Psychiatrists plead against ban of direct electro convulsive therapy

Rita Dutta - Mumbai

The Indian Psychiatric Society (IPS), an association of more than 3,000 psychiatrists across the country, will soon approach the Supreme Court to take scientific evidence into account before imposing a ban on unmodified electro-convulsive therapy (ECT) and physical restraint on mental patients. The Delhi-based NGO ‘Saarthak’ had filed a Public Interest Litigation (PIL) in October 2001 calling for a ban on the practice of physical restraint and administering ‘unmodified’ or ‘direct’ ECT, ie. ECT without anaesthesia.

Around three per cent of psychiatric patients require ECT

Analysts say around three per cent of psychiatric patients require (ECT) and around ten to twenty per cent of these patients are given unmodified ECT. While Saarthak dubs unmodified ECT as “barbaric”, because the patient is held by three to four people, IPS opposes the PIL tooth and nail. Says Dr Nimesh Desai, chairman of the IPS task force for this PIL, IPS and head of psychiatry at the Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, “IPS is ready to implead with the government to take into account scientific evidence and practical reality before imposing ban on ECT or physical restraint.”

Psychiatrists are not ready to accept the allegation of barbarism of unmodified ECT. “The patient has to be held by hand by other people so that he does not develop any fracture. ECT is given only for a few seconds and no pain is involved. Myths are floated about barbarism of ECT,” avers Dr Desai. During ECT, a small electrical current (0.5-0.8 A) is passed through the brain via electrodes applied to the scalp. The current stimulates the brain and elicits a generalised seizure. “When DC shocks are given for cardiac arrest, why electric shocks for the brain is deemed barbaric?” asks Dr Desai.

Dr Y S Matheswalla, professor, psychiatry, J J and Grant Medical College hospitals (Mumbai), points out, “Though modified ECT is preferable, where is the evidence to show that unmodified ECT has risks involved with it?” Psychiatrists say ECT is life-saving in suicidal and depressive patients and even in patients of Parkinson’s disease. “ECT is the only treatment for patients who do not respond to anti-depressant or anti-psychotic drugs,” says Dr Matheswalla.

According to Dr Kuldip Datte, psychiatrist, Institute of Psychological Health, Thane, “Anaesthesia is given so that the patient does not develop fracture of the bone, but anaesthesia is no safeguard against risks. It has its own risks. The complications involved in unmodified ECT in the form of fractures is one in ten thousand.”

Rajat Ray, head of department, psychiatry, All India Institute of Medical Sciences, New Delhi, informs, “There are mental hospitals in the country which are routinely conducting unmodified ECT because of unavailability of anaesthetist. This could be because anaesthetists give preference to surgeries, which are more lucrative.”

According to Dr Arun Bal, secretary, Forum for Medical Ethics and founder-member of ACASH, “Anaesthetists are generally available at the metropolis. What about the district hospitals and small cities which do not have any anaesthetist?”

Experts say the appointment of an anaesthetist depends on the importance accorded by the individual institute. “Only a few mental institutes have full-time anaesthetists. In most government hospitals, the anaesthetist comes twice or thrice a week,” informs Dr Desai. Experts say availing the services of an anaesthetist costs Rs 1,000- Rs 1,500, which is not necessarily affordable to the patient. “Sometimes anaesthesia cannot be given as the patient may not qualify for anaesthesia and drugs (muscle paralysing agent) required to administer anaesthesia are unavailable,” says Dr Ray.

However, Dr N Pradhan of National Institute of Mental Health and Neuro Sciences, opposes ECT, with or without anaesthesia. “ECT gives rapid relief, but it is like giving slow poison to a patient. The same results can be achieved by medication,” says he. Dr Soumitra Pathare, consultant psychiatrist, Ruby Hall Clinic, Pune opposes the PIL’s formation of a regulatory body for administering ECT when the patient is not in a position to give consent. “Though the idea of having a regulatory body is ideal to safeguard the patient against any kind of foul play, it is very difficult to form such a body,” says he. IPS is also opposing the ban on physical restraint. “We are against chaining of patients, but physical restraint is required, when the patient becomes suicidal or homicidal. Drugs take some time to calm down the patient. Then the use of jackets or getting some people to hold the patient helps,” avers Dr Desai.