Finding a Language for Mental Distress: Narrative Accounts of ECT

Electroconvulsive therapy (ECT) remains one of the most controversial treatments in mental health today. It can cause permanent loss of some personal memories. ECT if often given to people with severe depression who have not responded to other treatments or for people who have responded to ECT treatment previously. Estimates of its effectiveness for those with so-called drug-resistant depression vary from 40-70%. The decision to have ECT is viewed seriously by clinicians and ECT remains one of the most intrusive clinical practices in modern psychiatry. The issue of “capacity” to make a decision is viewed by the medical establishment in the UK as the ability to (a) understand the issues and (b) to weigh them in making a decision. However under the Mental Capacity Act, a doctor can declare that it is in their best interests. Alternatively, they may be detained under a section of the Mental Health Act. If, on the other hand, they are capacitous, then their wish not to have ECT must be respected: they cannot receive ECT, even if they are detained under the Mental Health Act.

However comparatively little qualitative research has been conducted into the decision-making process, experience of ECT or a fuller narrative investigation of the effects of ECT. This paper presents this decision as located in the wider context of someone's feelings about their mental health, their social care and support networks, and their experience of mental health treatment – including their experiences of compulsory care. Through the analysis of the narratives of 30 people who have been offered ECT, and 13 carers, (collected by the Health Experiences Research Group at the University of Oxford) the broad social context of this decision is described and analysed with some surprising results.