Sorry but there are dozens of studies and hundreds of reports of people basically losing memories of entire portions of their life and the ability to do simple things like tie their shoelaces or do simple math after just one round of ECT. How this is still not banned by the FDA is beyond me.
Not to mention the number of people who get heart complications from it or outright die during the procedure.
How can you say that "the alternative is unbearable"is beyond me, unless you're saying it's better to become mentally disabled than suffer from depression?
The argument that "this is not the same ECT" is also bogus. The difference is now they paralyze you so you don't convulse and break your bones while doing it. They also use a higher voltage (more damaging to brain cells) and higher frequencies with shorter, repeated bursts (also causes more brain damage and hemorrhaging). But it's "better" because the patient doesn't thrash around so much anymore. Give me a break.
> We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in mild to moderate and severe depression, and in treatment-resistant depression? Which interventions reduce relapse rates? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS:
> We found 88 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
This meta analysis found that ECT was beneficial.
The point of ECT is not to act as a long lasting cure, it's to get someone out of a depressive episode so that they can engage in work to treat their depression - it's a life saving short term intervention that gives them time and space to do other work.
>How can you say that "the alternative is unbearable"is beyond me, unless you're saying it's better to become mentally disabled than suffer from depression?
Most people who would be considered eligible for ECT are actively suicidal; if they are released from hospital, they are almost certain to attempt suicide. Some are suffering from catatonic depression and are too depressed to perform even the most basic tasks, often including eating and drinking. The overwhelming majority are being held on secure psychiatric wards for their own protection. The alternative to ECT is usually death. If you don't understand this (or refuse to acknowledge it), then you don't understand why doctors continue to use ECT.
Chemotherapy is horrible. It makes you constantly and violently nauseous, it makes your hair fall out, it can cause lasting physical damage and the side-effects are sometimes fatal. It's horrible, but it's better than the alternative, which is dying of cancer.
The evidence is overwhelmingly clear that ECT is a life-saving medical intervention.
The first link you posted is a highly biased summary of evidence compiled by CCHR, a known Scientology front group; Scientology opposes all forms of psychiatry, largely because of the belief that its own (completely unproven) method of Dianetics is capable of resolving all forms of mental distress. Please see DanBC's comment for a more accurate summary of the evidence.
> Have you ever had someone close to you commit suicide?
Yes. My girlfriend who lived with me for several years.
> If so, is that truly a better outcome than undergoing ECT?
Yes, absolutely, for the reasons imperio59 and others have already described. You don't solve mental issues by injuring the brain until they the symptoms are no longer obvious to outside observers.
Also, using this type of emotional manipulation that presupposes the false dichotomy of "ECT or suicide" is highly offensive. There are many potential options, and you do not know what someone will do with or without any particular "treatment".
I'm sorry but that's the equivalent of saying "This person is about to kill themselves, so let's take a bat and hit them over the head with it so they can't do that now. See, now they're doing fine, they're not killing themselves."
Would you take someone who is about to kill themselves and take a pair of live electric wires to their head to try to "cure" them? Because that's essentially what ECT is, despite all the supposed "new and improved" spiel which is marketing speak, that and they sedate you while doing it.
Inducing brain damage is not treatment.
Saying that is not denying the problems that some people are suicidal and need help. That's a very real issue.
But ECT is very real scientific fraud, often done without fully informed consent on the parts of the patients and family members, often done against and over the wishes of the person receiving ECT, and billed for thousands of dollars to insurance companies over and over again, with results that go away once treatment stops and side effects that remain for a lifetime.
There is a both a large and strong evidence base for the usage of ECT in cases of severe, treatment resistant depression. Many aspects of modern medicine can be made to sound barbaric with the right framing; those who disparage ECT are not so quick to characterise chemotherapy as “poison by any other name” or dialysis a “vampiric ball and chain”.
By the time ECT is on the table, every other option is exhausted and the sufferer has been through multiple acute hospitalisations for suicidal ideation, if not unsuccessful attempts.
It is certainly fair to say the effect is not always permanent, that maintenance courses are a burden, and that their long-term efficacy does not justify the risks of the procedure itself or the anaesthesia it requires. Nonetheless, for someone who has been depressed for many years, plagued by crippling ennui and a nihilistic view of existence not even Schopenhauer’s grimmest passages can match, any respite is welcome. To deny them that option, with full knowledge of the risks, is to deny them agency.
"But he acquiesced when told that if he resisted, the hospital would seek a court order to overrule him."
Are you claiming they would do this, yet have the deeply depressed patient's honest agreement ?
I don't buy that. This was forced, under threat of force. To protect the hospital against having a successful suicide attempt on their record.
Symptoms return. Normal cognitive function does not. That tells you more than enough. This person is now (hopefully lightly) mentally handicapped, and this has been done to her under threat.
You might as well shoot the person. That has the same demonstrated effect. Seriously. Shooting someone with mental problems can fix those mental problems, many documented cases of that happening.
>You might as well shoot the person. That has the same demonstrated effect.
This is ludicrous hyperbole. The majority of people who receive ECT are successfully treated and go on to live fulfilling lives. ECT is an evidence-based treatment for a life-threatening medical condition.
If it truly was, then why was that person threatened into doing it ? If what you're saying is true, then what possible motivation could the doctor have to threaten his patient into accepting this treatment ? (I get that someone else had to say "yes", but that doesn't change the situation)
Second, I resent psychologists using "evidence based" as a term. This, one might think, implies that they have proof. Well no, no proof. It doesn't mean that.
Ok, but surely it means that they have double blind statistical studies ? I mean, that makes "evidence" very misleading, but ... Yes, but those studies say there is no effect beyond placebo (in fact there are valid studies that say that all of psychiatry does not survive a double blind study). So statistical analyses actually says this does not work.
Ok, so what does "evidence based" mean ? Well, it means they have a few anecdotes of mostly temporary improvement (and lots of anecdotes of disastrous outcomes, conveniently left out). Which certainly exist for shooting depressive patients as well. Also they exist for not doing anything.
So why did the doctor force this treatment on her ? Well, to get her out of his clinic. You see, the way you get fired in a psychiatric department is to have a few patients commit suicide in the department. And observation and isolation only helps for so long. In practice, given 4-12 weeks of trying people successfully commit suicide, even under 24 hour observation with no tools in an isolation cell. This patient had gotten really close to doing that, as mentioned in the article (which, incidentally, would be the conditions this patient was held in prior to her getting asked if she'd agree to this treatment. Which of course also means she is mostly happy with the treatment because it got her out of an isolation cell, and still lives under threat of returning to those conditions. Reality of psychiatric patients).
So this is fact: this doctor forced permanent brain trauma on a patient because he was calculating that this trauma would temporarily prevent the patient from committing suicide, long enough so that she'd be out of his department before she actually succeeds.
So reality is simply that this patient was forced to get ineffective treatment that introduced permanent brain trauma against her wishes, with the decision made under extreme stress (introduced by this doctor), and under threat. That she got lucky and seems to be happy with it does not change that. PLUS she might merely be happy that it got her out of the isolation cell she was forced into for weeks/months before.
So let's go through your statement:
> The majority of people who receive ECT are successfully treated
If you don't count the permanent cognitive impairment, and the fact that most would have recovered without any help, then sure "successfully".
> and go on to live fulfilling lives.
Nope, most relapse. Unless you count redoing suicide attempts after ~4 months a sign of a fullfilling life. But of course, that's long enough to get them out of the hospital and let the doctor/hospital "not be responsible".
> ECT is an evidence-based
Nope. I know this term "evidence-based" is used in psychiatric literature, but that doesn't change the fact that it's bullshit, as explained.
> treatment for a
Nope. This is not a treatment by medical standards. For that to be the case there would need to be validation. This wouldn't even satisfy the standards for "experimental treatment", as that would require case-by-case review of an ethics board, which hasn't happened here.
> life-threatening
Nope. The vast majority of patients recover from this without any help. So it was not life threatening. Or at least, not any more
> medical
Nope, psychiatry is still not considered part of medicine by doctors.
> condition.
Well this is the only word in your sentence that was actually correct.
>Nope, psychiatry is still not considered part of medicine by doctors.
Psychiatry is a branch of medicine. Psychiatrists are medical doctors. Psychiatric disorders are recognised as diseases by the World Health Organisation in the International Classification of Diseases. The Merriam-Webster dictionary defines psychiatry as "a branch of medicine that deals with mental, emotional, or behavioural disorders". Psychiatrists are eligible for full membership of the American Medical Association, the British Medical Association and every other medical association I am aware of, because they are medical doctors.
The rest of your comment is just as wrong as this sentence and just as readily debunked. Due to the length of your comment and the sheer density of falsehoods, I am not inclined to debunk it point-by-point; I would suggest that anyone with an interest in the topic should consult the National Institute for Clinical Excellence's Technology Appraisal on ECT.
Psychiatrists are medical doctors because they need to responsibly prescribe medication. That's all.
That doesn't mean it is considered medicine.
You still haven't explained why the threat of force (and thus force) was used against this patient ... to enforce an elective treatment that results in permanent cognitive damage. I am very curious how you'll explain that one.
(I would like to point out that any treatment that does not prevent death or long-term injury is one that's considered elective)
Medicine generally relies on “informed consent”: you have the right and responsibility to know and understand the treatments you are receiving and their possible effects.
Mental illness is tricky because the condition itself impairs patients’ ability to provide this consent. Maybe you’ve got extreme lassitude and refuse everything, for example, even contradictory options. Maybe you clearly do not understand the options presented to you.
Nevertheless, we also don’t want doctors making decisions unilaterally, so the next best thing is to involve a third party. If the patient has a guardian, it’s their call. If you don’t, a court can act as one temporarily, with the idea being that they’ll get you to a state where you can take over. Obviously, this isn’t ideal, but it’s not clear what would be a better approach.
This article VERY clearly states that the patient REFUSED, and then was forced to let it happen under threat of force:
The actual quote: "her husband was alarmed when the doctor suggested ECT. But he acquiesced when told that if he resisted, the hospital would seek a court order to overrule him." (note: author is talking about herself in the third person)
So I really do not "feel" force is mischaracterized. The threat was explicitly made AFTER the patient "was alarmed" (which means refused, let's get real). And threats are use of force, of course. (if I threatened to shoot you unless you did X, you would certainly call that force regardless of whether I actually shoot you, not even if I say "please". You would strongly disagree with me calling that "informed consent", rightly so)
And it's not just force. This is forcing a treatment that does permanent cognitive damage to the patient against their will. This was done knowing full well that given enough time, odds are pretty high it will disappear by itself (most suicidal patients "recover", very few actually commit suicide. I did a quick Google search and we're talking 4% apparently. Unfortunately, public opinion REALLY punishes any hospital where it happens. But that doesn't change that there was a 96% chance this patient would get cured without any action, never mind permanently crippling them)
Let's not pretend this is a moral grey area. It's not. This is far over the line.
How do you even know that this article isn't positive because the patient fears being readmitted (again with force) into the psychiatric facility and/or resumption of convulsive "therapy" ? (where she would be locked up in dismal conditions).
When I was an infant, I (apparently) struggled valiantly to avoid getting shots or having blood drawn. It hurt and the benefits of (e.g.) vaccines don't really make sense to a kid who has just learned to string a few words together. Nevertheless, my parents forced me to get them, and, as an adult who does not have several debilitating diseases, I'm glad for it. The idea is pretty similar here: the patient herself can be in a state where she's (not) making decisions that their unaffected self would. I'm a little surprised at the lack of deference to her husband, but 'alarmed' can cover a lot from "NO, NEVER" to "My God, is it really that bad?"
As I wrote above, I don't think ECT is great, but the evidence indicates it is one of the better options for drug-resistant depression. The side effects, especially for older approaches, can be pretty bad, but so is depression (and newer approaches seem to have weaker effects on memory).
I think you pretty much have to take her at her word here that she eventually appreciated the treatment. There's no way in hell someone is getting recommitted due to an article, especially not 30-40 years later.
Would you feel even remotely the same if the treatment was not vaccination, but let's say you already had the measles. A bad case.
The odds would be 99%+ that you would get better on your own (essentially nobody stays depressed, after all), BUT the process of getting better would involve 2 weeks nausea, painful pimples all over, and of course generally feeling very bad. You would need to be locked up during that time to prevent spread of the disease. In < 1% of cases it would feed back onto itself, and those weeks would repeat, progressively getting worse.
The treatment is amputation, say of a foot (because ECT does permanent cognitive damage). And, even though they can give you something to prevent you from remembering the pain or the process afterwards, they can't actually sedate you. This has a decent chance of making you better in a shorter time "without" (visible) pain/issues. They may need to redo it several times, taking off some more every time. Let's say they start with a few toes, but progressively they'll take off more, and you can reasonably expect to lose at least all your toes, with your entire foot being a possibility. Of course, there's also odds you'll lose your foot, but remain ill. (there is widespread disagreement on what those odds are, so let's leave it at "not zero, and not very small either, so >10%, but not 90% like some claim either"). And there's a tiny chance you die.
Would you still feel as positive about the treatment ? What if your parents got threatened while making this decision with having you taken away by social services and having this imposed on you ? (with some small odds of you never getting returned to them, ever)
The ethical issue is more complex than you present it. You conveniently leave out that it mutilates the patient, just not visibly. You leave out that there's extreme pain involved, and they can't sedate you (that would defeat the treatment, because the point is that the brain learns to associate absolutely extreme pain and stress with "the problem"), but they can give you the date rape drug (yes, really). You won't remember. You'll still be mutilated though. Cognitive impairment. You won't remember how it happened. Usually you won't, that is. There may be some lingering trauma, and PTSD. So there's a 10% chance (it's pretty high for ECT) that you'll have extreme (fear or violent) reactions to things you associate with the treatment room.
> I'm a little surprised at the lack of deference to her husband.
Really ? What do you think about the "doctor thinking of his career" explanation ? Can you at least agree it's pretty consistent, that some doctors might think like that ?
As in, can you at least agree that giving psychiatrists that option at all presents a "moral hazard" ?
I don't know why this is being downvoted; the correct term is "completed suicide", because "successful suicide" implies that death is a desirable outcome.
Most forms of treatment, in terms of therapy, psychiatric medication, or more invasive options, cease to be effective when they're removed, eventually.
ECT and ketamine, for example, are sometimes found to be effective for O(months) after initial more frequent treatment, while most of the psychiatric meds you run through earlier if you're pursuing that type of treatment take weeks to become effective (or not), weeks to stop, and the beneficial effects often stop much sooner than the side effects after taking them (...if they stop at all, in some cases).
ECT can and often does do lasting damage. It should not be used lightly. But singling out ECT for being a recurring treatment seems unreasonable when the other avenues of treatment, both behavioral and otherwise, have the same caveat.
Not to mention the number of people who get heart complications from it or outright die during the procedure.
How can you say that "the alternative is unbearable"is beyond me, unless you're saying it's better to become mentally disabled than suffer from depression?
The argument that "this is not the same ECT" is also bogus. The difference is now they paralyze you so you don't convulse and break your bones while doing it. They also use a higher voltage (more damaging to brain cells) and higher frequencies with shorter, repeated bursts (also causes more brain damage and hemorrhaging). But it's "better" because the patient doesn't thrash around so much anymore. Give me a break.
Summary of the issues with ECT and associated studies: https://truthaboutect.org/ect-causes-brain-damage-a-review-o...
http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-Citi...