Editorial Note: This post interrupts the Crusoe series.
The comments from Deirdre Oliver and “Truth” posted below assume Crusoe and I are one and in attacking me they risk derailing a position being laid out by Dr Crusoe. Dr Crusoe and I share some views or her posts would not feature here but while the issues about ECT have some relationship with the position she was staking out about drug regulation it seems better to separate out the attacks on me from the wider debate.
Anyone who wants to engage more fully should ideally read the attached chapters from the History of Shock Treatment – The Swinging Pendulum, A New Chapter? & Irrational Science. It is worth visiting Let Them Eat Prozac The Shock Controversy, where saving some items that might have been embarrassing to those attacking me, things that have come up before are posted. Also worth reading are Better to Die RxISKing it One and Two – the text of an address to ISEPP in Los Angeles last November. This talk was going to be posted by ISEPP – it is close in content to a talk given recently in Yale that has been posted.
So this post is responding to some of the comments that seem to come after it.
I am as constant as the Nothern Star
Caesar’s words that sealed his assassination – or words from Joni Mitchell. Take your pick.
The initial charge from Deirdre Oliver – see below – accused me of lacking consistency. She and many anti-ECT activists find it bewildering that I don’t call for ECT to be banned. It seems inconsistent to them to campaign against the toxic effects of drugs and not to call for ECT to be banned.
I have never called for a treatment to be banned – not SSRIs, not antipsychotics, not benzodiazepines, not psychosurgery and not any of the therapies that have been linked to a recovery of memories of abuse that never happened. My beef has been to get the hazards of treatment, whatever they are from whatever branch of medicine, put on the map so people can be better placed to decide whether or not to take the risks involved or to work out what has happened to them should treatment go wrong.
Getting to grips with the hazards should leave people better placed to decide if the primary problem was bad luck, a negligent therapist, or a systematic cover-up by an industry or other group promoting a treatment in a misleading way.
The cover up
Having gone into the background research, probably more than anyone else on earth, on what companies knew about the hazards of their drugs, and what those linked to ECT knew about the hazards of ECT, my view is that companies unquestionably engaged in and likely still engage in negligent and sometimes perhaps even fraudulent behavior when it comes to the hazards of drugs. Because drug treatments within mental health are used somewhere between 10,000 and 100,000 times more commonly than ECT, the consequences of this company behavior are far more devastating than any ECT cover-up could be – were there a cover-up.
I seem to be able to spot a cover up where others can’t. AllTrials for instance looks to me something that suits industry all too well. But there is no ECT cover-up that I can find.
Those who defend ECT can be wary and defensive. This is not surprising in the face of implacable hostility, and little support from the rest of medicine. Yet the person who most clearly put on the map the idea that ECT involves an organic insult was Max Fink, the person most excoriated by the critics of ECT. It has been very difficult to get clear-cut test evidence of enduring cognitive dysfunction on ECT; one of the few bits there is comes from Max Fink. D.O. below cites Charlie Kellner raising the possibility that the next generation of scanners may reveal harms on ECT. Kellner has been the editor of Convulsive Therapy, the lead investigator on the CORE ECT studies, and one of the major figures behind ECT. The fact that he thinks some scans might show something suggests an openness to the data here just not found among drug company apologists.
When I wrote a celebration of activist movements in ECT’s history (The Swinging Pendulum – above), and the efforts to use abuses linked to ECT to promote informed consent across all of medicine, I got a lot of my leads from Max Fink. When I supported the publication of Linda Andre’s Doctors of Deception (see comments), some of those concerned for the treatment weren’t enthusiastic because unlike D.O below they didn’t think it was meticulously researched, but no-one vilified me or ostracized me.
The research evidence
The critics cite evidence of brain damage in a paper by Hartelius and memory dysfunction in a paper by Janis – both dating back to the 1950s – or they invoke brain scans. The Hartelius’ study comes up again and again and came up a short while back in a set of exchanges on the Critical Psychiatry website between Barney Carroll and the CP network that more than fulfilled the English definition of fair play – at least 11 against 1 (as in cricket). Peter Breggin weighed in with the Hartelius paper. Carroll provided an analysis of this – attached here. This is a must read. Exchanges like this lead to silence on the CP site or to someone like Barney Carroll simply not having their contribution posted.
None of this is to say there isn’t brain damage on ECT. Poisons, poison. Mutilation, mutilates. And a convulsion is never a good thing. Some generation of scanner or other tests will reveal damage linked to ECT. But the same scanners will reveal as much or more damage linked to antipsychotics and antidepressants. What then?
In the meantime having worked with a variety of colleagues on scanning and cognitive testing protocols in an attempt to elucidate the harms ECT causes, I can report that with the best will in the world it isn’t easy to draw up a protocol that gets to where the critics seem to want to get. Their response is that the failure to come up with results that nails ECT points to a cover-up but what is being missed is that current scanners are pretty useless for anything fine-grained and cognitive function testing is little better.
ECT is linked to autobiographical memory problems – but so are the benzodiazepines. It’s easy to demonstrate this for the benzodiazepines but far more difficult in the case of ECT. There is nothing distinctive that ECT causes that drug treatments don’t cause in spades and no-one who gets ECT doesn’t get drugs also.
In terms of the severity of the conditions it treats, from resistant Parkinson’s disease, through Neuroleptic Malignant Syndrome and catatonia to psychotic depression, the benefit-risk ratio may be better for ECT than for anything else in psychiatry – when used for those conditions. This doesn’t mean it doesn’t cause problems. Unnecessary convulsions are never good.
Led the wrong way?
This brings us to legal actions. On the drug side, the actions that I have been involved in have never been against doctors. They have been directed at companies. These actions have brought a huge amount of material about the sequestration of trial data, ghostwriting of articles and public relations sponsored harassment of people trying to raise the hazards of treatment into the public domain. When juries have convicted in cases of birth defects, or suicide or dependence linked to antidepressants, it has been on the question of whether companies had good cause to warn and failed to do so. It has not been about getting treatments banned.
I have found it difficult to be party to legal actions against doctors in circumstances where drug treatments have been involved as it has seemed to me difficult to hold them responsible for the air they breathe. It is not unreasonable for them to depend on the literature that appears in respectable journals like BMJ and NEJM, although we may be nearing a point when juries decide otherwise.
A possibly even greater problem in medicine that RxISK.org seeks to address is the often abusive treatment that many of us receive that is made possible by a power-imbalance between doctors and the rest of us.
If not broken, the mental health system is wobbling badly, and there are an increasing number of people trapped within it, the learning disabled, the elderly and anyone who has an adverse response to a drug, who are at increasing risk of being treated for the consequences of prior treatment, and whose lives are being blighted and shortened as a result. I’ve been writing about this for nearly two decades – see Foreword: Dying for a Cure – and spent a good deal of the last two years working on a way to formulate the issues that might provide a platform for anyone having unnecessary treatment inflicted on them whether ECT or drugs, in community or inpatient settings, to escape from under the juggernaut.
How do we tackle being powered out? This happens across medicine – its not just a mental health issue but mental health activists are more aware of the issues than anyone else. Diverting them into calls for getting treatments banned is a great way to prevent them bringing a revolution in all of healthcare. Success in getting ECT banned might also be a good way to make a market for the next pro-convulsant treatment – Ketamine analogues.
Having at one point researched most of the major ECT legal cases for The Swinging Pendulum chapter above, the difference between ECT and pharmaceutical cases is striking. The ECT cases should be about medical negligence but time and again plaintiffs have ended up with experts on a mission to get ECT banned completely, when it might have been better to seek out an expert who concedes that ECT may be helpful but in their case was used abusively. And the plaintiffs have lost.
Romance
The call to ban ECT is linked to ideas that mental illness doesn’t exist – and indeed that disease doesn’t exist given the benefits ECT can produce in NMS and Parkinson’s disease. There is a romance to the idea that disease doesn’t exist but ninety-nine percent of the population just ain’t going to go there.
Romance might sound pejorative. I was going to say ethical nobility. When anesthesia was developed in the nineteenth century, it led some, who could not accept the idea of benefiting the many at the expense of the few, to agonies. There was an ethical nobility to such agonies in 1860, but most of us would regard their rehearsal now as romantic. Some of us split the difference and regard the bargain medicine has made as Faustian, but when it comes to the crunch of cancer or the maelstrom of melancholia we take the bargain and opt for anesthesia or ECT.
See Sherwin Nuland’s extraordinary TED talk on ECT. But for every Nuland who gets the call right, the Devil probably wins in having ECT inflicted on someone who shouldn’t have it – but s/he wins even more comfortably when it comes to drugs.
At the end of the day, I don’t see it as my role to decide for anyone what treatments they should or shouldn’t have. The message that the benefits you can get from me are linked to poisons, mutilations and shocks would reduce the use of all treatments across medicine, however anyone thinks they help, but they would still be given by some doctors to more than those who stand to benefit, or be demanded by some who don’t figure on meeting Dirty Harry.
The resistance to the message that medicines are poisons is not confined to mental health. Delivered at a recent event at the Hay-on-Wye HowTheLightGetsIn Festival, the message was not well received but it’s difficult in any other area of medicine to imagine hostility of the type that the critics of ECT mount, unless orchestrated by the pharmaceutical industry.
ECT is the most disputed treatment in all of medicine. This hostility was once actively fed by Pharma with adverts for chlorpromazine and other psychotropic drugs portraying a switch to their medicine as a way to eliminate Cuckoo Nest scenarios. Pharma have done some brilliant things in the mental health domain. One was their linking of concerns about the risks of suicide on SSRIs to Scientology. This was doctor Rope-a-Doping. The same has been done to ECT. From the 1960s onwards Pharma influence has made it steadily more difficult and its now close to impossible to get symposia on ECT into APA or other mainstream psychiatry meetings – this is activist Rope-a-Doping.
A true story
In one of the comments below, Johanna Ryan notes the mystique ECT has among some doctors. I’ve never really noticed it. It’s difficult to believe any doctors see ECT as anything other than Shocking. It would be great if they saw drugs as poisons in the same way. Some say they’d have ECT themselves if they ever became melancholic but an increasing number of them have never used it or seen it used. The only person recorded as seeing ECT as anything other than shocking was Ken Kesey, the author of One Flew over the Cuckoo’s Nest, who rigged an apparatus up in his garage thinking it might offer something similar to an LSD trip.
But ECT is iconic in other ways. Clint Eastwood’s movie The Changeling opens with the line – This is a True Story. Not based on a True Story but an actual True Story. The Changeling portrays the horrors of psychiatry as they have been since One Flew over the Cuckoo’s Nest – through involuntary ECT, The problem is the heroine’s incarceration happened 10 years before ECT was invented. There is something about ECT that all but compels people to use it as a symbol of the horrors of mental health systems. There is something about health which means we ignore where the real problems are coming from when ECT and anything else is used.
The people most likely to profit out of Dirty Harry turning into a pussycat or talking to an empty chair are Lilly, GSK and Pfizer. Sorting out the honchos who make the treatments that cause the most damage would take care of the problems linked to ECT en passant, but we’ll be a long time waiting for Harry to tell a drug company executive to make his day.
Meanwhile in another part of town….
Ad hominem
From Deirdre Oliver
Submitted on 2015/08/04 at 11:35 pm
Let’s look at this discourse of yours Dr Healy,
Drugs have come lately to psychiatry. What you lay out below existed long ago, has always existed in psychiatry. “We are being told forget our ability to produce knowledge – to produce medicines. (treatments) They have put us through a machine that erases any inconvenient observations we may have. Our only role now is to consume whatever they give us and to swallow without question the information they provide with them. We have been made into consumers; we are no longer seen as producers.
The hypnosis is pretty dense.”…In psychiatry the inconvenient has always been set aside such that in spite of the fact that in ECT studies placebo is always equal to or superior to `real; memory/cognitive damage is recorded as serious and permanent; cell death is recorded in scans in ALL subjects; and only16-46% get ANY relief and that for under 4 weeks, there is NO critical analysis from the profession.
What may not be recorded with drugs IS recorded for ECT, Dr Healy, but this seems to remain unnoticed by you. You say…”many of these trialists are third raters you wouldn’t want to be treated by. To this day we don’t know how many of us return to normal sexually or emotionally after taking an SSRI even just for the 6 weeks of a trial.”…But we DO know that virtually nobody returns to normal intellectual function following ECT as evidenced by neuropsychological testing and current day MRI scans…”So when your son or daughter (or in ECT, mother, grandmother or child as well) rocks up to a doctor (visiting is too twentieth century) with the disturbing information that they have stopped functioning,”…slowed down, can’t learn, have forgotten years, decades of their lives, their education, their families, skills and talents, will you check the product label/literature including your own books and articles and not finding anything (you)…”like there,”…will you tell them…”it’s all in the mind, or this is their depression speaking.”
No… “the more they protest, the firmer the noose of neurosis will tighten around their neck.
If you were in one of these trials where your attention was diverted away from the effects of this”…treatment on your memory for instance, or when…”you tried to make an observation the doctor didn’t record it, the fact that you took risks in a trial for the benefit of your family and friends and community is now being used to skewer your family and friends, just as surely as your work in a lead smelter for most of the twentieth century poisoned any family or friends you had living nearby.”
Consistency? Dr Healy, what do you say?
DH response to DO
Deirdre
What I consistently say – and said recently in at an ISEPP meeting in LA is that what I as a doctor can do for you that your granny or lifestyle coach, priest or guru can’t do is I can poison, mutilate or shock you. That poisoning, mutilation and shocking must be expected to come with problems – none of which should be ignored – and its only when the condition you have warrants taking the risks – with you fully informed of the risks – and both of us monitoring for things going wrong that I as a doctor should treat or you should engage with treatment.
When it comes to telling you about the risks of ECT – I would tell you and tell anyone that ECT is linked to memory problems but part of the problem is that that no one who gets ECT is drug free and the benzos, antipsychotics and antidepressants you may also be on are likely causing memory problems (memory problems are the commonest complaint I get from people on antidepressants for instance who have never had ECT) so one of the hazards after ECT will be you will almost certainly have memory issues but aside from the short-term problems that no-one has ever denied are linked to ECT, it may be difficult for me or you to work out which of the longer term ones are linked to ECT rather than to any pills you are on. I have talked to many people who are very anti-ECT and when they describe their memory problems, these are much more consistent with antipsychotic or benzo induced problems that with ECT.
In terms of the research you mention – there are no scan data showing damage and there are no animal or other studies showing brain damage, whereas there are scan and animal studies showing damage on antipsychotics. In the case of scans and ECT this may be partly because it is close to impossible to run a study in which you can isolate out the effects of ECT. I know because I worked on a protocol to do just this and found it was not readily do-able.
In terms of letting other voices be heard, one of the best books written from an anti-ECT point of view is Linda Andre’s Doctors of Deception – this only got published because of my intervention and support for its publication.
In the case of the History of Shock Treatment parts of which were written by Ned Shorter and parts by me – the Sections on Informed Consent were written by me and are a paean of praise for the many people damaged by shock who over the years have worked hard to get a recognition or the hazards written into consent forms. I even had nice things to say about CCHR, Thomas Szasz and Peter Breggin en route.
I have never called for a treatment to be removed. They are all dangerous. But with the right collaborative arrangement good can be done. After my talk at ISEPP, several people in the audience mentioned privately that they had had ECT in the past and it had helped them. I know many other people who have also been helped by it – and have friends and relatives who haven’t been helped in any respect. Finally I’ve done more than anyone else here in N Wales to ensure that people who should not be getting ECT don’t get it.
David
There is no evidence that benzos or any other psych drug remove years worth of autobiographical memories and learned knowledge. ECT can and does and I have evidence.
Tony
There is lots of evidence that benzos remove years worth of autobiographical memory. There are many accounts of benzo dependence and withdrawal that state just this and state it as convincingly anyone who has had ECT.
I have no doubt ECT can cause problems. Part of the reason I have no doubt is because one of the smartest people I know had ECT – maybe 10 courses of 6. Thirty minutes after most fits she would get in her car and drive off to work or elsewhere – sometimes heed off several hundred miles. Now she would say she had some cognitive issues – she can pick out very specific things that aren’t as good now – name finding or word finding. Even though there are drugs to take into account she convinces me. As do a lot other people who convince me that on antipsychotics or anticonvulsants they simply cant concentrate or function cognitively in a much more global way than with ECT. My friend above had much clearer cognitive issues on meds than on ECT.
I’m speaking from a perspective of someone who has had close friends, and relatives given ECT and seen many people whom its been given to – many of whom it shouldn;t be given to – and someone who instinctively believes that you cannot have a convulsion without it leaving at least some trace.
But on the question of should be banned – no. Does it get abused – yes. Do we stop abuse in psychiatry by banning ECT – no.
David
Dear David,
I am astonished and dismayed to hear that ANYONE would be driving a car 30 minutes after receiving ECT. In the 1st place it is ILLEGAL to drive within 24 hours after an anaesthetic. It is also astounding to hear that ANYONE would be so clear of mind within 30 minutes of having ANY kind of major fit, much less the kind of huge fit people get with ECT, even without an anaesthetic that they would would be deemed capable of driving away and going to work even a few miles let alone 100s of miles away. Whoever was supervising this procedure at in whatever institution was grossly negligent in allowing this woman to even leave the building without a responsible adult. I am a psychiatric professional who would be deemed liable if anything happened to this woman or to anyone who could have been killed by her. I cannot imagine how this could happen – hospital records require that `obs’ involving assessment of confusion, orientation etc not be completed until at LEAST 2 HOURS after ECT. Outpatients MUST be accompanied or they may not leave at all, and are expected to be supervised at home for 24 hours. What if, as happens, someone develops a toxic confusional state, has further seizures, a stroke or merely becomes euphoric and irrational? All rare but possible. Not to mention the risks to life and limb for the individual and innocent road users. I hope your institution isn’t so brave and reckless to risk the legal consequences implicit here. As for the claims about the benzos, in my experience most ECT patients do not, or have ever have had them. Since most are depressed, normally the drugs used are anti-depressants and `mood stabilizers’ like Lamotrogine and Tegretol which like benzos are anti-convulsants as well, so shouldn’t really be used when you’re trying to give someone a fit. Lithium, Quetiapine, Zyprexa and Closapine are the others that most people have. Oh, and do you prescribe antidepressants at the end of the ECT course to make the effects last, the guidelines say you should and all the ECT doctors I know do, even if the person had a bad (or NO) reaction before?
Welll Maggie I’m glad to know I still have the potential to astonish people! I am that person who went back to work within a hour of having ECT and I should like to have seen anyone try to stop me. My manager knew about the situation, was happy with it and none of my other colleagues were any the wiser…..
The general anaesthetic given is minimal and short acting and I’m lucky to be one of those people that recover from it very quickly. Neither do I have ‘a huge fit’. I’m also physically (and 98% of the time!) mentally very fit, very stubborn and refuse to let bipolar disorder turn me into a ‘victim’, a ‘survivor’ or anything other than me… I’m an individual, a healthcare professional who is well informed, highly educated and supported by a mental healthcare team who I consider to be one of the best available anywhere.
I’m not prescribed any drugs apart from Lithium as they tend not to work (for me) and by and large make things worse. I sometimes ask for Quetiapine when things are particularly grim…that’s all I have. I am a terrible patient and the reason I’m still here is, in my opinion, due to ECT and the ability of the team to let me be in charge of my own treatment and not dictate.
I think it’s handy for all those for and against to hear a positive story from someone who’s had ECT.
You cannot eliminate abuse in psychiatry because psychiatry is inherently abusive. Electroshock is a crime against humanity.
Jason
Do you extend that to all of medicine – and if not where is the dividing line?
David
Psychiatry isn’t medicine.
J
Most of mental health medicine is done in primary care by generalists – are you saying they are being real doctors when doing everything else except mental health work and voodocs when they step into mental health?
Psychiatry was the first branch of medicine to have specialist hospitals journals, the first to have specialist journals, the first to practice evidence based medicine, among the first to cure and pretty well eliminate some of the major diseases that it was originally faced with – GPI, Pellagra Psychosis, Catatonia. Are you saying this counts for nothing?
Or are you saying they are now leading the way again for the rest of medicine by being the first to run RCTs where some of the patients didnt exist, the first to have almost all their literature ghost-written, the first to disease-monger on a massive scale?
Maybe even the first to abandon effective treatments?
What are you saying?
D
I am neither a scholar nor an historian — I speak from personal experience, as a survivor of psychiatry. I made the mistake of consulting a psychiatrist for the first time almost 25 years ago. I had been feeling depressed for a few months and took the advice of a family member to see a psychiatrist. He prescribed imipramine after a single 45 min. interview and in two weeks I was became ‘psychotic and delusional’ and was committed for six months in a private institution near Baltimore. I wasn’t suicidal or homicidal or violent in any way. I was straight jacketed and drugged until unconscious and kept in solitary, naked, for over a month. I was subjected to violent takedowns and forcible injections, as well. I spent 6 months in this place of horrors drugged into a zombie and upon release was labelled manic-depressive. I believed what the shrinks told me because of the intense drug reactions — I spent the next 20 plus years taking shrink drugs and being a compliant mental patient until I was shocked 23 times in the head by an eminent shrink in Philadelphia. I stopped all psych drugs and ran for my life. I am disabled and poor. I was a healthy 18 year old before visiting a shrink. Now I’m 44 and too disabled to work and often too disabled to leave my room all because I believed I was following medical advice. I should be in perfect mental health after all this evidence-based treatment, right? WRONG!!! Thanks for making my life a hellish nightmare, psychiatry. When I feel suicidal, which is often, I like to remind myself of a simple equation called the 3 F’s of psychiatry — FEAR, FORCE, FRAUD. Sums it up nicely, don’t you think?
If you read the RxISK Stories on RxISK.org, you’ll get just the same horror stories from the use of the Statin group of drugs or Fluoroquinolone Antibiotics and other mainstream drugs with people being intimidated into treatment and badly injured by the treatment. So if its abuse you are talking about the psychiatry is part of medicine it seems to me. And the best way to keep the problems going in psychiatry and similar problems going in medicine is to ghettoise psychiatry and say its not a science etc. People who get injured by treatment in whichever branch of medicine need to come together and get to grips with how this happening – what is it the blinds doctors to what they are doing – and how can we change the system.
From this point of view ECT is great for Pharma – they encourage people to figure just get rid of ECT and everything will be all right
D
There is a great deal in psychiatry that is terribly abusive. People have their lives destroyed by drugs and other treatments, while their psychiatrists ignore clear evidence that the treatments are causing the biggest problems, preferring to believe they are inherent. It’s the biggest scam going. Those mental states that are given psychiatric labels are real. Trouble is, most of the time there is no benefit in lumping sadness, anxiety, and extremes in emotional state under the heading “mental illness”, because the only purpose of doing that is to justify unneeded shock, poison and mutilation.
But what do we do with those very few people suffering extreme and debilitating mental states for no identifiable reason? Ignore them? What if there is some contributing physical condition involved? What if there is some therapy, perhaps involving medication, that might help? Would we not prefer a careful, knowledgeable physician to be the one to research and deal with the situation? Just because most psychiatrists in 2015 are ignorant, high-handed, abusive civil rights violators, does not mean that this is the way it always is or the way it has to be. If we ever tried to implement the utopian approach of anti-psychiatry we would soon see a pretty big gap in practical solutions.
The point is in psychiatry people aren’t suffering from real diseases. Psychiatrists control persons, not diseases. Psychiatrists are the ones who drive their patient/victims into ghettos by disabling their brains and stripping them of their rights. Psychiatry is state sponsored social control. Emotional suffering is not a disease, therefore medicalized interventions will ‘work’ by placebo effect and/or producing damage. It does not matter if some patient/victims report after such ‘treatment’ that they were helped — many head injury survivors become euphoric after their injury — this does not mean the injury is making them feel better or somehow improving their ‘mental health’.
Jason
In the rest of medicine you can make an excellent case for state sponsored control as well – and you are not answering the issue that most of the psychotropic drug prescribing is done by primary care doctors,
If head injury causes euphoria, can you explain why any old head injury isn’t more widely used – why go to all the faff of anesthesia etc? ECT is used to bring people who are manic back down to normal – how would something that makes you euphoric do that?
As I’ve outlined I would support you totally in your insistence on never getting ECT again, but do you have the right to stop someone else who has found it helpful?
david
Even if 95% of the things that get diagnosed have no element of physical illness and should not be called mental illness, what about that other 5%?
It is definitely important to fight to get emotional problems out of the hands of people who believe that solutions to years of bad learning and bad life experience come in a pill bottle.
In doing that, we need to be careful that we do not leave people with really serious problems in functioning – whatever the origins of those problems, with no solutions. Remember, it is not just psychiatrists who are handing out psychiatric drugs. GPs dispense dangerous drugs just as freely. “Helping professionals” like nurses and psychologists and social workers are lobbying hard for the right to prescribe and they have made inroads. School counsellors threaten parents that they must medicate their kids or face state intervention. Are these people doing a better job than careful psychiatrists?
There is a problem, all right, and a lot of it is systemic. We need better accountability of psychiatrists, better drug knowledge (and it would sure help if they got the truth about studies) better listening skills and better knowledge of other options. But these are not incentivized; that is, they are not the things that socialized medicine rewards.
David.
Indeed, most antidepressants (though not most antipsychotics), are prescribed by general practitioners who are under pressure from lack of education, time, the drug companies and their patients. Ongoing psychiatric education, except from drug companies, is thin on the ground and entirely voluntary. Most GPs have neither the time nor inclination to pursue it, though I have known practitioners who studied for the DPM BECAUSE they were aware that many of their patients would have mental health problems.
Many GPs insist that most of their patients are happy with the drugs they are given and when asked how they assess this they state, as you do, Dr Healy re ECT, that they’ve `seen people’s lives made so much better, or even saved, by the use of these drugs.’
In fact I’ve been asked by a group of GPs to devise a questionnaire to help them decide who might NOT need chemical intervention, what social factors might be at work including ongoing and frequently unmentioned bullying, physical, emotional and sexual abuse, whether or when to refer them and to whom. Perhaps psychiatrists could mount a campaign to educate these sorely pressed people, to explain the `voodoo’, and reduce the use of these dangerous drugs.
Nobody expects a GP top be a psychotherapist but if THEY understand the basics of the psychological issues their patients face, they are the ideal candidates to educate them. Let’s face it we all face a daily barrage of advertising that tells us a pill will help just about everything. `Wind’ pain, take a pill, constipation, take a pill, headache, take a pill, tiredness, take a pill, anxious, take a pill. Don’t do it hard like lose weight, stop smoking, fix your diet, your posture, do more exercise, cut coffee, coke, alcohol.
As for psychiatry being the first to `have specialist hospitals journals, the first to have specialist journals…practice evidence based medicine’, given the parlous state of `evidence’ in psychiatry today, I’d be very interested in seeing more about this. In fact it seems to me that it was medicine generally that identified GPI as the result of syphilis infection and treated it with antibiotics, and pellagra as a dietary deficiency. Catatonia, `Catatonic schizophrenia’ (it was never a diagnosis in its own right), disappeared when the mental institutions were reformed from hell holes, and was quite possibly a dissociative state in response to intolerable living conditions. In 1969, when I started my training, in a hospital complex of some 3000 beds, nobody had seen it for 10 years. Was this due to the advent of medication or the removal of a need to totally withdraw? Nobody knows but I’m not sure psychiatry alone can take the credit.
Interestingly, ECT is still prescribed for Catatonia. (See the RCP, APA, RANZCP, CPA and David Healy)
As for the appalling bad behaviour in medicine you mention, in saying that psychiatry not the ONLY one who behaves badly does not excuse it. A criminal who says `but he did it too’ or `he did it first’, is still guilty.
M
thanks for this _ wont be able to respond for a bit
D
Should it be banned -definitely, just like lobotomy, ice baths, and insulin comas, some of Psychiatry’s other “brilliant ” treatments.
Does it get abused-yes, often.
Do we stop abuse in psychiatry by banning ECT- we stop ONE abuse in psychiatry that has destroyed the lives of thousands of people.
So, when patients like “amnesia” who have been the victims of psychiatric malpractice, misdiagnosed and driven iatrogenically insane through poly drugging and withdrawals do not have ECT waiting in the wings, administered as the “final option” by morally and medically challenged and inept psychiatrists.
Peter Gotzsche says it would be better if psychiatric drugs were banned because “doctors cannot handle them” and they cause more harm than good. The same holds true for shock, which is simply a human rights violation, packaged as a “medical treatment”.
There is, as far as I can tell, no “informed consent” document that states the following outcomes:
“permanent amnesia, with the risk of the loss of 5 years (Linda Andre), 15 years (Jonathan Cott), 30 years (Peggy Salters)”, “permanent cognitive dysfunction”, reduced IQ, change in personality, post traumatic stress disorder, risk of epilepsy, increased risk of Alzheimer’s ( which is linked to repeated head injuries), and the fact almost all patients relapse in 6 months.
So, you have never called for a “treatment” to be banned? You would not have agreed to a ban on lobotomy or thalidomide?
Diane
So if ECT gets banned, what do you say to the 96 year old lady who asks for it because she wants to get back to playing bridge? What do you say to the people many mental health staff can see stuporose one day and doing cross-words the next? What do you do for the people such as the actor who can’t go on the with show without maintenance ECT?
When treatments get banned, in the case of drugs its the company who pulls them. In the case of psychosurgery etc its because the main advocate dies. But in all these cases the abuse goes on – the bigger issue facing you and me and everyone else here is how to tackle that abuse
David
Dr. Healy,
You asked me a question and I would like to provide an answer.
I am not sure what you could say to the 96 year old old who wants to play bridge or the people who are doing crosswords, or the actor who relies on ECT. Could you suggest rTMS or MST? Could you figure out how much of this is a placebo response? Could you tell them they risk cognitive injury and the “improvement”, in almost 80% of cases or more is gone within 4-5 weeks? Do you investigate alternative treatments that are not as invasive?
But, what do you say to the mother who can’t recall the births of her children or their growing up years? What do you say to the teacher who cannot teach, the artist who cannot create, the musician who cannot compose or play his/her instruments, the nurse who cannot recall her training, the husband who cannot recall his wedding, the academic who cannot read, research, retain, to learn new material? The list goes on and on. Does the benefit to the few justify or negate the damage to the others?
You are a brilliant academic, scientist, researcher, author, doctor. Would you ever take the risk of losing even a tiny bit of your memory or your cognitive abilities, diminishing any part of what makes you unique, capable, and in possession of a well-defined sense of self?
Can you tell me what is faulty about Bentall and Read’s Review of the ECT Literature 2010 that states that the risk-benefit is so poor that the use of ECT cannot be scientifically justified? This seems to be a carefully prepared review that states ECT is no better than sham ECT, and cannot be proven to prevent suicide.
How do you believe the abuses of ECT could be addressed when there are no universal standards and protocols in place regulating ECT clinics or shock doctors?
Respectfully,
Diane
Diane
Thanks for the response.
Having interviewed many of the rTMS and MST researchers I’m pretty sure that if asked to make a living will about what to do for them should they have a depressive psychosis, severe melancholia without psychotic features, catatonia or NMS for instance, they would want ECT rather than rTMS or MST, or VNS or DBS.
I am repeatedly faced with mothers who don’t remember their children growing up, or artists who cannot now work, musicians who cannot compose, academics who cannot retain new information etc – none of whom have had ECT. They have had benzodiazepines, or antipsychotics or worse again statins and I have several complaints every week of the year of brain fog or chemo brain linked to antidepressant use.
I’ve made it my business to chase everyone around here who has had ECT to see what effect treatment has had on their cognitive function and it’s difficult to find comparable complaints. Even the woman, as I mentioned in an earlier response who I advised not to have ECT again because of cognitive issues soon after treatment, said she would as she figured they were linked to the anaesthetic and she gets comparable effects from anaesthetics given for other purposes.
I greatly value my cognitive function. In terms of my cognitive function, I think I can tell you honestly that I would take ECT before I would take a statin. The human body is better able to withstand brief insults than chronic poisoning.
Having interviewed both of them, my position fits pretty well I think with the views of Fred Frankel in the US and John Pippard in the UK, psychotherapists both, who were among the people most responsible for keeping ECT available as a treatment.
I have great respect for both Richard Bentall and John Read. There are a few points to make in regard to their review. It doesn’t take the CORE studies into account. These offer pretty definitive results in support of ECT.
Second, RCTs can often get things badly wrong and reviews of RCTs can make a bad situation worse. The experience of many doctors as mentioned in another comment is of seeing a person, could be any age, stuporose before ECT and a few days later happily doing crosswords. It’s rather like seeing someone jump out of a plane and land safely on the ground, you know in terms of benefit – if and only if it’s being given to the right people – that RCTs of ECT are not much more relevant than an RCT of a parachute would be.
The problem is ECT has been and is still abused and is still given to people to whom it should not be given in terms of benefit. The issue of harms is different. That’s where things become a crapshoot with any surgical and most medical treatments even when being used for the kind of serious problems to which they should be restricted – for most people the treatment works out for the best but for a significant number it doesn’t.
As regards universal standards and protocols, the issues are complex. ECT operates much more on the basis of standards and protocols than any other treatment in psychiatry. But standards and protocols aren’t necessarily a good thing. Literally millions of people are being forced onto statins, antidepressants and bisphosphonates and fluoroquinolones every year on the basis of standards and protocols. This is appalling and the antithesis of good Care.
I fractured my shoulder recently in a fall. A mechanized protocol has swung into place and sent me out a letter inviting me to a bone density scan after which even if my bone densities are normal its likely that I will be offered a bisphosphonate and if I refuse the doctor is liable to turn nasty. This is a monumental waste of money and exposes hundreds of thousands of people to needless injury – I would take ECT before I’d take a bisphosphonate.
At the end of the day if you have problems you want someone who will see you and listen to you rather than someone operating from a recipe book and increasingly the person helping you needs you to be as engaged in your treatment as much as possible because the results are much better that way, the job is more interesting that way and the relationships between people working together to solve problems are at the heart of what makes Care work.
David
In your community there are people who have had the procedure called ECT or electroshock. In the last decade, use has greatly increased, and is used for many reasons now, and offered readily. Used at leading facilities. I am submitting from Oregon, but speak on behalf of my peers, as many cannot. We are showing damages on MRI, EEG, neuro/cognitive testing and SPECT. This is a public health issue that needs to come to light.
As a result of receiving this untested FDA procedure, patients are now living with traumatic brain injury outcomes, at minimum. Electrical trauma impacts all bodily systems, so there are other issues in addition to the baseline of TBI. This has now been proven in the California courts in a now national device suit, yet facilities are still doing this. ECT also impacts our children, veterans and women in pregnancy. Suits filed against the FDA, and firms interviewing for medical malpractice.
My opinion is that providers, who are well aware of these poor outcomes, have a duty to warn, protect and not cause harm. There is an oppressive silence around this, as when it comes to light there will be much to account for. Those standing by silently in complicity and collusion are just as responsible. We need these providers that include nurses, to step in to advocate and intercede for these vulnerable patients.
We are told in consent to expect temporary memory loss to resolve in six weeks and typical anesthesia risks. Their own research reports structural brain changes that result from this. They dare to take this upon themselves, and withhold these known damages? They cannot just suddenly stop doing this now without admitting harm.
Electrical trauma can extend years out to include ALS and CTE. There is a great betrayal of patient trust. We are betrayed with the initial procedure, and again when we can find little assistance to address our outcomes following. Many would like to see criminal charges levied.
Very sadly we can find little help in addressing our outcomes of repeated brain injuries that all other TBI patients have at their disposal. Doctors will not address in referrals and testing, as it will implicate peers and facilities, and risk their standings whatever that may be. My peers sometimes commit suicide as a direct result of damages, and they are isolated. We are greatly suffering and need extensive rehabilitation. Our complaints are written off as psychiatric to protect those responsible. Billions involved annually in the U.S. alone from this in cover ups of decades.
This is trauma pure and simple, not help. Creating temporary euphoria and memory loss for difficulties that led to admission result from brain injury, and is not mental health. There is a two time increase in suicide following ECT secondary to brain injury and isolation in outcomes. Please let others know what is taking place. Others, which may include someone you care about, are at great risk if they are offered this. See ectjustice.com, Thank you.
Yes there is and my son has whole chunks of his life that he cannot remember and his short term memory has been affected through SSRI withdrawal.
Electroshock patients at consent deserve to know device has never had FDA testing for safety or effectiveness, that devices have never had to have pre-market approval, that device and procedure are classed as experimental, that procedure based on known mechanism of electrical trauma results in permanent and extensive traumatic brain injuries with each and every procedure. To be given this information and to not be highly impaired on psychoactive drugs at the time of consent is TRUE informed consent. These damages are reflected in DSM4 by psychiatry’s own admission. They are fully aware of damages and doing despite it. They have duty to warn and protect. A duty to not cause harm! Their actions are criminal. Physicians know what is occurring but everyone turns a blind eye to protect the established system that is highly profitable off the backs of vulnerable patients. Patients are also being used in research around electroshock and not being consented appropriately. There is a class action product liability suit now in US around ECT devices that’s expected to become a national suit. A firm in Canada has accepted a similar suit. We are also moving to hold physicians and facilities accountable. Please see ectjustice.com
Dear Dr Healy
GP colleague from South Africa here. I have just read the forum to advise a patient on ECT after she read the your forum and also saw some videos by you and Dr Josef (USA).
Deirdre Oliver stated that only 16-46% of patients get any relief at all from ECT. My personal experience with patients in South Africa (and having worked in the UK) is that the success rate is better than those figures, but I do not see actual data. Could you point me to any recent data or just comment if the 16- 46% is factual.
Thanking you in advance.
Theo
I have a recent Auditing ECT that may help. https://davidhealy.org/wp-content/uploads/2024/02/2023-09-25-Healy-Auditing-ECT.pdf
There are no reliable figures. In some centres only patients with melancholia or catatonia or other problems that ECT resolves will be given ECT and success rates may be more like 70-80%. In other centres they give people ECT after they have thrown everything else at them and nothing has helped because these may be social problems or treatment resistant caused by an SSRI and in these centres the response rate is likely to be dramatically lower. It’s not possible to offer you a figure to guide practice.
From a patient’s point of view you and they need to assess the doctor and the service in which you might make a referral – you and your patient can make a good stab at what is wrong and whether ECT will help but you depend on a good service to tell you – no in our opinion this is not the treatment for you – if that is it’s not the treatment for this patient
David
Thank you for the prompt reply. I believe the higher success rate that I have seen is indeed a factor of the right threshold for referral.
i have also sent an email.
From Sally McGregor
I’m glad ECT has been raised as a topic because recently I decided to ‘put my hand in the wound’, if you like, and really think about it. Cards on the table: I ‘had’ ECT 6 times over three years – 36 zaps in total. I hated it – most vehemently the first time. I was utterly terrified that I would lose my memory – and I did. I was confused and addled for a couple of weeks after each batch and have permanently lost memories of events immediately preceding/during the zaps (including my son’s graduation ceremony – and that loss is very hard to bear). And, ECT didn’t ‘work’ for me – although objectively, the first time, everyone said how much brighter I seemed, until everything fell apart again.
But – 12 years on – my long term memory is completely unaffected. What I had failed to realise was that the dreadful cocktail of drugs was blurring my memories of the past – and once they had (mostly) gone, the past began to unroll again. Like lifting a carpet – my childhood is there, so my sister and I can exchange reminiscences, my life before becoming a mental patient – all there. So, the Royal College of Psychiatrists Leaflet which states that memory loss is ‘transient’ – is, strictly speaking, largely accurate, despite me sitting in the ward in 2000, in a steaming fury, painstakingly writing ‘THIS IS NOT TRUE!’ on each leaflet.
And now, while having no memory of my son walking across the podium to collect his degree certificate is painful – it’s not half as bloody awful as not being able to hold his daughter for more than a few minutes because my arms are too weak, my wrists too sore and my balance too uncertain. Or not being able to manage the noise and movement of a toddler without having to crash out in a dark room, after an hour. All the consequence of brain damage caused by drugs, not electricity.
But – and this is a question for all psychiatrists – why do patients hate having ECT so much? Why do we all feel violated, intellectually? Why do we all firmly believe that we’ve been damaged on some deep level? Why do we feel that we’ve never been the same since? I saw One Flew Over the Cuckoo’s Nest – but, to be honest, my instinctive, visceral fear of the zaps was far deeper that having been affected by a film. There is a collective, societal fear of having electrodes pinned to your forehead which goes back to Mary Shelley’s Frankenstein and beyond. She didn’t create the fear of creating a monster from electricity – it seems to have been ready and waiting – she merely tapped into it.
But I’m not sure even that is a really adequate explanation.
I’ve seen ECT work a miracle: a young Mum, so wretched and mad that she couldn’t recognise her baby son. We had ECT together, travelled by taxi to the local ECT suite, sat and waited for the zaps. Watching her the next morning cuddling the baby, and then, a bit later starting to walk him out in the pram – was truly miraculous. It maybe didn’t last, but I can’t close my eyes to the fact that Katy was brought back from some unspeakable place.
Debate about a treatment which, to my mind, is far, far less damaging than the effects of long-term chemicals, needs urgently to address why it is so profoundly terrifying to those of us who’ve been through it?
Sally,
You have the answers to why victims/patients “hate” ECT so much. Because we HAVE been violated, intellectually and physically; we HAVE been damaged on a deeper level, causing trauma; and we NEVER are the same after losing memories, skills, IQ points, cognitive functions, and personality traits that defined us, validated us, and created our identity. As Johanna says: “Isn’t the loss of memory the loss of self?” Yes, it is, exactly.
ECT is terrifying because it is the “final solution”, a “holocaust” of the brain/mind, the Frankenstein monster we fear. There is the loss of control, confusion, and the repeated traumatic closed head injury assaults on our lovely, delicate, and unique brains.
I was not exposed to long-term toxic psychiatric drug damage; it became very clear that ECT was administered to me carelessly and without my being TRULY informed about the REAL risks of what I now see as a “bogus”, non-medical “procedure,” perceived as “medical” because it is performed in a hospital by a doctor. A consent form and discussion of risks should clearly outline the potential risk of permanent amnesia (can cover 10-20 years), permanent brain damage, and loss of intelligence. Unfortunately, no consent form includes these details.
I have forgotten the author of the following: “A blow to the head can change behaviour, but it isn’t science or medicine.”
I have responded to comments other than Sally’s here:
There are various case studies that describe patients becoming manic or euphoric, giddy, and disinhibited after having ECT. One described a Turkish woman who experienced this during three separate courses of ECT. Another article is titled “The development of mania and organic euphoria during ECT.”
The question of why “any old head injury won’t do” is answered by the fact no doctor would be allowed to pound someone in the head several times or hit him with a bat because it seems barbaric and does not bear the trappings of legitimacy found in giving muscle relaxants, anesthetic, oxygen, hooking the patients up to monitoring equipment; that is, making it LOOK like something medical is happening when it is just a closed head injury electrical assault that can-cause pin-point hemorrhages, breach the blood brain barrier, cause edema, trigger spontaneous seizures, etc.
From Johanna Ryan
Good question Sally! I hope some docs listen to the answers, it may teach them things that go way beyond ECT. I too had it, and it didn’t help me. Like you, the loss of memory was temporary but frightening and demoralizing nonetheless. For an odd, quirky and desperately unhappy young person who sometimes felt her only redeeming characteristic was to be Very Bright, it seemed utterly damning. The only thing you and others value about yourself, the only thing that gives you self-respect, is now to be rubbed out! For your own good, naturally.
But I think it must be the same for anyone, even if they were very sociable or never thought to be terribly bright. Isn’t the loss of memory the loss of self? Isn’t that why we all fear Alzheimer’s so much? And for the vast majority it is temporary, but it’s also true the vast majority are not beset with urges to murder on Zoloft.
Maybe the answer lies in a more in-depth and honest dialog with people who have “natural” or organically-produced seizures. Some of them have transient mystical experiences or feelings of great serenity too. They also have many ill effects, which tend to get worse the more seizures they have. We could probably learn from both.
I’m very encouraged to read David’s “narrow” description of the problems for which he thinks ECT can do great good. Even “very bad” depression is not always an indicator, as I read you David — it has to be of a particular type.
It’s also incredibly refreshing to hear a doctor admit that there are ANY cases in which ECT does no good. Almost all doctors I meet repeat the same thing, like drones: “It’s the Gold Standard.” The best, the absolute tops for depression. I can name almost any pill and say it did not help me, and doctors will accept that, nodding sagely and saying “well, some do not respond.” But when I tell them I had ECT and it did no good, they just gape at me like goldfish–and change the subject. It’s like telling them I used to walk upside down and breathe carbon monoxide instead of air. They can’t process it, and I think they very quickly soothe themselves by deciding I am wrong.
For about 6-7 years there was one drug that would produce the same “goldfish” reaction: Cymbalta! Hopefully the news that Cymbalta doesn’t fix everyone no longer produces a state of temporary catatonia in doctors.
For anyone interested in medicine in society, and especially how doctors are marketed to, maybe this is an even more interesting question: Why do a few treatments, particularly ECT, inspire this almost religious faith in so many doctors? What’s the secret?
Deirdre Oliver
August 8th
As a DOCTOR, Dr Healy, you are `licensed’ by the state to be paid to poison, mutilate or shock. You are PERMITTED to do these things which means you have an OBLIGATION to make sure that when you do, the individual, your patient, suffers LESS overall as a result. What you are supposed to do is HEAL (I’m sure you’ve noticed) or try to, without causing HARM. An ancient tenet, too often ignored as you so often point out. What you seem to be saying here is that it’s okay to cause harm if you tell people you’re going to, and if these people choose that, the ball is in their court.
Isn’t this a bit ingenuous? No lay person can understand all the ramifications of risk and harm, they have to trust the expert to take care of them, therefore the expert must honour that trust.
THIS is your point in your article. I haven’t queried that, merely that you confine it to one area and abandon it in another.
As the author of a book on the history of ECT it seems odd that you ignore the fact that memory problems, especially autobiographical retrograde memory loss, were documented from 1938, some 15 to 20 years BEFORE benzos, antipsychotics and antidepressants existed. An excellent study by Janis in 1952, very clearly demonstrated this. Since this was such a definitive study, it was deemed unnecessary by honest researchers to repeat it, and was/is avoided by less rigorous researchers later who didn’t/don’t want those kinds of results to see the light of day.
I didn’t mention any specific research into brain damage but your claim that there are no animal or other studies showing brain damage astonishes me. There are few if any animal studies that DON’T show significant, definitive and specific brain damage in ALL subjects. Before 1952 there was a bit of to-ing and fro-ing about whether the damage every study found was actually caused by the electric shocks, but after Hartelius’ exhaustive and rigorously designed cat study it was accepted that this was the case. There were further studies in the 1970s in Russia that supported Hartelius, and the researchers recommended that ECT be withdrawn as a treatment, so later `modifications’ in the procedure did not avoid the problem.
I am surprised that you state that there are no scans that indicate ECT specific brain damage. I must believe you aren’t aware of the 2012 study by Perrin et al where all subjects were given an MRI scan before and after ECT and ALL showed `changes’ that could only have the the result of ECT. Second to this, you may not have noticed Dr Charles Kellner’s (Mt Sinai Hospital, New York) article posted in the Psychiatric Times in January 2015 where he suggested that because of the sensitivity of todays MRI scans, a rethink about structural brain `changes’ caused by ECT might be necessary.
I am aware of your involvement with Linda Andre’s book, `Doctors of Deception’ but I’m not sure that your claim that it `only’ got published because of your intervention is quite as simple as you say. Here is Linda’s feeling about the matter in 2007…
“From: “Linda”,INTERNET:ctip@rcn.com
To: “‘David Healy'”, healy_hergest
Date: 03/12/2007 15:52 PM
RE: RE: Book blurb
David,
The book is unlikely to be published. Doreen (the publisher) simply cannot accept that it is true…The only purpose the book contract has served so far is to prevent criticism of your book. (The History of Shock Treatment). You know Doreen, you know a bad review is her worst fear in life.
Even if the book eventually gets published—and what purpose would that serve for Rutgers at that point?—it has served you well.
You are too smart not to have known this was what would happen right from the beginning.
You can deny it, but you are a liar. We’re not pretending any more.
Linda”
Regarding your book, one review (of many) sums up the continual confusion people feel about your stance on ECT.
“The oddest thing about Healy and Shorter is that they appear to accept the conflict-of interest-driven, spun, “research” on ECT, while they excoriate similar psuedo science when applied to other areas of bio-psychiatry…this book stands in stark contrast to the clear-eyed analysis Healy has displayed elsewhere. Peter C Dwyer 2011”
My point is that very contrast. You appear today to be scrambling to justify both yourself and ECT. I’d like to think you have a subconscious conflict resulting in cognitive dissonance reduction, that your need to continue to believe in yourself as the good guy, the beleaguered messiah, attacked not only by the `establishment’ but by ill-informed people who don’t understand that you only want to do good, allows you to deny facts, evidence or reality that contradict this belief. But I’m afraid I don’t.
You are too intelligent to have such a large `blind spot’ and be unaware. As a scientist who is rigorous in one field it is reasonable for people to believe you are equally rigorous in others. Therein lies the rub. People come to you, believe in you, trust you. The fact that you, here, in your book and in public places such as ISEPP conferences, avoid and deny any evidence that doesn’t support your position, prevaricate and divert with anecdotes, indicates that when it comes to ECT you behave exactly as those you castigate so eloquently and persistently elsewhere, and that you use the extraordinary respect you have striven so hard to generate to continue to deceive vulnerable people.
You promote yourself very well, claiming you give credit and help to your enemies, stating you do ECT better than anyone else, but really, up to 80% of psychiatrists NEVER prescribe ECT, many new graduates balk at even having to do it in training, only doing so under threat, several countries, including Italy where it began in 1938, ban or rarely use it, and no one under 18 `needed’ it in Texas in 2013-14, so should anyone get it AT ALL, better or not?
In `cognitive dissonance’ the more one invests in a belief, the more value one will place in this belief and, as a consequence, be more resistant to facts, evidence or reality that contradict this belief.
The `true-believer syndrome’ examines the phenomenon whereby no amount of evidence, no matter how good it is or how much there is of it, is ever going to convince the true believer to the contrary…No amount of logic can shatter a faith consciously based on a lie.”(Witness `Creationism’)
`Confirmation bias’ which contributes to overconfidence in personal beliefs and can maintain beliefs after the evidence for them is shown to be false. This is contrary to scientific thinking which is the search for falsifying as well as confirming evidence.
Which one do you use when you talk about ECT, Dr Healy?
Deirdre
Linda’s book would probably not have had a look in in Rutgers without my support and after a critical review would not have got published without my ongoing support
David
Deirdre Oliver
August 8th
Comment:
Hi Sally,
Are you saying, Sally, that since you claim you have NO long term memory loss, nobody will? Plus it didn’t help you at the time, so you went through a hellish time for nothing & lost your son’s graduation. Has that memory come back? If not you HAVE suffered permanent memory loss. Not much of a recommendation even if that’s all you got from it. Of course it’s possible you are unaware of other events, abilities and subtle functions of your life, because if it they’re gone, unless others mention them you can’t know their gone. Or maybe you’re lucky, no one has ever mentioned something you wish you’d been there for, or you haven’t lost anything that impacts too greatly on your quality of life, or maybe the apathy that accompanies brain damage means you just don’t care. Speaking of the `miracles’ and every ECT proponent has stories of these that justify the enormous physical and emotional destruction they perpetrate, but I was a mental health professional, I saw
one `miracle’ in 6 years. I also saw wards full of people whose lives had been `stolen’ from them by ECT. Who were no longer functioning as social human beings, who had not enough initiative to go to the toilet, get a cup of tea or decide to go bed. Who sat, in `affable apathy’ year in and year out, who were not sad, depressed, or despairing because they weren’t anything. Some had been there for 30+ years, once young women with a future. We called them the `waking dead’. They didn’t have families who were prepared to take them home but believe me there are many, many people today who live diminished lives just like these women, who have no `back’ wards to sit in.
Perhaps you should check into a web site called Psychiatric News, if you’re interested a in wider view. Not too many `miracles’ there. And do you still know this young woman whose `miracle’ could have set her up for the early onset dementia that is an all too common result of repetitive brain injury, especially in younger people.
I too, lost the graduations of both my sons, their sporting triumphs during their adolescent years (they were both elite athletes) and almost every other aspect of them growing up over a five to seven year period. I lost my skills as a professional artist, a novelist, and a film writer. So ECT effectively wiped out my past and destroyed my future and I didn’t have any drugs until AFTER ECT and the PTSD I suffered from your beautifully described and so often un-mentioned psychological impact.
Unfortunately I did not suffer anosgnosia, a curious state of unawareness of the deficits caused by diffuse damage to the fronto-temporal junction, which is where the electrodes of David Healy’s `careful’ ECT are placed in both uni & bilateral ECT. I am only too aware of my losses to the traumatic brain injury that is ECT and it has devastated me and my family.
If you substitute `TBI’ for `ECT’ you will see very clearly what ECT REALLY does, including the ongoing depression, suicidality, fear, rage and personality changes that are the actual aftermath of the brain injury, just as much as depression, suicidality, and psychosis are the complications of psychotropic drugs.
Hardly a lesser outcome. In fact, it takes just a few weeks for ECT to do what drugs take several years to do and while many people successfully get off the drugs, there is no coming back from the patches of cell death, mini haemorrhages, atrophy and scarring throughout the cortex from 400+ volts of electricity for 8 seconds again and again, (36 for you – 87 for me – 100 for some) that predispose all of us who’ve had ECT (from as few as 1 or 2) to learning difficulties, loss of executive function, creativity and the loss of our lives, because our memories are what makes us human.
Deirdre
You know nothing about me other than what I chose to share about my experience of ECT. I did so, because I recognised in your anger something of what I felt for many years. My question was trying to get at the root cause of why I felt so angry.
Your responses also exemplify something I’ve written about elsewhere: that whilst patients/service users are unable to debate matters respectfully, tolerate differences of opinion, acknowledge that all of us have the right to have our opinions taken seriously and resist personal attacks – we none of us stand a snowball’s chance in hell of changing a damn thing.
Sally,
You’re absolutely right, I don’t know anything other than what you’ve shared, nor do I pretend to. What I did was share my experience of ECT, personal, which like yours was, and in my case still is very painful; and my professional experience based on years of training and of working in a large mental institution. I am sorry if you feel that I was disrespectful or that I in any way personally attacked you. In fact your description of the fears and distress that ECT evokes is, as I said, beautifully described, and is an insight that the profession would do well to consider. Angela Gilchrist, a UK psychology lecturer postulated that `How can something so terrifying possible be therapeutic?” You might be interested in reading a study by Lucy Johnstone 1999, `Adverse Psychological Effects of ECT’ and Diana Rose, Pete Fleischmann, Til Wykes, Morven Leese and Jonathan Bindman, “Patients’ perspectives on electroconvulsive therapy: systematic review,” British Medical Journal, Volume 326, 21 June 2003, p. 1365.
I totally agree that we must debate matters respectfully and tolerantly. I have my opinions, they are based on long and wide experience and I will continue to present them. I do not expect that I will be attacked, abused, or accused of disrespect or intolerance because I hold those views.
I totally agree that we must debate matters respectfully and tolerantly. I have my opinions, they are based on long and wide experience and I will continue to present them. I do not expect that I will be attacked, abused, or accused of disrespect or intolerance because I hold those views.
Its a pity you didnt extend that to Dr Healy.
Deirdre, You’re not helping, and I thank Professor Healy for addressing this issue which bombed its way into his blog. I refrained from replying as I managed to remind myself of the purpose of his blog.
I speak only for myself. Your contribution almost stopped me from reading dhblog.wpengine.com. Not because I was doubting his motives but because of you.
I saw this new post this morning and was going to try and write a measured response regarding ECT, which is similar to Sally’s experience. Then I saw more from you.
You’ve made your point. I don’t doubt for one moment what you saw on psychiatric wards. I saw a lot too. But your apparent one-upmanship on experiencing and observing psychiatric harm only made me angrier. You don’t speak for me.
Suffice to say, in the last 6 months I’ve discovered:
Anti-psychiatry: I totally ‘got’ it. I had plenty to be angry about. But the more I read the angrier and more bitter I got. It didn’t help me. It actually made my situation worse, not better. I backed off.
Critical Psychiatry Network: Great for academic debates but an exclusive club – non-clinicians not allowed in. It didn’t help me. I backed off.
Critical Psychologists: Promising but then the mud-slinging re psychiatry got too much. It didn’t help me. I backed off.
Rxisk and Professor Healy: the information I was looking for – specifically psychiatric drugs, which have been insidiously more destructive to me than the ECT.
Rxisk and Professor Healy have treated me with more respect in the space of a couple of months than all the psychiatrists and patient /uservoice groups that I’ve had the misfortune to encounter over almost 30 years. This does help me, and for that reason I’ll stick with them.
You’re not doing me any favours with your vitriol.
“it takes just a few weeks for ECT to do what drugs take several years to do”
Really, because it only took a few weeks for the so called safest antidepressant (Prozac)to make my wife want to obliterate herself from existence. It took only 6 weeks of Effexor to make her decide to destroy her family and 18 year realtionship… and 4.5 years after her last pill (she was on them for about 18months), she has memory loss, anger problems, word replacement issues, weakness and pain in her extremities and sexual dysfunction – to name but a few little things. And she never had ECT… so where does that leave us?
Neil,
My son is still suffering the same effects as your wife 14 months after stopping venlafaxine ( Effexor) He is better than he was but I sometimes wonder if he will ever be the person he was before it again.
Im grateful he’s not dead, in prison or a secure hospital though which were all distinct possibilities at one point. So after that every little improvement is a huge step forward.
Author: Truth
August 8
Comment:
Good to see some degree of truth in the comments: “…I can poison, mutilate, and shock..”… None of these “treatments” should be be considered as potentially beneficial, especially in the context of “first do no harm”. The RISKS outweight any short-lived “benefit”.
A telling reference to “…. the many people damaged by shock…: acknowledgment that this is indeed the outcome for thousands and thousands of people.
It is commendable that you facilitated the publication of “Doctors of Deception” by Linda Andre. Strangely, you have not taken anything away from her analysis which is meticulously researched and presented?
Key point: Andre was medication naive- no benzos, anti-psychotics, anti-depressants to blame for her 40 IQ point drop, her loss of at least 5 years of her life, her education, her skill sets, her cognitive dysfunction. ECT was very clearly and specifically the reason for her injuries, her brain damage.
I was “treated” for six months with medium dose anti-depressants and benzos. I had zero memory issues. These appeared in direct relation to my being shocked: I had ZERO difficulty “teasing” this out. I ended up with amnesia and cognitive impairment and a 20 point drop in my IQ, NONE of which appeared until I was electrocuted.
You mention people coming up to you privately saying they were “helped” by ECT and knowing friends and relatives who were helped while others were not helped in any respect. Unfortunately, there is the other group you have omitted when speaking of “helped” and “not helped”.
It is the, not only did it NOT help, I was injured, brain damaged, lost memories, was traumatized, have cognitive dysfunction…etc. How it it that you are unaware of the animal (cats, primates) ECT studies (Hartelius for one), and the animal and human autopsy studies outlined in “The Iatrogenics Handbook: A Critical Look at Research and Practice in the Helping Professions” by Dr. R.F. Morgan.??
Linda Andre and Peter Breggin have both covered this evidence in their books.
A few select quotes from this book:
“From a neurological point of view ECT is a method of producing amnesia by selectively damaging the frontal lobes and the structures within them.”(page 253)
After analyzing the studies he had done, Hartelius, who correctly identified all animals exposed to shock after being given unlabeled slides of control animals noted: “discernible vascular, glial, and neuronal changes in cats subjected to a maximum of sixteen shocks..”
He concluded: “The question of whether or not irreversible damage to the nerve cells may occur in association with ECT must be answered in the affirmative.” (page 249.
Neurologist Dr.Friedberg concludes:” Assuming free and fully informed consent, it is well to reaffirm the individual’s right to pursue happiness through brain damage if he or she chooses. But we might ask ourselves whether we, as doctors sworn to the Hippocratic Oath, should be offering it.”
Studies have shown ECT has no superiority over Sham ECT, does not prevent suicide, and has no benefit beyond 4 weeks, with 40% of improvement lost in 10 days…
Perhaps you are conscientious about the “selective” use of ECT but many doctors are not, diagnosing patients incorrectly, failing to identify paradoxical reactions to drugs vs a disease state, failing to truly inform patients of the “real” risks, using outdated equipment, failing to differentiate between organic brain syndrome and “improvement”, using dangerous bilaterals, etc.
When you state you have done more than anyone to stop people who do not “need” ECT from getting it, I would assume that would mean there are no patients getting it because NO
ONE “needs” brain damage, subtle or extensive.
The thousands of victims of ECT have clearly outlined the development of memory and cognitive damage which directly coincided with being “shocked”. Just as “rape” should not be the “treatment” for sexual assault,
the closed head injury assault of ECT
should not be used as a “treatment” for people already experiencing shock and trauma in the form of mental illness.
Distressed people, often on drugs, confused, and desperate, willing to agree to having an arm removed with a rusty spoon if they thought it could “help” are in NO condition to give “consent” AND with each additional closed head concussion, less able to ask that the “treatments” be stopped.
A 2012 study using functional MRI found “lasting effects on the functional architectural of the brain”, more specifically, “ECT reduces frontal cortical connectivity in severe depressive disorder, the specific area affected being the “dirsolateral prefrontal cortical region” ( the same area assaulted by surgical lobotomy.)
How much longer can this barbaric practice continue?? How much denial and cognitive dissonance is there at play when “doctors” reject the studies, the evidence, the testimonials of the victims, telling such “experts by virtue of suffering the procedure and living with their damage” that they must be lying, must be neurotic, and further insulting them by trying to convince them that those pesky benzos and antipsychotics did the damage and it just pure coincidence that the new deficits appeared routing and after ECT??
Give the victims of brain damaging ECT the same consideration you give to the victims of toxic drugging who claim they became manic, or suicidal, or homicidal.
Stop the “spin”, stop refusing to see the elephant. It is there and pretending it isn’t is insulting and shows arrogance and a desire to hide and obfuscate because admitting you have been wrong and doing harm all this time is too much of a shock to the ego.
Yes, we can all agree that those priests didn’t molest those children, those drugs didn’t trigger suicidality,
Bill Cosby did not drug all those women, Bill Clinton did not have sex with that woman, and ECT survivors cannot be sure ECT caused their brain injuries. Yup, deny, deny, deny, and alternatively, censor, censor, remove those offensive but reality and evidence based conclusions.
Hello Truth,
Most of us have come here because our lives have been trashed by unbridled psychiatry, whether drugs or ECT. You are clearly angry, and seeking to lash out at someone (or perhaps anyone).
Dr Healy is a very easy target. He runs a refreshingly open and deeply honest blog, and his head is so far above the ‘professional parapet’ that he can be seen from Jupiter. It seems nothing less than miraculous that he has survived for so long, against the massed ranks of Big Pharma and his venal so-called ‘colleagues’ in chemical psychiatry. When a dozen ex-patients step forward to claim that he ECT’d their brains to mush, then maybe you will have a point.
So please tell us all who subjected you to ECT, and I’ll add him/her to the little list I’m compiling. Respectfully, Truth, it is now time to man up. If you can’t do that, then please go away.
Yours in anticipation,
Walter K.
Totally agree with You! Dr. Healy is an honest man. His you tube lectures are extremely educational. I learn something new everytime I watch one!!
Hey, Walter K,
Thank you for saying something that I wanted to say. I am a retired psychotherapist and have professional experience of psychiatrists who I would gladly have trashed; I have experienced others who have been very human, constructive, and importantly, vulnerable. Isn’t that the basis of our humanity?
I agree with your words, “Dr Healy is a very easy target. He runs a refreshingly open and deeply honest blog, and his head is so far above the ‘professional parapet’ that he can be seen from Jupiter. It seems nothing less than miraculous that he has survived for so long, against the massed ranks of Big Pharma and his venal so-called ‘colleagues’ in chemical psychiatry.” Bravo!
Christine
Truth you say
‘Perhaps you are conscientious about the “selective” use of ECT but many doctors are not, diagnosing patients incorrectly, failing to identify paradoxical reactions to drugs vs a disease state, failing to truly inform patients of the “real” risks, using outdated equipment, failing to differentiate between organic brain syndrome and “improvement”, using dangerous bilaterals, etc.’
So why not direct your anger at those Doctors instead of at a Doctor who has dedicated years to campaign for transparency and patients rights. A Doctor who has risked his career to speak out about abuse in medicine.
You also say
‘Give the victims of brain damaging ECT the same consideration you give to the victims of toxic drugging who claim they became manic, or suicidal, or homicidal.’
When has David Healy not given consideration to anyone who has suffered from any treatment or drug.
He campaigns for transparency, full disclosure and patients rights to full consent.
He prescribes drugs but I dont attack him because a drugs side effects that he didnt prescribe ruined my sons life.
Why are you attacking him for something that he didnt do to you or any of the people your talking about.
And by the way the patients who have suffered through prescription drugs dont ‘ claim’ to have become manic , suicidal or homicidal … THEY DID become it.
I’ve been doing some looking into the Cuban medical system and the current state of psychiatry there. I picked up a 2014 “Primary Care Bulletin” dealing with depression. It’s part of a series of Bulletins mainly for Cuban GPs who want a review of the “latest consensus” on various medical problems and treatments. For those who can read Spanish to any degree, here’s the series: bitfarmacoepidemilogia@msp.sld.cu
Here’s what they state about ECT:
Bilateral ECT can be effective for short-term improvement:
a) in severe depression with psychotic or catatonic features;
b) in patients who do not respond either to psychotherapy or drug therapy;
c) in cases requiring a rapid response to suicidal impulses or nutritional compromise; or
d) in patients who have responded well to ECT in the past.
It sounds like a policy I could live with. Much more conservative than the US consensus.
This is in the context of a psychiatry which seems pretty conventional, but has a pronounced “social” or “environmental” slant which I like. It may keep them from rushing to conceptualize all varieties of depression and anxiety as “brain disease,” for instance. Psychotherapy of some sort is generally seen as option #1 with drugs being option #2. For children they are option #3, with a kind of social-work approach focused on helping with problems at school and in the family situation being #1, and psychotherapy #2.
There’s only one thing I’d add: Voluntary. I don’t know how much involuntary treatment is countenanced in Cuba. They began an intellectual divorce from Soviet Russia in the early 90’s, so maybe much less than Americans assume.
OOPS — wrong link for Cuban Primary Care Bulletins! Here it is:
http://www.cdfc.sld.cu/boletines-atencion-primaria-de-salud
I think you are right to be cautious re voluntary and other systems. There were some disturbing reports from Turkey not too long ago that make it clear that serious abuse exists in many countries re ECT.
Voluntary is key. ECT should never be involuntary unless we are looking at something like NMS when the patient is obtunded or close to comatose and even then if on recovering to a point where they regain capacity if they refuse further treatment it should stop.
The greatest problem in the “West” is that people often still don’t realize they can say no and in some cases staff fail to respect this.
I would have some problems with the idea of giving ECT to patients who fail to respond for instance to antidepressants. I have seen too many people who have been abuse victims who have been tanked up with meds and when they fail to respond been referred to ECT because they fail to respond to drugs. ECT should never be given in circumstances like this.
In terms of depression it should really be restricted to melancholia – that is depressions with clear motor features such as psychomotor retardation – a depression that is often accompanied by raised cortisol and either has psychotic features or is continuous with psychotic depression. It should be pretty rare that ECT is given to people under the age of 40 unless for instance there are marked catatonic features or NMS.
DH
David, you are invited to talk with a group of ECT survivors in the worlds first and only live chat room for ECT victims. It would be very cordial and open ended. Please respond here nd I will let you know how to proceed as the Group as closed to the public.
Thank you
TCB
Tony
I’ll be delighted to take up the invitation but its going to have to wait – I have a number of other fish to fry at the moment
David
As David floats his art tickles on MIA, I wondered who would be the first to jump in about James Holmes and the verdict.
Then I wondered who was ‘off the rails’.
This could only be written by an A merry can…
https://www.madinamerica.com/2015/08/why-was-james-holmes-the-movie-theater-killer-spared-the-death-penalty/
I don’t know about MIA…love Rodge and Phil and a few others, but, some of this stuff is puerile.
http://www.denverpost.com/theater-shooting-trial/ci_28601756/aurora-theater-shooting-jurors-begin-watching-gory-video
The Daily Mail points out today that:
It is feared the next generation of GPs and hospital doctors will increasingly choose to move abroad, as they battle anxiety and depression caused by the pressure of a job
Good.
If doctors haven’t got the common sense to organise themselves and not tell perfectly normal people that they have mental health problems then I would be glad to see the back of all of them. Apart from the surgeons.
They are all off to Australia and New Zealand, apparently.
Good.
Might be a better chance at a relaxing occupation which is what they all seem to want.
Stress. Me. No.
I’m off to Oz.
As one person who can spot a cover up at ten paces I know who floats my boat.
I was rope-a-dope….it chafes…it is exhibit A..I kept it as a souvenir….
A not so good day in the life of a mass murderer
The US Health Services did a great job with James, twelve dead, and, they did a great job with Andreas, 150 dead
When there is more talk about the dead than the living then we are getting somewhere….its just a question of which dead…..
http://www.dnaindia.com/world/report-germanwings-crash-families-prepare-lawsuit-in-us-2112650
When I was an undergrad I worked in a Psych unit for a couple years a Tech. ECT was used there and many if not all had a clear benefit from it. Obviously I could not follow up with them after discharge though. I can say I don’t remember seeing these particular patients on the unit again!
Following an adverse drug event, David has been of tremendous help to my mother. As such, I wrote him via e-mail on the subject of this blog; he has asked me to re-post our correspondence here, so that he might reply to it publicly:
On 10 August 2015 at 20:36, Alyssa Ryvers wrote:
I don’t expect to be the one to change your mind on this, but you have no idea how confusing it was to grow up with a mother who was missing some significant frontal lobe functions – including lack of impulse control, and what seemed like an inability for real empathy. She was a highly sophisticated person, but child-like in some ways. I’ve met a lot of people in my life; from many walks of life , but none came close to my mother in the ways in the unusual way in which she related to people. Of course, I’d known about the hundreds of ECT my mother had experienced, but as I’d been told that these had been a positive thing from the time I was a child, I’d never questioned them.
There is no doubt in my mind that the “mental illness” that my mother had was largely brain damage caused by those ECT. Certainly you couldn’t argue that the patients of Dr. Cameron didn’t experience brain damage?
Alyssa
On Aug 10, 2015, at 3:38 PM, David Healy wrote:
Alyssa
I agree entirely with you but what Cameron did wasn’t ECT – it was abuse
Happy for you to add a comment saying just what you’ve said here
David
On 10 August 2015 at 20:36, Alyssa Ryvers wrote:
Before I do – you know that as far as I know, the ECT my mother was subject to was prescribed by Dr. Lehmann — would you still consider what he did abusive? What distinguishes what you refer to as ECT from abuse?
Alyssa
Alyssa
For some people the 1960s and earlier were extraordinarily abusive in lots of ways. It was a time when Doctors were Gods. They simply stated that such and such a patient was for ECT in the morning or psychosurgery or whatever else. Cameron exemplified this feature. If a doctor got an idea that something like regressive ECT might be a good thing he was pretty well free to inflict it on people. And there is no doubt that people were damaged. Many recovered amazingly from being reduced to near vegetable status. Others didn’t.
One of the features of the ECT story is how activists used their experience of ECT as punishment and ECT used in arbitrary ways to help create the Informed Consent movement. It was women with Breast Cancer and people being given ECT who gave us informed consent as we have it today.
It looks on the surface today that things are better. People detained in hospital have rights. But in the 1960s your family if they weren’t cowed by the doctor could and did discharge you if they thought treatment wasn’t helping. Now if a family member tries to discharge someone who is being made worse by treatment, the system will likely respond by attempting to get them displaced as the nearest relative. Despite all the tribunals we have it seems harder to escape from the system now that it was before. Across medicine despite all the protocols that talk about people centeredness, we are powered out now in more ways than ever before – the doctors may be pleasant but they have to do what the guidelines say and even good doctors end up doing abusive things to a greater extent than happened in the 1960s as books like Dying for a Cure and above all Dear Luise show.
There is a marvelous movie that touches on these issues – Calvary – about abuse within the Catholic Church. What’s good about it is how it brings out that even good people lose their emotional connection to people who are being abused and when you lose that you become part of the apparatus of abuse. In this movie, probably no accident, the most callous, most unfeeling person is the doctor. Medics often have to turn off their feelings – but once they do there is a risk that just like the depersonalization caused by SSRIs, when you stop the drugs you remain emotionally disconnected
David
Dr. Healy:
When my 21 year old daughter lay in a hospital bed with catatonia, the treating psychiatrist said that electroshock was the preferred treatment because the drugs were ‘toxic’. He was frustrated because I cited, as rationale for resistance to shock, stories regarding brain damage from shock survivors and he retorted: “You can’t believe what those people say! They are psychotic!” To me, this smacked of slander because he was referring to individuals who I consider dear friends and I don’t consider my dear friends ‘psychotic’ but rather, living reminders of the potential to experience complete recovery from even the worst mental and emotional distress and extreme states. This conversation broke a spellbinding I was experiencing regarding psychiatry. Since that day, I have been extremely skeptical of every aspect of your profession. Even though I didn’t have guardianship of my daughter, I made it clear I would seek a court injunction and call in the Director of Ethics at that hospital if they attempted to shock her without her informed consent (rather impossible, if one is catatonic, staring into space, mute, motionless, etc.). The four mg. of ativan every four hours through a drip tube to get her out of that state of catatonia, followed by an involuntary admission to a locked psych ward, large daily doses of neuroleptics, followed by long term institutionalization and court ordered neuroleptic poisoning turned out to be indeed ‘toxic’ as predicted by the shock doctor. However, I do not regret helping my daughter avoid even more brain damage
Interesting dialogue here.
David, you have been nothing if not consistent in general and on this issue.
My son was brought out of a catatonic state with ECT. He was brilliant and never lost a brain cell until killed by Zyprexa – profound hyperglycemia- at the age of 39.
I have not chosen to argue much with those who claim ECT is horrible – perhaps it was for them, but in the above instance, and at other times, my son was saved by it.
I save my fire for those in the pharmaceutical industry, whose internal documents reveal that they know, yet choose to hide and ignore, lethal side effects for the sake of profit. Justice has yet to be done to them, any of them. And I save my fire for those in places like the FDA who choose to shill for the industry, as opposed to meeting the mandate of protecting the public health.
I’m aware of at least some of the dangers of ECT and I expect most people are – especially aware in comparison to other medical treatments they have no experience of. I am also aware of cheap and buggy medical devices, ineffective surgery and unnecessary screening procedures, subjects that seldom get a mention here either. But then I’m not here to read about any of that. I am here to read about the problem that has personally affected my life. There is a clue at the top of the homepage as to why I would come here to read such things:
It begins….
‘Making medicines safer for all of us’
‘Adverse drug events are now the fourth leading cause of death in hospitals.’
So apart from ECT not being a drug so being off topic from the get go…, where does it stand in the rankings of leading cause of death? How likely is it that myself or anyone I care about will be subjected to it? If they are subjected to it, how likely are they not to be aware, or be made aware of the potential harm? Where is the ghost writing, the financial incentives, the corrupt and hidden evidence base and the growing mass of harmed people who want to be recognised?
Most people are already very wary of ECT – that awareness/fear of ECT and 60’s/70’s psychiatry is what my GP attributed to my initial observations about my wife’s life destroying drug treatment. She babbled something about One flew over the cuckoos nest affecting my opinion of psychiatric treatments, then went on to say that psychiatry isn’t like that anymore so I should stop thinking that way. In other words – its all in your head, stop watching films.
In the beginning when my wife told me she was prescribed an antidepressant, I didn’t really bat an eyelid – would anyone think it strange that I thought of antidepressants no differently than any other medication back then? Would anyone think it strange if I said I would have reacted very strongly to hearing my wife had been prescribed ECT?
Like Deirdre said, the things that AREN’T recorded for drugs, have been for ECT – The community around Davidhealy.org and RxISK who read and post on these websites, have been harmed or are concerned about that which isn’t properly recorded, that which isn’t given proper attention, that which doesn’t get blockbuster movies made about it, and that which you or your loved ones are increasingly likely to encounter in every day life. While ECT no doubt causes some people harm, the danger to society from big electrode hyping their questionable treatments is not really something that keeps me awake at night. The subject that this blog is primarily about however, has and still does keep me awake some nights.
How many people in my local village are likely to have had or will have ECT in the future? I have no idea to be honest, I don’t know of anyone… My GP did tell me of the local population that use her surgery (about 4000 people) about 15% have a prescription for anti-depressants. (note: she used this in defence of antidepressants). I personally know six people who have had lives damaged by antidepressants in one way or another – only four of those people had mental health issues. But forget antidepressants, what about everyday prescriptions for all the other illness… I know my dad takes four medications a day to treat some symptom free numbers that came up. (he isn’t symptom free anymore though his numbers look a little better). The fact is, most people are medicated in one way or another these days, and ECT is vanishingly rare in comparison while the risks also appear to be fairly widely known by the public.
So after considering all of that, my opinion is this is little more than a crude attempt to discredit someone whose core following is largely made up of ex, current and relatives of mental health patients by using and somewhat misinterpreting his stance on ECT to foster mistrust among those people most likely to have strong feelings on the subject. Someone tell me how I’m wrong?
I’ll leave you with wikipedia’s definition of an internet troll.
In Internet slang, a troll is a person who sows discord on the Internet by starting arguments or upsetting people, by posting inflammatory, extraneous, or off-topic messages in an online community (such as a newsgroup, forum, chat room, or blog) with the deliberate intent of provoking readers into an emotional response[2] or of otherwise disrupting normal on-topic discussion.[3]
What I find almost impossible to understand is when someone spends an entire lifetime trying to help the disadvantaged who have been either wrongly prescribed or prescribed and then blamed for resulting effects is why the need for a lifetime of needling…
Its absurd and ridiculous when the whole world should be on the same side…I feel like I have been on a degree course with this blog and could take my finals, but, then, it would be the David Healy Degree Course on the Truth About Drugs, Psychiatry and Doctors and as we all know not many people want to learn about that…..its like all those people who never took a driving test because it didn’t exist and who are now careering all over the road, blind, deaf and out of control…it would be nice if a few academics signed up to this course and actually, opened their minds, to, perhaps, learn something.
One of the best lines to come out of David, was to hold two thoughts in the head at the same time…why don’t they do this?
Has educating any one in the perils ever been more difficult…why has the purchase of voodoo dolls gone up….and not down…..along the lines of what Neil is saying……or is grown up speak just not applicable any more?
I doubt for one moment that David has even one misgiving about starting all this, but, it can’t be easy carrying the conscience, largely, by himself….
A little thought for the day, I found……about conscience…
While a person’s judgment may be wrong in light of a biblically enlightened worldview, he or she must be given correct information and the opportunity to pursue maturity without oppressive external manipulation. This is the way of love (cf. 1 Cor 8:1-3 ). On the other hand, the classic question, “How long do you put up with the weak?” is easily answered by contextual implication. You work with their weakness until they have had the opportunity to learn the correct way and it becomes a new conviction for them. If they refuse to learn and mature, then they have shifted from the category of weak to belligerent and thereby come under new rules of engagement.
When ( or IF?) consensus is reached on how to strike a no-fault agreement that assures a qualified, certified, experienced healer shall be the only authorized administrator of Shock, Mutilation and Poisoning , ONLY after the intended recipient of said medical assaults has agreed that the odds are 50/50, that any individual intervention or combination thereof is, for all intents a purposes, a crap shoot– (noting, I must add, that there is no predicting the identity of the rogue individual who reacts in an completely unpredictable way)
Yes, only after this totally level playing field has been established; after the patient/service user and doctor/healing enthusiast agree to wage the experiment – as partners for discovery, joined at the hip for the long haul, risks be damned–
When this moment arrives, The Medical Mission has been accomplished—
And we can smoothly transition to considering new schemas that conceptualize the human being as a landscape of interconnected energy channels accessible for applying treatment of every sort of malady via precise needle punctures (enhanced by low current electrical stimulation), moxibustion cautery and superficial abrasions. Or rather, Traditional Chinese Medicine will loose it’s shocking — lack of appeal.
Expanding our choices with the addition of the very first- authentically ancient injuries employed by healers whose vastly superior method for testing and recording evidence is the missing link for making medicine safer for all of us– (why not?)
-Not a nostalgic detour to a over idealized past– but a compass to navigate thru and beyond treacherous misinformation; all that we have been led to believe we *need* that really just reflects the obsessions of those who seek wealth and power, whose knowledge is limited to our fear of death and physical demise– will vanish like the morning dew, as we encounter profound truths of ourselves— consistent over time and shared by all human beings:
According to the Neijing, the universe is composed of various forces and principles, such as Yin and yang, Qi and the Five Elements (or phases). These forces can be understood via rational means and we can stay in balance or return to balance and health by understanding the laws of these natural forces. —
The natural effects of diet, lifestyle, emotions, environment, and age are the reason diseases develop-
Same as it ever was—
“The natural effects of diet, lifestyle, emotions, environment, and age are the reason diseases develop”
I think this would be better if it said:
The effects of unnatural diet, lifestyle, emotions and environment, along with the natural effect of age are the reasons diseases develop.
Our natural diet, environment, lifestyle and emotions do not make us sick – they make us strong.
Patterns of disharmony that cause disease develop just as naturally as vitality, fitness *good health* –all are natural effects of diet, lifestyle,emotions, environment and age–.
It is often the case, that people fail to see the natural effects of these aspects of our lives–until they get sick.
Mindfulness based on awareness of the relationships between our beings and our surroundings–the heavens and the earth, is the perception of the human condition that explained and defined health and disease –or rather is the context for Traditional Chinese Medicine.
While invasive or painful interventions, like acupuncture, for instance, were accepted as treatment/ correcting imbalances–, herbal medicines were actually shunned by some , as detrimental to health. If it was too easy, or too quick a remedy for the ill effects of some aspect of lifestyle indiscretion, then there would be less motivation for the patient to make efforts to change the *root cause* of the malady.
Interesting that ancient Chinese medical practitioners harbored reservations about natural medicines– but did not mind using needles, causing abrasions,burns,– or rather creating injury, — to effect cures.
As far as I can see, the main difference between ECT and oral medications is our interpretation of them. We are so used to popping pills that we hardly bat an eyelid when given a prescription for yet another pill to add to our menu – that is, until things go wrong. I can only add that watching our son in bouts of adverse reactions to SSRIs – his split person, with one half of him pleading for help before the urges of the other half became too strong for him to control; his total loss of memory of the 3 months that he was on the said meds.; his total change of personality even to this day – do nothing to support the positives of the more “modern” ways of dealing with mental health issues. As you always say David, we need to be AWARE of things that can go wrong BEFORE we start on a medication and also to be supported when things go wrong. Anyone offered ECT would be fully aware of their treatment as would their family or friends – it would not be seen as “just another pill to pop”.
Bonnie bites….
[#MIA] dot com [.]
Bonnie Burstow, Ph.D. (MIA Author) on August 11, 2015 at 1:37 pm said:
Indeed, shock is not Healy’s strong suit.
Greg_Martin on August 11, 2015 at 12:25 pm said:
As one who unnecessarily received ECT because of drug withdrawal, I honestly believe our focus should be on psych drug harm to a much greater degree than banning ECT. This is not to endorse ECT by any means and there are probably harms not yet identified, but there just isn’t any comparison to the degree of suffering I’ve experienced from psych drugs than the 11 treatments of ECT I received. I guess I’m a Healy-ite on this.
I dont have the knowledge or experience to comment on ECT.
But what I do feel more than willing and able to comment on is Dr Healy.
This man was the only person to help when I was absolutely desperate over my sons severe withdrawal. When I contacted him I never for a minute thought I would hear anything back but I did and without him my son would rotting in a prison cell or a secure mental hospital.
Daid Healys kindness and compassion shine through when you meet him. He is not only expert in his knowledge and his field, he is willing to share that in way that is understandable so that the patient can make their own informed decision.
My son’s withdrawal was a terrible time. He is still suffering the effects of it now but without David Healy things would have been so much worse.
It upsets me when I see such personal attacks on this honest and decent man. He has helped my family for over a year now and many, many others. He has dedicated so much of his time to campaigning for transparency. He gives up and puts up with a lot to fight for the rights of patients.
Debate and opinions are one thing but trying to discredit someone who does so much good in such personal attack is underhand. Its such a shame that it detracts from what this blog is supposed to be about which is Transparency In Medicine … maybe that was the point of it.
The conscientious psychiatrist who employs his/her full range of human skill to care for patients and challenge ALL that undermines patient safety, is STILL a psychiatrist.
When I first began to participate on critical psychiatry web sites, I was *the enemy*– a psychiatric nurse, no less repugnant when my status changed to *former* psychiatric nurse.
Anyone who has been severely harmed by psychiatry will have one basic legitimate weapon in their arsenal– though ALL people who are survivors of psychiatric *abuse* do not employ this weapon. Psychiatry does not meet criteria for a medical specialty in the first place–. The field is barren–ZERO scientific inquiry into etiology, and no medical basis or calling someone, “mentally ill*–
but there are psychiatrists who have *helped* people suffering from symptoms — by utilizing some or all of psychiatry’s treatments– YET– to me, this is no reason to validate or support psychiatry as a *medical practice*.– though to others the *good* psychiatrist deserves to be called, Doctor– and “shame on the rest”
I am not advocating for banning any specific psychiatric intervention– even ECT, which I, too, have heard people praise as an effective treatment for them–BUT, I would snatch the credentials of psychiatrists, so that they are no longer able to to perform ECT under their shroud of secrecy and controversy–
I would like to see a more evolved discussion — one that challenges the whole of western biomedicine’s view of the human condition–, one that introduces the culturally based perceptions of human beings, challenging the role of the brain in so-called mental illness, for example–
I agree that Dr. Healy demonstrates ALL qualities that earn him the title, GOOD Doctor– but since there is no school (of psychiatry) graduating his disciples /students– we are going to be screwed unless he leads us in a viable new direction–away from psychiatry as a powerful, medical specialty– at the very least.
If David Healy sees something Worth noticing in the experience and research on ECT, he probably takes that into account.
It might actually be hard to exclude other factors in the research that has been mentioned above.
Most of us, me included, aren’t very bothered by factors that contribute to what we “know” stems from the ECT/SSRI.
But for David Healy, in order to have his good name put on any conclusion, he must consider variables that are borderline silly to me.
But I can understand that is how you maintain some sort of scientific integrity.
So if any research into ECT has also included test subjects who are on psychoactive or other drugs. He might be right to ask questions wether or not one or the other taint the results.
Nevertheless, as with SSRI, ECT is a ‘blunt tool’, and to me it seems like a “shot in the dark”, by modern standards of medicine. (theoretical standards of modern medicine, we don’t live up to it, but we Think we achieved it in many other areas of medicine)
If we can attach a strand of DNA to Another, zapping whole areas of the brain with electricity seems outdated.
Shock therapy is/should be an absolute last resort in catatonic states/vegetative states.
Fascinating debate, but I’m hesitant to join in as SSRI’s were what poisoned me, I have no experience of ECT. I never had ECT but I can understand why people would be wary of it. It has a bad rep, but as Healy says, the psychiatric drugs are used much more than ECT, and also many who would be prescribed ECT are likely to be also on a various cocktails of psych drugs too. Personally, i think it’s important that Dr Healy has provided a blog here with comments and debate allowed. Healy is one of the few psychiatrists who I would trust… you can’t fault his sincerity or integrity. This blog is invaluable, I hope the wider psychiatric community is reading (I’d be pretty sure that they are lurking anyhow!).
Psychiatry by the very nature of the conditions it deals with will always be fraught. The thing is though a lot of patients damaged by SSRIs have never seen a Psychiatrist, they are prescribed often long term by GPs without psychiatric evaluation. They are also prescibed off label for other conditions that are not pyschiatric in nature by other specialists with no psychiatric evaluation beforehand.
My son has a neurological condition. He never had problems that needed a Pychiatrist until after the SSRIs which were prescribed for his neurological condition.
SSRIs are prescribed freely to patients a lot of whom dont even have a pychiatric condition they are just going through a crisis in their life and understandably feel down and anxious. Many of them will end up with a MH problem after the SSRIs though.
I totally agree that from what I have found out in the quest to help my son there is a lot wrong in psychiatry and the treatment of mental health. But what happens to the patients who do have real MH conditions if we got rid of psychiatry ? Im not asking that in an argumentative way. I just dont understand. If there was no pyschiatrists who would treat them. Surely people with severe mental health conditions need help from a medical specialist, so who would that be ?
Whilst I personally think that counselling, nutrition and lifestyle play a massive part in mental well being and should always be used first in mild to moderate depression, anxiety etc. What about people with severe mental health problems who this will not help enough ?
Another problem with banning drugs or treatment that help some but harm fewer is that what about the people its helping. By saying this I do not wish to take away from the terrible harm that has been done to victims harmed. I would be the last person to do that, I watched my son and my family be destroyed by side effects from SSRIs. But the drug my son reacted so badly to, I have been told by others has helped them tremendously. Patients with the same condition as my son have been able to live a more normal life due to the drug that wrecked his life. So by banning it they would be condemned to the full effects of their life changing condition. I would obviously never want my son to take it again but neither would I want to take it from someone its helping.The problem I have with the drug is that the company who make it do not admit that it can in some people it causes severe problems. So Doctors who only have the information they are given at hand do not realise when things are going wrong. They dont know the warning signs and will often dismiss side effects or confuse them and think they need to increase the dose. They also dont realise the need to taper properly and think 3 days is enough ! If we had the full information on this drug when he first went on it, with hindsight we and his Doctor would have known within the first couple of weeks that it wasnt suitable for him. Instead of his dose being increased he could have been tapered properly and come off it. Instead side effects and warnings were ignored the dose increased because of the information his Doctor had and the rest is history.
Regarding ECT, I dont know enough and agree with Katie that that the shroud of mystery surrounding it should be removed. The veil needs lifting on all of medicine so that Patients and Doctors can work together instead of the Doctor being someone you blindly put your faith in when quite often the Doctor is blindly putting their faith in half truths and misinformation.
David,
I was not aware that Dr Crusoe isn’t you but why didn’t you mention that before now? I have no brief with `Crusoe’, I find her observations interesting and insightful and enjoy reading them. I merely pointed out the inconsistencies inherent in your attitude to ECT vs the principles Crusoe writes of.
I also have no issue with your stance on the drug issues in medicine generally and psychiatry specifically. Like so many, I applaud your `clear-eyed analysis’ and anyone reading your blog in the past will see several posts by me where I say this. I also understand that the neuroleptics have a place, albeit far less than currently used.
I am bewildered as are many others by your attitude to ECT, NOT whether you should ban it, or anything else. As you continually say, your brief is to `get the hazards known’. In the drug arena, you and many others with the same brief are working hard to do this. People like Peter Breggin who has published in 1986, 1991, 1994, 1997, 2001, 2008; Whitaker, 2002, 2010, Angell, Abramson and you, 2004, Moynihan and Kassirer 2005. Then the later works of Moncrieff, Kirsch, Greenberg and Allen that precede or are contemporary with with Pharmageddon. The difference appears that many of these seriously query ECT as well and you wrote a book praising it.
Interestingly, Peter Breggin, who has written of drug cover-ups for over 35 years, and who, with Irving Kirsch, (The Emperor’s New Drugs, 2009) exposed the cover-up of the suicidal effects of SSRIs in 1998, has also exposed ECT as a destructive, ineffective and ultimately unnecessary procedure, has until recently never suggested it be banned. He always maintained that people should be fully informed of its risks. Now he considers that due to the persisting refusal of psychiatrists to acknowledge those risks, it should be banned entirely.
If we look at Thalidomide, we see a drug that held few risks for men, women not of childbearing age or who were unlikely to become pregnant, e.g. nuns. The risks were however, that not every prescriber would adhere to even very rigid guidelines, so it had to go.
In your ECT unit Dr Healy, are you sure that only those who `need’ ECT get it? Who decides who `needs’ ECT? Given your beliefs regarding brain damage, are you sure people ARE fully informed? Are you even sure they’re not agreeing to it to please you, their own doctor, the nurses, their family? Do you ask them of they think it might kill them (euthanasia), are they merely acquiescent, accepting anything, believing they deserve punishment (Johnstone 1999), i.e. the symptoms of their depression being the basis of their decision? Are you sure they haven’t been threatened and coerced by the nurses, their doctor or their family?
The opportunities for abuse are legion and very common, and coupled with lack of complete disclosure of risks, I suggest that nobody ever gives free informed consent. In some countries ECT is brutal, without `modern’ refinements and is used indiscriminately for many purposes far from any pretense of `therapy’, e.g. for political and social dissidence, punishment, behaviour control and such spurious `treatments’ as `excessive use of video games’. Considering its potential for permanent brain damage, poor efficacy (30-46% for weeks rather than months Prudic 2004) and that up to 80% of doctors and several countries don’t see that it’s necessary at all, perhaps a complete ban is the only humane option.
That ECT harms far fewer people than do neuroleptics is making a judgment about harm based on numbers. A drug was recently withdrawn because one person in a thousand might die from it. The problem was that it was impossible to predict who that might be. ECT harms at least half a million people a year. At what point is harm acceptable?
I was ‘fully informed’ about the possible outcomes and side effects of my ECT (see my comments above and below) and under no pressure from anyone at all. Did I like the procedure? No. Am I glad I had it? Yes. Would I have it again? Yes. Am I a quivering, brain damaged wreck? No, I am a fully functioning, intelligent, healthy individual and (most important to both me and my family) I am alive.
To continue to answer Dr Healy’s challenge:
Max Fink has indeed always claimed openly and without guile that ECT causes brain injury, `it wouldn’t work if it didn’t’, and he was removed from a court case recently because he embarrassed his colleagues by repeating it in court. He also dismissed those who complained of memory loss by describing them as “malcontents who have nothing better to do than sit round complaining all day”. These were vulnerable people who were his patients. Kellner’s `openness’ has only occurred when the `possibility’ of revealing scans is a fait accompli. However, as an historian you are well aware of the fact that ECT was DESIGNED to `disable the brain’, that it was the last, most reliable, and `CHEAPEST’ way of doing it. The cover-up started after Insulin coma `therapy’, unreliable, often deadly and EXPENSIVE was discarded in the 1960s. It too, however, `helped some people’.
ECT cleared beds in overstretched hospitals, disabled complainants and, with the growth of the private psychiatric hospital system in the 1970s, made money. It had to stay, so the PR spin machine took over. The designers and manufacturers of the machines became the major researchers, their associates published reviews, (at times scientifically and ethically compromised); they took up powerful positions in the guilds, in universities, on editorial boards and government bodies, and have made a lot of money.
I have read Linda Andre’s book, and Bonnie Burstow’s several works, including `The Business of Madness’. I have also read Robert Whitaker’s and Peter Breggin’s works along with my friend Rebekah Beddoe’s book, `Dying for a Cure. (She has issues even with the small number of ECT treatments she had). Then there are a large number of papers. a few of which are: Read & Bentall (2010), Colin Ross (2006), Robertson & Pryor (2007), Richard Warner 2003, Sackheim 2007, Prudic 2004, plus, plus. We also should add the works on the adverse emotional effects, so well described in a recent post on your blog, Johnstone 1999, Rose 2004, Van Daarlen-Smith 2011. As Angela Gilchrist says `how could anything so terrifying possibly be therapeutic?”
I don’t need to go blow by blow into the research as this has been done and I’ve already mentioned enough names. but I find it interesting that you debunk the evidence for damage then admit that nobody denies it. In fact you’ve consistently denied it since this debate began. I support the recent post by Maggie Macdonald that very few ECT recipients have a long history of benzo use and many people who report cognitive damage following ECT have had little experience of antidepressants or antipsychotics. Of course the damage from the drugs must compound that of ECT and the question remains, how do we justify increasing the risk?
Finally I will just state the facts as they stand:
A traumatic brain injury (TBI) occurs when a sufficient external force is applied to the head that disrupts normal function of the brain. This may or may not result in unconsciousness, however he greater the period of unconsciousness, the greater the injury.
ECT renders ALL recipients unconscious with the application of an external force. The resulting seizure indicates severe disruption to normal function. Therefore ECT causes a Traumatic Brain Injury. (TBI)
TBIs commonly causes residual memory, cognitive, personality dysfunction that is likely to be permanent, and increases in severity with further injury.
Repetitive Traumatic Brain Injury is caused when a further injury occurs before the first has healed. This is commonly considered to be after two to four weeks.
ECT usually causes a TBI twice to three times a week for at least two weeks and may continue routinely for six weeks, i.e. From 6 -20+ consecutive TBIs. Therefore ECT causes repetitive TBI.
Once we substitute TBI for ECT we can see what is the real aftermath of ECT. Most of it is never seen by the psychiatric treating medical team, and a recent study showed that brain cell death continues for weeks following brain injury, long after the person has left the hospital. Problems mentioned later by the person and/or their relatives are blamed on the illness therefore often leading to further treatment, as spoken of by Dr Crusoe re drugs which triggered this entire debate.
TBI causes:
Post Concussion Syndrome (TBI) which includes memory loss, impaired concentration, attention disorders, mood swings, heightened arousal, personality problems, fatigue, and diminished IQ, etc. These are symptomatic of a neurological disorder that is caused by brain injury due to head injury. Often the effects of head injuries are not immediately apparent. Many months may go by before such changes become apparent.
Predisposition to early, or earlier onset dementia.
Cognitive impairment among severely head-injured patients includes memory loss, characterized by some loss of specific memories and the partial inability to form or store new ones.
Injury to the frontal lobes of the brain that can affect the area of the brain that normally controls impulses.
Loss the ability to see the world from another person’s perspective, a very complex cognitive skill.
Lack of self awareness, anger, depression, fatigue and reduced social skills
Loss of communication difficulties that are not realised until people are in stressful situations such as returning to work or study.
These are sophisticated mental skills that occur in the frontal lobes of the brain, the area damaged by ECT. All of this can occur after a single TBI.
Personality changes may cause serious disruptions in family and social life. Doctors, friends may not believe the family when they talk about the difficulties of the new personality they are facing.
These are the FACTS. How anyone wants to view them is up to them.
If people believe that because I disagree, or even deplore Dr Healy’s attitude to ECT, I am `vilifying’ him in all things, then so be it. I have no personal issue with David Healy. I have a problem when people with power are careless with that power, but I have no axe to grind, no personal benefits, no vested interests, no aim other than to save people from the damage that I have seen and experienced.
My understanding is that the true scientist welcomes criticism because science is a search for the truth. It is the pseudoscientist who excuses, dodges, prevaricates, diverts and insults critics because pseudoscience is the search for support of a belief.
David Healy, you appear to do both, THAT is my dilemma!
Deirdre
I don’t see the facts or the history the same way. Most of the details you cite about who discovered or did what are wrong – Irving Kirsch had nothing to do with the hazards of SSRIs and while Peter Breggin bravely got involved in the Fentress case, he was not the person who put the SSRI problems on the map. I know Bob Whitaker and most of the other people you mention pretty well. Bob’s book is having a huge effect for the good – but its not right about ECT. Books can sometimes be helpful when they are wrong.
Bob didn’t go any checking of primary sources re ECT. I interviewed most of the leading living practitioners, i interviewed may of the critics from Linda Andre to Peter Breggin. Many of the critics don’t have a good word to say about others on the same side of the argument. I read all the literature on the origins of psychiatric survivor movements before putting together Chapter 9 in the book. Many of the people who worked to improve ECT practices were psychotherapists – John Pippard and Fred Frankel – both of whom ended up as supporters of ECT when done properly and with consent.
What i take out of it is this. First its common across medicine to have doctors defensive about treatments. There was and still is much grosser cognitive dysfunction from Cororary Artery Bypass Surgery from ECT. In this case the first medical response was to blame the patient. But when you add the resources of an industry defending its meds to this defensiveness you have a much more dangerous situation. ECT is not an industry with access to PR facilities etc.
The Survivor movement seems to me right on the money when they talk about people having far more rights in the penal system than in the mental health system. At this point though being abused by ECT is pretty rare – at least here where i can see what’s happening. There were only two seriously disturbing cases that I was aware of – there are far more abuse with drugs cases. This is what needs tackling – and there are all too few people tackling it. In my clinics I can think of one person who complained about cognitive dysfunction after ECT, but every week of the year I get someone else complain of post- SSRI or antipsychotic cognitive dysfunction. I have never seen cognitive dysfunction after ECT that is as bad as what I have seen with statins. In one case I remember of a lady with cognitive problems who had improved clinical but whom I advised not to have any more ECT in a hurry – she turned to me and said she had just the same kind of problems after the anesthetic for day surgery on several occasions.
I’ve just had surgery two days ago for a fractured clavicle and chipped bit of shoulder – its a crap shoot, you take a risk on the anesthetic and on the antibiotics and whatever else they might infuse into you. But i was faced with having a badly shortened shoulder for the rest of my life and I made a decision to go ahead. Things seem to be okay so far. In the case of ECT people have a lot more time to consider the options and I’d have plenty of scope to ensure if you were being treated here to ensure you didn’t get treated against your wishes. But what are you going to do about the 96 year old lady who walked into me sometime back and said “look young man, I need ECT”. She’d had in unmodified form in the 1950s and again in the 1960s and knew the signs of what it could treat – turned out she was absolutely right and where pills did nothing for her ECT helped a lot. Can you really deny treatment to people who want it?
As for how it works, ECT is not the same as a head injury or a traumatic brain injury. This is stuff you read in books that does no good for people with Head Injuries or TBI who are usually brittle, anxious and unhappy. It pretty rare to have euphoria. Its the convulsion that makes the difference in ECT it seems. Everyone would love to do what it is that ECT does without the convulsion and some of the most effective drugs are proconvulsant – clozapine, lithium and ketamine – suggesting that a greater focus on this might be helpful. But even if something is found, it will be a poison and if used in medicine its important to make sure its not given to people who don’t stand to benefit because for every effective treatment from anesthesia through to antibiotics there are many who don’t.
David
From a completely non medical perspective, the novels and journals of Fydor Dostoyevsky describe grand mal seizures, from aura to post ichtal state, in puzzling, contradictory ways. Dostoyevsky’s illness, some type of seizure disorder has been diagnosed in hindsight as a form of epilepsy (with various arguments presented by neurologists) however, it is apparent that the severity and frequency of *seizures*, as well as the timing, of them are interwoven into his literary genius — maybe his seizure disorder was the fabric?
The most notable epileptic characters in Dostoyevsky’s novels are Prince Myshkin in The Idiot and Smerdyakov in The Brothers Karamazov. Myshkin is almost certainly an autobiographical character, based on Dostoyevsky’s own experiences of epilepsy. “The Idiot” is my favorite. No doubt this classic novel influenced my take on reports from patients who experienced ECT as a *treatment* that worked for them– as well as settled the paradox of how ECT could have even been considered….
Yes, seizures were experienced and observed, long before ECT was even conceptualized– And, I wonder, though seizures are frightening to observe, and known to be potentially fatal, if the concept of inducing a seizure as a means for reversing or arresting an intractable mental state that is experienced as intolerable,is linked to disclosures like Dostoyevsky’s that romanticize the terrifying nature of a seizure–. Not to say that a patient contemplating ECT is not terrified for good reason, but that the paradoxical stigma around ECT being offered as a treatment might be rooted in the most detailed personal accounts of seizures?
Dostoyevsky journaled about a particularly severe bout of seizure episodes he suffered during his writing of The Idiot”– leading him into mystical renderings and unexpected changes in the development of his main character (thought to be himself)– even plot alterations. Pure genius, is what I would call this particular work–. It is worth contemplating.
The prospect of informed consent coupled with responsible application of ECT is what I cannot fathom. There is more enigma associated with Dr. Healy’s practice of psychiatry than what has been written so far on this thread. It defies anything but pure speculation, that he has attained both the self confidence and the humility to engage in real dialogue and regard patients as dignified, respect worthy human beings. I have observed how these traits are trained out of a psychiatrist, or maybe the natural selection process in a psychiatric residency is set to favor arrogance and authority? It is noteworthy to ponder this :
Just as the errors in judgment occurring with potentially fatal consequences from the authority wielded by the most uneducated medical professional, in the realm of psychotropic drugs,- gross, misleading statements about organic syndromes and physiological processes are spewed with equal arrogance from psychiatrists. Nothing is more misleading than the bold statements of correlation between TBI & ECT. Interjecting specific emphasis on the variables that make ECT more or less dangerous, calls into question the basic issue again :Are most psychiatrists qualified to offer and administer ECT safely? I say, probably not.
Reviewing years worth of literature on success stories- recovery from what modern psychiatry has called chronic, debilitating mental illnesses/ brain disorders, there are some very interesting points of commonality. The human element– care, nurturing– and a wide range of skills for grounding and improving negative, and enhancing positive mental states involve a myriad ways we humans can generate our own healing and maintain our health. Absolutely NONE of these successful methods are in the tool kit of the modern psychiatrist – who sees *patients* through a narrow lens focused on the brain.And apparently, those psychiatrists who are most adamantly opposed to this narrow focus on the brain, are also quite ignorant in the realm of organic brain syndromes and traumatic brain injury. The paradoxes are greatly diminishing the prospects of getting *safe/effective: treatment from a psychiatrist. Dr. Healy is an exception for some very difficult to articulate reasons–
The acupuncturist I have assisted to help people through withdrawal from psych drugs is Chinese and my help was initially as a translator – intermediary, actually, because I made the referral. When she is asked why so many other aspects of a person’s emotional well being and mental clarity seem to appear after withdrawal effects are abated, she says very clearly, “I don’t know”- “But, maybe something to do with improving chi flow? Something to do with how needles do some injury and body responds with healing?” It is amazing to observe the changes in lifestyle that are evoked from whatever it is those needles have done. This TCM physician, with my humble assistance, develops a very profound relationship with *our* patients by asking questions and listening- palpating pulses and observation. The real skill is knowing where to place those needles, and before she places the first, she knows *our* patient better than the patient knows herself.
If I were assisting Dr. Healy, as a nurse, which often times is the role of intermediary between doctor and patient, I would be just as challenged to explain the success of his treatments. The combination of knowledge, skill, wisdom and personal interest in the patient as a person– seems no easier to explain, than how acupuncture works. Maybe has something to do with the Chinese character for learning, which translates as “to study” & “to question”– Maybe because he is more interested in leveling the playing field than being the foremost authority? Could have something to do with improving the flow of chi through open dialogue?
I’ve just happened upon this post (and the argument therein contained) by pure chance and have no interest in trying to convince anyone suffering from depression, mania or any other kind of mental illness that ECT is a perfect cure or an obliterator of memory. I can only speak from my own experience when I say that ECT undoubtedly (in my opinion) saved my life….and may be required to do so again at some time in the future.
I’m sure I’m not one of the smartest people DH knows. I have a bipolar disorder that, when it kicks off, leads to debilitating highs and life threatening lows. Over the years I’ve tried almost every drug going and all but one (lithium) have left me with unacceptable cognitive issues and all the other run of the mill side effects to boot. I’m also a fairly non compliant patient even when well so drug treatments have never been the best option for me.
Be clear, I loathe having ECT, I have a morbid fear of general anaesthetic for a start. However I have never once been forced to have it, although on many occasions I’ve sat in clinics, clutching a cup of coffee hallucinating (visual and auditory), believing I’m being eaten alive by maggots and quietly planning my own death whilst my clinician suggests carefully that maybe, just maybe, it might be time to have a short course of ECT. Looking back I have been sectionable many times and could have been forced to have the ECT but this has never happened.
I had the ECT as an outpatient. I’d turn up at about 8.30, go to the ECT suite when they were ready, I’d be up and about within 30 minutes, and then get back to work.
Side effects? Of course. After some shocks I’d get quite a nasty headache and there are memory problems. These are not debilitating at all, annoying sometimes (probably more so for my family than for me) where I can’t remember if I’ve seen a particular film or not, that kind of thing. I also have word finding problems where I can’t pull the word I want from my memory sometimes…again irritating but not the end of the world. In both these cases the memory is not ‘gone’ I simply can’t retrieve it at the time I need it. If I start to watch the film the memory comes back. Imagine you’ve mislaid your car keys…you know they’re in the house and you turn the place upside down and you still can’t find them. Ten minutes later you turn round and there they are behind the microwave.
So basically I firmly believe I’m alive because of ECT and all can tell you is that it works for me and that it hasn’t ruined my intellect or my life. I’m not a jibbering wreck and hold down an interesting (and stressful) fulltime job. Mind you I still have no recollection of seeing the first two Mission Impossible films but maybe that’s just as well.
ECT is nothing but humane if an individual is gripped with the profound and unshakeable depression that can go with real manic depression ….often this comes on after a psychotic, manic high has run its course. There is nothing worse than watching your loved one gripped in the tragedy of this unbearable depression, and nothing causes relief so quickly as a course of ECT – willingly agreed upon by the person in the throws of it.
I fail to understand why one would not believe Dr. Healy, the most skilled and compassionate psychiatrist I have ever met, on this matter.
I fail to understand the invective and vitriol thrown his way.
Why not go after the real villains – doctors/psychiatrists who give drugs willy nilly and barely dain to speak with their patients?
Why not go after the villains in the corporate suites who sit around figuring out how to hide the side effects that could dampen the market of their blockbuster drugs – be they psychiatric or otherwise?
Why not go after a government that permits such an industry to thrive in an all but unregulated state, permitting the death of thousands and thousands of innocents every single year?
This discussion really highlights how the treatments in themselves aren’t necessarily the problem, but the harmful ways their use is encouraged, the fact they are too-readily and over used, and perhaps our cultural attitudes and expectations when it comes to medicine.
I know whenever I’m offered a treatment, usually medication, the informed consent process is pretty nil. Doctors have generally been consistent in reassuring me that side effects are rare and that I shouldn’t worry. I’m sure the doctor hopes the treatment works, yet when I’ve ended up harmed, doctors proved completely incompetent and ill equipped to even recognize what’s happened, let alone respond in any dignifying way.
There seems to be a lot of shame tied to the issue of medical harms. Much of this might be due to perfectionism in medical culture, yet patients also have quite a sense of entitlement when it comes to what we can expect from medical treatments. The fact that in our society (in the US, anyway) people are prone to suing doctors when things go wrong, surely feeds into that culture of shame and a doctor’s tendency to deny or sweep under the rug when harms occur.
David and Debra,
As we see there are many anecdotes supporting ECT but can we please be protected from outright lies. I’m sorry Debra but unlike Maggie Macdonald, I don’t just question your story, I totally don’t believe a word of it. NO hospital/clinic/Day hospital is going to hand car keys to a person who has had an anaesthetic after a half hour, an hour, or even ten hours. The law states that such a person is deemed cognitively impaired for 24 hours following ANY anaesthetic, therefore in the event of an accident, the facility would be held CRIMINALLY liable. Every bartender knows that. OK, not everyone who drives with a blood alcohol reading of 0.1%+ has an accident, BUT, most accidents involving death and serious injury involve impaired drivers, with alcohol, drugs and fatigue being the main issues. So, NO, David, and absolutely NOT, Debra!
It seems rather sad that in your attempt to support your case you need resort to lies, anecdotes and filibuster.
Remember too, folks, that David Healy is not everyone’s hero. There are a whole lot of people out there who are more than happy with medication, who are terrified that it will be withdrawn, who swear it saved and continues to save their lives. People who will deny, despite all evidence to the contrary, that they have had ANY side effects, that they are NOT addicted and are happy to, and even demand that they take the drugs for the rest of their lives. I can give you a list of these stories as long as my arm from my own friends and acquaintances, but this doesn’t mean that I deny the truth staring me in the face that the drugs are dangerous and ineffective.
A review of your ECT book with Edward Shorter, David, notes that… “In their 382 page book Shorter & Healy (2007) cite only four studies to support their claim that ECT is effective…All four are from the 1940s. Three of them (Kalinowsky, 1944; Myerson, 1941; Smith et al., 1942) had no control groups, vague or non-existent definitions of “recovery”, and the people assessing “recovery” were either the hospital staff or unidentified (in the Myerson study none of the ‘schizophrenics’ improved). In the fourth (Tillotson & Sulzbach, 1945) a control group of “clinically comparable patients” improved less often (50%) than ECT recipients (80%), but there was no definition of “improved” and no mention of who decided who was “improved.”
I rest my case.
The other issue here and I will leave it here, is not whether I’m right or wrong, but that I have the temerity to disagree with a hero and that, unfortunately, is not acceptable. Since I do not indulge in name calling I will suggest that killing the messenger is the modis opperandi in `confirmation bias’ and pseudoscience. It always exposes the killer far more than it does the messenger.
For further information on all the topics raised here I suggest people read the `Mad in America’ Blog, started by Robert Whitaker but not run by him.
Deirdre
Fortunately I don’t take offence easily but even I find being called a liar a little irritating. Why would I lie? I’m glad to say that my life has not yet reached the nadir where I have to scour medical blogs to leave fictitious stories to wind credulous people up. Unfortunately for you I can (and am prepared to) back up every single detail. My manager at the hospital where I work says (after much laughter) that he’s more than happy to confirm my story, my consultant would be happy to do the same (he has my permission to do so) and I’m happy to ask the discharging ward to back the story up also.
Despite the fact that you are willing to expound on what you regard as the evils of ECT you seem to have a very limited grasp of what is actually entailed in the physical process. The anaesthetic is minimal and very short lived and I recover from it very quickly. Once awake I’m good to go. Why sit around when I can be getting on with the job for which I am paid?
I’ve never heard of you, have no idea who you are, what you do or where you live but I can assure you that things in the UK are very different. I work in a hospital where we do many day case procedures where patients have invasive procedures with longer lasting general anaesthetics than one needs to perform ECT and go home the same day. It is certainly not against the law in the UK. I was a voluntary patient and not detained under a Section of the Mental Health Act and was therefore free to discharge myself at my own risk. If it had been necessary – and it never was because I am treated by a forward thinking consultant and nursing team – I would have discharged myself from the hospital’s care, they would no longer have been liable and I would have been responsible for my own safety.
I do not regard David Healy as any kind of hero (that accolade goes to David Sedaris as it happens). However I completely agree with him on the issue of ECT and it’s usefulness in some cases. I can see that, like many of the pharmaceuticals on the market, it may not be the treatment of choice in every circumstance but it does have it’s place for some. I would never be so crass as to tell another sufferer of life threatening depression what they should or shouldn’t do to alleviate their suffering, that is an individual’s choice arrived at (hopefully) by consultation with their doctor.
Frankly Deirdre I find the tone of your reply to my comment disparaging and ill informed. You called me a liar on a public forum. I am not and can prove it. I hope you will be as quick to apologise as you were to make the false accusation in the first place.
DEBRA
I’m delighted to hear that you manage what can be such a debilitating condition so well. However I’m still very concerned about your story. In my country it is illegal to drive, sign legal documents or be sent home alone within 24 hours of an anaesthetic no matter how mild. In fact any contract signed within that period can deemed invalid in a court of law.
`PATIENT (UK)There is considerable pressure these days for day case surgery and so anaesthetics are often arranged for rapid recovery so that the patient may be discharged just a few hours later. However, effects will last and the patient must be discharged into the care of another who will drive home. A taxi can be used (but not a bus) and only if there is someone at home to receive the patient. Under no circumstances should a person drive on the same day as having received a GA. Driving should be avoided until 24 hours after the anaesthetic and even important decisions such as signing legal documents should be avoided for this time as judgment is impaired.’
In fact, no contract signed within 24 hours of an anaesthetic is legally binding.
-Wikipedia-Recovery from anesthesia is not simply the result of the anesthetic ‘wearing off,’ but also of the brain finding its way back through a maze of possible activity states to those that allow conscious experience. Put simply, the brain reboots itself…
As for the seizure being mild, I guess you had the standard ECT treatment of 250-450volts for 8 seconds, that you had a muscle relaxant to prevent fractures and that the power used was strong enough to cause a `grand mal’ fit? Because ECT is supposed to cause a `grand mal’ fit. Working, as I have in the past, in a neurology unit, the aim there was to prevent fits under all circumstances, with people even undergoing surgery, and radiation therapy to burn out areas of the brain thought to be involved. As a result I find it strange that causing a fit can possibly be a good thing.
Mayo Clinic – Following a grand mal seizure…Unconsciousness may persist for several minutes after the convulsion has ended. A period of disorientation often follows a grand mal seizure. This is referred to as postictal confusion. Sleepiness is common after a grand mal seizure. Headaches are common but not universal after grand mal seizures.
University of Virginia-After a tonic clonic seizure, (masked by drug in ECT) the body is limp. The nerve cells in the brain are reacting to their massive misfiring during the seizure. The person is usually confused, sleepy, headachy and irritable for a period of minutes or hours afterwards, and should be allowed to rest until they have fully recovered.
You describe your reaction as good because you are fit and healthy and strong minded but I have so often seen fit, healthy, young, middle-aged and old people who have become so confused, tearful and terrified that they try to discharge themselves, call for their mothers and crouch in a corner when the ECT nurse comes for them, begging them not to do it again. I have seen these people then threatened that they will be placed on an Involuntary Treatment Order and transferred to a `disturbed’ unit, or have their visitors and leave stopped if they don’t agree. I’ve seen people crying and holding their hands over their heads begging the doctor not to do it and having the nurses pull their hands away and the treatment done anyway.
A few years ago a mother come into the hospital, some months after her 21 year-old son left having had ECT against his wishes, to tell us he was dead. He’d hanged himself because he couldn’t learn any more. He was an honours student at university. His entire family was destroyed. You might say that was just her belief but it was hers and her family’s life so her opinion about what happened was the most important factor here. The doctor and staff tried to say it was his depression not ECT that killed him but he believed it was, his brothers and mother felt it was, and I believe it was.
Last year a man I knew hanged himself because he was being bullied into having ECT which terrified him. He was threatened with being `sectioned’ which would have meant his career would be over, told he would never recover and that he could ask as many psychiatrists as he liked they would all agree that ECT was the only treatment possible for him. He hanged himself in the hospital between the 3rd and 4th ECT after trying to withdraw his consent for a week.
I recently saw an EEG series from a course of ECT for a 68 year old woman. She received 375 volts for 7.8 seconds for 20 treatments. I did not know her in the hospital at the time but she said she hated and was afraid of ECT and had often asked them to stop. Apparently she was in hospital to monitor an SSRI drug trial and was not really ill. She had a bad mood slump two weeks after beginning the drug and was persuaded over a 4 day period to try ECT again. She’s had it 10 years earlier, hated it and got no benefit from it. She could not understand why the doctor had persuaded her to do it again. But, the EEGs. There were 4 different doctors doing the treatment (3 times weekly). 2 used settings that were well within the guidelines but one used settings over 14 times higher on one occasion, and 10 times on another- the other 4 times the setting were 4 and 7 times higher. Another doctor did the treatment on 3 occasions using settings 4 – 7 times higher than the recommended settings. There did not seem to be any reason why this happened.
For 2 years this lady has not, as she put it, `done anything, gone anywhere, or seen anyone’. Before the ECT she played bridge, worked as a volunteer and regularly lunched with a group of friends. With a lot of support she is just now beginning to `come alive’ but believes that the bridge is gone forever as she cannot remember the cards. She wasn’t a high powered, highly intelligent, well educated woman, just an ordinary one who suffered two devastating losses, her husband and her daughter, and twice got depressed. She has now forgotten the last months of her daughter’s life (she was killed in a road accident).
All of these instances happened in private hospitals since 2000, not the `bad old days’. I feel terribly guilty that I stood by and watched these people suffer such terrible abuse from those they turned to and paid to help them. I’m afraid my experience with ECT is appalling and I believe it should be banned.
I think you are a lucky woman, Debra, but you are only one. Not everyone can boast the same.
You’re absolutely right Maggie. I am a lucky woman and I know it. I’m lucky to be treated by a great team in an NHS hospital who understand that all it’s patients are individuals. The essence is that we’re all different and I would never dream of saying that everyone, or indeed anyone, should go for ECT as a treatment option based on my own experience.
I’m fit and very healthy, I’m not elderly or juvenile, I work in a hospital environment and therefore probably have a better understanding of how things work inside a hospital than people who don’t.
At no point in my comment did I say that all depressed people should have ECT and I don’t believe that. I simply ran my eyes down the almost exclusively negative comments and thought that, as my experience was quite different, it would be useful to give a different point of view which is what I did. I was quite shocked when I had came back to the site today to see that I was being accused by Deirdre of making my story up. I replied to her above if you’d care to take a look.
I’m sure all the comments you have brought in above are true (though I’d be wary of using Wikipedia as a definitive source for anything) and I know that many people have suffered terribly as result of ECT. Still my experience is my experience and as valid as the next person’s. Thanks for the kind words.
So, when someone with amnesia, cognitive dysfunction, and brain damage, who KNOWS their symptoms appeared immediately in direct relation to being “treated” with ECT, they will be told they must be mistaken, it must have been the drugs? Seriously?? They cannot be believed bc they are “mental” and “lacking insight”?
They do not NEED to be told “your massive memory loss and SUDDEN inability to think or retain new information is ‘more consistent with benzo damage'”. They have lived the experience. They have verbalized the truth. Their family members see them after ECT and testify to the fact there were issues before ECT but NONE related to NEW massive memory loss, inability to form new memories or to learn new information.
What kind of scanner or testing is required when those closest to the victims of ECT see, identify, and elucidate the brain damage done to their loved ones when ECT is administered to them, NONE of which was evident pre-ECT, even after massive drugging?? Are their relatives and loved ones delusional and stupid? They are confused when they emphatically state: “it destroyed my loving grandma”, “my husband was never the same”, “it drove my mother to suicide”?? Really? They also “lack insight”?
The comments made by Debra suggest ECT is helpful and not very invasive. Just bc anesthetics and muscle relaxants mask the actual devastation being visited on a patient
does not mean the injury and trauma are not happening. It just
looks less distressing to the shrinks when they administer an electrical baseball bat to their patient’s heads. It makes them less squeamish and more able to frame their assaults as “medical procedures”.
We do not know how many shocks Debra was given, what the type they were, the power used, how spaced apart they were. So she survived her limited brief assaults with minimal damage. Lucky? Yes. Most victims of this “intervention” are not. And, how do we know for a fact that her expectations or the placebo effect or the extra care of doctors and nurses or the mere passage of time did not effect the “relief” she experienced? What “tests” are there to validate her anecdotal reflections?
Dr. Healy made a few statements that need to be pondered. I have bolded a few words, but the statements are verbatim:
1. “None of this is to say there isn’t brain damage on ECT.”
2. “And a convulsion is NEVER a good thing.”
3. “Unnecessary convulsions are NEVER good.”
Repeat: “Never”. As in never. Not in “select cases”, but NEVER. What is confusing about this?
Another troubling statement: “… My beef has been to get the hazards of treatment …put on the map…so people can be better placed to decide whether or not to take the risks involved…”.
Denying or minimizing the real dangers of ECT or suggesting damages patients experienced are more likely the results of benzo damage or advocating not so subtlety for the use of ECT by referencing Sherwin Nuland’s “story” about his ECT miracle or including Rachel Perkin’s “Choosing ECT” does not help to clarify the hazards.
Saying Bob Whitaker is “wrong about ECT” but right about toxic drugs? Strange this lauded journalist would be so off the mark. Wrong bc he failed to interview the living “practitioners” of this bogus treatment, people like Max Fink, who made a lot of money on ECT?? Max who acknowledged that ECT was “craniocerebral trauma”? Has he changed his story?
You could just as easily have included Linda Andre’s story in your “in another part of town” (especially since she had zero drug use before being brain damaged by ECT) or perhaps the story of “Amnesia” or Jonathan Cott or any other of the thousands of people destroyed by ECT.
But, even Perkins notes she and her friends and family were “ignorant” about ECT. She was looking for a “quick fix”, even though she had recovered previously in 6 months. It is great to read her follow-up investigations revealing that NONE of the ECT machines in use at the time met the requirements for a “good ECT machine” and that “psychiatric practice was deficient in two-thirds of the ECT clinics-failing to meet even the minimal standards laid down in 10% of clinics”.( So, she was just lucky to avoid disaster or had minimal numbers of low dose ECT??)
And who was made fully aware of these facts? Patients today are no better informed than Perkin’s was in 1993. The consent forms don’t list “brain damage, reduced IQ, change in personality,” or any of the other REAL and dangerous risks. They blather on about “headaches, muscle soreness, transient memory loss”…so how are patients being informed and protected??
So obviously many people continue to be given ECT who do not “need it” when in a compromised mental state and given false information. How well is this working?
Rebekah Beddoe was given ECT postpartum after first being driven mad by psychiatric drugs. Was she catatonic, suffering from NMS, treatment resistant Parkinson’s, treatment resistant depression? Nope. Just another victim of the “last resort” used after drugs cause severe iatrogenic illness. And what does she write?
“I was barely able to focus long enough to make my bed in one hit let alone digest information in a legal (ECT) document. But it didn’t matter-if Max said I needed ECT, if Max said ECT would help, if Max said ECT wasn’t scary, then I would have ECT.”
So, that is the way ordinary people who do not “need” ECT and are not “truly informed” end up with ECT. Being fed misinformation and lies, just like those generated about the safety and usefulness of psych drugs.
Beddoe goes on to cite Breggin’s statements about ECT, referencing “acute organic brain syndrome” and pointing out that “in the first couple of decades of use, many shock authorities boldly declared that the treatment works precisely by damaging the brain and that brain cell death is the key to successful treatment”. Good to know.
In the foreword to Dying for a Cure, you appear to downplay the dangers of ECT and write: “In regular psychiatric practice, insiders, both staff and patients, are much more likely to fear forcible and indefinite medication with long-acting antipsychotic injections-a treatment that is MORE CLEARLY brain damaging and MORE likely to turn a person into a Zombie than ECT”. And this is based on what comparisons, data, studies?? How many ECT induced zombie stories have you read and accepted as fact/truth?? What if it the SAME, how is this acceptable “treatment” in either case?
And, I am somewhat confused, perhaps bc I have difficulty with comprehension and recall and the simple ability to just think or make connections since I was severely injured by “safe and effective” ECT, but I re-read some of Debra’s comments and have some questions.
So, Debra says: “…I’ve sat in clinics, clutching a cup of coffee, hallucinating (visual and auditory), believing I’m being eaten alive by maggots and quietly planning my own death whilst my clinician suggests, carefully that maybe, just maybe, it might be time to have a short course of ECT”. She notes she was section able many times but never was given “forced ECT”.
She is in rough enough shape to be sectionable, but writes: ” I had ECT as an outpatient. I’d turn up at 8:30, go to the ECT suite when they were ready, I’d be up and about within 30 minutes, and then go back to work.” Really? You were working in the condition you describe? Hallucinating? Maggots? Suicidal? But your supervisor laughs at anyone astonished by what you write and wants to “back up your story”? And that quick blood boiling brain zap just restores your sanity instantly? Hmmm… It really is the penicillin of psychiatry…
I cringed when I read Maggie’s descriptions of “fit, healthy young, middle-aged and old people” becoming “terrified, crouching, calling for their mothers..BEGGING the nurses not to do it again…crying, putting their hands over their heads…”
Her descriptions of the ECT related suicides and the coercion of the doctors “persuading” the SSRI drug trial volunteer to have ECT and then noting it was given at up to 7 times the “recommended settings” give a clear picture of what ECT does.
Dr. Healy, you asked “what do I tell the 96 year old lady who asks for it because she wants to get back to playing bridge”? I guess you tell her there is a good possibility she won’t remember the cards, like the woman Maggie describes who “can’t remember the cards”, has “done nothing, gone nowhere, seen no one” for two years as a result of ECT. That would be the honest thing to do.
I concur with Maggie, who watched all this torture as it happened and states “my experience with ECT is appalling and I believe it should be banned”.
As a final comment, why are there all these references to the cognitive problems caused by cardiac surgery when cardiac surgery is a real medical procedure which is necessary or justified bc it is a life or death situation?
And the question you pose:what if scans show equal or worse damage done by antipsychotic or antidepressants than ECT? “What then?”
Simple, ban both. Brain injury should not be a “treatment option”. Why justify or distract from ECT damage by saying it might be just as bad as drug damage?
Well ‘Truth’ I find your reply to my honestly stated account of my personal experience of ECT (which I feel I should emphasise is as valid as anyone else’s) to be patronising, mocking and sneering. So I don’t fit into your preconceived little box of what you consider a person treated with ECT should be….a broken, jabbering amnesiac? Because my experience isn’t what you would like it to be you feel you have a right to dismiss it in such hectoring tone? Shame on you.
I stated that, at the time, ECT was helpful to me…..at no point did I suggest that it’s efficacy in my case could or indeed should be taken to mean that I thought anyone else in my position should also have ECT as a form of treatment. I firmly believe that each case is different….there is no ‘one treatment fits all’ scenario. Neither did I say the procedure was not invasive….compared to surgery it obviously isn’t but of course it is invasive in the sense that one’s body is convulsed (or would be without the use of a muscle relaxant) by an electric current.
For the record I have had several courses of ECT, usually up to 6 in a course at a rate of 2 per week for 3 weeks….by this point I have usually become appreciably better. ECT has never ‘instantly restored my sanity’ and I’ve never said or implied that it did. I haven’t made any ‘anecdotal reflections’…merely an accurate description of my own experience. Unlike may of the people in this section of comments I have at no time taken it upon myself to speak for others…I would never be so presumptuous.
I have frankly been shocked by some of the vituperative comments and reactions posted after Prof Healy’s blog post on ECT, not just to my few paragraphs but between others who have commented also. I would like to have imagined that people who suffer from the life changing devastation that any mental illness can wreak might have more respect and empathy for each other than has been displayed here. It seems I am to be disillusioned and disappointed.
Debra,
My last post referred only briefly to your experience; it was not the main focus of what I was saying, but, in re-reading it, I can see that my choice of words and phrasing regarding your story is offensive. I apologize; your story is obviously as valid as anyone else’s. It just sounds somewhat startling in the context of your described state of severe distress.
It is not a matter of my “dismissing” your experience because it “isn’t what I would like it to be”. I would not “like” anyone to have suffered brain damage from ECT and I am glad you are well. I do think you were “lucky” (as Maggie has also said) and perhaps all the negative stories you say encouraged you to tell your positive one, should show that the ratio of devastated to “helped” is pretty high.
Even observers in the mental health field have written here of seeing many many injuries and few “miracles” in decades of observations of patients who have been “given” ECT.
I did express incredulity that anyone as sick as you have been could have bounced back so quickly, off driving or working after what we know is an invasive procedure. It obviously did not reflect my own experience, so I was left trying to puzzle out the difference.
In retrospect, it is pretty obvious that patients given minimal numbers of brief pulse unilateral ECT spaced at two a week will do better and have less brain injury than those being administered bilaterals three times a week for up to 12 treatments in four weeks, some at many times the “recommended dose” as Maggie relates is known to occur.
So, when people say “ECT saved my life”, they may be describing a very different ECT than that given to a majority of people. But people desperate for help, read that with little education about the various incarnations there are of ECT. They are not thinking about or informed about variables such as gender, age, skull thickness, seizure threshold, practitioner’s skill level, type, concurrent medications, validity of diagnosis, etc. and their role ; they are reading “it saved my life” and that is what they WANT to hear and what blinds them in part to reasonable decision making, which is already compromised by their “illness”and probably by their drugged state. Hospitals do, repeat, hand patients ECT information booklets full of lies and misinformation, listing pro-ECT articles and books as “resources”. The video? Old and pro-ECT. This is medical malfeasance and fraud.
We all make comments that people find unfair or upsetting. In response to one of Deirdre’s posts you wrote: “despite the fact you are willing to expound on what you regard as the evils of ECT, you seem to have a very limited grasp of what is actually entailed in the physical process”. Given that Deirdre has had 87 ECT herself and has, as far as I can see, researched and read more on this topic than anyone else I know, I think she is pretty clear about what ECT entails. She has described the process and its impact on the body and delicate brain in great detail.
I do find it confounding that Dr. Healy states that no one says there isn’t brain damage and that a convulsion is NEVER a good thing, but then goes on to say ECT is not a brain injury and speaks of those benefitting from ECT, playing bridge and doing crosswords, while suggesting memory loss is benzo or other drug related and cardiac surgery effects or statins are worse for cognitive damage. So, does his lady playing bridge cancel out Maggie’s lady who became a recluse and could not remember the cards? A 50-50 chance of help or profound disability? A crap shoot, and if it relates to absolutely no other option heart surgery, perhaps worth contemplating. Otherwise? No. Unpredictable. Too much risk.
I did not “need” to read the “positive” stories from Julie Hersh and Carol Kivler; I needed the stories from Deirdre, Linda Andre, Peter Breggin, Jonathan Cott, etc. Because the potential and risk of becoming that “broken, jabbering amnesiac” which you seem to gloss over lightly or dismissively, is a risk no one should take.
Key point: “more harm than good” seems to be the majority outcome and “first do no harm” means ECT should not be considered a treatment a “doctor” should provide; no brain disabling procedure should.
As I stated, the stories told by Maggie and Deirdre obviously resonate more strongly with me and point to how appalling this “treatment” is. Suicides, trauma, memory loss, lost skill sets, amnesia, cognitive dysfunction, personality changes, etc. all expressed in valid stories as actual outcomes suggest ECT is not a reasonable risk to incur for some rare and unlikely benefit that few people experience.
No one can determine what will happen when a brain is assaulted with electricity and induced to seizure multiple times. Just like no one needs multiple head concussions, even “mild” ones that may be even more dangerous that one “big” concussion.
And, the latest research is pointing to more detrimental effects of having repeated anaesthetics, which are given for ECT, even if briefly. The interfere with the brain’s waste clearing system and may increase risk of Alzheimer’s. Another reason to ban this barbaric assault, no matter how benign it looks, with a peaceful patient and a barely discernible toe twitch, even while the EEG is recording an electrical holocaust in the brain.
I do not want one more person injured by ECT. People need to be fully and truly informed of what can really happen to them as far as shock is involved. Shock, not “therapy”. Assaulting the brain is not therapy; it is not a way to “heal” an already injured or tortured mind.
Apology totally accepted….please understand that all I ever did in my comments here was lay out my own experience. As it’s the only kind of experience I’ve ever had that’s all I can comment on. I’ve never denied or decried any of the awful experiences that others have suffered from ECT. I completely believe that they are true for those individuals and, given that, I can understand why they are so angry and distressed.
The bit I’m having a problem with is that when I lay out my (clearly very different) experience I’ve been told I’m lying, that I’m in some way denigrating those who’ve had terrible experiences and (most recently) that I’ve clearly never had ECT and have ‘read a book’ about it and that my account is ‘ill-informed’ and that ‘Debra Rees’ is ‘not real’ (What?!!). It seems to me that there is no room in this forum for anyone who has had an experience that doesn’t fit with that of the majority. I had always assumed that there was (and previously experienced) a lot of support from other people with enduring mental health problems and this experience has been totally alien to me and very hurtful. I assume everyone commenting here is as decent a person as you are but no-one will boost their case by trying to to destroy the opinion or standing of someone who disagrees with them. If you have a valid case and cause for complaint – and I think that you do – all of you can state it clearly without trying to deny the experience of others that may differ from your own.
Dear All Concerned,
Your debate about ECT has been very important.
I am a psychiatrist in DC. I prescribe drugs but only when I am weaning a patient off of PsychDrugs. I find all categories of PsychDrugs to be dangerous, idiosyncratic in efficacy, unpredictable in their affect,habit forming/addictive and interfere with any serious self exploration.( I am also averse to most other medical drugs as well.) I do psychotherapy, groups, meditation, some herbal formulations, some supplements but only those that I am willing to take myself. These supplements may not “work”, but there is virtually no danger of harm.
Everything “works” for someone.
I would never prescribe ECT for myself; therefore, I would never prescribe ECT for someone else.
I have advised colleagues at the Washington School of Psychiatry that if they are perplexed about how or when to refer for ECT to do the following: send the person to 2 different psychiatrists, 1 who believes ECT can and should be prescribed for selected patients and 1 who , like me, would never send someone for ECT. The patient than must decide.
Although I agree with Healy, no banning, any patient who is considering ECT should talk to at least 1 psychiatrist who will advise against it!
I wonder, do we confuse science with art/philosophy.
“I don’t want to talk and work and debate and reflect on my life. I just want my bad feelings to go away!” vs ” All that I feel and think and do are a part of me. I want to understand myself better, not just remove what is discomforting/torturing me.”
Fink in his text opines from his research that only “endogenous” depressions should be shocked.
But from my philosophical position there is no such thing as endogenous depression, rather there are just some people who can not or will not imagine where their misery
comes from.I think they are the ones who might want to pursue ECT. I don’t begrudge their choice, as long as they are aware of the dangers.
Dr “T”
Dr”T”
Physicians have a duty to warn, protect, and not cause harm. They fail criminally around the issue of electroshock. No patient should be offered this knowing full well mechanism of electrical trauma. I ask you to speak public on social media to help inform others as you seem to have some sense of ethics. I want doctors and hospitals held financially accountable for great harm they have inflicted and cover up to this day.
So, are all continuing challenging comments being censored and blocked for a reason?
No. What has been blocked are abusive comments that say nothing new and accuse other contributors here of lying. I also blocked a response by DR making these points. In this response she says her’s may be a minority point of view. Difficult to know. In this part of N Wales her’s appears to be by far the majority point of view
DH
I didn’t make any abusive statements – just truthful and sensitiveness ones- i thought anyway- believed i had- that you haven’t allowed because of your dishonesty- their no other possible reason -not that i can see- that’s what dishonest people do – they cherry pick their own truth- or lies-anyway mate-more sheep than shepherds hey- good luck to ya.
I was traveling and haven’t been able to access the site to approve any comments for 48 hours. Not sure the sensitive comments add anything. D
After 19 ECTs i can not function/eat/get out of house. My cognition fails. Memory severly affected etc…Brain is damaged and i can not do even simple things anymore. How anyone can call this procedure effective? Please explain.
You can access my comment to the FDA here: https://www.regulations.gov/searchResults?rpp=25&po=0&s=1k0-8oqo-69e7 To view the entire 8,500 word comment (many pages) you will have to download the attached file which is available in Word .doc and also in .pdf. I am immensely proud that the file is up there now for public viewing. I chose to name names in the document, naming the hospital and the doctors involved. I have received much feedback from many people worldwide.
The one thing I want to reiterate is that from what I could tell, and continue to observe, ECT is “offered” in the USA just at the very moment when the patient’s insurance is running out. Ahhh, so the insurance won’t pay anymore, so the patient is now a nuisance. We gotta do something drastic. ECT. Perfect solution. This is done regardless of severity of condition. It’s a complete myth that this is done in “extreme cases.” Unless “extreme” means “no more money” or, “You used up all that you are worth.” That was about what they said. Worthiness is counted by how much they get paid.
So suddenly, you are worth much, much more. Per shock. Till you can’t think straight. Then, you bet there’s coverup. Or at least in my case there was. Instead of saying to me, “We’re sorry, we shocked you too much and honestly, we know you had a high IQ, performed well academically and could take good care of yourself prior to ECT, but we don’t really know if you’ll ever be able to function in any capacity again.”
They didn’t. Instead, get this: They told me, “You were always confused like that.” Yep, they told me I had been that way all my life. Because I was already so confused I actually believed it and found some comfort hearing this.
It is a stroke of luck that I came out of it. This occurred suddenly. I am told by other shock survivors that to suddenly come out of the ECT haze, even after years, is not uncommon. I ended up writing my first novel, and going back to college, shocking all those doctors.
I know for sure this was not predicted. They were all set to get a bed ready for me at State.