November 11, 2008Neuroscientist Defends Forced ECTYesterday when I wrote about a case of forced, invountary ECT--outpatient no less--being imposed on a man in Minnesota, I noted that if anyone wanted to write a defense of involuntary ECT, then I'd post the result. Well, an anonymous neuroscientist in the UK who writes the Neuroskeptic blog took me up on my offer and wrote a post on his end. His basic argument, which I find weak, is that ECT worked for his grandfather back in the days before anti-depressants in the 1940s. And, then, he continued: "* Sometimes consent is a luxury Oh and it wouldn't be cruel and neglectful to take a procedure that has very unpredictable results and then zap someone's brain and scrub off their short-term memory? Perhaps, I look at this too much as an American (we tend to take our civil liberties a bit more seriously than Brits do, sad to say), but consent is never a luxury, it is essential when it comes to ECT (I could make that argument for about 98 percent of mental health care, too) because ECT is so risky and even psychotic people have a right to not run the risk of having their brains zapped. If you think it's not important, read this post by someone who had it done to them, somewhat voluntarily. Voluntary ECT, as I noted yesterday, is a different matter altogether. Anyway, offer your thoughts in comments here or over at Neuroskeptic's blog. Posted by Philip Dawdy at November 11, 2008 12:05 AM
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"Perhaps, I look at this too much as an American (we tend to take our civil liberties a bit more seriously than Brits do, sad to say) . . . " god, you're an ass. btw, my grandfather fought in WWII as well--so what? did YOU serve? no, you didn't. so spare us all of the "i'm more patriotic than thou" bullshit. Posted by: aaron g at November 10, 2008 09:57 PMJust because it might have horrendous effect on some people doesn't mean that all people should freak out. I mean, accidents happen all the time, but that still doesn't mean that you need to get someone's consent before putting them in a car, especially if it's the ambulance or the police. Obviously, this is a risk verses reward relationship. But you haven't properly explained why in this case ECT is wrong because the risks outweigh the rewards. Just that it is wrong to force people, which is rather weak because then you should also be aruging that people who in the middle of a psychotic episode who wander down the street naked shouldn't be forced into hospial and be treated. Oh, and if your going to start beating your chest about American human rights, explain guantanamo. Posted by: Felix at November 10, 2008 10:05 PMaaron, you are blind if you can't see how the brit govt has trampled all over peoples' individual rights in recent years. cameras all over the place, mics, the government telling you what language to use. hell the citizens there don't have anything close to the bill of rights americans have. brits are awesome and brave people, but your govt and all the nanny state crap going down over there is appalling. as for the risk v reward argument, i don't know of a single case of a course of ect having ended someone's depression forever, meaning no more ect, no more drugs, etc. if such cases exist then i bet they are quite quite rare. Posted by: Philip Dawdy at November 10, 2008 10:14 PMHowever - in psychiatry, things are not so simple. I totally agree Neuroskeptic. Psychiatry does not deal with people who are drunk and will be sober as soon as the alcohol effects go away. Posted by: Ana at November 10, 2008 11:11 PM for one appellate court's reasoning, see Guardianship of Ruth E.J. at To respond to these quotes: "Adults should not be treated if they have made an informed choice not to be - as patients we have a right to autonomy, including a right to refuse treatment and even a right to die." "However - in psychiatry, things are not so simple. It's often those who are most ill, those who have the most to gain from treatment, who are most likely to refuse it. From my own experience I know how even moderate depression can warp your thinking - severe illness can lead people to be, temporarily, unable to make informed decisions. They may not know that they are ill, or they may not be able believe that there is any hope of recovery." Hmm, if Ray's thinking was warped, why was he able to phone his local library's reference desk to ask about human rights groups, when the librarian referred him to MindFreedom International.? It sounds like he is making a fully informed choice that should be totally respected.
"Sometimes consent is a luxury..." Erm, I don't think that that's a precedent you really ought to set, to be honest... "...They may not know that they are ill, or they may not be able believe that there is any hope of recovery..." Only because, in your world, others have to be defective, in order for you to be correct. This "anonymous psychiatrist" appears not ever to have had a conversation with one of his patients as an equal - if (s)he insists on assuming that (s)he knows more about his patients' experience than they do themselves (which is as impossible as it's possible to be), then it's not surprising that (s)he holds the views that (s)he does. And it's equally unsurprising that (s)he knows as little as (s)he does about the human mind, what ails it, and what fixes it. Matt Posted by: Matthew Holford at November 11, 2008 04:55 AMThanks for posting this - even though I am British. So politics aside... Felix: Yeah, exactly my feelings. Philip: ECT may never have finally cured anyone, but it can make lasting recovery possible (with follow-up meds or occasional ECT.) As I've said, for some people it is the only hope of getting better at all. Those are the people I'm concerned about. Ana: Actually my depression is very much like getting drunk. I get depressed and I start thinking stupid things and I get unable to function. Then I get better and I look back and I think, what the hell happened? I know that's not everyone's experience. I stand by what I said - sometimes people are too ill to give informed consent and if that happens you have to do what's best for them. And in some very rare cases ECT may be what's best for them. Posted by: Neuroskeptic at November 11, 2008 05:01 AMFelix wrote: Why should he be arguing that? Put another way, why should people who have decided to walk naked down the street be forced into institutions? I can think of things far worse, which nobody bats an eyelid at. Look, what you need to do, I think, is to distinguish between "behaviour that I don't like," and "behaviour that is genuinely (or at least potentially), harmful to self or others." Walking naked down the street does not fit in the latter category, but it appears to fit in the first, which while it may qualify the behavioiur as mental illness in your mind, and in the minds of others who are embarassed to see a person walking naked down the street, does not make it dangerous, and therefore does not justify incarceration against a person's will. In the UK, it would amount to a breach of the peace, and there are probably equivalent offences in US Law, but that's all. In summation: I suggest that you distinguish between social mores and diagnoses of mental illness. Matt Posted by: Matthew Holford at November 11, 2008 05:45 AMI think any form of involuntary treatment is appalling and a human rights abuse. Once that door is opened, involuntary treatment laws can be used upon anyone psychiatry deems suitable. Psychiatrists have way too much power, especially considering there is no validity to their "medical" treatment. I think involuntary treatment laws should be repealed -- they're just too easy to abuse. Posted by: Francesca Allan at November 11, 2008 06:00 AMNeuroskeptic, would you make this same argument for lobotomies also. I’m not referring to criminally insane individuals here that are violent and infringe on others rights without some form of intrusive intervention (we as a society have that right to protection and the rule of law in criminal matters). Choice is exactly that! Human free will is making a decision on whether to take a calculated risk or not; as is the case with ECT. There are too many factors associated on the harmful side of the equation to ever make the determination that this is the one and only option available for treatment. I know those will come here jumping up and down it was the last option; I will only say it is only one option is series of others options their Doctors may have not even considered due to the constraints of diagnostic criteria they function under. Stan this comment in Neuroskeptics profile explains everything: My line is usually that the experts know much less than they think, but much more than everyone else. I think he/she thinks they're being humble but it's a pretty damn twisted way to put it. Patients and their personal experience make them experts on their own bodies and to discount that they may know more than any so-called "expert" by neuroskeptic's definition is the height of arrogance and places him right back with the rest of his kind... Also it's clear he's never heard of or completely dismisses the kind of radical care that people like Loren Mosher support... ugh, it's sickening to hear someone say consent is a luxury... also, Philip, my husband is a Brit and would have no problem agreeing with you, also Aaron, I frankly could give a rats ass about being an American...I'm a citizen of the world and not a patriot or a nationalist and I share Philip's view...without letting patriotism come into it at all... who's an ass? Posted by: Gianna at November 11, 2008 07:26 AMECT is not approved for any indication in the US, despite decades of use. It has NO FDA approvals, so why is it OK to use it involuntarily? It has never been studied in two RCTs in the US which are scientific enough to be submitted to the FDA. Plus, the machines' inventor, distributors etc are involved with the (bad) research and the promotion of ECT. NO FORCED TREATMENT WITH ECT seems logical to me. Posted by: Eileen at November 11, 2008 07:32 AMIn comparing involuntary ECT to drunk driving, Neuroskeptic makes a false analogy. Taking a drunk's car keys away is analogous to removing sharp objects from the room of someone who is suicidal. ECT is not taking something away that causes harm, it's causing harm, more like the idea of an anecdote for a snakebite being a bit of venom. It's causing pain and disconnection from reality on the argument that pain now will cause less pain later, more analogous to giving venom because you think someone might have been bitten by a snake but can't prove it. It should never be forced, is a serious risk that rarely works, however, if someone is truly unconscious, then perhaps guardians should be able to consent to trying it. As I suspect Neuroskeptic well knows when he writes, "severe illness can lead people to be, temporarily, unable to make informed decisions," ect permanently prevents people from making informed decisions. It's like amputating the foot to treat an ingrown toenail. Posted by: Sally at November 11, 2008 07:52 AMAccording to Neuroskeptic's logic I should have been forcibly given ECT. After all, a psychiatrist thought it was best for me, in fact it was his very esteemed opinion that this was my only hope. I suppose if the laws had been different in my state, that's what he would have done. I was very depressed, so I shouldn't get to make the decision of whether or not I want to risk brain damage? If only I had been right in the head I would see it Neuroskeptic's way and have gladly risked brain damage? Bullshit. Once off the psych meds & away from my shrink who was hitting on me, with my female hormone issues addressed, and seeing an ethical therapist who helped me deal with some pretty shitty things that happened in my past, an amazing thing happened - I got better. I guess it's too bad for people like me, because people like Neuroskeptic know what's best for us. Posted by: Lisa at November 11, 2008 08:16 AMRighty-ho : 1. AA : As I've said, I have no comment on Ray. 2. Matt : I'm a he, and I'm not a psychiatrist, I'm a neuroscientist, and also a patient. I know, from my own personal experience, that depression makes you think crooked. My depression is a lot milder than some people's, so I can only imagine how bad it is for them. I'm all for distinguishing between social mores and mental illness. If someone wants to walk down the street naked, go ahead, it wouldn't bother me. I've done worse myself when I was well. But if someone is ill, then I want them to get better. Francesca Allen : yes there are risks of abuse yes, but there are risks of abuse whenever anyone has any power over anyone. There is police abuse, parent abuse, doctor abuse - and it's all wrong, but that doesn't mean we should have no police or parents. Gianna : I'm certainly not humble. Look, psychiatrists should never go against a patient's wishes *unless* they are incapable of making an informed decision, unfortunately some people are. Or are you saying that no-one is ever so ill that they do things they would later regret? More replies later... Posted by: Neuroskeptic at November 11, 2008 08:48 AMPerhaps you take your civil liberties more seriously because your government doesn't have hundreds of years worth of common law etc which enshrine your rights - like we do in the UK. As for ECT - you can only be given ECT in the UK if you give valid consent in writing. If you are incapable of consent and have a valid advance direction stating that you do not want ECT, it can't be given to you. If you don't have an advance directive then an independent doctor has to be appointed and consent or not on your behalf. The only time ECT can be given without consent is in an emergency in order to save a life. As for a court ordering ECT - that is just an abuse of power! still i would think that being a brit as we obviously don't take civil liberties as seriously as the Americans do we!! Posted by: jono at November 11, 2008 08:48 AMis any human being capable of never doing something they will regret "sick" or not?? no I don't think so...and I don't think it's your choice to determine whether someone can make an appropriate choice...you can't see the whole picture which spans the persons whole life. I've been forced treated much to my detriment..and I've seen, as a social worker, hundreds of others inappropriately treated "in their best interest." The problem is there are not humane alternatives in the current infrastructure...the fact of the matter, however, is that humane alternatives do exist...no one wants to take the time though...hurting people take time personal one on one time...ECT takes seconds. Sally, Lisa, .....things got so dreadful that ECT had to be used as a treatment for depression again and the patient felt terrible but at least everybody around thought that it was better and that was the important. .... Although the so-called "antidepressants" were taken on command and the use of antipsychotics - they thought that serotonin was the only thing to blame but all of a sudden they started using dopamine.... LOL ...mapping the brain was a magical tool at that time. Neuroscientist jumped of joy reading which parts of the brain responded to certain activities and a new hypothesis or theory was born. ...... ... patients started rebelling writing "blogs"* and there was a journalist, Philip Dawdy, who...... psychiatrists, Big Pharmas, FDA, MHRA, Harvard, Nemeroff, the government everybody was very angry with his work and he could not find a job anywhere..... blogs of people reporting daily their struggle to withdraw... a mother reported all her struggle... even a British Bruce Lee.... and a bunch of people who had nothing better to do with their lives... *refer yourself to our database to see some samples of these kind of thing. Posted by: Ana at November 11, 2008 09:17 AMPersonally, I can't see how anyone could possibly defend forced ECT. There is absolutely no long term benefit to shocking someones brain. As soon as the shock wears off the person is right back to where they started, but after shock they have memory and other cognitive problems. This is pretty evident just by looking at the man who sparked this discussion. He is being forced to have shocks weekly. It obviously isn't having too much of an impact on his mental illness. (It makes you wonder what behavior will be acceptable for them to stop.) It is inhumane to punish people with ECT because medications didn't work. Especially when in far to many cases the medications are what is causing the symptoms to begin with. ECT is not a treatment you will come out of without severe and lasting treatment effects. Notice I said treatment effects and not side effects. Cognitive damage is what ECT causes. It does not cause someone to be free of mental illness. It causes brain damage. Forcing someone to have shock to the brain to give them time to adjust to medication is nothing more than lazyiness and anger on the part of the doctors and caregivers. As providing someone with support and time would do more than take someones memories and enssense, thier life. And if you are going to take someones memories, which is their life, why is it not okay for the person to take their own life? Why do we find it acceptable to destory someones brain to where they cannot function in the world but we are so against suicide? Because ECT is a lie, a false hope. It's a billion dollar a year industry based on shitty research in which they deny long term cognitive damages occurs. Doctors and manufactorers are getting rich to destory lives under the name of "treatment". ECT does nothing more than hide the failed treatments of Psychiatry. This shouold not be forced on anyone. Posted by: Jane at November 11, 2008 10:32 AMGod, there is so much I would like to say on this topic but every time I read an article and then the comments I get so emotional and upset that I can't think of a concise way to express my feelings. I was coerced into having ECT and it has damaged me signifcantly. I was never informed of all the potential risks. I do not believe that had I known I would end up losing so much of my memory and my ability to learn new stuff (I lost the knowledge I had of the vocation I had been in the majority of my working life, some 30+ years) that I would have agreed to have the proceedure even if that meant suffering the consequences my Psychiatrist threatened me with. If you have NOT experienced the damage caused by ECT then you CANNOT relate. You may be able to sympathise but you will never know the devestation it causes to ones life. Posted by: SallyT at November 11, 2008 10:34 AMwell well well, has Fuller Torrey come to town? Forced ECT treatment is NOT justified, the same as Torrey's stance (TAC- Treatment Advocacy Center)on forced outpatient drugging of schizophrenics because Torrey and crew believe they are violent and need meds to prevent violence. It's absurd, and when talking about a man (Ray Sandford) who is a patient like any one of us being forced to leave his home and endure a procedure that he says is "HELL" why anyone can say he should be forced to endure it is beyond hope, inhumane and twisted. Fuller Torrey, the "so-called expert" on Schizophrenia believes in this way of treating mental illness, he believes Haldol is a preventative anti viral drug that helps schizophrenia and the Stanley Foundation owns the patent to an under the skin disk for Haldol for this reason. Why discuss Torrey in this thread about forced ECT? Because forced treatment of mentally ill patients whether with ECT or drugs is cruel, inhumane, and the loss of civil liberty and human dignity is at stake. Anyone promoting the forcing of an outpatient to take drugs or ECT has something severely wrong with them. What has Ray Sandford done to be given a forced rx of ECT? What has he done? He was given a psychiatric label, and someone who doesn't give a shit became some sort of advocate for him that signed something against his best interest. Ray needs a real advocate, someone who would not force a barbaric electricution of his brain cells on him. Write the letter to the Governor!!!! Posted by: Stephany at November 11, 2008 10:54 AMNeuroskeptic wrote: I'm all for distinguishing between social mores and mental illness. If someone wants to walk down the street naked, go ahead, it wouldn't bother me. I've done worse myself when I was well. But if someone is ill, then I want them to get better." Ah, you are one and the same with the "anonymous neuroscientist." I didn't like to assume. And shame on me for suggesting that you were a shrink: perish the thought! Anyway, I think you've lost me with the analogy about nudes on our high streets, unless what you're saying is that it is not the fact of the nudity that is the issue, but what prompts the decision to walk naked down the street? A (chronically), confused person is inevitably mentally ill, then? In any event, depression is a funny thing, which nobody properly understands. Occasionally a patient feels that drugs have helped them; occasionally psychotherapy; occasionally ECT. But none of these treatments appears to have a 100% success rate - I've never seen that claimed, anyway. As such, the phenomenon by which a person experiences relief from their symptoms is not explained by current understanding. *Something* led to the patient to feel relief, with each of these treatments, but what on earth could it have been? As I suggested to Doug Bremner, recently (my apologies for quoting myself, but the ramblings of such eminent scientists as Keller, Koplewicz, Biederman, et al, are beyond my meagre comprehension), depression is nothing more than the accumulation of problems that a person has been set during their lives, and has never succeeded in solving. As I noted to Doug, I have seen the effect that solving a problem for a person that they weren't able to solve for themselves has. That, I suppose is all beside the point, except that, if one accepts that my analysis is correct, ECT is never going to solve anything, other than accidentally. Matt Posted by: Matthew Holford at November 11, 2008 11:02 AMHere's the dirty secret of ECT research. Researchers know about the cognitive and memory deficits associated with this treatment, so they do one of two things. They either leave out cognitive or memory measures from their research (if you don't test for it, nobody can hold it against the treatment), or they use virtually useless measures (like the mini mental state exam, which is rarely used in modern psychological research).
So yes, you might survive the depression, but at what cost? The loss of a part of your identity -- the memory of autobiographical events. It's also noteworthy that because there is such a great degree of variability in the procedure for how ECT is actually performed, most efficacy and safety research in this area is useless. There are over two dozen different, acceptable ways of administering ECT, including the type, electrode placements, and course. Posted by: John Grohol at November 11, 2008 11:52 AM SallyT, I'm just thinking about the woman I met last year I'm thinking about all I've seen on the mental institution I go from time to time. And reading here... It's inhumane. It's a crime. Jane, Stephany, I believe that Governor Tim Pawlenty has received e-mails enough to take action. Neuroskeptic, You have NO way of knowing what the circumstances of another person's life is. For me to have forced treatment of any kind would be such a replication of my childhood abuse it would definitely precipitate my death. My spirit could not endure another episode of bodily invasion, which is what any kind of forced treatment is. I would literally rather DIE that endure ANY form of forced treatment. In fact, you can be sure that after I got done shining you on, telling you whatever I needed to say to get out of incarceration I would, indeed, kill myself. Because of the nature of my abuse issues--of which you know NOTHING--it would be the only means I'd have of regaining control in my life. There are worse things than being dead. Forced treatment is one of them. There is absolutely no argument to justify that sort of mental rape of another human being because, in your limited opinion, you "know" what they need. Who elected you god??? How dare you. Posted by: Sherry at November 11, 2008 12:08 PMConsent is a luxury for some people and not others. So let's talk about that. For whom is consent a luxury? You take 2 people expressing similar mental and behavioral phenomena, but one of them is empowered to refuse consent and the other is a lamb jumping for the knife. What accounts for this difference in outcome? There is no innate constitutional difference between the individuals, so what is this "luxury" of which you speak (and which I agree)? Think about this neuroskeptic. The source of Ray's privilege. What did Ray Sanford have that others don't, besides access to power? Take away the telephone and Ray's left to his fate like the majority of others in his position. Should a person's social circumstances decide their fate? Neuroskeptic, I don't know what your depression is like but even when I was so depressed I stopped working, showering, etc. I was still capable of understanding that ECT could cause permanent memory loss & brain damage - it wasn't worth the risk to me then, and I feel the same way now that I'm not depressed. I bet if you were to poll the general public you wouldn't find too many who support the use of forced ECT. Posted by: Lisa at November 11, 2008 12:49 PMJohn Grohol, Sherry, I second what you said: "You have NO way of knowing what the circumstances of another person's life is. For me to have forced treatment of any kind would be such a replication of my childhood abuse it would definitely precipitate my death. My spirit could not endure another episode of bodily invasion, which is what any kind of forced treatment is. I would literally rather DIE that endure ANY form of forced treatment..." Posted by: Lisa at November 11, 2008 01:12 PMneuroskeptic said... Hi Cthulhu, I liked what you wrote here : I wish that when such people think they have a solid argument against a large body of science they would first think "hang on this argument is quite simple, it's not believable that scientists haven't already thought of it. Perhaps this argument is actually my own misconception" That's an excellent point - most objections to accepted science are so simplistic that the experts would really have to be idiots not to have already thought about them. This is the problem though - many many people seem to think that anyone who claims to be an expert, is either a fool or a knave (or both.) You can tell these people by the fact that they refer to "so-called experts" or "experts" (in quotes.) It's bloody infuriating and it happens all the time. As you say, if you try to argue with such people they can become quite irate. I think it's because they see the non-existence of experts as almost a political issue. They don't want anyone telling them what to think! It's a bit juvenile, but it matters a lot to them. 01 November 2008 08:50 I've visited the blog. I've searched for the skepticism but it's not there. Posted by: Ana at November 11, 2008 02:07 PMFor crying out loud Sherry, condescending to thank John Grohol for his remarkable honesty? That might seem less remarkable once you learn the difference btwn a psychologist and psychiatrist, including the longstanding mutual hostilities between the two disciplines. Christ. Hey Philip, I've been away for a few, due to a massive mental crash. When I came back, the first blog post on my dash was Dr. John Grohol of PsychCentral. He wrote about the heinous forced "treatment" of a mentally ill patient. The sole response he got was from a certain "drjean", who stated this all could have been avoided, had an advance directive been in place. I hope you don't mind me copying and pasting my reply:
I live with a primary MH diagnoses of Bipolar II Disorder. I cannot tell you exactly when, but around the turn of the century, I started being hospitalized for suicidal depressions. The doctors told my best friend and boyfriend that I was hopeless, that it was just a matter of time before I killed myself. Around the third stay within a year or so, I agreed to ECT. My friends and boyfriend tried to talk me out of it, knowing in my healthy mind I am against it. I don't remember much of this. In fact, after over twenty-two "treatments", I cannot remember but slivers of the years 1999-2002. My friend would bring me in for the shock, point out that I was still slicing my wrists open and they'd smile and shock me again. I do recall enjoying the guy holding up the knock-out needle and smiling, saying, "Small prick." I loved being knocked out because I was in such bad shape. But I don't remember those years. I watched as 9/11 unfolded, but I don't remember it at all. Some might say that's a blessing, but it's not. Imagine, if you will, a random three years of your life were wiped out. I'm not even talking about the recovery time. Where my best friend watched the same documentaries that I picked, four or five times before a glimmer of recognition came to me. The crosswords I struggled with. The slowing of my brain that used to be photographic in memory. This is the end of the second year that I have not spent at least two months on a psych ward. I cannot credit ECT with this, whatsoever. In fact, it might have happened sooner, had it not been for my brain damage. I had to spend down all my savings to go on SSDI, a state of living which is not helped by the majority of public servants. I would like to thank Phylis Hilly of The PA Advocacy For Workers With Disabilities. Over the last decade, she has shone with her kindness. But about that advance directive that drjean posits. I didn't know how quickly I would crash and lose everything. As a single, successful female, I never imagined the position I found myself in. Maybe the good drjean cannot, either. My best friend ended up being a "rep payee" for my SSDI check, in case I was in hospital. I also gave her my Medical Power of Attorney a few years back. Turns out the MPA does not apply to mental health. How do I know? I was in a psyche ward for three months December 2006-February 2007, receiving treatment my friend thought was detrimental. They laughed at her. We now have to find a lawyer to draw up separate MHMPA. Maybe drjean might like to recommend one. My mind is part of my body. Why the hell is it not included in a Medical Power of Attorney? drjean? Posted by: Dano MacNamarrah at November 11, 2008 04:30 PMNeuroskeptic said: "Francesca Allen : yes there are risks of abuse yes, but there are risks of abuse whenever anyone has any power over anyone. There is police abuse, parent abuse, doctor abuse - and it's all wrong, but that doesn't mean we should have no police or parents." Police and parents aren't authorized by law to perform invasive and dangerous medical procedures without consent. Psychiatrists are. Posted by: Francesca Allan at November 11, 2008 04:47 PMThe very few forced ECT cases I have personally heard about (they are vastly outnumbered by the voluntary, indeed the desperately so) involved catatonic patients who were unable to express an opinion one way or another. If someone is catatonic and therefore mute and neither eating nor drinking, and they have had ECT in the past with complete recovery, is that not a rationale for proceeding without consent (although with an appropriate court order)? Would you let your loved one die of malnutrition rather than receive the ECT that helped him or her before? (It sounds like this does not describe the Minnesota case, though, which I haven't studied in detail). arspsychiatrica.blogspot.com Posted by: Novalis at November 11, 2008 05:51 PMflawed plan, "Psychiatric diagnoses including and especially catatonia are figments of the imagination of psychiatrists. Catatonia whatever else it might mean implies resistance. Can resistance be overcome by torture? Obviously." -John Friedberg, M.D. "Resistance" - to what? Well, to having one's feelings, thoughts, perceptions etc. denied. To being categorized, dehumanized, discriminated against, oppressed, invaded and trampled on. To being abused and betrayed. To being locked up, put in restraints and/or seclusion, and forcibly drugged and/or brain-zapped. For example. Interestingly, I've never heard of anyone entering a state of life-threatening "catatonia", who didn't respond to the simple presence of an understanding soul, as for instance in context with humane alternatives to mainstream psychiatry. The Norwegian human rights activist and survivor Hege Orefellen says that many of the suicides of psychiatric patients are caused by the system's "own suicide-triggering mechanisms". I want to take her thought as far as to say: many of he "symptoms" of "mental illness", "catatonia" very much included, are caused by the system's own symptom-triggering mechanisms. And, btw, I've been "catatonic" myself. The empathic presence of another human being could get me out of that state. The mere thought of being subjected to any kind of psychiatric "treatment" interventions could get me into it. There's no justification, whatsoever, for involuntary treatment.
catatonia is a safe place for some ppl; one being my daughter. she can hear us, see us, yet there is a place where she is safe from (psychiatry)the world. Posted by: Stephany at November 11, 2008 09:47 PMAs a young man left to languish in one of the country's "best" psychiatric hospitals for two awful months, I had the awful experience of watching patients cycle throught the short-term inpatient ward. The ECT service blasted the patients from our unit a few scheduled days a week. Being on a short term unit that long, gave me a unique position to watch it's gross effects on people and compare them to others. Universally, the ECT patients in my single experience at this hospital were sadly the most desperate. They were often people so desperate or despairing, they would try anything. In these situations, informed consent counts for little for obvious reasons, but on a positive note, as far as I could tell all the patients submitted voluntarily (private hospital + legal = money). At the time two years ago, I was pretty naive and knew relatively little about it's effects. So I almost found it amusing in a wrong and naive way that they would come up in wheelchairs and be seated, staring at the wall, or into space, and unable to speak. They were delirious. Towards the end of my stay I became very upset every time I saw this because there is something so surreal in this age (2006) to watch medical professionals care for a person whose brain they just electrocuted and to realize how little we know about ECT, how obviously dangerous it is, and how its effects have been minimized even to this day. I watched many people come in and out of the hospital and several told me outright it didnt help. Others said the first couple helped, but then stopped. Some werent sure at all. I can assume that those for who the treatment worked did not return to the hospital. But I happened upon a few of those people who did too. So my overall impression is consistent with what I imagine electrocuting someone's brain and praying for the best might result in. I don't mean to upset anyone who has had ECT. I hope it worked or is working and I believe there should be nothing bad to say about it when it works to someone's liking in a situation of their own volition. I believe the psychiatrists comments about consent being a luxury are absolutely vulgar, and it is clear he has little respect for other's human-rights. Frankly, I don't mean this in a loud or confrontational way, but frankly, this man should be fired from any position involved with caring for the indigent. Say what you want, there are plenty of other more principled people caring for the sick. ECT causes petichiae hemmorhages in the brain. Causes long term memory loss. Causes diff'nt types of aphasia. And must be continued for maintenance bc its relapse rate is extrordinarily high. My own thinking is that considering the obvious problem of relapse, psychiatrists have not dispensed with the treatment because there is a professional compulsion, to use a generally barbaric treatment like ECT, a relic of the past, in a modern setting, completely sanctioned by the profession and the public. Are you asking if I think as a collective group, many prominent psychiatrists comprise an organizational attitude of sadism? Yes, I am. And having spent several months languishing in a state hospital, with a forced-medication order pending; I can only say to Neuroskeptic that he might never know enough to honor the basic human right to not have your body violated. There, the polemics are done. I pray for Mr. Sanford. Ahem - Although I said I wasn't going to comment on Mr Sandford, someone has brought it to my attention that Victory House, his residence, is a home for Alzheimer's patients. Take that as you will. Posted by: Neuroskeptic at November 12, 2008 03:00 AMI just posted on the earlier piece on ECT. In a nutshell, forcing ECT or ANYTHING on someone is wrong. I don't care what it is, whether it's ECT or anything else. If anything I have learned from this case, and all the letter writing I have done,, is simply this. Advanced directive. I had ECT forced on my in Dec 2002. My last hospitalization I had it down in print. NO ECT! NO ECT! The pdoc wanted to give me another round of it. I was so glad I had it written, or (shudder). The only good thing is my next of kin saw what damage it did to my brain and my soul- and wouldn't allow it. Lot of passion here in the comments. It's wonderful, yet it saddens me that so many have had the same experience I did with ECT. Let's hope this procedure goes away and is relegated to a footnote in psychology text books. Posted by: susan at November 12, 2008 03:18 AMNovalis, When people attacked you earlier this year on this blog, I was horrified and felt you didn't deserve it. I hate to say this but based on comments I have seen from you on other blogs and the one you wrote about this issue, I am beginning to understand why people were so angry. Anyway, how did we get from someone not drinking and eating to forced ECT? Not that I know anything but isn't the next step a feeding tube when that happens? Not that that is a wonderful option but it sure seems less drastic than zapping someone's brian. I know Philip asked for justifications of ECT but for some reason, your post just rubbed me the wrong way. Maybe if I hadn't read other posts you have written, I would feel differently. Anyway, thank god for professionals like John Grohol, who see this for what it is. I don't always agree with him but I just don't detect the arrogance that I see with professionals like you. Posted by: AA at November 12, 2008 04:04 AM@ Jono I don’t think this is correct. Under UK law ECT can be given without consent to a detained patient but only after they have been seen by a S12 approved Psychiatrist and an ASW (approved social worker). It can also be given without consent if it is being given as an emergency treatment under S62 of the MHA although the number of treatments that can be given under these powers is limited. However practice does vary between hospitals as the MHA also prohibits treatment without consent that is considered to be “high risk” (hence psycho surgery is not possible without informed consent) and some hospitals put ECT in the same category as psychosurgery. (Presumably they would not give it under S62 either for the same reason) @ Sally T Not everyone who receives ECT is damaged by it, in fact some people swear by it, does this change your opinion on it’s validity as a treatment option? @ Matt “Depression is nothing more than the accumulation of problems that a person has been set during their lives, and has never succeeded in solving…… if one accepts that my analysis is correct, ECT is never going to solve anything, other than accidentally.” Two points few treatments for any condition but especially depression have a 100% success rate the question is how good is good enough. Also I am not sure if I accept your premise that depression has a solely psychological cause @ Marian There are those who would say that they owe their lives to having been detained and treated against their will. What would you say to such people who might not now be alive if it were not for involuntary treatment? Marian, I agree with what you said about catatonia. My medical records state that I was catatonic - this was during my first experience with psychiatric care, I was put inpatient thanks to a therapist (who has since lost his license to practice), and I was so terrified I couldn't speak. Good thing they didn't decide to zap me with ECT to help me out of my catatonic state. Posted by: Lisa at November 12, 2008 07:37 AMNovalis said, "If someone is catatonic and therefore mute and neither eating nor drinking, and they have had ECT in the past with complete recovery, is that not a rationale for proceeding without consent (although with an appropriate court order)?" If they had "complete recovery" then why are they back needing more & more ECT? Apparently it wasn't a "complete recovery." Wasn't the woman who was in a New York state hospital & fighting against her forced ECT given ECT over & over & over yet she was STILL living in a state hospital. Doesn't sound like it was real effective to me. Posted by: Lisa at November 12, 2008 08:15 AME: "There are those who would say that they owe their lives to having been detained and treated against their will. What would you say to such people who might not now be alive if it were not for involuntary treatment?" I'd say to these people, that it is unlikely that their "madness" (i.e. their despair, terror and the resulting resistance) ever had reached a point where their lives were in danger if they'd been offered humane, i.e. non-psychiatric, treatment, and that, even if their "madness" had reached such a point, humane treatment very well could have saved their lives - without having the disabling effects psychiatric "treatment" usually has. Mary Barnes and Cathrine Penney are examples to prove this. Posted by: Marian at November 12, 2008 10:46 AMNeuroskeptic wrote: LOL. I don't will anything, particularly. However, if we're to speculate on the connection between his treatment under coercion, and his status as (presumably), diagnosed with Alzheimer's, then we should be clear on the research that has been conducted into the success of ECT, in relation to this condition. Naturally enough, his memory loss may be put down to his condition, and we can all sleep easy in our beds. Praise the Lord! Matt Posted by: Matthew Holford at November 12, 2008 04:02 PMMarian, E wrote: Erm, you've missed the point I was making, so *your* first point is redundant. Allow me to elaborate: *something* permits people to feel better, occasionally, with each of the treatments mentioned, BUT the treatments themselves are not the explanation, because if they were, then everybody would be getting better with each of them. Is anybody interested in establishing which element of these treatments it is that allows a person to feel better? Or should we continue to adopt the scattergun approach?.. Good thinking: I'll get some shrapnel. I really don't care whether or not you agree with my analysis of mental illness as being solely grounded in learned behaviour, to be honest. Although I would point out that your lack of agreement is, in and of itself, learned behaviour (because you've chosen to contradict, rather than establish how I have established my belief, to see if it is valid). Matt Posted by: Matthew Holford at November 12, 2008 04:10 PMI've got an analogy, because taking the keys away from someone who is drunk doesn't work. There's no downside for the drunk. Therein lies the logical flaw. Therein lies the reason you don't need to get informed consent to take away the keys. In fact, this analogy exposes an incredibly unsophisticated, simplistic and insensitive understanding of these issues. Instead, take away the drunk's car and force him against his will to ride a bicycle down a steep hill to get home instead. Without a helmet. Then claim success because he didn't crash his car. Oh well. That little matter of the brain damage from the fall is just the price you pay for success. Oh, and don't forget to require him to be grateful for the intervention on his behalf. One must never forget that with psychiatrists or one will pay dearly for the oversight. Posted by: Torrie at November 12, 2008 04:15 PMI've got an analogy, because taking the keys away from someone who is drunk doesn't work. There's no downside for the drunk. Therein lies the logical flaw. Therein lies the reason you don't need to get informed consent to take away the keys. In fact, this analogy exposes an incredibly unsophisticated, simplistic and insensitive understanding of these issues. Instead, take away the drunk's car and force him against his will to ride a bicycle down a steep hill to get home instead. Without a helmet. Then claim success because he didn't crash his car. Oh well. That little matter of the brain damage from the fall is just the price you pay for success. Oh, and don't forget to require him to be grateful for the intervention on his behalf. One must never forget that with psychiatrists or one will pay dearly for the oversight. Posted by: Torrie at November 12, 2008 04:15 PMCatatonia is a common component of dissociation in people with PTSD. You simply wait until they come out of it. They always do. Can't eat or drink? Well, I don't see them doing ECT on coma patients. In my opinion, most ECT occurs not for "treatment" reasons but for financial reasons. It *does* get those pesky helpless patients out of the hospital faaaassst, saving on insurance and/or uncovered stints. I've seen it way too often. Insurance running out? Too bad off for us to dump you out on the sidewalk (the first choice)? ECT is the solution. The local hospital I used to go to got turned into an ECT mill for a time by a Phillipina psychiatrist. It was horrible. She "recommended" ECT to me after a twenty-minute interview. I escaped ONLY because of my husband and outside therapist who managed to get me out of there. Informed consent is a joke. While people here have spoken of people grateful for forced incarceration and tx, I wonder just how many of these folks there are? Beofre you respond with "if it's only one it's worth it", may I remind you of the fact we don't know how many people have been driven to their deaths by forced "treatment". I know of one woman who committed suicide and another who died, unattended, after four days in restraints. I wouldn't treat a dog that way. Posted by: Sherry at November 12, 2008 04:26 PM@ Matt, Don’t be so defensive. "something* permits people to feel better, occasionally, with each of the treatments mentioned, BUT the treatments themselves are not the explanation, because if they were, then everybody would be getting better with each of them." Your conclusion does not follow from your premise. People react differently to treatments especially something as poorly understood as ECT so it does not follow that because people react differently and to different degrees it is not the treatment that is responsible for the improvement. I don’t know the reason for your antithesis towards psychiatric (ie physical interventions) but it’s a shame that some people here are allowing their own personal experiences of the mental health system to cloud their judgment. ECT is a controversial treatment but rather than basing your estimation of it’s effectiveness on anecdotal evidence how about looking at the broader evidence for it’s effectiveness. ECT has been shown to be clinically the most effective treatment for severe depression, and to result in improved quality of life in both the short- and long-term. After treatment, drug therapy can be continued, with some patients receiving continuation/maintenance ECT. The American Psychiatric Association and the British National Institute for Health and Clinical Excellence have concluded that the procedure does not cause brain damage in adults. McCall WV, Prudic J, Olfson M, Sackeim H (February 2006). "Health-related quality of life following ECT in a large community sample". J Affect Disord 90 (2-3): 269–74. Posted by: E at November 12, 2008 10:01 PM@ Marian “it is unlikely that their "madness" (i.e. their despair, terror and the resulting resistance) (would) ever had reached a point where their lives were in danger if they'd been offered humane, i.e. non-psychiatric, treatment, and that, even if their "madness" had reached such a point, humane treatment very well could have saved their lives - without having the disabling effects psychiatric "treatment" usually has.” That is a rather sweeping statement if I may say so. Psychiatric services may not always live up to the ideal but I don’t know of any Psychiatrist, Nurse, or Therapists who doesn’t at least try to offer a service that is both humane and effective, whether it is perceived as such is another matter. To equate “inhumane” with “mainstream psychiatric treatment” is a little harsh I think. E wrote: I'd be careful where you go with that: I've been trying to understand the fucked up reality of the people who get to have their wild speculation officially recognized, but they won't explain it to me. The fact is, you can't explain to me how it is that ECT "works". If you could, you would. The best you can do is say "well, it works some of the time, and the fact that it doesn't work with everybody is to be expected, and the fact that it causes a lot of patients discomfort isn't a good reason for discarding it." I'll tell you why I don't like psychiatry: it was used as a tool to intimidate me. That's why. And psychiatrists are as unwilling to sit and explain their shit theories to me, as the people who chose to try to intimidate me. They have that in common, and they are both as stupid as one another. *Everybody's" judgments are flavoured by their experiences: you patronizing tone towards me is one borne of a superiority complex, I imagine. I'd shed that, if I were you. Matt Posted by: Matthew Holford at November 13, 2008 01:04 AME said: "ECT has been shown to be clinically the most effective treatment for severe depression" PROVE IT. ASK RAY SANDFORD WHO IS RECEIVING FORCED ELECTROSHOCKING OF HIS BRAIN AND CALLS IT HELL. Posted by: Stephany at November 13, 2008 05:43 AME, Sorry, you're wrong. You've fallen into one of the common traps that folks who are in favor of forced treatment (for other people of course sub humans with less judgment than you - your real flaw is the inability to see folks with psych labels as fully human so of course your opinions do make you harmful and morally repugnant). That trap is using some bogus journal article to prove your point. It's hard to believe that the APA could simply be wrong, but they are. Posted by: Sally at November 13, 2008 05:48 AMDear E: Let's start with your premise that ECT does not cause brain damage! You have the actually gall to reference the APA (The American Politically Association, and the British National Institute for Un-Health as your reliable sources of information). So logically the more ECT that a person receives, with factoring in the amount of electrical charge sent through the brain tissue, and the number of times applied would equal a certain measure of brain tissue damage). In fact your stating arguments that really don’t exist, since the studies of ECT brain effect and memory loss are so limited in scope and the science so tainted, that we really don’t have much data on the amount of permanent damage this form of treatment actually causes even after decade of use! We do know that countless patients that have received such treatments have suffered significant memory loss both in short and long term function. That’s unless you are going to sit at your keyboard and deny the numerous stories and those that have experienced this primitive and inhumane treatment, as have been reported on this blog, and in clinical data reported by John Grohol. “Up until 2007, no large-scale study was even ever conducted on the cognitive deficits concern (despite ECT being a treatment available for nearly seven decades!). The study conducted in 2007 (Sackeim et al.) found -- surprise, surprise:” "At both the short- and long-term time points, patients treated with BL ECT (the most common form of ECT administered) had greater amnesia for autobiographical events, and the extent of this amnesia was directly related to the number of BL ECT treatments received." “So yes, you might survive the depression, but at what cost? The loss of a part of your identity -- the memory of autobiographical events.” Quote from you, E: “ECT is a controversial treatment but rather than basing your estimation of it’s effectiveness on anecdotal evidence how about looking at the broader evidence for it’s effectiveness.” You have evidence? Considering the limited scope of the studies it must be quite deficient in deed, as is your argument! I believe you used the word controversial because you cannot sit here and tell anyone us exactly how ECT affects the brain and what the outcome will be in each and every case. That information is unobtainable at this time, because they just don’t know. They were so damned right; it was effective in behavior changes for those poor victims that were subjected to it. I guess you stand on shaky science because you have some sort of professional or intellectual stake in the game. But I will remind you that we are talking about real people that should have the constitutional right of self determination whatever the treatment is. You are making an argument out of thin air for ECT because it suits your agenda. If you choose to go fry your brain with ECT; then that is your personal choice! I say you should definitely go for it. You will in all likelihood forget you ever uttered a word here. But you or anyone else has the right to play God and force an unproven and in your own words Controversial treatment on any other human being; especially just because they have a mental health label placed on them by some doctor that really has no idea what effects the treatment outcome maybe. That’s paramount to throwing darts in the dark with people’s lives. No One, even if you have a thousand PhD’s or Dr. Labels in front of your name has that right to infringe on free will and choice. Psychiatry has lost its way, it has lost its moral compass, its ethical marking post; and corruption and greed have replaced those time honored values. I personally would question each and everything that comes out of any and all psychiatric circles. Because we know now without any doubt that the Studies are tainted with greed and mongering, the data skewed beyond repair and quite questionable and limited in scope, and the very criteria used as the so called psychiatric bible is so mired in investment pandering that it’s a completely unusable and worthless diagnostic tool. So where does that leave us? Today is not much different than where we were a hundred years ago, and even five hundred years ago. If you were to remove the massive ego that runs psychiatry, there would be nothing left but pure clean air and patient’s that actually might find a better way through other means yet to be explored because psychiatry and pharmaceutical companies have brain washed and lied to the general population and quashed all other alternative that doesn’t bring them in billions of dollars. That is the real issue here in the end, chew on that for a while and then come back with your standard response of your just another anti-psychiatry person; without ever wonder why someone would have these issues with this so called profession. If nothing rings true to you in this comment today, this will. Power corrupts, absolute power corrupts absolutely! Psychiatry has done this to themselves, it’s high time they starting paying a price for all their greed, egocentric attitudes, and bad science. I can only imagine what taking me by force to have ECT would have done to help me with my depression. The process of forcibly strapping me down would have felt very therapeutic. Maybe they should do clinical trials that focus on the use of ECT to help wipe out the memories of inpatient treatment. Susan, I can't even imagine the "choice" between ECT or a state hospital. Some choice. Yes, Sherry, the informed consent process is a joke. After I told my shrink I did not want ECT because of the risk of permanent memory loss & that there's no way to undo "permanent" he proceeded to tell me how "it's not like the movies," & all this negative info is put out by the scientologists, etc. I said, "So you are telling me there is not a risk of permanent memory loss?" He finally admitted that yes there was a risk but that with everything there's a risk, and so on. I told him yet again that I did not want to take that risk. I thought the matter was closed, oh I had so much to learn. Later, he asked to talk with my mom to update her on my situation & I agreed not realizing that he was going to start in on her about my need for ECT. When my mom mentioned ECT to me that was the last time I gave permission for the shrink to speak to my mom. It has been several years since I've seen the psychiatrist. I talked to my mom yesterday & asked if she remembered the psychiatrist telling her I needed ECT & she said yes. I said, "Aren't you glad I didn't do it?" She said, "I'm really glad you got away from him." ECT should never be forced. I continue to be glad I didn't have it. Posted by: Lisa at November 13, 2008 08:23 AMWow, where does one start! As stated previously, ECT is a BILLION dollar a year industry. People get rich and have made names for themselves by calling brain damage an improvement of depression. Harold Sackiem, Max Fink and even David Healy now has gotten into the picture to get himself back into the "good old boys club". After head injuries from accidents, people go through a period of euphoria. That is a stage of a brain injury. That is exactly what is occurring with ECT. Surely you would not call this an improvement in the quality of someones life? Surely if a depressed person had a car accident and became euphoric the doctor would not advise his patient to go out and have another car accident once the euphoria wears off. The doctors would not dismiss the accidents victims memory issues, aphasia, time and place disorientation, etc as being from depression. They would have the patient evaluated for a head injury. Brain injury evaluations do not occur after ECT. All the symptoms are blamed on the persons depression and not on the brain injury sustained from ECT. It is disgusting how science is allowed to misrepresent the truth of what is occurring. There is a reason why neuropsychological tests are not given before and after ECT. There is a reason why certain tests are used in clinical trials of ECT. Lets not find out what really is occurring with ECT and call it an improvement. The comment about drug therapy "can be continued" after treatment is bullshit as it insinuates people were able to stop their medications because ECT was successful.I have read literally thousands of personal accounts of patients having ECT and very few if any stopped their medications. In fact, just the opposite occurs, medications dosages are increased, or changed or both. Which indicate right there that ECT is not working. But doctors convince their patients they are actually being helped. I know a woman who has been having ECT once a month for 6 years. She is convinced ECT is helping her. She has lost her job because she can't remember how to do her job, she is unable to relearn how to do her job, she can barely read and write, is aphasic, continually gets lost when she goes out alone, her doctors have changed her medications continually, and this year alone she has been hospitalized three times because of suicidal thoughts. The last time was last week after her ECT treatment. Yet her doctors have convinced her ECT has improved her quality of life and she is no longer as depressed as she was. Anything her friends and family have to say is meaningless. Her memory is so bad she doesn't even know she can't remember day to day. Because she has nothing bad to say about ECT doctors and researcher use stories like hers as success with ECT to make their claims about how successful ECT is. Give me a fucking break! "The American Psychiatric Association and the British National Institute for Health and Clinical Excellence have concluded that the procedure does not cause brain damage in adults" are you serious? Posted by: Jane at November 13, 2008 08:27 AME, you said "I don’t know of any Psychiatrist, Nurse, or Therapists who doesn’t at least try to offer a service that is both humane and effective" Hello??? How do you explain the numerous sexually (and otherwise) abusive *ssholes who've lost their licenses? Or do you live in some sort of alternative universe that allows you to make such ludicrous sweeping statements with a straight face? Do you think that profession--which attracts so many people interested in having power over other human beings--is immune to having sociopaths and narcissists in its ranks? You truly amaze me. And not in a good sort of way, I assure you. Posted by: Sherry at November 13, 2008 09:29 AM@ Matt and others, No one here is trying to intimidate or patronise you but your threatening and aggressive manner does not support your argument in any way. And yes if I could explain how ECT works I would but as you say I cant. But there is good empirical evidence that says it does work for some people some of the time and that is I think a good enough reason for it’s continued use. (Why is the article I cited supporting it’s effectiveness bogus BTW) Relying on anecdotal evidence that it harms some people some of the time is not a good enough reason to ban it’s use because I can provide anecdotal evidence that it is effective (see http://www.shockmd.com/2007/10/31/video-of-lecture-on-electroconvulsive-therapy-ect ) . I can also give you anecdotal evidence that there are people out there that are grateful (you may not be one of them) for the forcible intervention that psychiatric services have made into their lives. These are people who honestly believe that they have an illness, a treatable illness, and that if doctors and nurses had not intervened in their lives they would not be alive to tell the tale. BTW because ECT is a controversial treatment that can have serious and profound psychological not to mention neurological side effects I would not be in favour of it’s forcible administration where informed consent is being withheld (AS is the case with psycho surgery) Advance directives (as they are called in the UK), which are legally enforceable (not currently the case at the moment although it is considered bad practice not to take them into account) would seem to be the way here. I have provided evidence that ECT is an effective and reasonably safe form of treatment this position is backed up by NICE and the APA. To the other contributors here I am sorry you have such a low opinion of your own APA but NICE (National Institute of Clinical Excellence) has no particular axe to grind for or against ECT (why should they) and I have no reason to suspect they would knowingly advocate a treatment they know to be unsafe and ineffective. I am perfectly aware that we are talking about real people. My own mother received ECT many years ago. The results were not spectacular and the memory loss she suffered was transient, she was not left cognitively impaired as a result. She went on and in time made a full recovery using a combination of drugs and talking therapy. She did have further relapses of her depressive condition but elected not to receive ECT again and her physicians respected those wishes. These are not rambling words of propaganda, but hyperbole like accusing mental health services as viewing patients as somehow subhuman do your arguments a disservice. Posted by: E at November 13, 2008 09:46 AME: "Psychiatric services may not always live up to the ideal but I don’t know of any Psychiatrist, Nurse, or Therapists who doesn’t at least try to offer a service that is both humane and effective, whether it is perceived as such is another matter." 1. I'm sorry having to say it, but the majority of mental health professionals I know, unfortunately only and solely offers medical "treatment" for non-medical problems. While they do everything in their power (and their power unfortunately is almost unlimited) to suppress any information about alternatives that not only are less damaging to the "patient", but may even be healthy. Whether they do this because they fear for the psychiatric branch of medicine to be exposed a fraud, and thus fear for their jobs, because practicing alternatives doesn't feed their power-tripping, narcissistic ego sufficiently, or for whatever reason, the consequences are mostly devastating. To call that "humane" and "effective" seems a little hypocritical to me. 2. To question and devalue the perception of an individual, whose perception accidentally doesn't fit the current dogma, is totalitarian tactics. And the well-known tactics of psychiatry. Congrats to mastering these tactics to the letter! Posted by: Marian at November 13, 2008 10:33 AMStan- You Rock. Truly. Posted by: susan at November 13, 2008 10:47 AManonymous said... I have major depression since I was 15 (it's been twelve years now). Tried every category of antidepressant, sometimes every single one in the same category, with almost no success. Recently, something bizarre happenned... My new psychiatrist prescribed me TMS, and as I returned to see him feeling even worst he got *pissed off* (yeah, he got pissed off at me because I, severe major depression for over a decade, was crying helplessly) and sent me directly to ECT. Even after I told him I would not do ECT, that I'd rather keep on TMS until we had a more conclusive outcome (he said there could not be any good done with only two sessions), he just ignored me and told my husband to talk to my family to get consent for the treatment. I freaked out. He is a well known researcher but when I told him my symptoms, he actually laughed at me, in front of my husband, and made fun of what I was feeling, saying he never heard in 'all history of psychiatry' such awkward symptoms and that he could not help me with that, I would need a psychologist and better go to ECT, since I didnt believe in TMS and for some reason for which, seemlingly, I am the only one to blame, no antidepressant, nor antipsychotics, nor anticonvulsivants, nor all of them altogether did me no good. I was sentenced to ECT against my own will and I will never forget that. Luckly, my husband is already convinced we will never do ECT. However, after being discredited by a Phd in front of my husband, I feel like he, my beloved one and main support, obviously doubts all my symptoms. I know he loves me, but he wont take me seriously, at least not on that manner, that's for sure. He would never do me any harm, but I just wanted him to know that all this is real, it is not just something my mind made up to backup a shameful seek attention behavior. I suffer. I am in pain. I am exhausted. Cant take it anymore. Meanwhile, knowing that this so 'qualified' psychiatrist was mad at me for being such a 'bad, bad girl' scared the hell out of my father, which 'convinced' me to call him back and, in a nice and very polite manner, say I was sorry and beg him to not refuse to treat me. He was, then, very pleased with my 'improvement' and increased my MAOI dosage. And, of course, last thing he heard from me was that I was feeling *great*. For sure, I dont want to be sentenced to shock treatment again... I've been through a lot because of my mental illness. But never thought I'd fear my own doctor. Now, I am doing a research on my own, trying to earn back my husband's confidence so he'll help me decide, because I want to quit with my medication. It wont be easy, I tried it a few months ago and it was excruciating, this psychiatrist suspended most of my medication really abruptly and I could not deal with the withdrawl symptoms (which I was not aware were really really withdrawl symptoms, but my illness coming back, what meant, of course, that I do need those medications), so I had to get back on the meds. I know it wont be easy, but I want to know if it is POSSIBLE. It is nice to read your last statement: there is nothing you can say, except that you care. Thank you for those lines of support. August 21, 2008 6:37 PM This comment was left on my blog. I think that patients are needed to be heard. Posted by: Ana at November 13, 2008 11:11 AM@ Marian "To question and devalue the perception of an individual, whose perception accidentally doesn't fit the current dogma, is totalitarian tactics. And the well-known tactics of psychiatry. Congrats to mastering these tactics to the letter!" I would question your perception of psychiatry as power-tripping and narcissistic certainly, but how exactly does disagreeing with your point of view devalue you personally? That certainly was not my intention. If I had so little regard for your views I would not bother to debate the issue with you at all. Posted by: E at November 13, 2008 01:22 PME wrote: I did not suggest that anybody here was trying to intimidate me, not that they would have any success, if they tried. You'll forgive my being blunt, I imagine, but I take your tone to be patronizing, not least because you are telling me about my own experience: you are telling me that I am threatening, and aggressive, which is your perception, and not a reality (do you see how easy it is to learn behaviour - a person takes the polar opposite position from you, and you assume them to be aggressive?). You've suggested, here, that anecdotal evidence of harm from ECT is not to be leant significant weight, and then proceed to recount the success of the treatment, from your own experience. *Your* anecdotal evidence, by your own measure, is without significance, too. In any event, I have made no argument, and I have made no argument, because I see little value in it: you are determined that ECT is valuable, in some sense, not least because it is supported by experts, I think. I think ECT is a waste of time - if it has any level of success, it is a fluke, and probably transient. There appears to be no ground for agreement, between the two of us, so let's not waste one another's time. Matt Posted by: Matthew Holford at November 13, 2008 01:32 PME, re-read this carefully: "Psychiatric services may not always live up to the ideal but I don’t know of any Psychiatrist, Nurse, or Therapists who doesn’t at least try to offer a service that is both humane and effective, WHETHER IT IS PERCEIVED AS SUCH IS ANOTHER MATTER."
Fact is, that the concept of anosognosia in itself is a means created to devalue an individuals perception - as disturbed by an alleged brain disease. The same applies to by and large all psychiatric symptom- and diagnosis-concepts. Posted by: Marian at November 13, 2008 02:12 PME wrote: "I don’t know of any Psychiatrist, Nurse, or Therapists who doesn’t at least try to offer a service that is both humane and effective" See, it doesn't matter. The expectation in this statement is that we concern ourselves with the fact that they are *trying* to deliver service that is human and effective rather than whether services are *actually* humane and effective to those receiving them. Your emphasis is on the wrong parties, which is a huge part of the problem. It sounds like you think if they are *trying,* then services can't truly be inhumane and useless because what's really important is the intention not the outcome. This means what's really important is the experience of the professionals rather than the experience of the patients. This expectation is simply one small part of the larger, often inhumane and disrespectful, picture. Posted by: Torrie at November 13, 2008 04:40 PM@ Torrie Ok let me firm that up for you; I don’t know of any Psychiatrist, Nurse, or Therapists who doesn’t at least try to offer a service that is both humane and effective and by and large they mostly succeed in doing so. This may not be your experience but it is the experience of many other service users, at least in the UK. @ Matt “not least because you are telling me about my own experience: you are telling me that I am threatening, and aggressive, which is your perception, and not a reality” I am telling you nothing about your experiences, your experiences are just that, your experiences and my experiences are my experiences. But why is it when we are talking about our perception of reality your perception is not to be questioned (and any attempt to do so it is met with such a visceral reaction) but at the same time you feel permitted to write off my perception as “not a reality”? (My perceptions are my reality and just as valid as yours). The difference between us is that I am prepared to back my arguments up with some objective evidence not based solely on what I have seen or heard with my own ears and eyes. I am sorry if you find this offensive but I do find your tone threatening and aggressive (not that I am threatened by it either BTW) . E wrote: OK, for the third and last time: you have told me what my behaviour amounts to, when only I have any right to make that analysis, according to my own approach. You have told me that I am being "visceral," "threatening" and "aggressive." I would point out that I have not attacked you personally on any occasion. I have merely stated my position, and noted that it contradicts yours; that you seem wed to your position; and that there is no common ground between us. I have said that bluntly and succinctly, but I see nothing untoward in that. That's all I've said. If you wish to interpret that as aggressive, etc, then please yourself. I don't really care, one way or the other, because no discussion with you is going to change how I've been treated, how Ray Sandford has been treated, nor, indeed, how anybody else has been treated by this system. On which note, I feel compelled to note that I don't see much of any kind of system, at all. And, now, I must bid you "adieu." Matt Posted by: Matthew Holford at November 14, 2008 06:30 AME said, "ECT is a safe and effective treatment for people and for that reason alone should remain an option for those who want it." E, the topic is FORCED ect. If people want to accept the risks that come with having ECT, then I think that's their right. Obviously Mr. Sandford doesn't want it. Why doesn't his voice matter? Posted by: Lisa at November 14, 2008 10:21 AMDear E: Threat topic: Forced ECT Your own statement: "BTW because ECT is a controversial treatment that can have serious and profound psychological not to mention neurological side effects I would not be in favor of its forcible administration where informed consent is being withheld (AS is the case with psycho surgery) Advance directives (as they are called in the UK), which are legally enforceable (not currently the case at the moment although it is considered bad practice not to take them into account) would seem to be the way here." Forced ECT without consent was the topic and issue in discussion on this particular threat; your advocacy for or against someone using or not using ECT is a mute point now, and your own personal choice! You appear to be making your same argument over and over again anywise. I for one have stopped listening as of now. Yours truly, @Matt and others, “E, the topic is FORCED ect. If people want to accept the risks that come with having ECT, then I think that's their right. Obviously Mr. Sandford doesn't want it. Why doesn't his voice matter?” Of course Mr Sandford’s voice matters, where have I said it does not? Your argument against forced ECT (it really is not necessary to shout) appears to be based on the argument that ECT is not effective or safe. And should not be used period. It is that assertion I am taking issue against. The evidence, while acknowledging that there are risks associated with ECT, would indicate that it is both safe and effective. “you have told me what my behaviour amounts to, when only I have any right to make that analysis, according to my own approach” Excuse me Matt but comments like “I'd be careful where you go with that:” And “you patronizing tone towards me is one borne of a superiority complex, I imagine. I'd shed that, if I were you.” have an aggressive and threatening tone to them. I am not telling you what your behavior amounts to only how it impacts on me. There is a strong anti-psychiatry flavor to the comments here, which is a shame because it is blinding some of you to the good that mental health services can and very often do do. But I am obviously not going to convince anyone here of that so finally can anyone tell me why I should distrust the advice given by NICE and why they would knowingly endorse a treatment they know to be dangerous and ineffective which seems to be the main thrust against the guidance they offer. What possible reason would anyone have for advocating ECT as a treatment other than for honorable reasons? It’s not like there is an evil cabal of doctors being paid millions by corrupt drug companies to promote a treatment they know does not work. Posted by: E at November 15, 2008 06:44 AMOh, here we go again. If you don't think like I do, then you must be anti-pschiatry. Give it a rest. I have already said if people want ECT, then they should have it. What I am opposed to are psychiatrists who minimize the risks (like you are doing & like my own psychiatrist did) and/or force people to have ECT. Posted by: Lisa at November 15, 2008 09:48 AM
Quote: "It’s not like there is an evil cabal of doctors being paid millions by corrupt drug companies to promote a treatment they know does not work." Funny you should mention and then deny what is exactly and actually happening in psychiatry and the Mental Health Industry today! Welcome to planet Earth, shall we take you to see our leader now? {Laughing} Another Quote: "There is a strong anti-psychiatry flavor to the comments here, which is a shame because it is blinding some of you to the good that mental health services can and very often do do." I believe the proper phrasing is DOO - DOO as in COW PIE. I have never hidden my strong distain for psychiatry and the mental health system as it is being propagated upon the general public today! I would only Question is why you wouldn't be questioning and doubting it (unless your vested in it?); especially with all the puritanical and substantial evidence that has come to light involving psychiatric, pharmaceutical, and academic corruption, pure greed, suspect diagnostic materials, tainted and hidden data, untold numbers of flawed studies, and the commercialization of medicine as consumer product; by so called medical professionals pushing pharmaceutical pills and other profit making treatment processes, as if they were selling soda pop, laundry detergent, or diapers. Let us not mention the unmeasured suffering and damage the medical model we are using today has caused millions upon millions of patient's, consumers, and thier families. Ignorance must be pure bliss in your world. I gather those magic pills work wonders for you(please keep taking them until your find total wellness, then it should be quite interesting to see how you do coming off them); why shouldn't they work that way for everyone? Some logic and argument you have going there for yourself. Too bad you can’t package it; so you can sell it along with an ECT treatment and spa day combo. Stan Today in the US a typical cost on of one ECT treatment is as follows: $2960 for the operating room, $400.00 for the psychiatrist to perform the procedure, and around $1000.00 for the anesthesia doctor and nurses. This is from a current statement I saw from a patient currently undergoing ECT. This is what the insurance paid. This is also private insurance and not paid by the government. It is also a pretty nice sum of money for hospitals when you consider they can do dozens of treatments a day. Don't you find it interesting there are no studies to show hospitals that preform the produre have less returning admits? That there are no studies that show that in cities that have hospitals that offer ECT having lower sucide rates? This is a billion dollar a year industry. One very good reason why NICE would knowly indorse a treatment is because they do not have all the facts. The research being done on ECT is done by just a few researchers. The key king opinion leader, Harold Sackiem, did not even research the cognitive side effects until just recently. There is a very good reason why he didn't do it until recently and that is, he has a new form of ECT, FEAST he is now pushing. He needed a reason for this new form and so he finally studied the cognitive effects and low and behold, he can now push "FEAST" as not causing these side effects. Money can be evil and money is what talks! E wrote: “I'd be careful where you go with that:” And “you patronizing tone towards me is one borne of a superiority complex, I imagine. I'd shed that, if I were you.” have an aggressive and threatening tone to them. I am not telling you what your behavior amounts to only how it impacts on me..."
Now, on the subject of you being "patronizing" toward me, consider this: you have felt it acceptable to suggest that I possess some quite unpleasant character traits (aggressive, etc). I have a couple of questions for you. First, why one earth do you imagine that you have the right to attach those labels to me? Put another way: what gives you the right to make those kind of sweeping assessments of my character? What makes you the arbiter of what any kind of behaviour amounts to? You see, it strikes me that you are speaking to me as though I were not your equal. I would urge you to reconsider that position. I am a professionally-qualified person, for what it's worth, so please bear that in mind. And finally, are you starting to understand that this is precisely what psychiatrists do, and this is precisely why people feel so badly toward that "profession"? Matt Posted by: Matthew Holford at November 15, 2008 12:20 PMJane wrote: I have to chime in and support that observation: when the Uni of Hull published that study, earlier in the year, which brought to light the issue of drug companies only publishing "successful" trials, NICE went on record as saying that it was limited in its own activities, because it had no legal right to demand *all* the studies for a given drug - it could only analyse the ones it was given (which would be positive, of course). It's difficult to conceive that things are different with ECT, which is to say that of the few studies that have been done, only the positive-looking ones are likely to have made their way through NICE's letterbox. Matt Posted by: Matthew Holford at November 15, 2008 02:52 PMFrom the Dumb Question Department: Sherry wrote: It's the "National Institute for health and Clinical Excellence," in the UK. Amongst other things, it drafts guidance to practitioners on best practice in the treatment of conditions. It also passes drugs for use on the National Health system, based upon a value-for-money formula, which gets slated, from time-to-time, on the basis that "people are being denied drugs that would save lives" (I paraphrase!): http://www.nice.org.uk/ Matt Posted by: Matthew Holford at November 15, 2008 04:20 PMFORCED ECT IS the topic. FORCED, as in NO choice, no choice, against will, and it is barbaric. Posted by: Stephany at November 15, 2008 07:11 PM@Jane Today in the US a typical cost on of one ECT treatment is as follows: $2960 for the operating room, $400.00 for the psychiatrist to perform the procedure, and around $1000.00 for the anesthesia doctor and nurses……………Doctors who perform ECT can double their yearly income with just a few hours of work. A typical ECT treatment, the part the Psychiatrist does, last no more than a few minutes, per patient. $400 for just a few minutes of work is quite appealing to some doctors. And believe it or not, does in fact influence doctors to perform the procedure. I am not aware exactly how Dr’s are paid in the US but here in the UK things are a little different. Doctors in the UK are paid a salary by the NHS (National health service) and Hospitals are paid according to a complicated system of tariffs by the PCT’s (primary care trusts) for each procedure and hospital stay carried out by the Hospitals. There is an issue with drug companies effectively bribing individual doctors with “honorea” (bribes in return for pseudo scientific papers that endorse and promote specific drugs) or by offering them free air tickets to attend academic conferences that just happen to be in favored holiday destinations in return for allegedly influencing their prescribing habits. But no one I know has an interest in promoting ECT in the same way. The patent on ECT machines ran out a long time ago.
It is possible that NICE have underestimated the risks associated with ECT but this is not the same as saying that they are knowingly promoting a treatment they know to be unsafe and ineffective which is the implication behind what you are saying. NICE issued their guidance in 2003 and the APA issued theirs in 2000 and both might be underestimating the risk of neurological damage. Certainly the paper by Sackheim (2007) indicates that the level of cognitive damage has been underestimated in the past. But NICE at least acknowledge there is a risk of cognitive damage because they advise is that ECT should only be used “when all other treatments have failed” and then preferably with informed consent. Personally I would advocate that it only be used with informed consent but that does not mean I think it should be banned all together.
“Note how,…….. I am supposed to be visceral, threatening and aggressive, Matt I am not saying you are visceral (what ever that means) I am saying your reaction is visceral; i.e. strongly held and from the gut (as in viscera) implying that it is what we call here in the UK a “knee jerk” i.e. poorly considered reaction to something. So the most I am accusing you of is not considering all the evidence before leaping prematurely to your conclusion. See how you are apt to jump to conclusions yourself, attributing motivation and attitudes like patronizing to others?
The same right you have to make similar sweeping statements about my character I would imagine.
But ECT is not being “pushed” by drug companies. (In fact if you think about it being drug companies they would have an interest in doing the exact opposite) No one (at least in the UK) has any vested or pecuniary interest in seeing ECT survive as a treatment modality. Posted by: E at November 17, 2008 02:21 AME wrote: LOL. You started it, and well done for trying to make your attitudes my responsibility. Anyway, if you don't know what "visceral" means, then I'm sure I don't - it was, after all, you who used the word, initially. So, nerrrrr. But thank you for the english lesson, anyway, I hadn't thought to use etymonline! Did you know that in Classical Antiquity, the bowels were regarded as the seat of emotion? Anyway, I didn't suggest that drug companies were pushing ECT, and how you managed to extract that from what I wrote, I have no idea - I was merely making the point (which I'm labouring, now), that NICE was operating blindfold, and I'm wondering if you deliberately misapprehended me? But there is a reason ECT's used, and if there wasn't a vested interest of some kind, then it wouldn't be, so to suggest that something that nobody supports and doesn't work is still being used, despite nobody having an interest has to be fallacious. We're told the reason is that it's effective. Ray Sandford appears not to agree, as do others, some of whom have been commenting on this thread. The "experts," then, have an interest in prescribing it. This interest may amount to nothing more than a confirmed belief that it's the best option (although they would have to ignore their patients, in order to do this, apparently). Or it might be because they're making a tidy sum from it, and are happy to delude themselves that it doesn't matter, because the patient's beyond hope, anyway. I wouldn't know, because these esteemed experts choose not to talk to me, and I have tried (The Great Genius Who is Professor Martin Keller (Brown), Boomhagel (Harvard), The Nematode (Emory), Kopulate (NYU), and so on). My ignorance, then, is not chosen by me. Anyway, let's cut to the chase: why are you commenting on this thread? Put another way, what do you hope to achieve by commenting on a blog, the readers of which seem to have views diametrically opposed to your own? Do you imagine that you will sway them? Or are you merely intent on demonstrating the absurdity of their views? Pleasant as this chit-chat is, I've lost interest in spiralling around inside your reality. Incidentally, the fewer of my questions you answer, the more trivial my responses will be. Assuming you're concerned about that, of course. Matt Posted by: Matthew Holford at November 17, 2008 05:16 AM@ Matt “But there is a reason ECT's used, and if there wasn't a vested interest of some kind, then it wouldn't be, so to suggest that something that nobody supports and doesn't work is still being used, despite nobody having an interest has to be fallacious.” I am having great difficulty following your argument Matt. When I say no one has a vested interest in prescribing ECT I mean no one in the UK at least, has a pecuniary interest in carrying out ECT (i.e. no one is being paid to use it over here) . Unlike the US, Doctors in the UK are paid a salary and have no financial incentive in carrying out ECT or any other surgical procedure. If they have an interest in prescribing ECT it is in seeing their patients get better. A difficult thing for you to accept I know but it is occasionally the case. But to cut to the chase as you say. Why am I commenting on this thread? Why do you think I am commenting on this thread? I could go and discuss the issue with like-minded people but what would any of us learn from agreeing with ourselves. Arguing with people whose views are diametrically opposed to my own forces me to re evaluate my arguments, I welcome that opportunity even if you don’t. I am not saying that I have changed my mind exactly but Jane’s comments and the references to Sackheim (2007) have pointed out to me that NICE’s advice, issued as it was in 2003, may now be a little out of date and probably needs up dating. E wrote: Small wonder: I haven't made one! May I ask how it is that you know that clinicians only prescribe ECT, in the UK, for the purpose of having their patients get better? I don't say that this is not the case, you'll note, I was just wondering if you'd had that "from the horse's mouth," or had just assumed that to be the case? You see, the vast majority of SSRIs are prescribed for mild depression, which NICE expressly states should be the last resort. Doctors aren't necessarily interested in best practice, if that example is anything to go by. In any event, as I mentioned in my previous post, I have attempted to speak to people who hold positions that are apparently at odds with my own (and, believe it or not, I was polite, initially), the MHRA was unable to maintain a discussion with me, and Keller, et al, didn't even bother to start one. Doug Bremner, a colleague of the The Nematode's is the only person who has made any attempt to speak with me. I do wonder, when people go quiet on me... It undermines the "feelgood factor," if you know what I mean. But coming back to the questions I raised in my previous comment, I imagine that it's laudable for you to be challenging yourself, in this way, but if I'm to reframe your comments, for my own understanding, do I take it that your expectation is possibly to glean some information, which you had not been in possession of, before, which might, in some indeterminate way, cause you to reevaluate (to use your word), your position? Your "objective" (I'm fond of goalsetting), is to seek information randomly, then? That's quite a vague target, if I may say so. Matt Posted by: Matthew Holford at November 17, 2008 01:35 PMLinda Ande “Doctors of Deception–What They Don’t Want You to Know about Shock Treatment” has a book coming out shortly regarding ECT. She knows more about shock than anyone on the planet. If you want to know the facts about ECT I would suggest you read this book! Posted by: jane at November 17, 2008 02:08 PMJane, Thank you for the heads up on the book- will pre order from Amazon. ECT really did a number on me, and i still have nightmares about it. Wouldn't it be great if it was outlawed and no longer used?
@ Matt "May I ask how it is that you know that clinicians only prescribe ECT, in the UK, for the purpose of having their patients get better?" What other reason would they have? As for the rest of your post sorry you have lost me. BTW NICE does not recommnd that SSRI's only be used as a last resort. They recommend them for cases of moderate to severe depression as a primary treatment. "If you have moderate depression, you
Yes. Do you have any hard evidence (apart from anecdotal evidence) that ECT is harmful? E wrote: I'm not surprised, to be honest: there's no clear pattern to this discussion. As to your question, I have no idea, because I haven't spoken to them (or rather, I have, but they wouldn't reply, as I've mentioned before). A wild guess as to an alternative might be "habit," which people get wed to all too easily, I think. As to NICE, CG23 (the depression guidance), has been updated, I see: http://www.nice.org.uk/guidance/index.jsp?action=download&o=29617 the old version most definitely did advise psychotherapy as a first thrust for mild depression. However, I see that the new version has this to say, at para 6.10.4: "Short-term psychological therapies (counselling, problem-solving therapy or CBT) are more effective and more acceptable to patients than either placebo or wait list control. There is evidence that there is no difference in efficacy between short-term psychological therapies and other treatments (mostly antidepressants and GP care), although psychological therapy appears to be more tolerable." And in the (abridged?), amended guideline http://www.nice.org.uk/nicemedia/pdf/CG23NICEguidelineamended.pdf NICE has this to say, at p8: "When patients present initially with severe depression, a combination of antidepressants and individual CBT should be considered as the combination is more cost-effective than either treatment on its own." So, it seems that NICE's position is now that no particular treatment is any better than any other (although drugs and counselling, in combo, work better than either, individually), but that there are fewer side effects with psychotherapy. Why, then, would one "normally be offered antidepressants," before psychotherapy? I'm thoroughly confused: NICE appears to be contradicting itself, in these statements. As a side point, waiting lists for psychotherapy are insupportable: a GP wishing to prescribe drugs and counselling, in combo, would not be able to do so, because of the waiting list for a counselling slot. Anyway, back to ECT, and in answer to your question "no, but then I haven't researched it, to be honest." However, I would counter with this: do you have any hard (non-anecdotal), evidence that ECT works, aside from the habitual prescribing of same by (possibly), interested clinicians? A word to the wise, E: while you said in your previous comment that you were keen to receive alternative views, in order that you might reevaluate your own, the questions you're asking appear to indicate that you're currently engaged in defending your position, which inevitably involves excluding the position that you believe I have adopted. You won't achieve anything, like that, because when you come across anything that rebuts your position (even though it might be demonstrated to be true), you will be obliged to ignore it. Ignoring inconvenient evidence that contradicts one's existing view is likely to lead to an absurd conclusion. Matt Posted by: Matthew Holford at November 18, 2008 04:52 AME wrote: Oh, just to reiterate what I wrote, before. I wrote nothing about moderate and severe depression; I wrote that the majority of SSRIs are prescribed for mild depression, and in an indirect way, you've backed me up with the quotation you chose. Incidentally, the thread is about Ray Sandford, and the ECT that he's being subjected to. Do you have a solution for him, at all? Or is it your position that he should continue to "enjoy" this coercive approach? If you are only interested in broadcasting your personal views on mental health treatments, then it is probably best that we agree that we have nothing more to discuss, because Ray Sandford is my concern, not you. Matt Posted by: Matthew Holford at November 18, 2008 08:37 AMWhat exactly would provide you with evidence? There was already a study cited that showed ECT was in fact harmful. What makes the above study meaningful is the fact it was done by the leading researcher of shock who until that article denied shock harmed people and still you do not believe harm is caused to patients. You seem to take the word of people who were helped by shocks as evidence that it works, yet you don't believe people who were harmed by shocks. Nor do you believe the leading researcher, so what evidence are you looking for? Posted by: Jane at November 18, 2008 09:21 AM@ Matt “do you have any hard (non-anecdotal), evidence that ECT works, aside from the habitual prescribing of same by (possibly), interested clinicians?” 1. ECT was shown clinically to be the most effective treatment for severe depression, and to result in improved quality of life in both short- and long-term. McCall WV, Prudic J, Olfson M, Sackeim H (February 2006). "Health-related quality of life following ECT in a large community sample". J Affect Disord 90 (2-3): 269–74. 2. The American Psychiatric Association and the British National Institute for Health and Clinical Excellence have concluded that the procedure does not cause significant brain damage in adults. 3. In the US the 1999 Surgeon General's report on mental health summarized psychiatric opinion at the time. It stated that both clinical experience and controlled trials had determined ECT to be effective in the treatment of severe depression. 4. In the UK in 2003 the UK ECT Review Group, led by Professor Geddes of Oxford University concluded that ECT had been shown to be an effective short-term treatment for depression. 5. The United States' Surgeon General's report says that the physical risks of ECT are similar to those of brief general anesthesia and that there are no absolute health contraindications to its use. 6. Both the APA and NICE have concluded that there is no evidence that ECT causes structural brain damage in adults. 7. The APA ECT taskforce guidelines report findings that most patients find ECT no more stressful than going to the dentist. They also reported that other research finds most patients would voluntarily receive ECT again if needed. 8. NICE ECT guidelines report that some individuals consider ECT to have been a beneficial and lifesaving treatment “ignoring inconvenient evidence that contradicts one's existing view is likely to lead to an absurd conclusion.” I was about to say the same to you ;-) “Or is it your position that he should continue to "enjoy" this coercive approach?” I think I have made my position on the involuntary administration of ECT clear. @ Jane “You seem to take the word of people who were helped by shocks as evidence that it works, yet you don't believe people who were harmed by shocks. Nor do you believe the leading researcher, so what evidence are you looking for?” I take anecdotal evidence as just that anecdotal evidence. Any piece of anecdotal evidence that says ECT is harmful can be refuted by another piece that says it is beneficial of which there is plenty. My point is not to say my anecdotal evidence has more weight than yours but simply to make this point. (BTW what have you to say to people who say ECT has helped them). If by leading researcher you are referring to the paper by Sackheim (2007) all that shows is that they advice being offered by NICE and the APA may have underestimated the degree of cognitive impairment that can occur in some individuals receiving ECT. I have never suggested that ECT is risk free and this fact is reflected in the advice offered by NICE and the APA. Like many procedures and treatments there are risks but overall the scientific evidence would indicate that the benefits to most people out weigh the risks hence it’s continued use in psychiatry today.
E wrote: Good for you. However, you don't know what my view is, because you haven't asked, and therefore you have no idea what I'm ignoring, and why. The studies you mention do not contribute to this discussion (which concerns Ray Sandford's wellbeing), they only appear to support your view that (coercive?), ECT is OK. Do you have a solution for Ray Sandford, which doesn't involve him being subjected to a treatment that he objects to? Matt Posted by: Matthew Holford at November 18, 2008 10:45 AM@ Matt I know what your view on ECT in general is and I think you know what my view on coercive ECT is (at least I hope you do I have stated it enough times) Posted by: E at November 18, 2008 12:24 PMOne thing I think you are failing to recognise is the fact patients aren't tested for cognitive damage. Before or after ECT. We have to rely on researchers who take money from both NIH and the machine makers. I don't know about the UK but in the US ECT machines are clasified to where they aren't even tested for safety. Also, many patients claim ECT works because they are not aware of the cognitive damage they sustain. People assume because someone has lost memory or other cognitive functioning they would be aware of it, but that is not the case. Patients have to rely on doctors to recognize the damage. If the doctors don't recognise (which Psychiatrist are not trained in brain injuries) their patients have a brain injury, they sure aren't going to attribute in cognitive functioning to ECT. They attribute it to depression and recommend maintenance ECT. Here is a 2008 study in which they recognise the need to talk about cognitive damage in informed consent -http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2526376 Posted by: jane at November 18, 2008 01:44 PME wrote: Unfortunately, my (generalized) position tells you nothing about anything, particularly. You were against coercive ECT, as I recall? I suppose that's something. Does this view help Ray Sandford, at all? If not, can you think of something that would help Ray Sandford, because that's what this thread is about? You see, Ray Sandford, who is a human being, I believe, is at the whim of a system that has difficulty seeing him as a human being, as far as I can tell. That's not good for anybody's credibility, but it speaks volumes for the mental health system, generally. And it says a great deal about human nature; as one of the most vulnerable people in society becomes a political football, quite ignoring his best interests. Who's speaking for Ray Sandford, E? Who's established what Ray Sandford wants, and then dug his/her heels in, until he (Mr Sandford), gets it? Who's made sure that Ray Sandford's interests are served first and foremost by the mental healthcare system? Nobody, that's who. So Ray Sandford gets to bear the fallout of everybody else's fuck-ups. Plus ca change, plus ca le meme chose. Matt Posted by: Matthew Holford at November 18, 2008 02:29 PMSo, just to re-orient: There is no need to ignore inconvenient truths, if we can all agree ECT is a crapshoot. You may get lucky or you may lose your soul. Who should decide this? And how does a person who decides they will submit to ECT arrive at their decision? Posted by: flawedplan at November 18, 2008 02:40 PMIt makes no sense to cause depression to treat depression which is exactly what docs do when they forcibly treat someone with ECT. Posted by: Lisa at November 18, 2008 03:42 PMI wonder how Ray Sandford will spend his day this tomorrow, November 19, 2008. The first time in weeks, months-- that he will not have: FORCED/INVOLUNTARY ECT. Against his will, against his choice. E, do you not give a fucking damn about someone being forced to have their brain electroshocked against choice? Human rights mean something here. This is just sick. Posted by: Stephany at November 18, 2008 07:33 PMI came into the debate half way through so I have not yet read the Ray Sandford case in detail. But to reiterate (in case any one is in any doubt) I am not in favor of ECT being administered without consent. @ Jane, Thanks for the reference. The paper seems to confirm the findings of the paper by Sackheim (2007) in suggesting that we may have underestimated the degree of cognitive damage that some patients suffer after receiving ECT. But like the Sackheim paper it stops short of saying that ECT is either unsafe or ineffective. This study suggests that there may be a greater need to discuss the intermittent cognitive risks associated with ECT when obtaining informed consent prior to treatment. Further that self-reports of cognitive difficulties may persist even when depression has remitted. However, patients may not acknowledge or be aware of changes in their memory functioning, and post-ECT self-reports may not be reliable. Feliu et al (2008) Posted by: E at November 19, 2008 01:20 AME, You hit on the root of the problem. People unfortunate enough to be labeled as "psychiatric patients" are literally not considered human as a matter of convenience, not fact, when we in fact are human. You write: "patients may not acknowledge or be aware of changes in their memory functioning, and post-ECT self-reports may not be reliable." Note the word may. No one really knows what happens during ECT and the effects apparently are unique from one patient to another, but, as in all psychiatry, once one is placed in the category of sub-human, i.e. a place where self reports are considered insignificant, much psychic pain, terror, rage and deterioration occur, in other words, with ECT like most mental health treatment, the cure is worse than the disease. Posted by: Sally at November 19, 2008 03:12 AMDon't you think it is at all wierd you point out that a treatment that is being used more and more, has to be proven to be unsafe and uneffective? Treatments are suppose to be safe and effective prior to their use. As things are right now, we don't even require safety regulation on the machines that are used. And just why would sackhiem and all find ECT is unsafe and uneffective? They would be putting themselves out of work. What would Psychiatry use as their "treatment of last resort?" Thats right, they have nothing so there is no insentive to actually test people before and after treatments to find out what they are actually doing to the hopeless souls they could give shit about. Even the US miliatarty has implemented cognitive testing prior to our men in women going into battle. A 10 minute computerized cognitive test for each and everyone of our shouldiers. This same technlogy couldn't be used in our psych hospitals to help protect our mentally ill? No, lets just keep telling everyone ECT is safe and effective because no one can prove that its not. The point of my earlier comment, if it was missed, is that you cannot call ECT safe and effective if you don't test for cognitive damage because you don't know if lessing of depression is actually a symptom of brain damage. neuroskeptic said... Hi Cthulhu, I liked what you wrote here : I wish that when such people think they have a solid argument against a large body of science they would first think "hang on this argument is quite simple, it's not believable that scientists haven't already thought of it. Perhaps this argument is actually my own misconception" That's an excellent point - most objections to accepted science are so simplistic that the experts would really have to be idiots not to have already thought about them. This is the problem though - many many people seem to think that anyone who claims to be an expert, is either a fool or a knave (or both.) You can tell these people by the fact that they refer to "so-called experts" or "experts" (in quotes.) It's bloody infuriating and it happens all the time. As you say, if you try to argue with such people they can become quite irate. I think it's because they see the non-existence of experts as almost a political issue. They don't want anyone telling them what to think! It's a bit juvenile, but it matters a lot to them. 01 November 2008 08:50 This is from Neuroskeptic's blog. It's amazing that someone can claim that there's no harm. Oh my God! "ECT has been shown to be clinically the most effective treatment for severe depression, and to result in improved quality of life in both the short- and long-term. After treatment, drug therapy can be continued, with some patients receiving continuation/maintenance ECT. The American Psychiatric Association and the British National Institute for Health and Clinical Excellence have concluded that the procedure does not cause brain damage in adults." What a shock! Posted by: Ana at November 19, 2008 05:25 PMAna,
But not in Psychology. Posted by: susan at November 19, 2008 07:29 PMSusan, But I was just thinking about this thread. What kind of objective evidence are we talking about? According to my experience all I said was ignored or underestimated not by one, or two. I'm assuming we are talking to a real psychiatrist. "People react differently to treatments especially something as poorly understood as ECT so it does not follow that because people react differently and to different degrees it is not the treatment that is responsible for the improvement." Is this objective evidence? Can anyone explain to me what on earth does it mean objective evidence? I guess we will reach 250 comments and frustration will be the result. But I believe that's the reason why we are all on this: @ Sally, You write: "patients may not acknowledge or be aware of changes in their memory functioning, and post-ECT self-reports may not be reliable." Those are not my words I was quoting from the paper by Feliu et al (2008). @ Jane, “Don't you think it is at all weird you point out that a treatment that is being used more and more, has to be proven to be unsafe and ineffective? Treatments are supposed to be safe and effective prior to their use.” All treatments are tested prior to their use on humans to prove they are safe that is what we have clinical trials for. ECT is/was no different in this respect. Before withdrawing a treatment that has in the past been shown to be safe and effective for some patients I think it is reasonable that some objective “evidence” is provided that this is not the case. Posted by: E at November 19, 2008 11:56 PMYour objective evidence is funny. Here it comes another one of those discussions that will end with Philip's intervention closing discussion. E, I'm not sure why you'd think I wasn't aware you were quoting. Again, your quote exposes a major weakness in the biopsych school. What other area of medicine is there where the patient's response to treatment is not considered relevant? While ECT was briefly tested on animals, there were no clinical trials on humans, and I think the sole criteria for success on an animal was if the animal lived through the ECT. "Italian Professor of neuropsychiatry Ugo Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his colleague Lucio Bini developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1937, experimented for the first time on a person. ECT soon replaced metrazol therapy." Cerletti, U (1956). "Electroshock therapy". AM Sackler et al. (eds) The Great Physiodynamic Therapies in Psychiatry: an historical appraisal. New York: Hoeber-Harper, 91-120. E: "Before withdrawing a treatment that has in the past been shown to be safe and effective for some patients I think it is reasonable that some objective “evidence” is provided that this is not the case."
2. Objective evidence isn't really of any importance. Not when it comes to making money. Not in regard to medicine, and even less so in regard to psychiatry, that deals with individuals, widely regarded sub-humans, as Sally has it so to the point. Who cares, if these sub-humans' brains and/or lives are damaged or destroyed? Certainly not those, who make a - quite nice - living, damaging and destroying the sub-humans' brains and/or lives. Objective evidence and economic/political interests usually don't go very well together. This is what the term "conflict of interests" refers to. BTW: You don't need to go far to find evidence, that no one really cares. Just find the latest entry on Zyprexa on this very same blog. It says it all. And another BTW: This is about Ray Sandford, as Stephany has pointed out several times. Ray doesn't want any more ECT-"treatments" (yep, I'm one of those, who use quotation marks... ). And, no matter how safe and effective ECT is or is NOT, as the human being Ray in my world is, it is his human right to say "no" to more ECT, and have this "no" fully respected. So, while your hobbyhorse obviously is defending the alleged safety and effectiveness of ECT, this is about human rights - and their violation by the mh system. Why don't you go ride your hobbyhorse somewhere else? Posted by: Marian at November 20, 2008 09:09 AM@ Marian psychiatry, that deals with individuals, widely regarded sub-humans,………….. Who cares, if these sub-humans' brains and/or lives are damaged or destroyed? Certainly not those, who make a - quite nice - living, damaging and destroying the sub-humans' brains and/or lives. Anti psychiatry? No of course not. Posted by: E at November 20, 2008 02:59 PMI think there needs to be a Godwin's Law for mental health posts. Those who are losing the argument label those who disagree as anti-psychiatry or a scientologist. I was interested to read the part about lack of clinical trials with ECT? How did this get approved without clinical trials? Posted by: Lisa at November 22, 2008 09:45 AMImagine they just invented ECT today. They ask for depressed volunteers for a double blind test study. One group gets ECT, they other gets pretend ECT. I wonder what would happen? Posted by: mark p.s.2 at November 22, 2008 11:25 AMMark, great comment. Posted by: Stephany at November 22, 2008 10:48 PMImagine this clinical trial - one group of boys told by their teachers that they are unruly is sent for a "psych" evaluation and the boys and their parents are told the boys have adhd and given pamphlets and dvds and trendy books about adhd and of course support group info; one group and their families are told the boys have schizophrenia and have auditory delusions and imaginary friends and of course get the same marketing products but for schizophrenics; other groups treated the same way are told bipolar, ocd, autism...and one group is told that the unruliness is normal and a symptom of the child being particularly gifted and insightful...wonder what would happen? But back to ECT, of course there are clinical trials comparing it to drugs, but ect was developed without clinical trials and predates drug therapy as a treatment for "mental illness". No matter what, it doesn't ever produce long lasting improvement and must be repeated. Lets look at the obvious reason why: Shock is often a way to change psyche, whether it's a slap in the face, a insulin treatments, a death, electric current, a winning lotto ticket (I bet that one would cure lots of depression regardless of the current view that depression is unrelated to life events). Among the many problems with ECT is that it doesn't last. All it is is causing acute physical pain which as we all know makes the brain focus only on the acute physical pain. Tricking those with psych labels into stumping our toes or I guess more analogously, stepping on our toes would have the same effect but without the same cognitive deficits, in other words, the medical problems with this kind of torture would show up in the toes and feet and then spread upwards, as opposed to harming the brain which is what is done with ect. Acute toe pain goes away and perhaps you actually are for a moment so relieved not to have acute toe pain that you forget whatever emotional distress you are in. Perhaps for a small percentage of people this distraction works and their depression is cured. Still it's inhumane and the best treatment is not incarceration in a psych hospital and toe torture, it's dealing with the normal ups and downs of life in a community setting. Ect is the same in many ways. Send painful volts of electricity through someone's brain and you get their attention. But when the pain wears off, they are still unhappy, except when you remove the memories they were unhappy about, as the memories come back, the same problems ensue. Again, kind of like amputating the foot to treat an ingrown toenail, if you don't have a foot you won't have ingrown toenails, but most of us would rather have the foot and deal with the ingrown toenails as they come up. Forcing a foot amputation in that situation is like forced ect. Having a panel of experts promise you that you won't lose your foot in the amputation but you'll save lots of money on shoes is like the lies people are told to get "informed" consent for ect. Posted by: Sally at November 23, 2008 06:41 AMSub-humans... Post a comment
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