Proposals for the regulation of electroshock
- May 18, 2008
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Presented to the "ECT Study Committee" of the Vermont State legislature on July 17, 2000 by Peter R. Breggin, M.D. Director, International Center for the Study of Psychiatry and Psychology
Two pages--Revised after live report to the committee
ECT should be banned. It is so damaging and ineffective that the risk/benefit ratio is too high. Also, informed consent requirements are difficult if not impossible to enforce. However, since banning the treatment is probably not a realistic possibility, I would suggest the following alternatives:
1. Ban involuntary shock treatment. No one -- including incompetent individuals -- should be subjected involuntarily to a controversial, brain-damaging treatment, and essentially experimental (i.e. scientifically unproven) treatment. Whenever advocates have stood up for the individual, doctors and facilities have tended to back down on this issue.
2. Ban ECT for children. Anyone under 18 should not be subjected to ECT under any circumstances. An unhappy or depressed young person is not in a position to make such a decision. Parents of distressed children are too often in conflict with them to make well thought out decisions for them concerning drastic psychiatric treatments. Furthermore, there are no controlled clinical trials to justify ECT for young people. Common sense also dictates that it is a bad idea to give head trauma to young persons whose brains are in the process of rapidly changing and growing.
3. Obtain informed consent provided by a patient advocate. Before anyone consents to ECT, require an individual presentation by an advocate using a video that offers critical positions by professionals and by survivors of ECT. The advocates of ECT pressure patients and use videos made by the shock machine companies and/or by staunch advocates. (Anything written can be easily dismissed.)
4. Monitoring of on-going ECT by a patient advocate: Require regular visits by an advocate during the course of ECT in order to respond to any patient requests to terminate the treatment. Patients often realize during the treatment that their mental functioning is being severely harmed. Doctors too often take advantage of their helpless condition to continue the treatment against the patient's will.
5. Require state-wide data reporting for all ECT cases. Special regulations and forms should be required to report at the minimum the following information: age, sex, diagnosis, type and number of treatments for all individuals receiving ECT. Advocates have fought these requirements because they disclose patterns of abuse, for example, concerning the disproportionately large number of elderly women who have no one to advocate for them.
6. Require a one year follow up on all patients given ECT. The follow up should include at the least reports of death, cause of death, additional hospitalizations, and causes of hospitalizations. Once again, advocates have fought these requirements. Studies show increased rates of mortality and hospitalization for the elderly who are given ECT.
7. Ban emergency ECT. Attempts are being made to allow doctors to give ECT on an emergency basis without the usual safeguards and precautions. There is no therapeutic justification for this. Other means of restraint and control are preferable, including medication or physical restraint. Usually human service interventions can calm down a disturbed individual. A patient given ECT on an abrupt and sudden basis is likely to fear and avoid doctors for the rest of his or her life. Allowing emergency ECT will also expose patients to the risk of outright abuse by doctors who feel frustrated or angered with them, or who do not know how to build a therapeutic alliance and rapport with a distressed person.
8. Ban maintenance ECT. Forcing repeated convulsions on the human brain over an extended period of time renders individuals unable to perceive the damage being done to them, and hence unable to protest their mental deterioration. Repeated exposure to electrically-induced seizures ultimately leads to dementia.