Transcript File - Electroconvulsive Therapy: Closing The Gap

Electroconvulsive therapy:
Closing the gap between myth and reality
Ashley Frith-Pridham, Angela Kermack, and Annamaria Langellotti
Department of Nursing, Mount Royal University, Calgary, Alberta
INTRODUCTION
ECT DEFINED
Significant stigma exists surrounding the use of electroconvulsive therapy (ECT) in
treating severe depression. When all other therapies have been exhausted, ECT can
be an effective way to manage treatment-resistant depression; however,
misconception, stigma and fear can dissuade individuals from accessing this
treatment. This poster aims to bring some clarity to the misconceptions and stigma
associated with ECT use, and illuminates the importance of empowering individuals to
make evidence-informed decisions regarding their care and treatment plans. Current
literature, research and expert interviews will be explored to provide a realistic analysis
of the risks and benefits associated with the use of ECT.
The Department of Health (as cited in Bray, 2009) defines ECT as “a treatment involving the
passage of an electric current across the brain. The treatment is only administered to an
anaesthetized patient who has also been administered a muscle relaxant. The electric current
induces seizure activity in the brain which is necessary for the therapeutic effect of treatment” (p.
561).
HISTORY OF ECT
REPRESENTATION
ECT, representing all that was brutal and inhumane in the past, began to acquire a
massive stigma during present time. Kevin Carver, Registered Nurse, notes that, “there
is a huge stigma surrounding ECT. Society portrays it as a barbaric procedure”
(personal communication, March 5, 2012). Media depictions of ECT and anti-ECT
coalitions play a role in the stigma surrounding this treatment. Distorted information is
provided through the internet, movies, television, and press. Negative public reaction
due to the history of ECT treatment is also a factor in stigmatization.
Anti-ECT Legislation
In the 1970’s, lobbying against ECT was initiated by ECT survivors, who had
undergone unmodified ECT or who had suffered severe cognitive impairment after
receiving ECT. Psychiatrist, Peter Breggin was an active voice in lobbying for anti-ECT
legislation. Peter Breggin’s view on mental health focused around the negative
iatrogenic effects of conventional psychiatry and treatments such as ECT.
Media Portrayal of ECT
Ken Kesey’s movie, One Flew Over The Cuckoo’s Nest, shows an unrealistic depiction
of ECT as an inhumane treatment. In this movie, ECT was characterized with elements
of electrodes, mouth guards, and thrashing limbs. Actor Jack Nicholson was shocked
with a high dose of electricity and was administered without anesthesia. In 1971, Joan
Didion wrote a review in the New York Times on Doris Lessing’s novel, Briefing for a
Descent into Hell. The review noted that ECT had “obliterated the protagonists
memory” (Shorter & Healy, 2007, p.156). In contrast to the barbaric portrayal of ECT in
the past, recently the Dr. Oz Show featured a special episode on treating depression
with Electroconvulsive therapy in January 2012. The show answered pressing
questions that the public posed. Dr. Oz specifically spoke about how medical advances
have dramatically modernized ECT, which improves its safety. These advances include
general anesthesia and the switch to safer types of electrical stimulation.
CONCLUSION
One patient who received ECT for depression commented that “no one thinks twice
when electricity is delivered to a heart that has stalled but when electricity is
delivered to the brain, it is viewed as torturous rather than a miracle” (Payne &
Prudic, 2009a as cited in ECT, Alberta Health Services, 2011)
References
Alberta Health Services (2011). ECT. Retrieved March 9, 2012, from http://insite.albertahealthservices.ca/amh/tms-amh-mod-ect.pdf
Bray, J. (2009). The nurse’s role in the administration of electroconvulsive therapy. In P. Barker (Ed.), Psychiatric and mental health
nursing (pp.560-570). London, England: Edward Arnold (Publishers) Ltd.
Calgary Health Region. (2000). Electroconvulsive therapy (ECT) (E-1). Retrieved February 14, 2012, from http://iweb.calgaryhealthregion.ca
Canadian Nurses Association. (2008). Code of ethics for registered nurses. Retrieved from http://www.cna\
aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf
College and Association of Registered Nurses. (2005). Nursing practice standards. Retrieved from
http://www.nurses.ab.ca/pdf/Nursing%20Practice%20Standards.pdf
Delva, N., Graf, P., Patry, S., Gosselin, C., Milev, R., Gilron, I., & ... Chan, P. P. (2011). Access to Electroconvulsive Therapy
Services in Canada. Journal of ECT, 27(4), 300-309.
Procedural modifications as well as the advancement of biomedical ethics
have shaped ECT into a safe and effective treatment. Unfortunately, many
patients may not access this potentially life-saving treatment due to stigma
and negative portrayal of treatment. It is crucial for mental health care
professionals to provide an evidence informed, accurate portrayal of ECT to
patients as well as the general public. The use of ECT as well as other
treatment options should continue to be explored to improve safety in the
treatment of mental illness and ensure positive patient outcomes.
Acknowledgments
Kavanagh, A., & McLoughlin, D. (2009). Electroconvulsive therapy and nursing care. British Journal of Nursing (BJN), 18(22), 1370.
Payne, N., & Prudic, J. (2009). Electroconvulsive therapy: Part II. A biopsychosocial perspective. Journal of Psychiatric Practice,
15(5), 369-390. doi:10.1097/01.pra.0000361278.73092.85
Shorter, E. & Healy, D. (2007). Shock therapy: A history of electroconvulsive treatment in mental illness. Toronto, Canada:
University of Toronto Press.
Van Daalen-Smith, C.L. & Gallagher, J. (2011). Electroshock: A discerning review of nursing literature. Journal in Mental Health
Nursing, 32, 203-213. doi: 10.3109/01612840.2010.542879
We would like to thank Kevin Carver, RN, for his involvement and input of his expertise. We also
express gratitude to Sonya Jakubec, Associate Professor, for her guidance and support throughout
the development of our scholarly poster.