"He felt that they wanted to hurt him, he got scared. We called the emergency room, they stabilized him... What we did not expect is that all this would happen," explains Juan Carlos Alonso, Iván's father. As a result of this crisis, Iván –elder of age – has been admitted to the psychiatry floor of the Conxo Provincial Hospital in Santiago de Compostela since February 10. There he is receiving electroconvulsive therapy (ECT) by court order when he and his family objected. Seventh session This case has provoked a bitter social debate.
Initially, the relatives accepted the therapy, which involves causing convulsions in a controlled manner and under anesthesia with a small electric current. “They told us that they had tried all possible medications and that they had not worked, and that they had to give him electroshocks,” says the father.
The family requested a second opinion from a private psychiatrist, after which they reversed their decision. It was at that moment that the hospital requested a court order to carry out the electroshocks, according to the family.
The judge authorized the procedure based on the conclusions of a judicial and forensic examination, in addition to the psychiatrist's report. Electroconvulsive therapy would be justified, above all, by the “absence of any other alternative”.
The family has mobilized by collecting signatures and has made a social appeal, whose most current event has been the concentration last Tuesday in Santiago of almost a hundred people, according to El Correo Gallego. The father has been on a hunger strike since last Saturday and complains about the prohibition to visit his son for "having violated the rules of the unit" by passing Iván a document to authorize the family's access to his history. clinical.
One of the people who has supported the family is Rosalía Fariñas, a mental health activist. “There are thousands of situations like this. Ivan is the last straw. The main problem is the involuntariness of the treatment”.
The Association of Patients and Users of CHUS (Complexo Hospitalario Universitario de Santiago) and groups for the defense of the rights of psychiatric patients, such as Orgullo Loco Madrid, have also joined the cause. "Iván's case shows the psychiatric violence in our country, which violates human rights, European fundamental rights and constitutional rights," they say from this organization.
The European Court of Human Rights establishes that giving a treatment contrary to the decision of a person is a violation of the right to their physical integrity and an involuntary admission supposes the deprivation of their liberty. Therefore, it must be a judge and not a psychiatrist who authorizes it, even if the proposal comes from the latter. United Nations observations on the legislation in Spain cite “the prevalence of a paternalistic approach and the absence of human rights-based provisions in mental health systems”. The groups argue that in other medical fields the patient can refuse therapy, even if it means death. And that there are alternatives to avoid resorting to a judge. One of them is advance directives, where the person collects in writing the treatments that he would accept.
Regarding electroshock, it is indicated for severe depressive symptoms that do not subside with treatment and also in other symptoms resistant to treatment, such as acute psychotic episodes. The data speaks of up to 80% favorable response in cases of resistant depression, where it would be the therapy of choice.
“Therapy works. It is known that it stimulates brain metabolism and the release of neurotransmitters, although all the details of how it works are unknown”, says Manuel Martín Carrasco, president of the Spanish Society of Psychiatry and Mental Health. The hypotheses point to this release of neurotransmitters as one of the main mechanisms of success. The Galician Association of Psychiatry was also in favor: "It is a clearly stigmatized technique" and that the advances allow the load on electrical stimulation to be minimal, with the consequent decrease in cognitive side effects.
Although electroshock is endorsed, there are contrary opinions due to the invasiveness of its practice or memory loss. "In some cases it works, but far from as many as it is practiced," says Jordi Marfà, who in his more than 40 years as a psychiatrist has indicated it less than five times and as a last resort.
