and muscle relaxant begin to wear off and the patient is taken to recovery. Patients say they wake up confused, their memory blank, but hopefully with a brain that’s been shocked into healing. Although the exact mechanism is little understood, psychiatrists agree that it’s all about hormones. Dr Grobler says it has to do with rewiring the brain. ‘The magnetic stimulation and convulsion is a wake-up call for the brain to release massive amounts of neurotransmitters: dopamine, serotonin, endorphins, norepinephrine and acetylcholine. All natural feel-good neurochemicals. It’s the chemistry,’ says Dr Pierre Cilliers, a psychiatrist specialising in ECT in Cape Town. ‘Hormones are activated, which play a huge role in mental illness – postpartum blues, menopause depression. Their proper functioning is essential to a healthy mind as much as to a healthy body. Hormones are released by the brain’s endocrine glands, the hypothalamus and the pituitary. These master glands, which lie deep in the middle of the brain, are directly stimulated when seizures are induced by electricity or by medicine. Such stimulation re-establishes the proper glandular functions of the brain, bringing all the other glands into line, including those that affect mood, thought and motor functions.’ Dr Grobler says that having an electric current pass through your brain for 45 to 60 seconds is not a panacea for all mental illness, but it has had excellent results in patients with treatment-resistant illness. ‘Not all conditions respond to ECT and, for those that do, it is almost always their only hope.’ Anti-ECT activists see it differently, saying it damages the brain. They believe the patient is dazed, confused and disorientated and therefore cannot remember or appreciate current problems. Patients just ‘pack up their troubles in a vacuous or fuzzy kit bag,’ they say, and add that ‘the greater the brain damage, the more likely that certain abilities and memories will never return. It is the way in which psychiatrists sometimes choose to deal with troubled and troublesome minds. Rather like the now unpopular lobotomy, we question this dubious method of obliterating rather than dealing with emotional distress.’ A 45-year-old woman, who had 18 ECT treatments over six to eight weeks for intractable, dangerous depression appears to back this up. ‘I’ve been asked over and over again whether
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undergoing electroconvulsive therapy was a good decision. And whether I would have ECT again under the same circumstances. The only honest answer I can give is that I have no idea. To say whether ECT was the right treatment for me, I would have to compare my life before ECT to my life now. And I simply cannot remember life before ECT. In particular, I cannot remember much about the two years leading up to my ECT treatments. That period, along with much of the preceding years, is memory that I lost in exchange for the hoped-for benefits of ECT.’ Detractors have an ally in the form of Scientologists who are vociferously against the practice, saying it is brutally cruel and should be outlawed. They do, however, have a penchant for slamming all psychiatrists who they believe are ‘the sole cause of decline in this universe’ and ‘reincarnated evil’. Scientologists disagree with what thousands of scientific research studies in reputable, peerreviewed journals have shown: that most, if
‘I simply cannot remember life before ECT. In particular, I cannot remember much about the two years leading up to my ECT treatments. That period, along with much of the preceding years, is memory that I lost in exchange for the hopedfor benefits of ECT.’
not all, brain disorders are caused by chemical imbalances in the brain. Neither Dr Grobler nor Dr Cilliers are cavalier about the use of ECT in treating depression. They say that ECT isn’t taken lightly and is not the first line of treatment. ‘In fact, it is the third or fourth. We only treat patients who are very, very ill and whose quality of life is limited, where severe depression is accompanied by detachment from reality (psychosis), a desire to commit suicide, hurt someone else, refusal to eat, schizophrenia, severe mania as part of a bipolar disorder, impaired decision-making, life-threatening impulsive behaviour, substance abuse and catatonia,’ says Dr Cilliers. ‘In such conditions, electroshock may be
life-saving. ECT is also not the end of the line for patients. After six to 12 treatments, they usually need to continue with medication. More often, it includes antidepressants or other medications or psychological counselling (psychotherapy). It needs to be said that no scientific, valid research proves the alleged brain damage caused by ECT, but some evidence exists indicating that untreated mental illness leads to brain atrophy.’ ECT was the last resort for another two patients. One received a medication for treatment-resistant depression and anxiety after they had ECT. ‘That particular medication saved my life and gave me precious recovery. But I might not have been alive to try it if I had not been given ECT first.’ The other adds, ‘Friends and family say that I’m less gloomy than I was; cheerful and less brash. They say I’ve softened a bit, though my basic personality has indeed returned. In part, I attribute my gentler attitude to the truly humbling experience of having myself disappear. I attribute my change to a renewed desire for peace in my life. ‘I’m now dedicated to managing my depression and living a satisfying life day by day. I feel that if I can make the best of the moment, then the future will take care of itself.’ As in all medical procedures, the benefits come with a risk and a price. The most distressing side-effect of ECT is memory loss, which doctors say is a transient result. ECT can affect memory in several ways. Patients have trouble remembering events that occurred before treatment began, a condition known as retrograde amnesia. It may be hard to remember things in the weeks or months leading up to treatment, although some people do have problems with memories from years back as well. The period of treatment may pass in a haze, as one patient recalled. ‘I felt like a zombie and couldn’t recall events that occurred during the weeks of treatment.’ Some people have trouble with remembering events that occur even after ECT has stopped. These memory problems usually improve within a couple of months, but some patients have complained of permanent memory loss. For many, ECT is the only hope − and the loss of memory is a trade-off for quality of life and often survival. ECT can’t cure personality disorders or take away trauma. It can buy precious time to find treatments that do work for them, prevent the tragedy of suicide and help patients live − and like − their lives a little more.
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