Feature

Going though shock

Can electroconvulsive therapy for depression be justified? Mary Bell gives a personal account

I felt confused when I was first told that my mother was having ECT (electroconvulsive therapy, or more popularly shock treatment) as part of her treatment for manic depression. The little I knew about it frightened me. But after seeing her change so drastically as her mental illness took effect, there seemed to be no alternative.

Her mood swings were crazy. At times she would behave like a frightened child, afraid to go outside the front door. At other times she would be virtually catatonic. She began to suffer from delusions, believing that she had kidnapped me, at a time when I was looking after her. In the end I was willing to accept that something — anything — had to be done, in an effort to restore her peace of mind.

That was more than five years ago. Since then Mum has had five courses of treatment, and she is still diagnosed as suffering from depression. All that has changed has been my family’s blind acceptance of ECT as the miracle cure.

Most people have very strange ideas about anything that falls outside the mental norm. We are meant to cope with all the stress that life throws at us, even if that means popping pills or downing pints until the stress blurs a little at the edges.

Actually admitting that something is wrong is a big step, even for families. It would be great if the lives of the nuclear family were cut, dried and pressed into some advertiser’s dream.

But now I’ve got over the embarrassment (and that’s all it ever was) of telling people what the problem is. Outside the family circle I still watch people’s faces when I tell them, and you can see the shock as they recall images of the film One flew over the cuckoo’s nest when they think about ECT.

Nowadays ECT is a lot less disturbing than it was. Patients are anaesthetised and injected with a muscle relaxant to reduce the severity of the convulsions. Electrodes are placed on the temples and a charge of around 80 volts is passed through the skull. If the treatment is a ‘success’, this will induce convulsions (the ‘grand mal’ fit similar to those experienced by epileptics). The single treatment is repeated around six times over a period of two to three weeks.

I’ve never asked my mother what she knows abut ECT. I think I’m wary of her being angry that we let it happen, or that it would upset her too much to know the details. But I’m annoyed that I didn’t know more about it sooner.

When I did find out about it, I asked friends who were nurses and doctors, I asked organisations, I read medical texts and I spoke to people in the field of mental health. Somehow it made it easier talking to people who weren’t involved, keeping the reality at a distance.

When I visited Mum in hospital, I felt ashamed that the nurses knew more about her and her treatment than I did. Sometimes I would phone to hear that I couldn’t visit because she was ‘getting her treatment’. Other times Mum would get to the phone still groggy from the anaesthetic. I brought her copies of Woman’s Own and clean, practical nighties. It didn’t seem enough.

But the reality is that it could all happen again. There is no guarantee that her depression can be cured. Even the drugs available now might not be any use. Some medication has to be taken as long as the condition lasts, and for Mum that could be a lifetime.

So we wait and see. We wait in case there are signs of a relapse. Like the loss of appetite, or listlessness, or mood swings. Often the mornings are the worst for her. Surviving the pointlessness of the day seems to be a 24-hour struggle. And there’s no manual to tell you how to cope with the day to day confusion of a long term mental illness.

I still hope there will be an end to it all, but I’m beginning to find it difficult to remember what my mother was like when she was well. I’m still confused about ECT: it seemed to work, but the effect has worn off so many times now that further treatment seems inhumane.

I don’t know what I would do if the doctors decided that Mum would have to go through it again. I know now that critics of ECT describe it as barbaric and cruel. I also know that its defenders say it offers a last hope for those patients for whom all other treatments have failed.

For me it’s a difficult issue. I would have to sanction a doctor’s professional decision. For the patients in Britain, among them my mother, who have over 19,000 courses of ECT every year, what I cannot face up to is what they actually go through.