Stigma is a significant challenge that infects every issue surrounding mental illness. Mass media depictions of mental illness and treatments of psychiatric disorders perpetuate misconceptions by repeated presentation of negative stereotypes. The impact is seen when patients with mental illness are reluctant to seek the treatment they need.
Negative depictions of Electroconvulsive Therapy (ECT) contribute to the stigma of mental illness, by marginalizing this treatment and therefore those severely ill patients who receive it. It is a disservice to a vulnerable group of patients who could benefit from ECT, but who delay treatment and continue to suffer because they fear they will end up like Jack Nicholson’s fictional character in One Flew Over the Cuckoo’s Nest.
Most recently, the Toronto Star ran a series of sensationalist and stigmatizing articles (December 14; December 15; December 16; December 23), which reported that ECT “patients across Ontario … describe numerous cognitive side effects as a result of the treatment and want it abolished”. The same articles contained numerous long descriptions of patients reporting negative side effects. The articles claimed the number of treatments is increasing at an alarming rate. The pictures that accompanied the article did not depict modern ECT, but instead showed ECT treatment in the 1930s and referenced the shock therapy scene in 1975 film One Flew Over the Cuckoo’s Nest (a work of fiction).
The Star articles were followed by Drs. Blumberger and Daskalakis’ OpEd, ECT: A Life-Saving Medical Procedure and a letter by myself that gave more balanced perspectives about electroconvulsive therapy. But the damage had already been done.
Depression and bipolar disorder, the two commonest conditions treated by ECT, take a serious toll on people’s lives. Many die by suicide. In the next decade, depression is projected to be the costliest medical illness in western society. A significant number of patients with these disorders will not respond to medications and/or psychotherapy. As reported by Blumberger and Daskalakis “ECT works when other treatments do not. However, ECT is used in only about 1 per cent of patients with medication-resistant depression. This is primarily due to the media and social stigma that engender irrational fear and avoidance of this very effective treatment.”
The Star articles perpetuated the myth that ECT is a barbaric, inhuman treatment. It incorrectly claims that ECT is painful and that memory is permanently wiped out. Such characterizations are not supported by the facts. ECT is given under carefully controlled conditions and there is very little risk. The patient does not feel anything except the prick of the IV needle used to give anaesthetic. As Blumberger and Daskalakis report “ECT today is a very different procedure than that portrayed in old movies. During ECT, the patient is asleep under general anaesthetic and a current is passed between electrodes on the scalp to induce a controlled therapeutic seizure that is barely visible to the naked eye. This seizure usually lasts between 20 to 60 seconds. Afterward, the typical response of both the medical observer and patient alike is, ’Is that it?’”
When asked after treatment, most patients who have received ECT are very positive about the beneficial effects and say they would have ECT again if they became depressed again. Unfortunately, despite their positive experience they also report anxiety about the stigma associated with ECT.
The Star implied that ECT causes permanent brain damage. Studies have demonstrated that ECT does not cause brain damage, nor does it cause permanent brain dysfunction. In fact, ECT often improves the cognitive functioning of patients with severe depression. By treating the depression, patients often report that they are able to concentrate better and think more clearly. ECT can cause temporary memory loss, but when asked about it, patients respond by saying not being depressed is more important than their temporary memory loss.
The Star’s claim that ECT rates have increased dramatically is inaccurate and misleading. There have been modest increases in recent years, but the dramatic increase the Toronto Star reported was not due to an actual increase, but only improved reporting and collection of data. The actual number of patients receiving treatment is recorded in Ontario Health Insurance Plan (OHIP) billing data, which shows that in 2010-2011, 1,606 patients received ECT, which is up only 13% over the 1,425 patients who received ECT in 2002-2003. During this same time frame there was an 11% increase in psychiatric services and a 20% increase in the number of patients seen by psychiatrists in Ontario. In view of those numbers, a 13% increase in the number of patients receiving ECT should be expected.
But the most flagrant negative depiction of ECT in the Star articles is the use of pictures from the 1930s and referencing the 1975 movie One Flew Over the Cuckoo’s Nest that portrayed ECT as a torture rack with voltage. One cannot imagine a newspaper report about current day amputations using pictures of amputations from the Civil War. Or worse, from Hollywood movies, which often show Civil War amputations being done without anaesthetic, when in fact anaesthesia was in common and widespread use during the Civil War. When did substituting fiction for fact become the standard for responsible journalism?
All of the above contributes to the negative stereotype of ECT and the psychiatric conditions it treats. The suffering of psychiatric patients is not being taken seriously. Patients accept the side effects of ECT because it alleviates their suffering, just as cancer patients accept the side effects of chemotherapy for the same reason. I recently had a patient who had been hospitalized several times, been treated unsuccessfully with multiple anti-depressants, was unable to work, and who spent his days in bed thinking about ways to kill himself. After ECT he was active, able to work, involved with his children and no longer depressed. If you ask him about the memory loss associated with ECT he would tell you that the improvement to his life and being able to concentrate, learn and work again, far outweighed any problem with memory loss around the time of the treatment.
We have to have an open and frank discussion about mental health and its treatments. That discussion cannot take place if the mainstream media does not stop perpetuating negative stereotypes.
The issue of mental health stigma has received lots of attention in the past few years. The playing field is full of advocates such as the Mental Health Commission of Canada, the Canadian Mental Health Association, the Canadian Psychiatric Association and others. But all these efforts will be for nought if media outlets like the Toronto Star continue to use stigma as a way to sell papers.
If newspapers were to stop demonizing effective treatments and started to take the suffering of patients with psychiatric disorders seriously, that would be the beginning of the end of stigma. The mainstream media has extraordinary power over public consciousness, and could do more than any government commission to open the door to reasoned debate about mental health policy. I hope journalists will soon recognize this and take a leadership role in combating stigma and helping us heal mental illness.
For those who would like more information on the literature regarding general attitudes toward electroconvulsive therapy (ECT), and why there are so many misconceptions regarding this form of treatment I would suggest they read: Electroconvulsive Therapy Attitudes and Misconceptions or for information written from a patient’s perspective I would suggest reading Shock: The Healing Power of Electroconvulsive Therapy.