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January 8, 2010

ECT without consent

ECT without consent

Madam, – On reading Dr Dermot Walsh’s article, (Opinion, December 28th), and in conjunction with it, Ian Woods’s response to Siobhan Barry’s, the following questions burn for an answer: first, against what standards do these two doctors judge their “ethical obligations”? Previous correspondence from the Irish Medical Council would seem to indicate that medical ethics are based on a type of “consensus” – ie unethical behaviour, on the part of a particular doctor, is judged to be behaviour which is deemed to be unethical or unacceptable to a group of his/her peers. Note: only a doctor’s peers may adjudicate on his/her behaviour, ordinary laypeople are not deemed sufficiently qualified to do so.

Furthermore, if Mr Woods’s “professional ethics”, as a psychotherapist, require him to “respect clients’ right to self-determination and autonomy” and Dr Barry’s “professional ethics” require her to “impose ECT against the person’s wishes in relevant circumstances” it would appear we have here two diametrically opposed interpretations of the very meaning of “human rights,” “freedom of choice” and “informed consent”. To further add to the alarm – and well-founded alarm – of any person contemplating getting help for themselves or a loved one, who may be suffering with a “mental illness”, Dr Walsh gives a brief history of ECT, admitting that its discovery was based on the mistaken belief that “epilepsy” and “psychosis” could not exist at the same time in the same person. Based on this error, it was believed inducing epileptic fits, by whatever means possible, was capable of curing psychosis! Then came the accidental discovery: ECT was the best cure for “involutional melancholia” aka “psychotic depression”.

Dr Walsh goes on to wonder about the reduced incidence of “psychotic depression” in more modern times, attributing the reduction to – “either . . . depression. . . being recognised and treated earlier, or its characteristics . . . changed because of cultural or social changes”.

Is this a first? An admission by a psychiatrist that psychiatric diagnoses are essentially arbitrary in nature, capable of being altered by “cultural or social changes”? Thus, we have no defined standard of “normal” behaviour against which the “abnormal behaviour”, as typified by mental illness, can be measured and compared?

Just as psychiatric diagnoses are essentially arbitrary, it would appear psychiatric ethics are also arbitrary, decided only by psychiatrists among themselves, without necessarily referring to any human rights treaty or charter of fundamental rights.

In this age of accountability, is it good enough that doctors should only be answerable to their peers and not to their clients/patients/victims for their decisions, ethical or otherwise? And in the treatment of mental illnesses, with such arbitrary diagnostic criteria, why should the methods available to Western-trained psychiatrists, with their obvious limitations, be regarded as superior to methods practised by healers of other medical/ cultural traditions?

I am a survivor of “intensive” ECT, to which I was subjected without my consent or knowledge, eventually discharged from “hospital” as a virtual vegetable, no longer “psychotically depressed” – but, then – whoever saw a depressed vegetable?

Careful analysis (by myself) of my psychiatric records would appear to indicate that at least 90 per cent of my symptoms were caused by inappropriate psychiatric interventions. My conclusions are supported by the fact that I have not been hospitalised in over 27 years, despite extremely dire prognoses by all psychiatrists involved in my care, at the time. I have now returned to college, full-time, am a second-year legal studies student, very happily married, with three grown-up children. I am very acutely aware that I am one of the lucky ones, one that got away, with relatively mild – though permanent – memory and learning problems.

My good fortune I attribute to my extraordinary husband. His opinion of psychiatrists is unprintable! – Yours, etc,

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