This post follows on from Miracles of Artificial Intelligence and Artificial I.
The trigger was an intervention by Chris Dubey, who earlier this year wrote an article on ECT (electroconvulsive therapy – Shock Treatment) for the International Journal of Risk and Safety in Medicine, which was sent to me for review.
Most people, whether familiar or not with ECT, would figure Chris was offering a reasonable proposal. It was clear he had had some exposure to ECT and it had not helped, but rather than ask for it to be banned, his suggestion was to test it against other neuromodulatory treatments like Transcranial Magnetic Stimulation (TMS) – he didn’t mention the recent ‘Flow’.
Chris’ short, 500 word article with 18 references asked – if they did even nearly as well without the cognitive problems linked to ECT would it not be better to prioritise them? Dubey ECT Article 1 is linked here or available from DH if the link stops working.
Although saying it was pleasantly written, I rejected it. Healy Review 1 is linked here or available from DH.
These days journal Editors no longer take control of reviews. Instead algorithmic review systems ask a question – will you review this article again if it is revised and resubmitted. It is only when all reviewers lose the will to live and agree to accept or reject the article that the journal acts. This can run to the crack of doom.
I checked No – I would not re-review. I suggested the editor would have to make her own mind up. This probably happens automatically in journals these days without an editor getting to see that her reviewer has Just Said No.
Despite that a revision came my way for re-review. I almost deleted the email without checking but something stayed my hand. Later in a bored moment, pre-deleting I checked it out and was very surprised.
Asking Chat GPT, Co-Pilot, Anthropic and Grok for their input, Chris had fed them his original article along with 3 reviews, mine and two favorable reviews except one criticized him for not calling for ECT to be banned.
The published revision, Dubey ECT Article 2 which is here, had doubled in length and had 81 references or available from DH.
The draft for re-review also came with a marked up copy of Grok or Chat GPT’s suggestions with the reasoning behind them. These are also available from DH.
Chris’ resubmission also had his response to my point about the Sins of Psychiatry. It seemed to me his response boiled down to if there is a risk that surgeons might take out the wrong kidney we need to stop all kidney operations.
This fails to appreciate the practice problems in all of mental health and perhaps health which lead to psychotherapists recovering memories of abuse that never happened and SSRI drugs likely being as safe or safer over the counter as they are on prescription only. See Health Care and Science – for more on this.
As an article about ECT, Healy Review 2 I- here or available – I rejected it again.
But was it an article about ECT or an experiment with AI? I wrote to Chris.
Dear Christopher Dubey
I am reviewer 1 on the original ECT article you submitted to the International Journal of Risk and Safety in Medicine. Liliya Ziganshina, the editor of IJRSM, is copied into this email, along with one of her colleagues Axana Scherbeijn.
With Liliya’s permission, I have a proposal to make you. A proposal but not an offer. Liliya (and the journal) will need time to consider the options.
My suggestion is the journal publish your original article as submitted, along with your revised article. I will ask a well-known expert in ECT to draft a complementary article to your original article, specifically telling them to be collegial rather than hostile, roughly the same length and turned around quickly. Once they submit that I will critique it. Without being told or seeing your revision. the second author will be invited to do as you did and let Anthropic and GROK digest the second article and the review and help it its revision.
Why do this?
Clearly A.I. has some great things to recommend it. But the question is whether it will aim at writing something it thinks you on one side and the second author on the other want. Will it support rather than challenge each of you?
ECT is perhaps the most divisive treatment in medicine and as such ideally placed to explore what A.I. does. The results might be very different in this case compared with a scenario in which it was dealing with a topic on which there is a degree of consensus.
If things turn out roughly as I expect, the benefit for you is that you get two articles published and likely a considerable impact factor given current interest in A.I. This should be good for both you and the journal.
If you are open to this option, can you reply to all of us with your thoughts. I would also need a summary of what you did to get Anthropic and GROK to review your article – did you enter and article and reviews and what instructions did you give the system? We will need to give the second author similar instructions.
We didn’t quite keep to this format but Chris and the journal agreed to the proposal, which led to the 2 Dubey articles and 2 Healy reviews – and to a final comment – See Healy and Ziganshina ECT 3 – picking up the implications of AI from a journal perspective.
After the Deluge
The post is superficially about ECT, the Artificial I post is superficially about Transgender issues, and the Miracles of Artificial Intelligence is superficially about RSV Vaccines. The blink and you’ll miss it point is that if you weren’t there, you didn’t get a chance to spot the Elephant in the Room and the Probity Blocking process that has erased all traces of an Elephant from photos of past events or the history of the times.
As Milan Kundera’s The Book of Laughter and Forgetting fabulously illustrates, we expect disappearances like these in politics, especially authoritarian politics. We don’t expect it in Science.
Having interviewed many pioneers in neuromodulation, I know they tested their new techniques on severe cases, found they didn’t work, but never published the results, opening a door to anyone who wanted to make money from neuromodulation in a wellness rather than illness domain. We now have an increasingly messy wellness domain with puberty blockers being given to pre-teens, scaremongering about relatively harmless RSV infections, neuromodulation promising better than well outcomes with no cognitive problems and psychotherapies curing everything, along with paid but authentic influencers and lifestyle coaches – see Authenticity Inc – for all of which there is a clear demand.
AI cannot get hold of innocently or deliberately unpublished knowledge, or what might lie behind fraudulently transformed knowledge. This applies to the psychotherapies as much as physical therapies – see Health, Care and Science – and even more to psychotropic drugs.
In the short terms AI will make things worse. The extraordinary events surrounding Giovanni Fava and Psychotherapy and Psychosomatics bring the risks home. Giovanni himself has written a compelling account – see Intellectual Freedom – of what happened.
Put in place by companies like Elsevier who make $3.5 billion per year from their journals, business editors have replaced clinical editors. Algorithmithizing everything and dispensing with as much human judgement as possible appeals to businessmen. Clinical judgement is central to establishing a treatment related adverse event.
As a ‘sub-editor’ on a Nature journal for years, I was increasingly sent articles that had nothing to do with my domain expertise, for which I had to find reviewers. When I queried this, I was told the journal was putting an algorithm in place to suggest reviewers and all I had to do was send the article to them. Why not dispense with us, I asked, and just have the algorithm generate the product and pass it to an editor in chief?
Nope – legally we have to have a human in the process. Frontier and Nature Journals (like Cureus) now all operate this way. The de facto goal is to have no humans. It makes perfect business sense to have an AI screen of incoming articles – to reduce the very real burdens on notional humans.
A colleague recently submitted a brief rushed article on a potential SSRI benefit for vision which was instantly accepted. He also wrote a better, more detailed and substantial, article on a potential SSRI vision problem, which was rejected serially by journals without review. He was mystified.
Another colleague, Mayer Brezis, wrote an important article on Finasteride and Suicide, which he sent to a BMC journal. The reviews were broadly favorable but when he resubmitted it, it was rejected without further review or appeal. Other colleagues have had similar experiences recently. All it takes is one less than extravagantly praising review to cause the system to seize up and make some central editor decide to chuck the article.
RxISK this week features a post by a colleague marking the publication of an important article on SSRIs and Visual Snow. The post hints at a saga behind this article’s publication.
The first journal we sent it to claimed our article “did not have a high enough priority score to be sent out for external review”. Ditto for a second journal. A third submission is still languishing in BMC Ophthalmology where it was submitted over a year ago. BMC claim not to be able to find reviewers.
We switched to the International Journal of Risk and Safety in Medicine, who as the name suggests are a natural home for treatment linked adverse events – as long as the algorithms don’t get them.
As journals put algorithms in place, a minimal unwitting inclusion in the specification could rule out articles unlikely to come with open access fees or unlikely to lead to a good for business adoption of a new technique (articles about benefits). I emailed my prior, always very pleasant, Nature contacts asking if “did not have a high enough priority score to be sent out for external review” might point to an algorithmic glitch that might make publishing about adverse events increasingly difficult? He said – no this couldn’t happen.
Although a prior Nature-ist, very soon afterwards, I unexpectedly got a delicious Nature email inviting me to test their (my) new AI Research Assistant. Logging in gave the quotes to die for that feature in Healy and Ziganshina – all the little red dots you see in the image below are on the move In Real Life. Great quotes and red dots – what could be better?
With thanks to Chris Dubey who set this process rolling. The links above should work but if not, I (david.healy54@gmail.com) can send these AI/ECT articles and reviews with or without an important Visual Snow article.
Chris’ experiment with Chat GPT, Grok etc was my first exposure to what can be done. It is now clear any of us can do similar things. With what consequences?
AI and Homicide
The issue of psychotropic drugs triggering violence/homicides is a key concern for RxISK.org and many people injured by psychotropic drugs. Just a few days ago, a colleague found an Armed with Reason substack with a linked Gun Violence Pedia (GVPedia), who, deploying AI technologies/techniques, seem to have a mission to brand any idea that homicides with a gun might be linked to psychotropic drug use as a complete (NRA sponsored) myth aimed at deflecting attention from the guns themselves.
A divide that AI has the potential to turbo-charge is opening up across which may be unbridgeable. At the moment, megaphone diplomacy seems to be getting us nowhere. Neither democracy nor science can survive divides like this.
Comments and Footnote
The comments below have been as much on ECT as AI. One of them called for these ECT related links to be posted – chapters 9, 11 and 12 in Shorter and Healy Shock Therapy .
This is all very worrying.
I asked the fairly tame Google AI whether the monoclonal antibody nirsevimab for babies is cost-effective in preventing RSV infections.
“Yes”, it said, “numerous health economic studies and public health body decisions, including those in the UK, show that nirsevimab is a cost-effective intervention for babies. In many cases, for a universal immunisation program, it is even considered “dominant”, meaning it both improves health outcomes (prevents illnesses and hospitalisations) and reduces overall healthcare costs compared to previous standard care.”
Furthermore
“Similar cost-effectiveness conclusions have been reached in health economic evaluations for other countries, including Spain, the Netherlands, Italy, and South Korea.”
without mentioning that all these evaluations relied on “studies” financed by the manufacturers, AstraZeneca and Sanofi.
SOURCE Sanofi-Aventis Canada Inc.
Eight out of 10 infants and newborns in Canada have access to RSV prevention with Beyfortus® this season
https://www.lelezard.com/en/news-22010650.html
Six provinces and three territories to provide universal immunization programs for Respiratory Syncytial Virus (RSV) infant protection this respiratory season
Beyfortus will also be reimbursed through select private health insurance providers
Beyfortus demonstrated the ability to reduce the risk of RSV lower respiratory tract infections by 74.5%, including hospitalizations in infants entering their first RSV seasoni
TORONTO, Nov. 10, 2025 /CNW/ – This RSV season, eight out of 10 Canadian newborns and infants will have access to Beyfortus, the first and only protective antibody approved in Canada for the prevention of RSV lower respiratory tract disease in babies through their first RSV seasoni. Initially offered in 2024 in Quebec, Ontario, Yukon, Northwest Territories and Nunavut, Beyfortus is now also available in Saskatchewan, Manitoba, Nova Scotia and Prince Edward Island through provincial universal immunization programs, aiming to protect eligible infants from RSV.
A highly contagious virus, Respiratory Syncytial Virus or RSV impacts 90% of babies before their second birthday.ii RSV circulates seasonally between November and April and causes a high burden of bronchiolitis, pneumonia and hospitalizations in infants and newborns. Sanofi has worked closely with provinces and territories to make Beyfortus available this RSV season to help protect all infants entering their first RSV season and some infants entering their second season who remain vulnerable to RSV.
More…
It hopefully goes without saying that the above two comments look pretty misleading to anyone who has been keeping up with what is happening on RSV Ground Zero.
It probably also goes without saying that the capacity of AZ-Sanofi to churn out stuff that will find its way into LLMs is potentially likely to block the LLM from reflecting the facts on the ground.
We always risk being seduced by offers to tell us what is really going on in the world that liberates us from the hard work of having to establish what is happening or having to accept the socially embarrassing position of not knowing.
D
Your ‘Nature Research Assistant’s’ sales’ patter is hilarious:
‘It will give him accurate and relevant high-quality insights that elevate his research while keeping him in control and enhance but not replace his critical thinking.’
But, Chris Dubey’s AI. generated V2 paper is what’s really telling. As you observed, it reads with marginally more professional panache- loadsa references. But ultimately it just regurgitates information that’s already out there – and stimulates no further thought. What it delivers really is – MORE is less.
As you know, I’ve argued with Grok about the RSV vaccinations – safety, health economics etc. And despite responding to the charges quite ‘thougtfully’, it always reverts to the status quo narrative. It’s a pretty easy game for vested interested to play – just pump up the volume.
Chris Dubey is a really good guy. He had an appalling experience of ECT – seriously suicidal after paxil withdrawal and life stressors, he was subjected to forced ECT– he literally screamed as he was being wheeled off for more torture – and nobody cared.
https://www.madinamerica.com/2023/02/legal-protections-forced-
I know ECT isn’t the topic of this post. But I’ve listened to quite a lot of patients who’ve had ECT, some who’ve benefitted, more who haven’t – so I was interested in what you wrote – especially ‘Auditing Electroconvulsive Therapy’.
What you wrote about ECT as a targeted treatment for specific conditions where movement, of lack of it, is a key component – catatonia, melancholia – made sense – rather like a version of defib. But looking at the most recent ECTAS data – I’ve checked before – I notice they’ve beefed up their diagnostic categories by including with or without catatonic symptoms – but ‘with’ still only represents a minority of patients to fit the ‘Lazarus’ treatment model.
https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/electro-convulsive-therapy-clinics-(ectas)/dataset-reports/ectas-2021-dataset-report.pdf?sfvrsn=59757c5c_5
I also hear what you say about the difficulty of extricating ECT harms from prior drug damage – and sure enough the majority of patients (biased to older ‘depressed’ women again ofc ) are described as having ‘drug or psychotherapeutic treatment resistance’. But I do think we need to listen to patients. There are some patients who were able to function at a high level prior to ECT – even though they were medicated. Then experienced such significant memory loss afterwards they were cognitively diminished.
The least the system can do is, for any patient who is responsive, to monitor cognitive performance properly before and throughout treatment and give rehabilitation to those who are struggling.
As the post says and you note, this was about A.I. not ECT. But seeing that you’ve dragged ECT in and AI can only make the problem worse, let me add from background for Grok and Chat to chew on.
I am just not someone to let a treatment induced problem go missing. That said, well over half of the psychotropic drug legal cases that have come my way claiming to be drug induced – and this includes suicide and homicide – ive said have not been caused by the drug people claim their problem has been caused by. Claiming you know for sure this has caused that isn’t a sign that it has.
Claiming you have a memory problem is very different. We can agree fully on that. I’ve interviewed people who’ve written books and or read their books on their post ECT memory problems and while the books are well-written the problem they pin on ECT have not been caused by ECT.
I’ve assessed lots of people who claim they can’t remember the children’s childhood – who were on benzos for a lot of it – this is exactly what benzos can cause and not just cause but very obviously and unequivocally cause but there’s no evidence ECT does this. I’ve asked people about their change in function and back before smartphones they might say they were the kind of person who could remember everyone’s phone number but now they couldn’t. This is a set-shifting problem antipsychotics cause and in all cases where this was the complaint the person was on an antipsychotic. Now with everyone on SSRIs or post SSRIs complaining about Brain Fog, tell me how I pick out a specific ECT effect.
I helped an ECY service in what I’m sure was the best DGH mental health unit in Wales and one of the best in the UK before management destroyed it, and it had a stellar group of doctors. Even so there were inappropriate referrals of people on far too many drugs who were never going to respond. I did my best to block these and we reduced the ECT rate to the point the service in that unit was teetering on the brink of having to close – when an irate management actually did close it, probably helped by my refusal to give ECT to people who were not consenting – in my view legitimately.
If you’re dragged screaming into ECT, you are going to be biased afterwards. And all too likely to be helped by psychologists or others who faced with people becoming suicidal on SSRIs or getting PSSD use this to recover memories of abuse that never happened.
My approach was to tell people beforehand their treatment in mental health services is highly likely to cause memory problems but we may find it very difficult to make a link to ECT. Other things that have been done to them play a part. Having made this point, and bearing in mind the point about psychology above, the one thing in retrospect I’d do very differently now is make it clear to all nursing staff that if they thought the patient had post ECT problems to speak up. Way back then, nursing staff in the UK (other units) had got in trouble for blaming a patient’s post ECT problems on ECT. Rather than firing the nurse – as happened – this really should have been explored in much more detail.
On the system responding to problems though, the referring doctor remains the treating doctor and the person responsible for managing any post ECT problems. If s/he has tanked the person up on a bunch of drug without noticing any cognitive problems from drugs that must be causing them and has referred a patient for ECT who should never have been referred how likely is it that s/he is going to assess for cognitive problems or do anything to attempt to remediate the problem if s/he finds something?
The least the system can do – what bit of the system exactly?
Against this background, I can’t remember anyone I thought had a clear post ECT problem. I remember people who went over to the main hospital to work 30 minutes after ECT, or got in their car and drove over 100 miles safely 30 minutes after ECT. The history of ECT is also interesting. Back in the 1950s in Manhattan ECT was being done in doctor’s offices without anesthesia and people were having it before going into the office to work. None of this proves very much except that Grok is never likely to get to chew on it and pass it on to anyone who consults AI to find out if ECT has caused their memory problem.
D
AI is useful for a little spit and polish, getting past a creative block, or making you feel more equipped to speak to authority figures but its really quite useless at analytical tasks.
It reminds me more of an idea generation system, like Brian Eno’s oblique strategy cards or David Bowie’s verbasizer, ideas that go back to the parlor games of the surrealists. The only difference is that AI predicts the next word with the context in mind, generating something logical. But to my mind, it is still in essence a form of automatic writing. Fabulous for creative endeavors, hopeless for analytical ones. Its also horrifically sycophantic.
On the topic of ECT, its a little early for me to form a view but in my last six months of working on an acute inpatient ward, ECT is one of only two treatments where the consumer is described by family as “well” and where I regularily see them walk out under their own steam so to speak. The other treatment is lithium. Families tell me stories of their loved ones being well for years, having careers and raising families after ECT. These are not stories I hear about antipsychotics or antidepressant treatments. Naturally most people would conclude that this is a matter of diagnosis and prognosis and that the indications for ECT are simply diseases with natural remission cycles. For various reasons I don’t think this is the case. As a matter of routine practice, ECT seems to produce much better outcomes. There is quite a difference between raising a family and spending a decade on a CTO, especially when there is a strong suspicion of the same diagnosis.
Also, it is quite a thing to meet someone on a Tuesday who tells me their son has akathisia and catatonia, and walk in on Wednesday morning to find that one of those two issues has been entirely resolved.
P
This is hugely helpful to get but as Chris and Harriet say, there are some disasters too and these cannot be ignored or wished away. The disasters are psychiatry’s rather than ECT per se. The optics of ECT make it an easy target – people who know nothing about it get what the complaint is when they don’t with pills – all they see is a harmless looking swallowing of a med that some of the largest corporations on the planet spend billions ensuring we don’t see anything else. It suits these corporations that the gripes of people mangled by mental health systems focus on targets like ECT, which even when things go wrong only affect a miniscule fraction of the numbers swallowing ‘placebos’ – as even the critics who lambast ECT tell us about the pills.
Compared with a dishing out of pills, its much harder for a team giving ECT to ignore they are doing something potentially tricky and liable to go wrong. Still they could do better. There is maybe some chance with pills but it’s almost impossible for psychotherapists to take issue with their own good intentions – any problems stem from the resistance of the patient to an inconvenient truth.
D
That sounds about right. It is bit like what you’re taught in woodworking shop at school “respect the tools, most especially the powered ones”. Somewhere along the lines medicine forget this principle with the use of drugs, especially in primary care. Surgery has largely retained it. There was a time when drug treatments were viewed with as much, and at times more caution. Connoly understood it, Kraepelin understood it, Hammond, Weir Mitchell. Right into the 1950s drugs were viewed with caution. That’s not to say people back then were not reckless, indeed the entire concept of safety was very different. But there was a respect for what it is to put a very foreign substance into the body to fight a disease. It’s not just that drugs are in a sense “poisons”, it is also that diseases are formidable and it stands to reason that any effective drug is likely to have some formidable effects. The idea that serious illnesses can be treated with mild and harmless interventions is a worthy goal but unlikely to have been achieved in such a short span. It is remarkable that we are expected to believe that this transformation has already occurred despite virtually no novel drugs entering the market in decades.
It seems to me that it is not entirely the fault of drug companies. They’re simply taping into biases that are already there. It’s like Osler said, mankind has a unique appetite for medicines.
ECT retains all of the gravitas associated with a serious medical procedure, such as surgery. It’s fairly routine where I work but there is still plenty of pomp and ceremony as it requires a full tribunal hearing. The whole thing is far from perfect, and it is occasionally given purely on.the basis of treatment resistance. It’s not simply a Lazarus effect alone that makes the contrast clear, although that is certainly part of it. It is also that it just has very different outcomes that aren’t easily captured with an ordinal scale. Even the results that are less than Lazarus-like are not the sorts of results you need statistics to assess. If you made a simple nominal scale, ‘no improvement’, ‘moderate improvement’, ‘greatly improved’, it’s quite apparent that the almost everyone who undergoes the treatment falls into the latter. Most surprising to me was that this seems to include psychosis that is not obviously manic and depressions that are not clearly melancholic. It seems to work better than the drugs for damn near everything, which offers a less cynical reason for its widespread use. However, that is not to say it works out well in all cases, just that often beats the drugs. The non-manic psychosis often return between sessions for example.
I will also say that as far as I can tell it does cause memory loss. The type of autobiographical information that goes missing isn’t so easily noticed by the doctors. After all, they don’t know where you vacationed for Christmas the year before your mother died but your family do know these things and once they get to comparing notes it seems plain enough to me that it causes a great deal to vanish. I don’t think it’s much like the memory encoding problem caused by benzos. Since ECT is often given quickly for it’s indications and since many of them are people who became ill in middle life without having previously encountered psychiatric medication, it’s hard for me not to attribute the memory loss to the ECT, especially when it is clearly not an issue of encoding.
The only other issues I’ve seen are the occasional delirium immediately afterwards and the odd switch to mania. The delirious or agitated state thay sometimes occurs after waking is no joke and can be genuinely traumatic for some consumers even if they don’t entirely remember it. It’s the most common reason for treatment to be discontinued.
The other thing about it is that more definative treatment generally means less treatment overall. People are put on drugs for decades. And while relapse after ECT is common, it’s still not in the same ballpark as drug exposure.
One other thing I’ll mention, there have been studies done that show pain during and after surgery can be dramatically lessened if the doctor explains what kind of pain the patient should expect during and after surgery. Generally with ECT the consumers and families are given a thorough run-down of what to expect during and after. In the case of medication the reality is quite different, it’s more like going in for an operation and being told by the doctor beforehand that you won’t feel any pain at all, if you do the anaesthetist will ignore you and if anything should go wrong no one will ever believe you.
Listening to patients talk about their experiences of ECT is quite revealing. One patient, who had over 100 doses herself, told me there were times when she looked forward to ECT because she knew the anaesthetic would give her temporary relief from the akathisia that was making her suicidal. I’ve also heard some patients in akathisia fb support groups saying ECT helped them, but this is by no means universal. This does raise reasonable questions about what is going on beside the effects of seizure – the sort of territory Chris wants to explore.
It’s encouraging to hear Peter’s acknowledgment of the memory loss some patients have been reporting for years, and the system has minimised – as it always does harms. Yes, of course the prior drug load most patients have been exposed to must be implicated and likely inextricably so – I’ve never seen this explored in detail- but it doesn’t explain everyone’s memory deficits. You will both know far better than me, a relative newcomer, the review Diana Rose et al did over 20 years ago on ‘Patients’ perspective on ECT’, that concluded, as others have since despite refinements to treatment methods:
‘The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.’ https://www.bmj.com/content/326/7403/1363
H
I think you and Chris risk increasing the cognitive harms caused by mental health treatment. I took a risk on Chris in an attempt to bring out the point that AI almost exponentially increases the likelihood of making these things worse – but your comment ignores this point almost completely.
Of course people who get processed through mental health meat grinders have memory problems. They complain about memory issues – which can specifically be tied to drug X or drug Y but not to ECT. This is why so many court cases have been lost. Some of those who have been terribly treated by the system take legal cases which mean they have to show damages rather than just abuse and these cases often focus on memory problems because everyone knows ECT causes memory problems – you mention Diana Rose but we could add in Linda Andre, Marilyn Rice and lots of others. Courts though don’t deal in opinions – they aim to establish facts and these legal cases lose.
The tribunals P refers to are close to a sham – both those held in respect of ECT but the much more common ones dealing with involuntary detention and approval for ongoing tanking up with antipsychotics etc. The doctors sitting on these couldn’t spot an adverse effect of drugs or ECT if their lives depended on it. Jim Gottstein’s The Zyprexa Papers paints a compelling picture of a rigged system. The blunt reality is that once you get sucked into the mental health system, unless you are lucky you are fucked.
By ignoring AI at this juncture in history you are going to suck more people in and damage them, with as Chris did, I think inadvertently, pointing to a key element in why people are being and will increasingly be harmed.
Around 0.001% of the population might get exposed to ECT, which we can’t specifically tie to memory problems. Over 20+% of women are stuck on meds that we can tie to memory problems. These women and men are sucked in by soft power (company marketing and zombie doctors) rather than compulsory detention. If we take the few whose ECT is compulsorily delivered (and this is always inappropriate), the ECT figures may be 0.0001% of the population.
There is a 2000-fold or 20,000-fold difference here. If we really wanted to spare the cognitive faculties of the population, where should our efforts be directed?
Chris’s and your comments will be chewed up by AI which will divert people toward more meds. In the absence of publications showing neuromodulatory techniques don’t work in severe mental illness, in Chris’s case AI will divert people toward more neuromodulation – while taking meds at the same time – because these things don’t work in the sense of delivering a crisp clean med free response for anything.
You mention Diana – whom I have known and chatted with and have included her report in my chapters in the Shorter and Healy History of ECT. I’m going to put a link to these 3 chapters up in the main post and will email them to you.
What the chapters don’t include is any mention that Linda Andre’s Rutgers University Press published Doctors of Deception only got published because I intervened to recommend the press go ahead with it. Do I think Linda Andre or Marilyn Rice had a specific ECT linked cognitive dysfunction. No I don’t. Why publish? We need these conversations. The conversations established facts in the case of SSRI hazards. There is a risk here – many people go on to claim an SSRI has caused their problem, when details of their case don’t support the claim/opinion. There is another problem. Many people who have played a part in establishing facts, using clinical trial or other evidence, have been (are) useless at establishing the facts of particular cases.
Is there any evidence ECT can cause a specific cognitive dysfunction? Yes there is. Who came up with the evidence? Max Fink – the main proponent of ECT. Have I seen anyone who has any evidence of this specific dysfunction playing a part in their claims about their post ECT cognitive functioning? No.
In addition to Max Fink taking what he was doing seriously to the point of investigating its hazards, the very first audit in any area of medicine anywhere was done in 1980 on ECT in the UK by John Pippard, a psychotherapist.
Pippard found ECT machines that didn’t really work. When the machine work the treatment was being given by GP trainees after a night on call. It was being given in public places where the next in line might hear the anaesthetist say ‘Damn it, I hate it when they don’t breathe’. Pippard, a psychotherapist, said there is no way he’d have ECT in one third of the units his team visited. In one third, he would be reluctant. But, he accepted ECT could be beneficial and he’d be prepared to have it in the other third. He did more. He revisited these units a while later to see if anything had changed – this is where the audit element comes in. Very little had.
ECT and breast cancer surgery were the two medical treatments that gave us what we now understand as informed consent. Fred Frankel, another psychotherapist, chaired the committee looking at ECT and informed consent in the United States. Like Pippard, Frankel agreed that that the practice of ECT – like the later psychotherapy practice of recovering memories of abuse that never happened – left a lot to be desired, but he recognized the need to improve the practice as the treatment did work.
Chris’ view, not expressed clearly in his articles, is if the practice is bad we need to get rid of the treatment. If we followed this line, we’d get rid of most psychotherapy also.
The AI point comes in here. If you or I wanted to submit an article on a drug induced hazard, whether memory or sex or suicide, to increasingly algorithmythized journals, the chances of getting published are less and less. In contrast, NEJM, BMJ or the Lancet will publish pieces that play down the hazards of any meds or vaccines and will let Eric Rubin, Kamran Abbasi or Richard Horton rant from pulpits. These rants are journalism not science or evidence. The BMJ in particular seems allergic to establishing facts – it features medical journalism only, free of any doctors who might try to establish a fact rather than offer opinions that coincide with the prejudices of the editor of whoever it is who has the editor in a headlock.
Let me add one more twist to this you can find at the heart of Shipwreck of the Singular. The idea that medicine tries to bring good out of the use of a poison doesn’t compute for algorithms – either AI or management flowcharts or medical journals these days. We cannot practice medicine or care for people if we don’t embrace this idea. What we will do instead is increase health services and health service products, given in combination with illness diagnoses, so that the entire population ends up ill, festooned in diagnoses and suffering the very real effects of treatments semi-forced on them or perhaps seduced by he advocacy of people who think nice treatments that are all benefit (promises of) and free of problems (consequences) are what we should aim at.
See links to The Swinging Pendulum, Another Chapter and Epilogue above.
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