The gaudy gold border jars as Lakshmi’s faded sari hangs limply from her shoulders. The tikka on her forehead is smudged into the kumkum of her hair leaving the entire top of her head a blotch of dull,rash- like red. Her eyelids droop as if she has been drugged. The disolation of her slumped shoulders finds an echo in the tonelessness of her voice.

Lakshmis husband is haemaplegic with total paralysis of the left side of his body. A few months after her marriage, she gave birth to a daughter and suffered a mild depression. Six weeks ago she gave birth to her second daughter and has gone in to a severe depression. She has refused to breast-feed the baby. She refuses to perform any household chores. She is even giving up personal hygiene as she sits all day, staring vacantly into space. Her mother-in-law has brought her to Bombay from their village in Marathwada. She had heard that " Bomay mein sir ka injection dete hai"(They give injections in the head)

Though post-natal depression is known to be rooted in endocrinological imbalances ,the reasons behind Lakshimi’s depression might well be beyond hormones. Electro Convulsive Therapy (ECT) is becoming an increasingly popular form of treatment for depression, especially if the depression is accompanied by suicidal tendencies. It is also widely used in the treatment of certain types of schizophrenia, drug addiction and alcoholism. In fact, it appears to be a primary tool for psychiatrists dealing with a wide range of disorders they do not fully comprehend. "The unwritten dictum is ‘when in doubt, shock’,"jokes a young doctor specialising in psychiatry.

Lakshmi is taken to a bed beside where is kept the electro stimulator, as innocuous-looking as a ladies vanity case. A nurse loosens her clothing and wipes her forehead with a cloth moistened in spirit. Even while the anaesthetist is administering sodium amytal, the orderly starts pressing down on her knees. Forty-two patients have to be given ECT in the next one-and-a-half hours. A pad of cotton is thrust into Lakshmie’s mouth and electrodes are hurriedly placed against her temples. As the current is switched on, tremors begin to rack Lakshmi’s body. She moans softly, biting on to the cotton in her mouth as a strong convulsion engulfs her. Her whole body shakes violently. As soon as her toes begin to twitch, the current is turned off. It has taken between two and three seconds.

Lakshmi is moved over to the next bed which she shares with the patient before her who has yet to recover consciousness. She will remain in a state of mental confusion for two to three hours after which she will be allowed to go home. Though she doesn’t know it, she has been fortunate in coming to a hospital that uses anaesthesia before ECT. Not all public hospitals do. The mental asylum at Thane is reportedly notorious for administering ECT without anaesthesia.

Approximately 70-80 percent of all patients admitted to psychiatric wards of hospitals receive between six to eight ECTs spaced out over two to three weeks. Chronic patients who need to be hospitalised periodically may receive as many as 50-60 over a period of time, and the occasional patient of a doctor who particularly favours this line of treatment may receive over 100. Though it is claimed that the ECT patient does not feel any pain since he or she is anaesthetised before the shock, one meets patient who are terrified of the process as well as others who, bafflingly, seem almost addicted to it, such as a 65-years-old retired storekeeper who’s been a patient for 14 years and implores the doctor "Sahab aaj bhi aurek de do" (Sir, give me one today as well)

Though ECTs are normally administered at a voltage of 110, the electric current may range from 90-130 volts depending on the intensity of the shock required. However, in July ’82 the electric stimulator at J.J.Hospital, Bombay, was reported to be registering a voltage of over 200. Resident doctors at that time said that the stimulator had been malfunctioning for at least two months earlier.

No one seems to know what exactly happens when an electric current is applied to the brain. "So far there’s never been a post-mortem on a patient who’s just had ECT, so we don’t know exactly what electro- chemical changes occur," says neurologist Dr. N.H Wadia. There are over 50 different theories on how ECT works but not one has yet been conclusively demonstrated.

"The advantage of ECT is that unlike drug therapy it has no side effects," says Dr. Allen DeSouza a psychiatric consultant at J J.Hospital, Bombay. "And besides,many mental patients don’t remember to take their drugs regularly. ECT can cut down the time of hospitalisation by almost half and is a boon in a country like India where there are thousands of mental patients and only a handful of trained people to deal with them. As a form of therapy, it has been denigrated in the West mainly by the drug companies because it was making a dent in their sales.

" What ECT does do is remove painful memories" he goes on to explain. "If a young girl believes that Dharmendra is in love with her, it is in her interest to have that memory extinguished. ECT will do it in seconds whereas it may be weeks before drugs would have a similar effect. There may be a limited amount of brain damage in some cases but personally I feel it is for the better. Many schizophrenics have a very high I.Q, sometimes over 150, but they are unable to put it to good use. ECTs might reduce the I Q, to 130 but at least the patient would be able to utilize it. What is the point of having a high IQ.,if you can’t use it?"

Western countries have almost completely abandoned ECT, regarding it as too barbaric a form of treatment. Mental health personnel have laid greater emphasis on psychotherapeutic methods in dealing with patients in the West. In India, too, an increasing number of doctors of the younger generation are more circumspect about its usage. They point out that while drugs can be monitored and the dosage changed periodically if necessary, once an ECT is given there is no way to control or minimise its impacts. " Besides there is no evidence of its lasting values." Says psychotherapist Dr.Vijay Thakur who combines drugs and psychotherapy in dealing with his patients. "One reason why doctors use it so much is because they are terrified of having a violent patient on their hands. In practice, few patients get violent unless they are mishandled and even when that happens, they can easily be controlled by sedatives.

"The very nature of schizophrenic illness leads a person to erect barriers between himself and the world around him, and to construct a fantasy world in which he acts on his inner frustrations and desires," explains Dr. Thakur.

"The trouble with ECT is that once you give a patient ECT, the symptoms begin to disappear. So you are cutting off a window for looking into the patient’s mind. You are left without a vocabulary for getting to the source of the illness. ECT removes the symptoms, but it does not get to the source of the illness. And once the symptoms are removed the source gets forgotten or neglected. So, patients have relapses and have to keep coming back."

Hospital sources confirm that between 70-80 per cent of schizophraenic patients have a relapse within two years of being discharged from hospital. ECT is also a money generator for private practitioners who charge between Rs. 75-Rs. 100 for a single shock.(Now the amount may be double or more!)

However, when ECT is followed up by supportive psychotherapy, the prognosis is more optimistic. The Samaritans are a small group who combine the two for their patients, the majority of whom are people who have attempted suicide. "It is important to see the patient as a disturbed person, a person in despair, not as a mad man." Says Dr.S.G. Dastoor. "If he has lost touch with the world around him it is because it is too painful for him to face it. First, we have to re-establish his contact with reality and then help him locate resources of strength."

Recognising the need for supportive psychotherapy as a follow up to drugs and ECT, most hospitals employ at least one clinical psychologist and two or three social workers. A clinical psychologist is trained to perform diagnostic tests such as the Rorschach, Bender-Gestalt, Bhatias’ I.Q, and Thermatic Apperception Test in much the same way as a pathologist examines blood, urine and stools. Social workers follow up on idividual case histories intervening to make the environment more conducive to the patient wherever possible. However, with out-patients alone registering between 100-150 per day at each hospital’s psychiatric department (as compared to the Samaritans who deal with just 25-30 per day), the staff is hard pressed to produce results.

" A lot of the cases we get are of transient situational neurosis when the stress level in a person’s life becomes too much for him to handle," says Dr. H .S .Dhavale of Nair Hospital,Bombay. " This could happen due to a socio-economic situation, because of marital discord, in-law problems, problems at work or a combination of these."

Such is the case of Sarla, the wife of a union leader in a textile mill. They live at BDD chawls, Worli, the scene of mob looting and violence during last year’s police riots. Sarla’s two-year-old child was ill for three weeks after the riots. Four months ago, her husband’s best friend, also a union leader, was brutally murdered. As threats began to be made on her husband’s life, Sarla couldn’t take it any more. The tensions of her everyday life were overwhelming her. Rather than live under the constant threat of violence, she preferred to escape into a world of fantasy where Amitabh Bachchan is her brother, her husband is not her real husband but an imposter, and the only reality in her life is film music from an ageing transistor.

Sarla is to be admitted to hospital where she will be given ECT. Afterwards, she will be helped psychotherapeutically. Neither psychiatrist nor social worker can change the reality of her life. She can only be helped to deal with it.

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