|
Page 4 of 4
Levenson and Willett (54) explain that to the therapist using ECT it may seem unconsciously like an overwhelming assault, which may resonate with the therapist's aggressive and libidinal conflict."
Studies that examined attitudes of psychiatrists toward ECT found marked disagreement among clinicians about the value of this procedure. (55,56) Thompson et al (57) reported that ECT use decreased 46% between 1975 to 1980 in the United States, with no significant changes between 1980 to 1986. Fewer than 8% of all US psychiatrists use ECT, however. (58) A very recent study (59) on the characteristics of psychiatrists who use ECT found that female practitioners were only one-third as likely to administer it as were their male counterparts. (59) The proportion of female psychiatrists has been rising steadily and if the gender gap continues, this could hasten the end of ECT.
CONCLUSION
When ECT was introduced in 1938, psychiatry was ripe for a new therapy. Psychopharmacology offered two approaches to the pathogenesis of mental disorders: to investigate the mechanism of action of drugs that ameliorate the disorder and to examine the actions of drugs that reduce or mimic the disorder. In the case of ECT, both approaches have been pursued without success. Chemically or electrically induced fits have profound but short-lived effects on brain function, ie, acute organic brain syndrome. Shocking the brain causes increases in levels of dopamine, cortisol, and corticotropin for 1 to 2 hours after the convulsion. These findings are pseudoscientific, as there is no evidence that these biochemical changes, specifically or fundamentally, affect the underlying psychopathology of depression or other psychoses. Much of the improvement attributed to ECT is an effect of placebo or, possibly, anesthesia.
From the earliest uses of convulsive therapy, it was recognized that the treatment is unspecific and only shortens the duration of psychiatric illness rather than improves the outcome. (60) Convulsive therapy based on the old belief of shocking the patient into sanity is primitive and unspecific. The claim that ECT has proved its usefulness, despite the lack of an acceptable theory as to how it works, has also been made for all the unproven therapies of the past, such as bloodletting, which are reported to produce great cures until they are abandoned as useless. Insulin coma, cardiazol shock, and ECT were treatments of choice in schizophrenia, until they, too, were abandoned. For ECT to remain as an option in other psychoses transcends clinical and common sense.
When an electrical current is applied to the body by tyrannical rulers, we call this electrical torture; however, an electrical current applied to the brain in public and private hospitals by professional psychiatrists is called therapy. Modifying the ECT machine to reduce memory loss and giving muscle relaxants and anesthesia to make the fit less painful and more humane only dehumanize users of ECT.
Even if ECT were relatively safe, it is not absolutely so, and it has not been shown to be superior to drugs. This history of ECT, its abuse, and resultant public pressure are responsible for its increasingly lower use.
Is ECT necessary as a treatment modality in psychiatry? The answer is absolutely not. In the United States, 92% of psychiatrists do not use it despite the existence of an established journal entirely devoted to the subject to give it scientific respectability. ECT is and always will be a controversial treatment and an example of shameful science. Even though some 60 years have been spent defending the treatment, ECT remains a revered symbol of authority in psychiatry. By promoting ECT, the new psychiatry reveals its ties to the old psychiatry and sanctions this assault on the patient's brain. Modern psychiatry has no need of an instrument that allows the operator to zap a patient by pressing a button. Before inducing a fit in a fellow human being, the psychiatrist as clinician and moral thinker needs to recall the writings of a fellow psychiatrist, Frantz Fanon (61) : "Have I not, because of what I have done or failed to do, contributed to an impoverishment of human reality?"
next: She Was Shocked
REFERENCES
1. Berrios GE. The scientific origin of electroconvulsive therapy: a conceptual history. In: History of Psychiatry, VIII. New York: Cambridge University Press;1997:105-119.
2. Szasz TS. From the slaughterhouse to the madhouse. Psychother Theory Res Pract. 1971;8:64-67.
3. American Psychiatric Association. Task Force on Electroconvulsive Therapy Report 14. Washington, DC: American Psychiatric Association; 1978.
4. Royal College of Psychiatrists. Memorandum on the use of electroconvulsive therapy. Br J Psychiatry. 1977;131:261-272.
5. Memorandum on ECT. Br J Psychiatry. 1977;131:647-648. Editorial.
6. Royal College of Psychiatrists. Report on the Administration of ECT. London: Gaskell;1989.
7. Skultans V. Madness and morals. In: Ideas on Insanity in the 19th Century. London: Routledge & Kegan Paul; 1975:120-146.
8. Sakel M. Schizophrenia. London: Owen; 1959:188-228.
9. Meduna L. General discussion of cardiazol therapy. Am J Psychiatry. 1938;(94 suppl):40-50.
10. Cook LC. Convulsion therapy. J Ment Sci. 1944;90:435-464.
11. Ward JW, Clark SL. Convulsion produced by electrical stimulation of the cerebral cortex. Arch Neurol Psychiatry. 1938;39:1213-1227.
12. Cerletti U. Old and new information about electro shock. Am J Psychiatry. 1950;107:87-94.
13. Freeman CP, Kendall RE. ECT, I: Patients' experience and attitude. Br J Psychiatry. 1980;137:8-16.
14. Tennent T. Insulin therapy. J Ment Sci. 1944;90:465-485.
15. Bini, L. Experimental researches in epileptic attack induced by electric current. Am J Psychiatry. 1938;(94 suppl):172-173.
16. Weiner RD. The persistence of electroconvulsive therapy-induced changes in the electroencepha-logram. J Nerv Ment Dis. 1980;168:224-228.
17. Calloway SP, Dolan R. ECT and cerebral damage. Br J Psychiatry. 1982;140:103.
18. Weiner RD. Does electroconvulsive therapy cause brain damage? Behav Brain Sci. 1984;7:54.
19. Fink M. ECT-Verdict: not guilty. Behav Brain Sci. 1984;7:26-27.
20. Fink M. Convulsive and drug therapy of depression. Ann Rev Med. 1981;32:405-412.
21. d'Elia G, Rothma H. Is unilateral ECT less effective than bilateral ECT? Br J Psychiatry. 1975; 126:83-89.
22. Mills MJ, Pearsall DT, Yesarage JA, Salzman C. Electroconvulsive therapy in Massachusetts. Am J Psychiatry. 1984;141:534-538.
23. Templer DI. ECT and brain damage: how much risk is acceptable? Behav Brain Sci. 1884;7:39.
24. Keller S, Weiss J, Schleifer S, Miller N, Stein M. Suppression of immunity by stress: effect of graded series stressor on lymphocyte stimulation in the rat. Science. 1981;213:1397-1400.
25. Laudenslager ML, Ryan SM. Coping and immunosuppression: inescapable but not escapable shock suppresses lymphocyte proliferation. Science. 1985;221:568-570.
26. Stalker H, Millar W, Jacobs H. Remission in schizophrenia. Insulin and convulsion therapies compared with ordinary treatment. Lancet. 1939;i:437-439.
27. Salzman C. The use of ECT in the treatment of schizophrenia. Am J Psychiatry. 1980;137:1032-1041.
28. Appel KE, Myers MJ, Scheflen AE. Prognosis in psychiatry: results of psychiatric treatment. Arch Neurol Psychiatry. 1953;70:459-468.
29. Brill H, Crampton E, Eiduson S, Grayston H, Hellman L, Richard R. Relative effectiveness of various components of electroconvulsive therapy. Arch Neurol Psychiatry. 1959;81:627-635.
30. Lloyd H, Cotter A. Operant Conditioning in a Vietnamese Mental Hospital. Am J Psychiatry. 1967;124:25-29.
31. Fink M. Myth of "shock therapy." Am J Psychiatry. 1977;134:991-996.
32. Greenblatt M, Grosser GH, Wechsler H. Differential response of hospitalized depressed patients to somatic therapy. Am J Psychiatry. 1964;120:935-943.
33. Medical Research Council Psychiatric Committee. Clinical trial of the treatment of depressive illness. Br Med J. 1965;131:881-886.
34. Lowinger P, Dobie SA. Study of placebo response rates. Arch Gen Psychiatry. 1969:20:84-88.
35. Skrabanek P. Convulsive therapy: a critical appraisal of its origin and value. Irish Med J. 1986; 79:157-165.
36. Crow TJ. The scientific status of electroconvulsive therapy. Psychol Med. 1979;9:401-408.
37. Lambourn J, Gill DA. A controlled comparison of simulated and real ECT. Br J Psychiatry. 1978; 133:514-519.
38. Freeman CP, Basson JV, Crighton A. Double blind controlled trial of electroconvulsive therapy (ECT) and simulated ECT in depressive illness. Lancet. 1978;i:738-740.
39. Johnstone EC, Deakin JF, Lawler P, et al. The Northwick Park electroconvulsive therapy trial. Lancet. 1980;ii:1317-1320.
40. Gangadhar BN, Kapur RL, Sundaram SK. Comparison of electroconvulsive therapy with imipramine in endogenous depression: a double blind study. Br J Psychiatry. 1982;141:367-371.
41. West ED. Electric stimulation therapy in depression: a double blind controlled trial. Br Med J. 1981;282:355-357.
42. Brandon S, Lowley P, MacDonald L, Neville P, Palmer R, Wellstood-Easton S. Electroconvulsive therapy: results in depressive illness from the Leicestershire trial. Br Med J. 1984;288:22-25.
43. Gregory S, Shawcross CR, Gill D. The Nottingham ECT study: double blind comparison of bilateral, unilateral and simulated ECT in depressive illness. Br J Psychiatry. 1985;146:520-524.
44. Spiker DG, Weiss JC, Dealy RS, et al. The pharmacological treatment of delusional depression. Am J Psychiatry. 1985;142:430-431.
45. Breggin PR. Toxic Psychiatry. New York: St. Martin's Press; 1991.
46. Avery D, Winokur G. Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Arch Gen Psychiatry. 1976;33:1029-1037.
47. Fernando S, Storm V. Suicide among psychiatric patients of a district general hospital. Psychol Med. 1984;14:661-672.
48. Babigian HM, Gurrmacher LB. Epidemiological consideration in electroconvulsive therapy. Arch Gen Psychiatry. 1984;41:246-253.
49. Youssef HA. Electroconvulsive therapy and benzodiazepine use in patients who committed suicide. Adv Ther. 1990;7:153-158.
50. Jeffries JJ, Rakoff VM. ECT as a form of restraint. Can J Psychiatry. 1983;28:661-663.
51. Fink M. Anti-psychiatrists and ECT. Br Med J. 1976;i:280.
52. Pippard J, Ellam L. Electroconvulsive treatment in Great Britain. Br J Psychiatry. 1981;139: 563-568.
53. ECT in Britain: a shameful state of affairs. Lancet. 1981;ii:1207.
54. Levenson JL, Willet AB. Milieu reactions to ECT. Psychiatry. 1982;45:298-306.
55. Kalayam B, Steinhard M. A survey of attitude on the use of electroconvulsive therapy. Hosp Com Psychiatry. 1981;32:185-188.
56. Janicak P, Mask J, Timakas K, Gibbons R. ECT: an assessment of mental health professionals' knowledge and attitude. J Clin Psychiatry. 1985;46:262-266.
57. Thompson JW, Weiner RD, Myers CP. Use of ECT in the United States in 1975, 1980 and 1986. Am J Psychiatry. 1994;151:1657-1661.
58. Koran LM. Electroconvulsive therapy. Psychiatr Serv. 1996;47:23.
59. Hermann RC, Ettner SL, Dorwart RA, Hoover CW, Yeung AB. Characteristics of psychiatrists who perform ECT. Am J Psychiatry. 1998;155:889-894.
60. Convulsion therapy. Lancet. 1939;i:457. Editorial. 61. Fanon F. Towards the African Revolution. New York: Grove; 1967:127.
next: She Was Shocked
|
