The story is told through the experience of the patient, Paul, as well as through his partner and carer during that time, Sally. Their accounts feature next to each other, to provide a contrast for the different experiences of the patient and his wife. Following the decision to take early retirement from a high-powered job in business, Paul suffered a severe mental breakdown, which gradually led him into a world of fear, paranoia, catastrophic thinking and a desire to take his own life. For his own safety he was sectioned and spent four months in a psychiatric hospital. After various antidepressants and antipsychotics had no effect, Paul was persuaded to undergo ECT and, after only six sessions of treatment, had what his partner describes as ‘a complete and miraculous cure’. Four years after the event he is still fit and well and has had no relapses. This story explores the thoughts and feelings of someone who is suffering with acute anxiety/depression, as well as presenting the fears and desperation experienced by his partner.

Depression and psychosis came out of the blue for Berlinda, who found herself in A&E after trying to kill herself with various means. She is lucky to be alive, probably due to the excellent reflexes of a driver whose car should have driven into her. Admission to hospital was proving impossible due to lack of beds. Recollections from the hospital stay are patchy and are supplemented by the accounts of friends and relatives. More self-inflicted injuries followed, and the situation was getting out of control. When ECT was mentioned after a long time, Berlinda was sceptical of it as she thought that nothing would help her. And then everybody noticed an almost immediate relief of her symptoms. Berlinda has remained completely well since and started taking part in inspections of ECT clinics for the ECT Accreditation Service.

At a fairly early age Lucy was admitted to a psychiatric hospital and then spent years in low-security psychiatric units. After an episode of neuroleptic malignant syndrome, she became physically unwell and stopped eating. When her life appeared to be danger, ECT was suggested. Lucy refused to have it and the first sessions were given under restraint. After eight sessions ECT hadn’t worked, and the team stopped it. A second course was started later, this time with Lucy’s agreement, and it worked. She gradually improved, had psychological treatment, engaged in rehabilitation and eventually was discharged home. She continued with maintenance ECT as an outpatient. She got married and started work as an Expert by Experience for the local hospital.

Sue was living a charmed life: financially secure, a stable marriage, a holiday home, and lots of holidays made possible as a result of early retirement. In March 2020 she and her husband became locked down in different countries for several months. Sue contracted Covid, and symptoms of long Covid followed. Symptoms of depression developed, and Sue started carefully planning how to end her life. Then she became psychotic, believing that she would become destitute and homeless, that she had infected the country’s Child Protection system with computer viruses and that her husband would cheat her out of her money. Three hospital admissions and a lot of medication later, she was still suicidal. At that point her psychiatrist suggested ECT. Sue’s first reaction was horror. She had always thought of ECT as throwing the furniture of a doll’s house in the air and hoping it lands in the right places in the right rooms – an unlikely outcome. She decided to go ahead and ‘getting all the furniture in the right place’ has given her life back. Her husband finishes the story with recollections of Sue’s psychotic ideas and his inability to do anything about them.

Key Learning Points

1. 1. Emergency medical treatment should not be delayed and is provided in the patient’s best interests.

2. 2. Informed consent must be sought for further medical interventions. Capacity assessments are carried out where necessary.

3. 3. A risk assessment should be carried out at the earliest opportunity, whether the patient is conscious or not.

4. 4. Intensive care staff work closely with the psychiatry team to provide combined medical and psychiatric care.

5. 5. Ongoing training for intensive care staff caring for psychiatric patients improves confidence and reduces risk.

An often-cited finding in US-driven suicidology is that women have higher rates of suicidal behavior, and lower suicide rates than men. This pattern, however, is not representative of the global suicidality picture. In Asian countries, female and male suicide rates are similar. To stimulate new thinking about female suicidality, we put China at the center of our analysis, and the United States at the periphery, and then discussed the insights generated by this reversal. Insights include that the US-centered canon is caught in the mental illness paradigm; and that it generalizes to women assumptions and evidence that mainly apply to men. For example, China’s data challenge dominant assumptions that marriage offers suicide protection. For many Chinese rural women, suicide is an act of despair and protest against suffocating marriages and communities – not a plea for closer ties (nor an expression of mental illness). China’s evidence, including that women’s suicide-mortality has significantly dropped since urbanization, supports a paradigm-shift in suicidology.