[2] About 1,500 ECT patients a year in the UK are treated without their consent under the Mental Health Acts or the provisions of common law.
In 1939 it was brought to England and replaced cardiazol (metrazol) as the preferred method of inducing seizures in convulsion therapy in British mental hospitals.
Originally given in unmodified form (without anaesthetics and muscle relaxants) hospitals gradually switched to using modified ECT, a process that was accelerated by a famous legal case.
[5] Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J Meduna who, believing that schizophrenia and epilepsy were antagonistic disorders, induced seizures in patients with first camphor and then cardiazol.
[6] Meanwhile, in Rome, professor of neuropsychiatry Ugo Cerletti was doing research on epilepsy and using electric shocks to induce seizures in dogs.
[7] Cerletti visited the Rome abattoir where electric shocks were used to render pigs comatose prior to slaughter.
[7] Inspired by the fact that the pigs were not actually killed by a voltage of 125 volts driving an electric current through the head for a few tenths of a second, he decided to experiment on a person.
As a trace origin, galvanism may have been a more primitive form of ECT such that James Lind was among the first to suggest electroshock therapy for insanity in the late 1700s.
Kalinowsky demonstrated Cerletti's technique at the Burden Neurological Institute (BNI) and wrote an article about ECT which appeared in the Lancet in December 1939.
[10] Gerald Fleming, the medical superintendent of Barnwood House Hospital in Gloucester and editor of the Journal of Mental Science, psychiatrist Frederic Golla and neurophysiologist William Grey Walter (both from the BNI) described how they had tested the new method of convulsion therapy on five chronic schizophrenic patients from Barnwood House.
[13] The therapeutic value of ECT in schizophrenia was recognised as limited, but some psychiatrists saw it as useful to control the behaviour of institutionalised patients who had been diagnosed as schizophrenic.
[18] Barnwood House, which catered for "ladies and gentlemen suffering from nervous and mental disorders", said in advertisements that it offered "all the most modern methods of treatment including electric shock and prefrontal leucotomy".
Cyril Birnie, the medical superintendent of St Bernard's Hospital, Middlesex, raised concerns about persistent intellectual deficits following treatment and said that mental patients were "in danger of having a pretty thin time of it".
[22] A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones, caused by the violence of the muscular contractions during the convulsion.
In 1957 a patient who had sustained fractures to both hips whilst undergoing unmodified ECT at a London hospital took legal action.
At St James' Hospital, Portsmouth, William Liddell Milligan gave neurotic patients ECT up to four times daily.
[24] Robert Russell and Lewis Page tried a slightly different regime, giving patients one or two sessions of ECT a day but with several additional electric shocks during the convulsion.
[25] The Page-Russell technique was taken up by Scottish-American psychiatrist D Ewen Cameron who used it to "depattern" his patients at the McGill University in Canada.
One of the region's mental hospitals had been the subject of a committee of enquiry, and the use of force when giving patients ECT had been criticised.
[32] The Royal College of Psychiatrists duly produced guidelines, in the form of an eleven-page article in the British Journal of Psychiatry.
[33] The guidelines summarised the current state of knowledge about ECT, set standards for its administration and discussed aspects of consent.
Recommendations for the administration of ECT included: anaesthesia for all patients, a pre-treatment physical examination, avoidance of currents greatly above seizure threshold and the use of machines with a choice of waveforms.
The guidelines recommended that informal patients who were unable or unwilling to consent to ECT should be sectioned and a second opinion obtained (unless the need for treatment was seen as urgent).
[37] ECT was not actually put on the face of the Bill, in recognition of the fact that some people thought it belonged in section 57 with irreversible treatments and a subsequent Secretary of State might wish to move it there.
This time the survey was limited to East Anglia, and showed a 12 fold difference in the rate of ECT use between hospitals.
There were still problems with the training and supervision of doctors administering ECT; only a quarter of clinics were rated as good and two-thirds failed to meet the most recent standards.
[47] In 2007 Parliament in London considered amendments to the Mental Health Act 1983, including one which would give capable people the right to refuse ECT in some circumstances.
[48] Section 58A of the Mental Health Act 2007 gives people who retain decision-making capacity the right to refuse ECT, unless their psychiatrist thinks they need it urgently.