Inappropriate Use of Electroconvulsive Therapy [ECT]
According to mental health professionals in Iran whom we interviewed, Electroconvulsive Therapy [ECT] is often carried out unnecessarily, or for conditions in which ECT is not likely to be helpful, and without the informed consent of the person receiving the treatment. ECT consists of passing electricity through the brain to induce a seizure and is used in mental hospitals in many countries to treat bipolar disorder and severe depression. ECT is used as a last resort in cases where people are unresponsive to medication or in cases where an immediate or swift recovery is sought.
Hoda, a social worker specializing in therapy with persons with psychosocial disabilities, said, “All mental patients and their families know that hospitalization in a psychiatric hospital very likely, if not always, equals shock-therapy. At the first noise or signs of disobedience, they send the patient to be shocked.” Reza, a psychiatrist, who has worked for more than 20 years in Tehran and another city in central Iran, stated, “If the person has the ability to judge and understand, we tell them what we are going to do. Otherwise, we speak with the family. But in urgent cases where the mental patient is a threat to themselves or to the society, then we practice it without getting the consent form and ask for the consent when the emergency is over,” he said.
Similarly, Farhad, a psychotherapist who has been practicing in Tehran for nearly 30 years said, “But even if the psychiatrists explain the process and effects, this does not mean that they ask permission from the patients and if the patient refuses, they are not going to practice it. They tell the patient’s family that ECT is the only solution and they must accept it if they want their patient to feel better. So families eventually agree.”
All persons with psychosocial disabilities interviewed said that each time they have been hospitalized, they received between 6 to 12 ECT sessions. Persons with psychosocial disabilities interviewed said that they learned about ECT by experiencing it several times. “The first time I had electroshock, a heart physician visited me the day before. Then they took me for the shock and it was only then that I learned how it was. I forgot many things after that. They did it every other day. Now, I know how it is and what happens afterward,” said Jafar, a man with psychosocial disabilities. Another man with a psychosocial disability said, “The night before they take me to receive shocks, they gave me light food and told me that I was going to be shocked the next day. That’s how I knew it was going to happen.”