Shock therapy should not be forced
Journalist Cecile Meier has written extensively about mental health. Now she reveals her own battles in the hope it will help reduce the stigma associated with mental illness.
Iwas alarmed to read a recent report revealing that almost 1000 electroconvulsive therapy (ECT) sessions were given without consent last year in New Zealand. Reading this made me feel sick to my stomach because I was once almost given ECT against my consent. If it wasn’t for my mother’s fierce protestations, I would have had electric jolts sent to my brain, potentially causing long-term side effects.
Advocacy groups have tried repeatedly over the past decade to ban ECT while others say the procedure saves lives. The treatment is generally used for patients who have not responded to medication or whose lives are in danger as a result of their illness.
They are given a general anaesthetic and wired up to get an electrical current through their brain, causing a brief seizure. Some improve after the procedure, but experts are still divided over how and why they improve. ECT comes with serious side-effects, including permanent memory loss, confusion and disorientation. Some believe these outweigh the potential benefits.
Patients must consent to ECT treatment in writing. If they won’t or are unable to, their clinician can still administer it if they get a positive second opinion from another psychiatrist.
I was first admitted to a psychiatric hospital in France just after Christmas 2008. I had spiralled into a paranoid psychotic outbreak over the holidays, convinced my family were part of an intricate conspiracy against me. I saw and heard signs of the conspiracy everywhere and thought I could read people’s thoughts and communicate with the universe. I was admitted to the hospital kicking and screaming; I was not aware there was anything wrong with me.
I was diagnosed as bipolar and heavily sedated for 10 days. I can’t remember all the details but recall being made to take cold showers and being locked alone in a bedroom for hours at a time. My family was not allowed to visit for several days and I thought they had abandoned me in there forever. When my mum was finally allowed to see me after a week, I broke down sobbing and begged her to take me out.
I was admitted to a psychiatric hospital in France after a psychotic episode in 2008. After a week of heavy sedation, isolation and cold showers, my mother defied doctors who wanted to treat me with electro-convulsive therapy and took me home.
Doctors said I should stay for longer but she took me out anyway. She tried to care for me at home for two months but I did not get better. I was barely responsive, often refused to eat and barely slept at night.
My family decided to admit me to a psychiatric clinic. Upon arrival, the resident psychiatrist mentioned ECT. My mother was firmly against it and said it was out of the question. The psychiatrist initially agreed to try other treatments, but after a couple of weeks with little progress, he brought up ECT again. Again, my mum said no. The psychiatrist told her he would not keep me in the clinic if she did not allow the treatment. He was convinced ECT was the right treatment for me.
But my mum stood firm and a few days later I started responding to the drugs and showed small signs of improvement. After a couple of months, I was ready to be discharged. It took me several months after that to feel ‘‘normal’’ again and I kept taking drugs for two years.
I’ve been off medication for seven years now and have been mostly stable. I have a job, a longterm relationship, a child, friends and you’d never guess this had happened to me.
I’m sharing my story to demonstrate that doctors aren’t gods and a diagnosis, especially when it comes to mental health, is not gospel. I have no idea if I would still be diagnosed as bipolar today. Perhaps it is dormant and an episode could start again given the right triggers. I certainly live in fear of it ever happening again, which is why I don’t drink much alcohol, go to bed early, make sure I eat well and monitor my stress levels.
Insomnia is the biggest warning sign for me and I start worrying if I experience it for several nights in a row. I would start taking medication again if I showed early signs of becoming mentally unwell.
Not many people know about this because I don’t want the bipolar label to hinder me. I don’t want work colleagues, managers and sources to dismiss me because of it. I don’t want my friends to worry about possible changes in my mood. And I just don’t like talking about it.
But I also know that not talking about it contributes to the stigma around mental illness and to the silencing of people who are mentally unwell. I have covered mental health issues all year and seen too many instances where people with mental health issues or intellectual disabilities were treated as second-class citizens who had little say in their fate.
The thing is, mental health struggles can happen to anyone. You could one day be in a position where a clinician decides you need ECT against your consent.
In 2016, 251 people received ECT. Of these, 92 were deemed unable to give consent and 10 had capacity and refused consent.
The number of ECT treatments administered without consent jumped from 576 in 2015 to 954 in 2016, which may be due to efforts by the Office of the Director of Mental Health to improve reporting on non-consensual ECT, the report said.
It’s concerning also that 62 per cent of people who received ECT were female. The report puts that down to more women being admitted to mental health services with depressive disorders than men, but this figure makes me feel queasy. It smacks of dismissing women as hysterics who need lastresort treatment.
A doctor can be utterly convinced that a patient won’t get better without it and be wrong – as was the case for me. If we could be confident that other forms of therapies were easily accessible, the last resort use of ECT would be less concerning.
But I reported earlier this year that New Zealanders are more likely to see a psychologist in prison than in the mental health system. This is due to the Department of Corrections paying psychologists tens of thousands of dollars more than district health boards (DHBs). There are shortages in the system, with 50 unfilled positions across the country’s DHBs.
I don’t believe ECT should be banned – it has been a helpful therapy for some. But such an invasive treatment with potentially long-term implications should absolutely be consented to.
It is disgraceful that in 2017 people are still having it against their will.
‘‘Not talking about it contributes to the stigma around mental illness and to the silencing of people who are mentally unwell.’’ Journalist Cecile Meier