Electroconvulsive Therapy-A Necessary Evil

-Ripudaman Bajwa

So let’s begin by paying our tribute to the typical evil stepmother of Bollywood that along with her heinous laugh used Electroconvulsive Therapy or the so called ‘Shock Therapy’ as effectively as it could be. History dates back to 16th century when various agents were used to induce seizure’s to treat psychiatric illnesses. Our great Indian cinema generally being hyperbolic has been the leading stakeholder in dissemination of misinformation as the difference between Reel and Real continues to glorify.

       The Electroconvulsive therapy or the ‘Shock Therapy’ is much more than placing electrodes on patient’s scalp and hearing the poor human cry out loudly. A finely controlled electric current which the doctor chooses carefully based on a calculated threshold is used to produce a brief seizure that tends to prevent a disheartened guy from suicidal thoughts or puts a maniac to rest. Modification of conventional ECT with usage of general anesthesia and skeletal muscle relaxant has clearly made ECT with success rate of 70-90% as compared to the conventional medication’s with success rate of 50-60%a highly helpful and wonderful situation in extreme cases. This entire procedure of 10 minutes with less than 20 seconds being brief period of seizure has made extreme success in catatonic behavior of individuals or where suicidal thoughts ran over the basic senses in an individual.

       ‘My memory is becoming dull. After ECT, I cannot find a job. That is my first concern.’ reported a patient being treated on ECT. Indian Journal of Psychiatry has reported unusual side effects like pneumothorax, CT scan induced brain changes and even death. Yet this is far away from the image society has for the treatment which can be safely used, benefits definitely outweighing the risks. An author cited that while interviewing some nursing students in a prominent Government hospital asked what happened with the naughty patients to which they replied ’Sir, Next day the ECT is waiting for them.’

 

       Mental Health Bill, 2017 passed by the Indian Government has made direct administration of ECT without anesthesia illegal which is an appraisable step yet many lacunae continue to trouble the therapy. Informed consent of an individual continues to be just another signature or thumbprint for most of patients undergoing ECT or their respective guardian. An Indian survey reported 52% of institutions in India still use ECT without anesthesia, challenging the ethical medicine practice happening in our subcontinent. With public perception still being mainly negative there is a need to spread knowledge and educate Indian’s about the disputes that they still carry about ECT. A protocol, employed religiously and audited regularly can put things in place. Overall, ECT seems to slowly challenge stereotypes and make its acceptance up but this is a long marathon to run keeping the entire stakeholder’s in one lane.

 

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