Clashes between medical professionals and 'survivors' kept the temperature rising at a debate on ECT. Laura Donnelly was there

Electro-convulsive therapy is 'crude, horrible to observe and frightening', according to Dr Mark Salter, consultant psychiatrist at St Bartholomew's Hospital, London.

Yet banning the controversial treatment for extreme depression - administered to some 2,800 patients quarterly - would be a 'potentially homicidal' move.

A passionate debate saw Dr Salter come under attack from many service users, who suggested his analysis failed to take into account the feelings of ECT recipients.

The first in a series of mental health debates hosted by the Institute of Psychiatry centred on the motion: 'This house believes ECT is barbaric and ineffective.'

Judi Clements, chief executive of mental health charity Mind, proposed the motion, sharing her personal views on a treatment which has 'no place in modern psychiatry'.

'There is no place for a treatment which even doctors disagree about, where the theories of how it works vary from doctor to doctor, where there are established and various side-effects or results of treatment, and where those who have experienced it use words like inhumane, cruel, brutal and terrifying.'

Ms Clements flagged up variations in the number of administrations carried out nationally - with twice as many patients per 100,000 receiving ECT in the North West compared with London.

She focused on disagreements between experts as to whether or not ECT - the passing of electrical currents through the brain to stimulate seizures - causes side-effects including memory loss, permanent or temporary headache and brain damage.

Her arguments were backed by testimonials from patients claiming long-term memory loss.

But Dr Salter argued that 'when passions run very high the first casualty is objectivity'.

'Individual experience is clearly not enough. . . A large body of evidence tells us that overwhelmingly as a last resort for severe psychotic illness it works for a minority of people.

Sure, we don't know how it works. . . but it does actually save lives. How can something be barbaric when it saves lives and can do some good?'

Lucy Johnstone, senior lecturer in psychology at the University of the West of England, said: 'There is no such thing as the established truth about ECT. You can actually find evidence to back up any view on ECT.'

Ms Johnstone disputed the claims of a widely quoted Royal College of Psychiatrists fact sheet which said 'eight out of 10 people with severe psychotic illness benefit from ECT' and said she had been unable to trace original research backing the statistic.

Opposing the motion, GP and Times columnist Dr Tom Stuttaford said: 'Our job as doctors is to balance the risks of any procedure against the benefits. We have to do this with ECT just as we have to do it with any surgical procedure. . . Should I get into a state of psychotic depression, I would accept ECT myself.'

Some people highlighted the gender and regional variations in the amounts of treatments administered, one asking: 'If ECT is really so effective and so many more women than men get ECT then how is it that men are so much more likely to kill themselves?'

Dr Stuttaford's suggestion? 'Because we don't give them ECT perhaps?' was probably not the answer they expected.

George McCulloch, clinical nurse specialist in ECT at Charing Cross Hospital, spoke of a patient's 'gratitude' when ECT ended a 'far more horrific' psychotic depression. He said the lack of after-care was 'far more barbaric' than the treatment itself.

And Tony Murphy, a former mental welfare officer and social worker said he had administered ECT in the past. 'I am neither ashamed nor proud of that - except for the fact that through the treatment some people's lives were transformed.'

But he urged the government to ensure that proposed reforms of the Mental Health Act ensured that ECT could no longer be given without consent. But Ms Johnstone argued: 'I think the true enemy is a model which treats us as faulty machines.'

The motion: 'This house believes ECT is both brutal and ineffective' was rejected in votes held before and after the debate. Final figures showed 35 per cent backing the motion, 51 per cent rejecting it and 14 per cent abstaining.'

Passions run high: debate soundbites

'I put it to you that ECT will in time be looked at as insulin coma and prefrontal lobotomy now are, and consigned to the historical dustbin of past medical practice.' Judi Clements

'I don't think it is wrong to feel emotional about vulnerable people turning for help and being left with a life-long impairment.' Lucy Johnstone

'Ignorance and prejudice are the real enemies and not doctors wielding ECT powers.' Dr Mark Salter

'It is true that ECT does affect the memory. But there are no memories in the graveyard.' Dr Tom Stuttaford

ECT administrations

January-March 1999 Total number of administrations: 16,500 Total number of patients receiving ECT: 2,800 Number of patients receiving ECT without consent: 416 Number of female patients: 1,900 Number of male patients: 900 ECT patients per 100,000 population in London: 3.7 ECT patients per 100,000 population in North West: 7.1 Source: Department of Health statistical bulletin 1999/22a