Monday, 13 March 2017

Call the Midwife: A Shocking Storyline

A recent “Call the Midwife” saw one of the nuns, after suffering a mental breakdown, being taken into a very grim mental hospital of the kind that was unfortunately prevalent in the 1950s. There, she meets a fellow patient who has a lobotomy, and herself undergoes a course of ECT or electro-convulsive therapy.

Lobotomy, also known as leucotomy, is a neurosurgical operation that involves severing connections in the brain's prefrontal lobe. When used with patients who were violent or suicidal, it was very effective because it effectively destroyed brain tissue and left them husks of the people they once were. The most celebrated fictional story about that is "One Flew Over the Cuckoo's Nest"

The use of the procedure increased dramatically from the early 1940s and into the 1950s; by 1951, almost 20,000 lobotomies had been performed in the United States alone. Following the introduction of antipsychotic medications in the mid-1950s and under the influence of the anti-psychiatry movement, lobotomies were quickly and almost completely abandoned.

However, Electroconvulsive Therapy is still used to this day!

Most people think that electroshock is completely banned but this is not the case. As of early 2015, Western Australia is the only state with a partial ban, where it is banned on under 14 year olds. In 2013, a complete ban was placed on the use of electroshock for all ages in Sicily and there are various other partial bans around the world.

The United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment in 2013 reported to the United Nations on abuse in health care settings. Mr Juan Mendez stated, “States should impose an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs, for both long and short- term application.”

The main side effect is memory loss (which is also common after seizures caused by epilepsy). This is usually short-term, but can be very significant, disabling and long-lasting in some people and is a cause of anxiety

Electroconvulsive therapy (ECT) is a procedure, done under general anaesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. When used with patients who are distressed, severely depressed or suicidal, it can cause a remission of symptoms, albeit on a temporary basis.

The principal side effect of ECT is memory loss, and of course the cutting out of memory can often help in the short term, as it removes both the immediate emotions and any recent events triggering the patient’s distress. Repeat treatments are often needed, because the treatment is only masking the causes of distress, and not removing them.

The loss of memory itself can be extremely distressing. As one patient recounts:

“As a result of these treatments, the years 1966-1969 are almost a total blank in my mind. In addition, the five years preceding 1966 are severely fragmented and blurred. My entire college education has been wiped out. I have no recollection of ever being at the University of Hartford. I know that I graduated from the institution because of a diploma I have which bears my name, but I do not remember receiving it. It has been ten years since I received electroshock and my memory is still as blank as it was the day I left the hospital. There is nothing temporary about the nature of memory loss due to electroshock. It is permanent, devastating, and irreparable.” (Patel, 1978)

In a court case in 2005, a jury found that a patient had not been informed about risks before undergoing ECT treatment:

“The patient, Peggy S. Salters is a 60 year old former psychiatric nurse. She was subjected to 13 electroshocks within the span of 19 days. The defence expert psychiatrists–one who testified, the other who was not called to testify but was deposed under oath–justified the “treatment” and failure to inform the patient about the risks. The jury found that her loss of 30 years of memory and cognitive impairment–which are demonstrable symptoms of brain damage–was due to ECT.”

ECT causes persistent cognitive impairments and long-term memory loss in 25% – 30% of patients, while its efficacy in relieving depression is admittedly short lived-about four weeks–at most, six months of mood improvement.

When memory loss in patients is relatively minor, it is like forgetting people’s names, or not being able to find their way back to their room, or around their local town, and forgetting their passwords and bank pin number, or how to spell. These usually return over time or if they have been reminded of them.

However some people have found that they had lost memories of important events such as a daughter’s dedication, a surprise birthday party, a holiday, or the birth of a child. Clearly not being able to remember events in their lives could be frustrating and distressing.

These examples are documented, and here are examples of more permanent effects:

“Sue experienced long term “fogginess”, which she was told would go away, but it never cleared. She still has ongoing short-term memory problems, which are getting worse, though she does wonder if this could be related to her chronic fatigue and pains. “

“Albert had ECT in the 1960s and wasn’t aware of the side effects of memory loss until recently. He said he suffered badly with memory loss and he had difficulties using his mind and that affected his life. He thought it was “[him] that was the problem” but now believes it was a side effect of the ECT and has met others who have suffered long term memory loss after having ECT.”

“ Sunil says for him memory loss is the most distressing effect of ECT. On a daily basis his wife tells him about something that has happened in the recent past which he has no memory of. His wife keeps a diary so he can look back at what has happened in the last few weeks. Dafydd’s wife watches repeats of television programmes but has no recollection of having seen them before.”

A 32 year old woman who had received 21 ECT treatments stated 5 years later.

"One of the results of the whole thing is that I have no memory of what happened in the year to year and a half prior to my shock treatments. The doctor assured me that it was going to come back and it never has. I don't remember a bloody thing. I couldn't even find my way around the town I lived in for three years. If I walked into a building I didn't even know where I was. I could barely find my way around my own house. I could sew and knit before. but afterward I could no more comprehend a pattern to sew than the man in the moon."

Dr. Harold Sackeim, a well-known proponent of ECT, produced a study in 2007 study in Neuropsychopharmacology entitled “The Cognitive Effects of Electroconvulsive Therapy in Community Settings, “which concluded: ““this study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period.”

The researchers found that modern ECT techniques produce “pronounced slowing of reaction time” and “persisting retrograde amnesia” (the inability to recall events before the onset of amnesia) that continues six-months after treatment.

While ECT may have beneficial effects, for instance in preventing suicide, and easing depression, it is clearly important – as the court case and the studies of patients have demonstrated – that potential ECT recipients be told the truth about the risk of disabling effects – including permanent memory loss and cognitive deficits – so they can make an informed choice.

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