PERSONAL VIEWPOINT The

Experience

of Electro-Convulsive

Therapy

By A I am a practising psychiatrist who has had the personal experience of receiving two series of treatments of E.C.T. for depression, in different hospitals as an out-patient. I had one series of three treatments three years ago, and I have only just finished another series of five treatments. It might be useful to describe the subjective experience of the treatment as far

possible in objective terms, because there seems to be much groundless fear of E.C.T. I have heard fellow psychiatrists decry this form of treatment as a brutal attack upon the person, and I have known them withhold it from patients to whom no doubt it would have brought great relief, or in whose case it might have even been a life-saving measure. From my personal experience of having the treatment and from my experience of giving E.C.T. to patients as a psychiatrist, I know it to be a highly effective treatment in depressions of endogenous or nonreactive type, with the great advantage that some measure of relief nearly always becomes immediately apparent. With the modern technique of adequate anaesthesia and relaxant drugs the patient loses consciousness pleasantly and quickly and is aware of nothing until he wakes up in the recovery room. For the next couple of hours he feels a little unsteady and ataxic; in the second series of treatments, though not in the first, I have felt nausea after treatment, and on two occasions I have vomited after reaching home by car. I have not been able to discover whether a difference in technique at the two hospitals or some other difference was responsible for this nausea during the second course of treatment. Another mildly unpleasant sensation which I have had after the first treatment in both series is a stiffness of the jaw, which lasted about a day. This evidently is a common experience after the initial treatment, but does not recur after subsequent treatments in the series. as

234

PRACTISING

PSYCHIATR^

One of the most celebrated effects c. E.C.T. is the memory loss it induces. can be alarming, as whole tracts memory seem to be expunged with? trace. Memory for recent events, duf"1 the week or so preceding treatment, pears to be the most severely affect ^ Memories for events of several years ? seem to be impaired hardly at all. TP 1 way in which memory returns is very teresting. When an event, entirely ten, is brought to one's notice, it sou11' u completely strange, foreign and c?c a known. One has the feeling that fabulation is being presented: the "e of the account seem unnecessarily elf ?' borate, as if to make the story convi" ing, and the whole effect is almost la^, able. Then a fragment of the story true; a name is recognised, for exaroP. and a series of events or facts come denly to mind, in a linear sequence. 0 is suddenly aware of a curious facul^ ^ "feel one's way" along this sequenceone element leads to the next. The tion has a marked quality of unreal1', | as if one is trying to convince oneself

de^1

^

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something fictitious, and as one ST?^ ?{ one's way along the sequence it is aS one is looking at the remembered fa ^ ?

for the very first time. This alienation is very strong, even in the of of indisputable evidence of the reality the remembered facts. It is as though can synthesise the fragmented elemfj of memory in this way. Although it ^ strange experience, it is in some ^ quite delightful. It is as if one is seeing ^ ne least some aspects of life through eyes. One might speculate that the mentation of imagery and the opP -s tunity it affords for re-synthesis in ?, be way may be one of the therapeutic fits conferred by E.C.T. } This faculty for re-synthesis means of overcoming to a extent the difficulties brought about j loss of memory. By anticipating l?s?. g memory for recent events and mak

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Personal Viewpoint: The Experience of Electro-Convulsive Therapy.

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