained consciousness and are able to be taken back to their ward.
“There are some patients who are given ECT without their consent”
If appropriate, the patients’ consent is gained before the procedure. However there are some patients who are given ECT without their consent. Any compulsory treatment, not only ECT, is an ethically dense area, which I, as a student nurse, am trying to reconcile myself with.
I do recognise however that as health professionals it is our job to respond to people’s needs and I understand that sometimes people cannot make decisions regarding their best interests.
In some situations, when other treatments such as pharmacology or talking therapies have failed to relieve a person’s suffering, ECT is prescribed.
“I would not leave somebody in intense physical suffering so why do I feel differently about mental suffering?”
I would not leave somebody in intense physical suffering so why do I feel differently about mental suffering?
I see ECT as resuscitation for the mind, something to be performed if a person’s life is at immediate risk for example from dehydration and self-neglect as a result of severe depression or exhaustion from a prolonged and life-threatening period of mania.
Risks of physical resuscitation include broken ribs, collapsed lungs and chest pain - but all are preferable to death.
I think similarly about ECT now.
“It is necessary to weigh up the side effects against the potentially life-saving benefits of ECT”
Side effects of ECT can include transient memory loss, jaw pain and grogginess from the anaesthetic. But again, it is necessary to weigh up the side effects against the potentially life-saving benefits of ECT.
There is still a lot I do not understand about the treatment, but seeing the benefits to patients’ health in life-threatening circumstances has led me to continue to read about ECT, its delivery in Britain and globally, and explore the ethical and legal issues surrounding its prescription and delivery.
This experience taught me how important it is to educate yourself on issues relevant to practice. By challenging your preconceptions and improving knowledge of legal and ethical aspects of nursing I hope to provide the best, most appropriate care for my patients.
Rosa Milne is a current student nurse