Unmodified ECT: what is the patient’s perspective?

Raval has correctly indicated that, when prescribing a treatment, it is necessary to be aware of the views of the recipients of the treatment. There is much literature on patients’ experiences with and attitudes towards modified ECT in developed countries (1,2) as well as in India (3). There is, unhappily, no literature at all on patients’ experiences with and attitudes towards unmodified ECT in any part of the world; in fact, it is uncertain whether, today, unmodified ECT is indeed practised in any other country!

Data on the subject should help form a more sound judgement about unmodified ECT. Unfortunately, such data are best obtained only through a study in which patients are randomised to receive either modified or unmodified ECT. If the data were to be obtained in any other way, adherents of unmodified ECT would claim that, in the absence of a control group, the experiences and attitudes documented merely reflect experiences with and attitudes towards ECT in general.

Raval additionally suggests that the practice of unmodified ECT may fuel the fears of patients who see ECT portrayed as a gruesome and barbaric treatment by the visual mass media. With apologies to Shakespeare, the fault, dear Brutus, lies not in unmodified ECT, but in its distorted portrayal. For example, an open heart surgery is well known to result in short- and long-term cognitive deficits; if the mass media were to use this knowledge to vilify open heart surgery, would it be justifiable to abandon the procedure? Sadly, in expressing his opinion, Raval is actually right. The strongest case for the abandonment of unmodified ECT is that its continued use may provide grist to the mill of publicity-hungry, self-important civil rights activists and sensationalistic film producers, and thereby jeopardise the survival of ECT itself.