ECT - ElectroConvulsive Therapy

JuliusCaesar

I'm starting a different thread for this as I'd like to keep it seperate from the one on the place in the USA where they punish ID patients with electric shocks for undesired behaviour.

ECT is in decline in Ireland.

It's given under GA, with an anaesthetist and a psychiatrist (both are qualified medical doctors) and a psychiatric nurse in attendance. Here's a 'What to expect".

NICE guidelines:

ECT should be used to gain fast and short-term improvement of severe symptoms after all other treatment options have failed, or when the situation is thought to be life-threatening.

Psychologists are not involved.

krd

ECT works by giving the patient permanent brain damage. It's very literally brain burning.

It's frightening this can be done here without consent. And for the treatment of depression.

Valmont

I read an article a few days ago about this practice in the UK, with a psychiatrist referring to what he thought were the favourable rates of response among his patients. I imagine that if I was feeling down, a few zaps to the brain would almost certainly rattle me out of my cage, indeed anyone.

I suppose it could be psychiatry's equivalent of slapping an hysterical person in the face to calm them down.

All that said, if an individual wants to have the treatment done, then I don't have a problem with that; however, the theories proposed to account for the 'mechanism of action' are not very convincing. I'm open to correction however -- does anyone any expertise or experience in the area?

You are unconscious during this process, so you don’t feel a thing. However, your brain is thought to be resetting itself because of the seizure, clearing its neuropathways and lifting the common symptoms of depression.

This sounds highly dubious.

krd

Valmont wrote: »

I read an article a few days ago about this practice in the UK, with a psychiatrist referring to what he thought were the favourable rates of response among his patients. I imagine that if I was feeling down, a few zaps to the brain would almost certainly rattle me out of my cage, indeed anyone.

A few slaps across the head with a hammer might rattle your cage too.

I suppose it could be psychiatry's equivalent of slapping an hysterical person in the face to calm them down.

No. It isn't. And face slapping is generally not considered an effective treatment these days.

All that said, if an individual wants to have the treatment done, then I don't have a problem with that; however, the theories proposed to account for the 'mechanism of action' are not very convincing. I'm open to correction however -- does anyone any expertise or experience in the area?

The 'mechanism of action', is actually really straight forward. The high falutin explanations you hear are complete nonsense.

How it works. Electricity is passed through the brain. There's no way to precisely control where it goes. It very literally cooks the brain. Causing burning more or less randomly. It's cruder than a full frontal lobotomy, and the results are pure luck.

If it "works", if you have a pattern of rigid thinking that is making you psychotic, if the electricity fries enough of whatever part of the brain that thinking is originating from, then your psychosis will be alleviated. If it doesn't, you end up with a fried brain. It's pure pot luck.

The story of its first use is funny. Some Italian doctors picked up a homeless man from a train station. He hadn't spoken anything but gibberish in years. They applied the electrodes to his head and gave him a blast - he bolted straight up and spoke his first clear sentence in years. Something along the lines of "WTF did you do that for?"

Valmont

krd wrote: »

No. It isn't. And face slapping is generally not considered an effective treatment these days.

I'm surprised you think I do -- I was joking.

krd wrote:

If it "works", if you have a pattern of rigid thinking that is making you psychotic, if the electricity fries enough of whatever part of the brain that thinking is originating from, then your psychosis will be alleviated. If it doesn't, you end up with a fried brain. It's pure pot luck.

If something like deception is unethical in experimentation, how can ECT be considered ethical for treatment?

krd

Valmont wrote: »

I'm surprised you think I do -- I was joking.

So was I.

If something like deception is unethical in experimentation, how can ECT be considered ethical for treatment?

In my opinion. ECT in this day and age is deeply unethical. There is some justification for its use as a last resort. But there is a very good chance you'll just get fried. But "last resort" is an ethical justification.

Ethics is a balancing act. It's a funny business.

Looking at the Mental Health Commission press release, about 12% of the ECTs are administered without consent. Then I wonder how many are administered with manufactured consent - consent obtained through duress ("If you don't have this treatment, we're never going to let you out of here").

Personally I've never been through the mental health system in Ireland. I've heard mixed accounts, and it can be very difficult to tell what the actual truth is.

The nightmare scenario, would be some kid presenting in crisis. And some doctor deciding their problem is their weirdness and personality - they're bringing their persecution on themselves by provoking the sadism of the normal well adjusted people. And deciding the only ethical course of action is to erase that personality, with ECT. I know in America, ECT was used to "cure" teenagers of their homosexuality. What's the line in One flew over the Cuckoos Nest....Blank in the face and nothing in the eyes.

Valmont

krd wrote: »

Looking at the Mental Health Commission press release, about 12% of the ECTs are administered without consent. Then I wonder how many are administered with manufactured consent - consent obtained through duress ("If you don't have this treatment, we're never going to let you out of here").

Was this discussed in the media at all? I'm surprised there wasn't more outrage.

krd

Valmont wrote: »

Was this discussed in the media at all? I'm surprised there wasn't more outrage.

Mental health stories don't really get reported much. It's mostly non stories about politicians or civil servants. Stories about the "important" people.

But it's funny, I found out they were still doing ECT from an Irish journalist. I won't mention his name. He said his father was a completely different person after the experience - and not in a good way. His father died a few months later.

It is certainly not a treatment I would volunteer for.

Odysseus

It is not something I am overly familiar with, but most psychs I know believe that it helps with severe mood disorders. The few patients I have worked with who have undergone this actually concur.

krd

Odysseus wrote: »

It is not something I am overly familiar with, but most psychs I know believe that it helps with severe mood disorders. The few patients I have worked with who have undergone this actually concur.

If you were offered the treatment - would you accept it voluntarily?

Would you play high voltage, electrical roulette?


My definition of the treatment is 100% accurate. It's random brain damage. Or a wonderful opportunity for rebuilding, as a psychiatrist describe it to me.

See it's descriptions like this

Surprisingly, experts are still uncertain as to how ECT works. It is thought ECT acts by temporarily altering some of the brain's electrochemical processes and helping to create new neurons.

That's complete and utter nonsense. The only effect the electric shock has on the brain is a heating, or cooking effect.

Odysseus

krd wrote: »

If you were offered the treatment - would you accept it voluntarily?

Would you play high voltage, electrical roulette?


My definition of the treatment is 100% accurate. It's random brain damage. Or a wonderful opportunity for rebuilding, as a psychiatrist describe it to me.

See it's descriptions like this

Surprisingly, experts are still uncertain as to how ECT works. It is thought ECT acts by temporarily altering some of the brain's electrochemical processes and helping to create new neurons.

That's complete and utter nonsense. The only effect the electric shock has on the brain is a heating, or cooking effect.

If my mood was that low that I ended up in a psych ward, maybe. I would be luckly in that I have psychs' that I know personally and if they thought I needed it I think I would consider it. Thankfully I don't think I will ever have to make that decision.

The Jury is still out for me, but when people I respect tell me that they see a benefit in using it with some patients, I take that into consideration.

krd

Odysseus wrote: »

If my mood was that low that I ended up in a psych ward, maybe. I would be luckly in that I have psychs' that I know personally and if they thought I needed it I think I would consider it.

Thankfully I don't think I will ever have to make that decision.

You do not know what kind of situation you could ever be in. And you should never think of these things in selfish terms. And there are many dimensions to this. If you have suggested it to anyone - or spoken favourably about it to anyone - and they go and avail of it, on your advice. Then you have responsibility.

ECT belongs to the realm of insulin shock, and cold water shock - which both induce uncontrolled brain damage.

The Jury is still out for me, but when people I respect tell me that they see a benefit in using it with some patients, I take that into consideration.

Leonard Cohen attributes the alleviation of his depression in recent years, to the age related deterioration of his brain.

If some patients have benefited from it, that's just pure luck - what do you hear about the failures? - or are they just chalked down to a neutral "failed to respond to treatment". Lou Reed (google him if you don't know) claims that the ECT he had when he was fifteen - to "cure" his homosexual tendencies, left him unable to empathise with other human beings. The strange flatness in his voice, may not have been a stylistic choice - but the result of brain damage.

Odysseus

We are just going to have to disagree on this one, as it is something that I don't really need to research because the people who are likely to undergo ECT are too sick to make it to my clinic. Additionally I know some psychs who are analytically trained and they would see some use for it in certain cases. They would be critical of psych in general so they are not just sticking to the party line.

Lastly I would never be advising anyone to under go ECT, I don't do advice in my clinic. I have seen a procedure on TV where the brain was really fried/cooked as a treatment for manic depression, a probe is place in the brain and then heated, you can see it cooking like an egg!!!

If a clinical team feel ECT would be helpful, and the patient is willing to undergo it, I have no problem with it. I make have an interest in it, but it has nothing to do with the treatment I provide, as at the end of the day it's a medical procedure.

Finally while none of us know what is around the bend for us, I know enough of my psychical structure to know it is highly unlikely that I will ever be in such a position. True there will always be that 0.0001%

Semele

Odysseus wrote: »

It is not something I am overly familiar with, but most psychs I know believe that it helps with severe mood disorders. The few patients I have worked with who have undergone this actually concur.

I have previously read that the relief these patients experience is actually the euphoria that often initially accompanies brain damage. I'm not a fan of the idea of ECT myself, although similarly I do know people who have said it worked for them. There was a horrible case in my last job, where there was a legal struggle over whether the father of a catatonic boy should be allowed to insist on him having another course, despite two previous ones shoing no lasting improvement. It provoked very polarised feelings in staff.

krd

Odysseus wrote: »

I have seen a procedure on TV where the brain was really fried/cooked as a treatment for manic depression, a probe is place in the brain and then heated, you can see it cooking like an egg!!!

Yep. The human brain is the most complex object if not in the universe, at least in our solar system. If you used every single computer in the world to simulate a human brain, there probably wouldn't be enough to do just one brain.

No one sticks a soldering iron in a microprocessor and hopes for the best.

Though I do know there are procedures that are incredibly precise (as precise as can be). There's a partial frontal lobotomy that is sometimes done with radioactive isotopes placed in the frontal lobe. It's done when there is clearly abnormal electrical activity in lobe. It's an incredibly rare procedure. Something like one person in the UK every so many years.

The famous lobotomies of 1950s America were far far cruder. Even carried out by people with no medical qualifications. The famous lobotomy scar didn't exist either - the device for carrying out the lobotomy went through the eye socket, and left no visible scar.

Finally while none of us know what is around the bend for us, I know enough of my psychical structure to know it is highly unlikely that I will ever be in such a position. True there will always be that 0.0001%

You never know. From personal experience, your life can be going exceedingly well. Then for reasons beyond your control you can be dropped into a prolonged trip through hell.

And you never know what can happen. Someone I know had a freak reaction to a steroid. He became extremely psychotic, and violent. He eventually made a full recovery - slowly. But at first they thought he wouldn't. ECT would have done him no good. The thing is, on top of this, he was/is a doctor. That 0.0001% chance found him. I'm not sure a doctor would give another doctor ECT.

Valmont

My issue is with the ethics of ECT; in the absence of any proper explanation for the supposed benefits of ECT, I'm not sure how any doctor can legitimately claim the right to force such a destructive (by its very definition) procedure on an individual.