Advocacy News about Electroshock in India

Chaitanya Mental Health Care Centre, Pune, had organised an interactive session on 1st of April 2007 at Fergusson College, Pune, to encourage the use of ECT The topic of discussion was “Myths and facts of Electro Convulsive Therapy (ECT) or shock treatment in psychiatric care”.  Dr. Yusuf Macheswalla, president of the Mumbai Psychiatrist association, and Dr.Vidydhar Watve, senior private psychiatrist from Pune, were the resource persons for the programme.

On All fools day, the program aimed to “eradicate myths” and bring back rationalism. The invitation letter to the program was appealing to the public: “To eradicate foolish myths and phobias on ECT”. A large poster with a message “Nothing Shocking about Shock” was also distributed widely.

Bapu Trust, an advocacy organisation in mental health, Pune, organised a peaceful protest at the venue. They distributed data and information countering the rosy and romantic picture painted of shock treatment. Questions were raised at the meeting, showing how controversial the treatment is. The organisation has condemned in no uncertain terms, such misleading public presentations, made by responsible senior members of the IPS (Indian Psychiatric Society) and is preparing a full fledged campaign against ECT.

A brief note on Dr Yusuf Macheswalla’s presentation

The doctor started by talking about the need to talk about ECT. He stoutly stated that ECT was very safe and if asked, he would say that “it was the only weapon” that he had to treat mentally ill patients. His reporting on the near magical qualities of ECT included: immediate clinical improvement, rapid recovery, easy management, no side effects, reduction in hospitalisation, and no potential of abuse or dependence.

Reiterating the medical view about the treatment, he advised that ECT may be used as the 1st line of treatment in the management of schizophrenia and related mood disorders. ECT, according to him, may be used as a life saving measure in cases of Neuroleptic Malignant Syndrome, (which is a serious and fatal side effect of anti-psychotic medication). He noted, remarkably, that death due to ECT is extremely rare. Among those eligible for ECT, he was far more inclusive than standard clinical practice. Other than all mental illness, he included neurological conditions such as Resistant Seizure disorder, Parkinsonism, Chronic or extended delirium, intractable epilepsy with psychopathology and Psychosis or depression associated with neurological disorders such as Wilson’s disease.

He advised the other psychiatrists present in the room that ECT can be safely used in young children, pregnant women, diabetic patients, senior citizens and medically, even orthopedically, compromised patients. In his practice, ECT has reportedly worked with autism, and childhood depression. He noted that the treatment works wonders with “young people who seem aimless and are drifting”.

His presentation repeatedly emphasised that there were no side effects. With respect to how ECT works, he gave the standard medical view that “it normalises brain chemical imbalance” without citing any evidence. Under anaesthesia or without anaesthesia does not make any difference, according to him. Both were pronounced equally safe, except that anaesthesia helped in avoiding the patient’s fright of the procedure. In his practice, 14-16 ECTs were commonly given. He noted that there was no upper limit to ECT, citing the case of one patient who was given 208 ECTs!

Success stories narrated by Dr. Macheswalla

• – Patient with schizophrenia who developed fracture of spine after an unmodified ECT was safely given modified ECT
• – Cervical spine fracture person was given ECT
• – Eighty two year old person showed rapid improvement after ECT
• – A middle class clerk, schizophrenic patient with strong delusions was treated with 44 sessions of ECT
• – A fourteen-year-old child started going to school after ECT
• – Four-year-old infantile autism has been treated with ECT

In response to consumer interests, he noted that his service facility charges between Rs. 1000 to 5000 per ECT. Taking the consumer culture one step forward, he noted that if a person takes “in bulk” (30-40 ECTs), they may receive one or two ECTs free of charge! The audience were informed that it is easy to subsidize ECT, compared to psychotherapy because it happens in bulk whereas, psychotherapy is time consuming where doctors may not like to subsidize.

In response to the question why ECTs are repeatedly given, he remarked that the nature of the illness is such where people keep relapsing and keep asking for ECT He observed that no regulation of the procedure was necessary, as lawyers or judges were in no position to decide whether a patient should be given ECT or not. While casually remarking on the possibility of death, he noted that there are hardly any chances of medical emergencies.

With respect to a question why a person with a mental illness is not given any choice and her consent is not taken, he pointed out that the nature of mental illness is different from the nature of physical disease: Anyone suffering from the former has no insight!!

Statement from Bapu Trust:

We are shocked at the very false, rosy, romantic, one sided picture of ECT, portrayed by the program and the senior IPS official, misleading the public. All our fears have been proved true in the IPS officer’s admissions at the event. ECT is used for anything and everything; there is no ‘upper limit’ and people routinely receive 30-40 ECTs; medical emergency precautions are not considered as a vital part of procedure; risks are not explained or are glossed over (“Even if you are walking on the street, you are at risk of death”).

It is shocking that 4 year olds are being given ECT. Nobody should ever receive 208 ECTs. The senior resource person was evidently abusing the practice. Even in sheer economic terms, this would have cost the patient a minimum of 2 lac rupees. The commercial and industry interests of doctors giving ECT should be examined. Most controversial of all, according to the Bapu Trust, is the practice of an ECT mobile van being provided by the said doctor: This was promoted as a community service, wherein the van picks up “unmanageable” patients at the doorstep and delivers shock in the van.

When a senior IPS officer makes such presentations, the IPS, which claims on its website that encouraging ethical practice is among its objectives, must be held responsible. The Indian Association of Private Psychiatrists, a 7 year old organisation, claiming to be committed to ethical practice, is equally accountable. These professional organisations have made no attempts to control or regulate ECT practice, or to establish some protocols and standards. It is another matter that none of these organisations have even a shadow of involving users in establishing standards for their practice.

Where fear and terror of the procedure is treated as an irrational symptom of mental illness, and sedation or anaesthesia is used to remove this particular symptom, there are serious attitudinal questions within these organisations which must be addressed. Some senior medical professionals in India even want direct ECT restored, with the argument that “India is a poor country and all Indians are poor”. ECT facilities must be licensed and regulated. There must be records of ECT practice: We have no idea how much injury and death is caused by shock treatment. In a world where litigations against ECT are the norm, there is a supreme court case against ECT, where the European Convention on Torture has referred to direct ECT as a form of torture, the serious misinformation about psychiatry and promotion of ECT presented herein is absurd and regressive.

Doctors should read more about mental health and well being, and keep themselves updated on alternatives to shock and medical treatments. Shock treatment is not a subject for creating “awareness” among the public; it is a matter to be placed before the consumer courts and human rights commissions / courts.

Visit www.camhindia.org for more on ECT [especially in India].