EST

[From Bruce Abbott (9712.1420 EST)]

Mike Acree (971217.0945) --

Depression is hardly unknown among psychiatrists; they have one of the
highest rates, if not the highest rate, of suicide among the
professions. Many of them also insist that electroshock therapy (ECT)
is the treatment of choice for severe depression. Yet Robert Morgan,
author of the _Iatrogenics Handbook_, has pointed out in court testimony
that _no_ psychiatrists have ever prescribed ECT for themselves--or for
anyone they liked. (There was one case of a psychiatrist prescribing it
for his mother-in-law.)

Electroshock therapy evokes images of the electric chair or the torture
chamber. It was depicted as a kind of punishment in the movie _One Flew
Over the Cuckoo's nest. Do you have any idea what electroshock therapy is
like, from the patient's perspective? From the therapist's perspective?
What its side-effects are? Why do you suppose psychiatrists would not
prescribe it for themselves?

Regards,

Bruce

{From Bruce Gregory (971217.1605 EST)]

[Dan Miller (971217.1450)

As for therapists' perspectives, a perusal of the literature reveals
studies such as the above (most as dreary and misdirected), and
elaborated rationalizations for their actions. It is difficult to
think of a theoretical rationale for ECT. No doubt that those on the
Seratonin bandwagon could try, but not very heartily I suspect.

Why not? Our brains have been scrambled from all the drugs we
have been taking. I guess my dosage needs adjusting again.
Maybe if I doubled it I would no longer feel compelled to post
to this network. I'll give it a try.

Bruce

[Dan Miller (971217.1450)

Bruce Abbott (9712.1420 EST)

Electroshock therapy evokes images of the electric chair or the torture
chamber. It was depicted as a kind of punishment in the movie _One Flew
Over the Cuckoo's nest. Do you have any idea what electroshock therapy is
like, from the patient's perspective? From the therapist's perspective?
What its side-effects are? Why do you suppose psychiatrists would not
prescribe it for themselves?

Since this was not addressed to me let me jump in. When I was a
graduate student (long ago when I thought lots of stuff was funny) I
was a research assistant for a big dipper social psychologist. He
had me reviewing studies of patient/subject responses to specific
therapeutic treatments. I was going through some psychiatric
journals when I read one study that I thought was funny and very sad.
I do not remember the name of the author or the study, but I
suppose I could find it if I had to. The researcher was doing a
journeyman's job of Independent Variable - Dependent Variable
research. Mostly he was looking at treatment (IV) and effectiveness
of treatment (DV). But, in this study he noted some of his own
observations.

In noting the effectiveness of Electro-Convulsive Therapy [sic] he
controlled for whether the patients were in private rooms,
semi-private rooms or on wards. He found that, in general and using
their measures of effectiveness, ECT was an effective treatment.
And this finding held no matter what type of room the patients had.
In fact, the author noted that with ward patients ALL the patients
got better after the first had undergone the therapy. Why? I would
guess fear. The study does provide some insight to their
perspective, as does Kesey's (who worked at the same asylum that
provided the grist for Fred Wiseman's classic film - Titticut
Follies).

As for therapists' perspectives, a perusal of the literature reveals
studies such as the above (most as dreary and misdirected), and
elaborated rationalizations for their actions. It is difficult to
think of a theoretical rationale for ECT. No doubt that those on the
Seratonin bandwagon could try, but not very heartily I suspect.

With regards to the effectiveness of treatment - as measured by
controlled (not clinical) studies using IV - DV type studies. The
last time I looked, this consistent finding had not changed: There
is no difference between those who receive therapy and those who do
not receive therapy no matter what therapy is used. That is, about
the same percentage of people get better (whatever this means) no
matter what. This may account for the reason that insurers are
getting stingy about giving money to the mental health industry.

The mental health industry is such a growth industry that a
disturbingly large percentage of the American public is being treated
for something or other. Perhaps we should stop for a while and ask
the question - where is all this "mental illness" coming from? Why
so much more now than twenty years ago? My guess is that much of it
is coming from the industry itself - in the form of advertising,
marketing, and the over abundance of professionally sanctioned social
control agents.

Years ago the state of Iowa had one mental hospital (though I prefer
asylum thus not confusing what happens there with medicine). This
asylum was consistently about 95% full. Then, in a fit of largesse,
the state legislature decided to front the cash to build another one
on the opposite side of the state. In a matter of weeks the other
one was up to 95% capacity with no drop in the other. By doubling
the number of state employees who worked in such a place, the number
of those defined as in need of hospitalization doubled. I would
argue that this direct relationship holds today. The more mental
health [sic] professionals, the more the mental illness [sic]/need
for therapy.
Dan Miller
miller@riker.stjoe.udayton.edu

[From Rick Marken (971217.1400)]

Bruce Abbott (9712.1420 EST)

Electroshock therapy evokes images of the electric chair or the
torture chamber. It was depicted as a kind of punishment in
the movie _One Flew Over the Cuckoo's nest. Do you have any
idea what electroshock therapy is like, from the patient's
perspective? From the therapist's perspective? What its
side-effects are? Why do you suppose psychiatrists would not
prescribe it for themselves?

Amazingly (for one who studiously avoids any contact with those
places in life where the rubber meets the road -- unless those
places are at the beach in Malibu;-)) I _do_ know what electroshock
therapy (EST) is like from a patient's perspective. This knowledge
comes from descriptions given to me by two acquiaintances who had
had EST. (I, to what must be the dismay of the medical establishment
and CSGNet community, have never had EST, though when I was in
graduate school a doctor prescribed Librium for what turned out to
be a sinus infection;-)).

One of these acquaintances, a woman in her 30s at the time,
lived in fear of having EST prescibed for her again. She actually
thought the EST treatments (PLURAL) had decreased her depression
but she hated the side effects (I forget what they were; this was
many years ago; I think the side effects were things like memory
loss and disorientation). She said she was now reluctant to confess
any depression to a "helping professional" for fear of being
required (yes, they _force_ people to have EST) to have EST. So
I suppose one could say that EST was effective since it stopped
her from complaining about being depressed;-)

The other case was a student at Augsburg College (call her S) who
wanted to commit suicide. One of my own students (call her H) asked
if I would talk to S before she jumped off the Franklin Ave bridge.
I was reluctant to do it because I didn't know the legal rules
about suicide ("If they'll lock people in a cell for _trying_ to
commit suicide", thought I, "imagine what they'll do to the person
who fails to talk someone out of it". I mean, this was the height
of the Reagan years and they were staring to put people in _jail_
for consuming the wrong kind of chemicals!).

I suggested that student counseling services should handle the
case but H said that that S wouldn't talk to them because they
would just send her off for EST, which S had had and wanted to
avoid. H said that if she could promise S that I would talk to her,
S would delay her suicide until after the talk. So I agreed and
I met S the next morning.

I approached the discussion with S in a way that would have done
Mike Acree and Bill Powers proud. I didn't come in thinking "I've
got to prevent this suicide no matter what". I've always believed
that people should be free to kill themselves if they thought
that that was the only solution to their problems. Geez. It's
THEIR life, for Chrissakes!

Well, it turns out that S had problems -- BIG TIME. From my point
of view, suicide seemed like a pretty reasonable solution. All I
said to S was that suicide, though a reasonable and effective
solution to her problems, would definitely be her LAST solution.
I suggested that she could do suicide any time; why not try to
think of other possibilities first. And she did think of some other
possibilities right then and there.

I never reported my encounter with S to the student counseling
people at Augsburg and the last I heard (about a year after our
encounter) S was enrolled at another college (Mankato State) and
doing fine. I knew she would do fine after our talk because I could
tell that she had come to see suicide as an _option_ -- one that
could be exercised at any time -- and not a requirement.

This all happened after I was already a PCTer (1982 or so). But my
"theraputic success" with S was certainly not based on PCT; I
didn't understand the theraputic implications of PCT at that time
anyway. I think it worked simply because I respected this poor,
homely, sad, confused person's humanity. I respected the fact that
only _S_ could possibly figure out what was right for S.

I was appalled to learn from this encounter with the official
custodians of the rubber/road interface -- the counselors who
are charged with helping students who contemplate or attempt
suicide (S had attempted suicide several times before) -- that
respect for others is not a big part of their program. The attitude
of the counselors was "we know what's best for you". That and
the god damn war on drugs nearly drove me into the arms of
Libertarianism. But I was saved from that, too, by PCT;-)

Best

Rick

···

--
Richard S. Marken Phone or Fax: 310 474-0313
Life Learning Associates e-mail: rmarken@earthlink.net
http://home.earthlink.net/~rmarken

[From Bruce Abbott (9712.1420 EST)]

Mike Acree (971217.0945) --

snipped
  Yet Robert Morgan,

author of the _Iatrogenics Handbook_, has pointed out in court testimony
that _no_ psychiatrists have ever prescribed ECT for themselves--or for
anyone they liked. (There was one case of a psychiatrist prescribing it
for his mother-in-law.)

Electroshock therapy evokes images of the electric chair or the torture
chamber. It was depicted as a kind of punishment in the movie _One Flew
Over the Cuckoo's nest. Do you have any idea what electroshock therapy is
like, from the patient's perspective? From the therapist's perspective?
What its side-effects are? Why do you suppose psychiatrists would not
prescribe it for themselves?

Near the end of his life, my father was doing and saying very strange and
troubling things. He was diagnosed as in a depression and
electro-convulsive therapy (ECT) recommended. Years before, I had been a
medical aide in the US Army with one of my duties serving on an ECT team. I
hated it. So, with that image in mind, I spoke with Eric Kandel, an
eminent psychiatrist-neurophysiologist, who married my cousin and knew my
father quite well.. He assured me that ECT had changed radically since my
army days and had been proven quite successful with the elderly. He was right.

I still feel that the profession should find better ways, but ECT is just
one of many stupidities with treatment of mental problems today. And that's
one reason that I get so frustrated by the difficulty getting more
acceptance of PCT.

David Wolsk
Victoria, BC Canada (a no-ECT area I'm told .... but we do love our drugs)

···

at 15:30 WST 971218 Psychologist David Wolsk wrote:
At 13:19 17/12/97 -0600, you wrote: