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‘Delusional’ consent in somatic treatment: the emblematic case of electroconvulsive therapy
  1. Giuseppe Bersani1,
  2. Francesca Pacitti2,
  3. Angela Iannitelli2,3,4
  1. 1Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
  2. 2Department of Clinical Sciences and Applied Biotechnology, University of L'Aquila Department of Clinical Sciences and Applied Biotechnology, L'Aquila, Italy
  3. 3Psychoanalytical Centre of Rome (CPdR), Rome, Italy
  4. 4International Psychoanalytical Association (IPA), London, UK
  1. Correspondence to Dr Angela Iannitelli, Department of Clinical Sciences and Applied Biotechnology, University of L'Aquila Department of Clinical Sciences and Applied Biotechnology, 67100 L'Aquila, Italy; iannitelliangela{at}gmail.com

Abstract

Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy (ECT). In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient’s motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient’s inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the ’error’ committed for which the depressed patient blames himself and the social repression of the maniacal patient’s affirmation of his inflated self-esteem.

  • electrical stimulation of the brain
  • clinical ethics
  • capacity
  • informed consent
  • psychiatry
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Footnotes

  • Contributors GB wrote the first part of the article related to the 'informed consent'. AI and FP wrote the second part of the article related to the 'ECT'. All three authors conceived and wrote the conclusions.

  • Funding This study has been supported by the Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila. AI is a recipient of a research grant (SSD MED/25, Rep. n. 43/2017, Prot. n. 685 del 19.7.2017).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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