I remember when Kitty Dukakis was promoting electroshock and her husband without any irony made this comment that it was great because if she was getting bad he could just drop her off and she'd be fixed when he picked her up. It was really horrifying. The woman needs a divorce not a current passed through her brain.

Well I haven't cried from an article in quite some time. The link to that Canadian study in Violet's post is so shocking, I just don't know what to say.

Bizarrely, I have some secondhand experience with this.

A good friend of mine used to voluntarily receive ECT for about one month a year while she was in her late 20's and early 30's. I don't think she'd mine me talking about this vaguely, she's very open about it.

I'm not clear if she's diagnosed as schizophrenic or has bipolar disorder. She's said either at various times. Ordinarily, she's prone to occasional bouts of auditory/visual hallucinations, paranoia and making fairly large scale irrational decisions. During one month of the year, things typically get pretty bad and she checks herself into an institution, her words, not mine, and gets ECT, I think once a week.

She's says it's not that bad, though she can't really remember anything short term over the month she's being treated. Both she and her husband insist it really helps.

They are an intelligent, educated, socially-conscious, loving couple. They've moved away since then, but we're still somewhat in contact. On one hand, I want to email her and ask if she's still getting ECT, if so, has she read this.

On the other hand, she probably has seen it. She tends to research things well. If it's her choice, it's not really my, or anyone else's, business.

ECT is by no means an act of medical barbarism. It's an appropriate treatment for extremely severe or refractory cases of depression and catatonia.

Has ECT been employed in completely unresponsible ways in the past? Yes.

Does that reflect the current environment in which ECT is employed? No.

Court-mandated ECT is another can of worms, and I'm not questioning the merit of the link.

My grandfather underwent ECT while he was institutionalized for Severe Anxiety Disorder, and it did seem to bring him back for a while. However, they didn't continue the treatment, I'd have to ask my grandmother for the specific reasons. I think it's something that CAN work in extreme cases. However, I also think that it should be voluntary, and that if one course of treatment is ineffective, then it should be immediately discontinued. Use of ECT as punishment is nothing new, as anyone who's read "One Flew Over the Cuckoo's Nest" knows.

The issue of why it's so disproportionatly recommended for women probably has something to do with the historic notion of women as hysterical. The idea that we're just emotional wreck that need to be "fixed" by men. Fix the attitudes and the ratios would probably fix themselves. But, that's why I believe it should be voluntary, if someone is helped by the treatment I believe they should have access to it, but it should never be forced on anyone.

I am shocked to discover that this practice is even still legal in the US.

I wouldn't even put a shock collar on a dog, let alone deliberately restrain and eletrocute a person.

I have to question whether it really works, or if part of it is the placebo effect. however even if it does help, it doesn't seem worth it to me. even if an individual requires large amoungs of shocking to fix their their ailment, the electroshock will damage their brain such that they may still not be able to function properly. I am not a doctor though, so clearly I don't know, but it just doesn't make logical sense.

Wow... I can't get over how totally stunned I am that this even still occurs.

I think that it's barbaric and reprehensible that this type of treatment be forced on anyone. However, if someone willingly (key word there) would undergo this treatment, I don't have a problem with that.
I also have secondhand experience with this. My father's father recieved ECT because he was so severely depressed that his life was in danger. (He consented to the treatment.)
I have clinical depression myself, and while it's certainly not so severe to require ECT, I might consider it if it were.
So I'm gonna be wishy-washy and both agree and disagree with the article.

I think the author of that piece needs to learn the difference between how ECT is portrayed in the media and the actual modern procedure. First of all modern ECT is done to patients under general anesthesia so pain isn't an issue. And just to point out the most obvious factual error, there is a plenty of research that it is in effective for serious depression as a quick search on Google scholar will make clear.

ECT is not risk free treatment mind you. The biggest of ECT is that it requires general anesthesia, and general anesthesia is not without danger. There are also plenty of other risks too. However saying "women [are] being shocked" as an argument against conjures up images of blood curdling screams, and that just isn't reality.

The fact of the matter is, in psychological disorders that could possibly merit such a treatment, safer chemical means are available and used. There is no way to deny that this is an antiquated means of treatment, and although it may have it's place in psychiatry, it is not a sound place.

In the end, like so many feminist issues, it's about human rights. Should we at all allow a treatment to continue that hurts so many? Is it worth it to have a legal treatment that may help a few, but is abused and misused to placate and terrorize so many women? In my opinion, no. It's just like the article said, it's like treating a headache with decapitation. As a scientist, I can't believe that efficient or effective.

Court-mandated ECT is usually employed when no competent decision-maker is available, and the therapy is potentially life-saving. A common scenario involves patients suffering from catatonia, for which ECT has been shown to be an effective short term treatment. A patient suffering from catatonia, much like someone brought to the ER unconscious from a car accident, has no means by which to consent. Both of those patients face life-threatening, acute situations.

Please erase "Cuckoo's Nest" from your brain when considering modern ECT. Patients are placed under general anesthesia and given neuromuscular blockers to prevent injury. If you watched a video of modern ECT, you wouldn't know when the electricity was on and when it was off if you couldn't see the switch on the machine.

Let me be absolutely clear that I am in no way condoning abuses of power against women or anyone else. I just don't want this thread to continue without an understanding that ECT has a rare but important role in responsible psychiatry. There's much about ECT therapy that is counterintuitive, but substantial, current medical literature exists demonstrating its safety, risks, and effectiveness.

OK, I'm a clinical social worker, and I worked on an inpatient psychiatric unit at a prestigious university hospital for the past year. This hospital was only one of 2 or 3 in the area that would perform electroconvulsive therapy (ECT). I am sensitive to both feminist and mental health issues, but my first impressions of this article are that it is alarmist and misleading.

Violet Socks is right to note that electroshock therapy as practiced from its inception up until about 20 years ago was, frankly, barbaric, and often used simply to control "difficult" patients (mostly women, who didn't have to do much to be considered difficult). However, the administration of the treatment has changed, both in terms of the criteria for its application and the method itself.

First of all, ECT is generally understood to be a last-ditch treatment primarily for severe depression that has not responded to more common treatments like pharmacology, talk therapy, light therapy, and/or changes in diet & exercise. Its use as an intervention for depression may account in part for the overrepresentation of women in ECT statistics, since women are diagnosed with depression twice as often as men. ECT is more rarely used to treat patients with schizophrenia or bipolar disorder. Whatever the diagnosis, it is not the immediate go-to treatment method of any reputable psychiatrist (unfortunately, though, there are no required accreditation standards for ECT in the US as there are in the UK. The doctors who perform the procedure at my facility have undergone special training programs to do so, but I can't speak for practitioners elsewhere). In a year, I can remember only 3 of our patients receiving ECT, all of them voluntarily.

Secondly, the current administration of the treatment no longer resembles the stomach-turning methods we've seen in One Flew Over the Cuckoo's Nest & other media images. The patient is given a general anesthetic and muscle relaxant and are administered localized pulses of electricity in a controlled environment. Side effects include muscle soreness, headache, and disorientation (generally for the first few hours after treatment). There can be temporary effects on short-term memory, but this effect usually disappears after the course of treatment is over (typical courses include 6-12 treatments over 3-6 weeks). I think it highly unlikely that Simone D. is experiencing pain during the procedure; perhaps her complaint refers to post-treatment side effects. The likelihood of brain damage is still under debate. I'm not a neurologist or a psychiatrist, so the best I can say about that is that most meta-analyses I've read indicate that evidence of ECT's harmful effects on the brain tends to be weak. Is there someone else out here who can provide more specific info? Its efficacy seems valid, up to a point: it tends to be around 70% effective at relieving symptoms of depression in the short term, but the effects tend to wear off after a few months, necessitating further treatment.

Finally, the legal aspect. I do not know the mental health law in New York, but in my state, obtaining a court order to perform involuntary ECT is *extremely* difficult. The psychiatrist must have the state's attorney file two petitions: the first is for involuntary hospitalization, and the second for involuntary treatment. In the second petition, the psychiatrist must note exactly what treatments (e.g. which drugs) he or she plans to use, and list alternatives and plans for the safety of the patient should his/her health be endangered. In order for the 1st petition to be granted, the state must prove that the patient is a demonstrable danger to herself or others -- suicidal, homicidal, and/or unable to provide for his/her own basic needs (e.g. unable or unwilling to feed him/herself, as evidenced by significant weight loss) and/or safety. This is not easy (and rightly so; I've encountered too many family members who wanted their relative committed b/c they thought his/her boyfriend was an exploitative dirtbag, etc., etc. Hello, mentally ill people have the right to choose lousy relationships, too!). The second petition is even harder, because it requires a lot of paperwork that must be worded in a very specific way, demonstrating that the person refusing treatment currently lacks the competence to do so, and that the treatment proposed is the least dangerous/invasive possible. No judge in Illinois would approve forced ECT unless the psychiatrist could prove that every other option (drugs, group therapy, occupational therapy, individual therapy, etc., etc.) had been tried and showed negligible effects.

Again, I don't know whether the laws and protocol in New York are as stringent. ECT (and the fact that women have been historically overrepresented as its recipients) is still controversial. A discussion about its use and misuse, informed consent, and the rights of the historically oppressed mentally ill is completely appropriate. However, an intelligent dialogue about this case would include information about Simone D.'s psychiatric history, including her diagnosis, the behavior that has led her doctors to believe that forced treatment (and specifically ECT) is appropriate, and what other services she has been offered prior to this petition. Without considering this information, and lacking a more informed understanding of ECT, jumping to the conclusion that she is being flagrantly violated due to her gender and ethnicity is, in my opinion, irresponsibly reactionary.

My roommate received a lot of ECT about a year ago, and it really seems to have caused her serious problems. A brilliant woman, she has a very hard time learning or concentrating these days, and has some severe memory problems. Her ECT was not entirely with her consent, as she'd periodically try to refuse it and they'd shove it down her throat anyways. As in "I don't want to anymore" "Well, you can refuse consent when you get there tomorrow morning. I'll leave you scheduled anyways."

These same doctors were trying to manipulate her to getting an implant in her vagus nerve. Their methods were brutal and very coercive, but it didn't matter to them. We lived too far away to really help much, but she clearly needed a patient advocate so she'd stop getting bullied.

Oh, and this was a private hospital, generally well-regarded, in a very upperclass area.

She's living with us now in the hopes that a change of location/situation will help.

To clarify to Garrett and ankathry, I wasn't using Cuckoo's Nest as a reference for the manner in which ECT is administered. I've seen videos about it in my AP Psych class in high school and my university Psycho-Biology class, I'm aware of the use of general anesthesia and muscle relaxants to minimize discomfort. I was referring to it as an example of ECT being used as a punishment or discipline tool; what the author of the article claimed was happening. It's a treatment that has historically been misused, and I wouldn't be surprised if it still is being misused occasionally.

Thanks to ankathry's for illuminated how ECT can be court ordered and the steps one has to go through to get that permission (at least in New York). I hope other states have similar controls.

I agree with the above poster who called the article "irresponsibly reactionary." I'm a psychiatry resident, currently training at an institution that does a lot of ECT. And like others have already pointed out, the reality of modern ECT is nothing like the Hollywood version. Even House got it wrong.

Depsite its infamous history, the fact remains that it is BY FAR the most effective, and fastest acting, treatment for depression, supported by multiple peer-reviewed scientific studies. For that reason, it can be a life-saving treatment for severe depression that has failed to respond to multiple medications. Other less-invasive treatments are in the works, such as transcranial magnetic stimulation, but ECT is the gold-standard to which they will be compared, because at the current time nothing works as well. Is ECT for everyone? Of course not. Many people respond well to medications and/or psychotherapy, and so of course those are tried first. But in a patient with severe depression and multiple suicide attempts which has failed to respond to every class medication we have, including some with some nasty and potentially fatal side effects, then yeah, ECT is a much better option than waiting for them to finally have a sucessful suicide attempt.

And FWIW, I'm female, the other resident working with me this month is female, one of the two attending physicians we're working under is female, and a good chunk of our patients are male. Where's this vast patriachal conspiracy?

Regarding court-ordered ECT, it differs from state to state, but is never taken lightly. In NY, I think the institution can petition the court for it, but in my state, the patient must first be found to lack capacity and have a legal guardian appointed, and then the guardian petitions the court.

I am really disappointed that feministing would link to such an alarmist article. ECT saved the life of a very close friend of mine and I would be heartbroken to see it outlawed.

i agree with the posters above - i remember learning in my college psych courses about how ECT was having a resurgence as an evidence based method of treating serious psych issues.

this article also seemed off to me based on the reference to women receiving more mental health diagnoses and treatment than men. my understanding is that this is largely because men don't feel like they should get help - that it makes them less 'manly' and self-sufficient by admitting to weakness. instead, many men self-medicate with alcohol and other drugs (not that women don't take this coping route as well).

i don't know...i feel like there's some interesting (and troubling) issues here, but the article this post links to is alarmist, so the real issues are hard to get to.

As a medical student, I agree that ECT is a mainstream, though not first line, treatment for severe depression. As someone who has had ECT, I have a hard time being objective about it. In my case, it didn't have much of an effect on my depression (despite a usual course of it 3 times a week for a month, while I was an inpatient in a locked ward), so I got none of the benefits and all of the side effects. True, there is no pain, but the cognitive effects are real and I think under-studied and thus underestimated.

For the month I was undergoing treatment, I had no short-term memory -- when I later saw "Memento," I had a shiver of recognition, because it had been that bad. I'd have a phone conversation one day and by the next day, it was forgotten. Also, the previous six months of my life were wiped from my memory entirely for some time (though some of those memories slowly resurfaced with time, it's still a hazy area). Hazy is better than empty -- you cannot imagine this sort of memory loss unless you've experienced it. It is horrible, traumatic, and the most terrifying part of the entire experience.

And I still live with the sense that my mind was forever made duller. It didn't make me into an idiot -- I'm not saying that it's as bad as a lobotomy or anything. Hell, I went back to college, eventually got into med school, and am doing pretty well at that. But there is still a sense that everything, cognitively, is more of a struggle than it ever was before ECT.

Violet's having trouble signing into TypeKey and asked me to post this for her...
----------------------------

Ann, thank you for picking this up. It seems your post has called out the
pro-shock reactionaries who happily parrot what they've learned in class.
At least that illustrates why it's difficult to get traction on this issue.

All of the smug, self-assured statements above have also been delivered,
almost word for word, in favor of lobotomies, insulin shock, and any number
of other horrific treatments, all of which are now recognized to be utterly
abhorrent. But in their heyday, the medical and popular literature was
full of people like the commenters here calmly assuring everyone that of
course it works, it's a responsible and effective medical treatment for
severe cases, etc., etc., etc., etc.

Electroshock does not cure anything. What it does, which is also what
insulin shock does, is daze the patient and eventually lead to permanent
brain damage. That ECT has an effect is undeniable. So does insulin shock;
so does lobotomy; so does any number of things that have been done to
patients. But it's not the effect that shock doctors pretend it is.

Do some patients get better after shock? Yes, but most don't. And some
patients get better without shock. But the same could be said of wearing a
rabbit's foot. Study after study has shown that any perceived curative
effect from shock treatments (both insulin and electroshock) is due to
either the placebo effect or to the human contact and attention that comes
with being given any kind of treatment at all. The damage, on the other
hand, is unmistakable, and has also been demonstrated in study after study.

It is ironic that one of your commenters says, "Without considering this
information, and lacking a more informed understanding of ECT, jumping to
the conclusion that she is being flagrantly violated due to her gender and
ethnicity is, in my opinion, irresponsibly reactionary." Indeed, and I hope
she's talking about herself. Certainly if she'd followed the links in my
post, she would know that Simone D. has been denied the most basic
alternatives to electroshock, that she doesn't speak English and hasn't even
been given a Spanish-speaking psychotherapist, that at least one of the
dissenting judges on the appeals court has castigated the court for
improperly ignoring testimony, and so forth.

I would strongly urge any readers to investigate this issue for themselves,
reading the academic papers I've cited and exploring the links.

Hmm. I was under the mistaken impression ECT was illegal in NZ, but having looked it up it appears not.

I am very much on the fence, having little to no knowledge on the topic.

Still, my current opinion is yes, it perhaps is effective in keeping alive suicidally depressive patients. BUT I find it very difficult to believe we have any idea of the long-reaching effects of such a treatment. We know little enough about how the brain works (what we do know, which is fantastic, is a drop in the bucket compared to what we DON'T know and anyone with even a passing interest in biology knows this) so it scares me that we're willing to do god knows what to somebody's brain because it helps with ONE problem :\

Even with anesthesia to prevent ECT from being torture, the idea of doing something that clearly causes brain damage and whose anti-depressant effects are questionable is worrying. I had read about electroshock before, but hadn't known it was still being used, much less in Canada.

ECT is by no means an act of medical barbarism. It's an appropriate treatment for extremely severe or refractory cases of depression and catatonia.

...which continues to be employed despite doing slightly worse than placebo in double-blind trials.

I'm gonna have to go ahead and be a dissenter here, as it is actually a very effective treatment for people with severe bipolar disease. My mother is one of those people. Her bipolar disease was so severe that, even with the right medication, she attempted suicide twice in one year. She had ECT done, and while she doesn't remember much of that year, she is still alive today and doing much better (While still on medication, mind you). I firmly believe that if she hadn't gotten ECT done, she would be dead by now. Of course, it hasn't been shown to do much good for anyone but people with bipolar disease, as history has shown. It is a treatment that should only be reserved as a last choice, when nothing else has worked.

I am a psychologist who has work in an acute care setting. I have personally seen people before and after ECT. ECT has been the one thing to keep these people alive. The chronically depressed/suicidal are the most common group that get ECT and the group that benefit most from it. There have been people who would be dead if it weren't for ECT and im not exaggerating.

The historical administration of ECT has left a bad taste in many people's mouths, however as many have pointed out the administration and critera for treatment have changed.

In Australia where I work, the criteria for involuntary ECT require a Magistrates review and approval which is not an easy process.

I would not like to see this option of treatment removed from the list because of sensationalism by those who do not have current information.

Now hold on just one second. I don't think the people here sharing personal anecdotes about ECT are reactionary or smug, and they certainly aren't just parroting things they learned in psych class. Passion and indignation over this case is laudable, but the only one sounding way way way too self-assured is the author of the original post.

One thinly-sourced opinion piece by a doctor in a Women's Studies journal, a link to an anti-psychiatry website, and a link to an individual's ECT activism site (which site, I have to say, takes a much more respectful and reasoned approach to the problem of "informed consent" in ECT than I saw in Violet Sock's post) and some rhetorical flourishes such as "people said x,y, and z were okay ... and look how bad they turned out to be!" is not a very good foundation upon which to base such sneering criticism of those who disagree on the merits of a scientific issue about which very few of us here (I'm guessing very strongly the author of the original post included) are experts.

Besides, in a case that potentially reveals so much that is structurally wrong with the way medical care (and especially mental health care) is administered to people in this country, attacking people who've come to a different conclusion about the overall merits of this specific procedure seems a bit like being mad at someone for supporting Prozac when one's argument is that Prozac shouldn't be force-fed to people who've been told it's oatmeal.

The lens of ECT is a very narrow one from which to view the mental health system and the social justice issues involved in it. All of the issues involved in the case in question here are problems historically with the medical field in general, and many of them are problems more broadly in the legal, economic, and scientific practices of psychiatry. With such admittedly pressing problems, it doesn't make much sense to make blanket and un-sourced disapproval of ECT a shibboleth for the cause.

The problem with deferring to "experts" (especially in feld in which no one can rightly claim to be one) is that it falsely assumes that belonging to a particular profession immediately makes one a paragon of rational, evidence-based thought (if you want to test that one, round up 20 emergency phyisicians, trauma surgeons, and critical care specialists, and ask them whether crystalloid or colloid is better for volume replacement).

Even if ECT hadn't compared poorly to placebo in the double-blind study, there is still one central issue: people who use ECT are intervening in a particularly unsubtle way in a system about which no one knows very much. Even fundamental questions about the functional subdivisions of the brain aren't completely resolved (for example, we can't really account for diaschisis yet). There is a certain irony to the fact that neuroscientists refuse to speculate about the brain-behaviour relationships of bees because the bee brain is too complex, while others seem to think that the human brain is simple enough that we can figure it out before we gain comprehension of the bug brain.

Taken in the most charitable light, the benefits of ECT are at best questionable and unclear (or, if we believe the double-blind study done on the subject, nonexistent). What has on the other hand been well documented is the harm this technique can do. Is it really so unreasonable to suggest that there is a need to seriously rethink the use of a technique that is not known to be beneficial (anecdotes aside) but known to be quite harmful in many cases?

The plural of anecdote is not data. Those who attempt to defend ECT on a scientific basis should keep that in mind.

I'd like to echo the more "balanced" approach here. I think ECT has a PR problem precisely because it involves electricity, which invokes images of Frankenstein & Hollywood horror movies in general. That isn't really fair. I've heard a lot of negative things about Prozac too, but since it's just a pill and pills have a much calmer, simple administration process, it's given a lot more benefit of the doubt in the public eye.

Not saying I'm qualified to make any definitive claims about the efficacy of either ECT or Prozac. Nor would I claim that medical abuse couldn't happen nowadays. What I will say is that if there is any issue here, it is one of informed consent or lack thereof, and that the specific treatment involved is NOT particularly the issue. Again, you could have the same issue with Prozac or any other drug, but I'm guessing it would be nowhere near as sensationalist. In fact, it wouldn't surprise me at all if more abuses happen with Prozac than with ECT, because the former doesn't get in the news.

This conversation seems to be devolving into people saying there have been several studies that says ECT helps in extreme cases, while other people claim that there have been several studies claiming that ECT hasn't shown any measurable benefits. In the court of public opinion, that's kind of a wash. Though some the anti-ETC posters, particularly Violet Socks, seem to be getting snide and confrontational. Frankly, that doesn't really do much to convince me of the soundness of your arguments.

Assuming everyone's telling the truth, there's clearly some controversy over the benefits of ECT. Looking at it rationally, even if it may cause long term brain damage it's still a last resort procedure for people who may not otherwise survive their depression. Worst case scenario, whether you'd rather be dead, or risk living out the rest of your life with brain damage is a tough choice. I don't think anyone has a right to make that choice for anyone else.

If a person feels they have no other option and is desperate for relief, a bad choice is better than no choice.

i looked in to this when i wrote my dissertation on sylvia plath. ect was used as a way of suppressing female rebellion and creativity. in the history of "mad" women, it seems quite often their complaints were reasonable against the problems they faced via repression etc. but the the idea of rebelling against the controlling patriarchy was seen as madness, and the woman had to be made docile via medical "science".

I spent the '80s in a state hospital in Missouri. While ECT was available, it was extremely rare. The patient didn't just have to consent, he pretty much had to initiate the process. While I don't doubt that some abuse exists, I have a hard time believing it's rampant due to restrictions in most state's law.

As far as the Simone D. situation goes, it does seem pretty outrageous. If she was competent enough to get her case heard in court how could she not be competent enough to refuse treatment? But, this just seems like abuse of a woman not systematic abuse of women in general.

LadyGrey posted:
Study after study has shown that any perceived curative
effect from shock treatments (both insulin and electroshock) is due to
either the placebo effect or to the human contact and attention that comes
with being given any kind of treatment at all.

Would you mind citing your sources for this? You mention "study after study". I'm interested in the matter, but can't find any remotely reliable sources. Unfortunately without sources, the argument is kind of meaningless:(

LadyGrey posted:
Study after study has shown that any perceived curative
effect from shock treatments (both insulin and electroshock) is due to
either the placebo effect or to the human contact and attention that comes
with being given any kind of treatment at all.

Would you mind citing your sources for this? You mention "study after study". I'm interested in the matter, but can't find any remotely reliable sources. Unfortunately without sources, the argument is kind of meaningless:(

I've been taking some medications for psychological issues recently, and being the kind of person that I am, I carefully researched everything my doctor recommended, and the alternatives to them. I also got interested in the subject and looked into treatments for things other than what I personally have.

Drugs can cause brain damage. Some of them almost never do (like those I've taken, thankfully; otherwise, my symptoms aren't severe enough that I'd consider taking them), but some of them almost always do, particularly the more potent anti-psychotics. Leaving a mental illness untreated can also cause further brain damage, either directly or because the illness causes the person to injure themselves or fail to take adequate care of themselves. Most treatments only work for some people. Sometimes all of the options are bad.

Now, I'm very big on consent; I'm quite happy to have a doctor who discusses treatment options with me and listens to my requests and suggestions. A court forcing someone to undergo any medical procedure is suspect, and the more side effects, the more questionable it is. ECT can have some pretty serious side effects, so no question the court decision which is described is wrong. But recent meta-studies of ECT (combining the results of lots of previous studies and trying to figure out what's really going on, since individual studies have a high track record of being overturned by further reasearch) have suggested it has short term benefits for depression, and for some people nothing else works.

I also wonder whether this specifically is a feminist issue, or if it's just part of the general feminist issue that women are much more likely than men to be diagnosed with depression. Depression is the major reason ECT is given these days. I think the ratio of women to men being diagnosed with depression is comparable to the ratio mentioned above of women to men getting ECT.

About brain damage...

if the part of my brain that's being damaged were to be the part that's malfunctioning, causing me to be suicidal and unable to enjoy anything in life -- if nothing else had worked, I might be willing to take the risk, even if other parts of my brain might be damaged as well.

What struck me about the case quoted in that link is that it appears that talk therapy in the client's native language (spanish, not all that uncommon) was not tried, or not given enough time to show results, or something like that. This makes me wonder if ECT was recommended because the client wasn't willing/able to go through lengthy talk therapy and/or the trial-and-error of finding a working drug treatment, or whether ECT was recommended because it's quicker/easier/cheaper for whoever's paying the bills.

Here's a meta-analysis from the Lancet in 2003. For those not familiar with med literature, the Lancet is pretty much Britain's equivalent of the New England journal.

Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003 Mar;361(9360):799-808.

And from the states, a nice review of the hows and whys.

American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 2000; 157:1.

There's a whole respected journal dedicated to nothing but ECT (not surprisingly, the journal of ECT). It's a responsible journal with the following mission statement:

The Journal of ECT (formerly Convulsive Therapy) covers all aspects of contemporary electroconvulsive therapy, reporting on major clinical and research developments worldwide. Leading clinicians and researchers examine the effects of induced seizures on behavior and on organ systems; review important research results on the mode of induction, occurrence, and propagation of seizures; and explore the difficult sociological, ethical, and legal issues concerning the use of ECT.

Ollie: someone else said what you're quoting, not me.

My apologies LadyGrey, I must have accidentally looked at the name above instead of below.

So correction: That was said by Ann and not LadyGrey

Ollie, Violet Socks actually wrote what you quoted; Ann posted it for her because TypeKey was acting up. The former is the author of the article linked in the Feministing post. If you follow that link, I'm sure Violet could provide you with sources, if she isn't too busy accusing people who disagree with her of being parrots of the patriarchy.

"The plural of anecdote is not data. Those who attempt to defend ECT on a scientific basis should keep that in mind."

I think that's good advice for both sides of the argument, actually, and would add that one study does not represent conclusive evidence. Elise, do you happen to have the citation for the double-blind study you referenced? I'd be interested to review it, specifically to find out more about the methodology, the number of participants involved, and whether the results have been replicated by other researchers.

I'm assuming that the double-blind study that some of the comments have referred to is the study cited in Dr. Burstow's article on ECT, which was linked in Violet Socks' original post. Although I did not read the actual study, I did notice that the study was conducted in 1978, which raises a huge red flag concerning its validity. No matter how sound its methods may have been, a thirty-year-old study on ECT does not reflect the efficacy of modern ECT and cannot be used as solid evidence claiming that ECT is ineffective. ECT has advanced quite a bit in the last thirty years, and a great deal of research has been conducted on it. Out of curiosity, I searched PsychInfo, a large database of the best in psychological research, and found hundreds of studies demonstrating the limited efficacy of ECT in treating depression and other disorders. I also found new research studying how ECT works (what chemical changes occur in the brain, etc.).
Violet Socks' comment in this thread shows a clear distrust of scientific research, yet it also references scientific studies to support her claims. It seems that many of anti-ECT comments in this thread have decided to ignore the many studies attesting to ECT's efficacy and instead use outdated studies as proof that ECT is ineffective. I think that the mixed evidence on the subject shows that we cannot conclusively say that ECT is 100% effective, nor can we conclusively say that it is without benefit. However, it appears that the bulk of current scientific research on the subject demonstrates a limited benefit of ECT in alleviating depression and other disorders.

http://scienceblogs.com/omnibrain/2007/05/more_antipsychiatry_ralliers.php

lthough I did not read the actual study, I did notice that the study was conducted in 1978, which raises a huge red flag concerning its validity. No matter how sound its methods may have been, a thirty-year-old study on ECT does not reflect the efficacy of modern ECT and cannot be used as solid evidence claiming that ECT is ineffective.[...]I think that the mixed evidence on the subject shows that we cannot conclusively say that ECT is 100% effective, nor can we conclusively say that it is without benefit. However, it appears that the bulk of current scientific research on the subject demonstrates a limited benefit of ECT in alleviating depression and other disorders.

It should be added to your comment that, while the benefits are admittedly debatable (despite some anecdotal support), the harms are not. If ECT had been invented these days, with our current rigourous research modalities, it likely would not have made it past animal trials; however, ECT was developed at a time in which real research on these subjects was rare and generally quite dismal, and has essentially found itself grandfathered in. This is in part because those who object most strenuously to its use — i.e., those who have experienced it first-hand — are rather easily ignored (as was done in the Simone D. case). A psychiatric diagnosis of the requisite severity and/or a history of institutionalisation is more than enough, in many cases, to cause someone's experiences to be discounted.

The desire to think of the Simone D. case as an isolated event is understandable, but a reading of the facts cited in the dissenting judge's opinion does not counsel optimism. Simone D. speaks only Spanish. Nonetheless, her treating physicians discontinued sessions with a Spanish-speaking therapist after only a few weeks. Slip op. at 8. It is not clear from the record whether her diagnoses (major depressive disorder, severe, with chronic features, Slip op. at 2) were in any way influenced by the few sessions she had with someone who could understand her language. She was subjected to 148 ECT sessions. At the time of the petition for further ECT, she was engaging in "assaultive behavior", remaining in a foetal position, and refusing to interact with others or to eat and drink — the same symptoms that were not cured by the previous 148 sessions. According to the testimony only psychiatric expert allowed to testify at the hearing, after an apparent initial benefit from the treatment, Simone D. "had become withdrawn, mute, and nonparticipatory, and spent most of her time in a corner in a fetal position", slip op. at 2. Against this background, her (non-Spanish-speaking) treating physician and the trial judge were confident that all she needed in order to recover was yet more ECT. "[W]with the treatment, she will not remain in a fetal position, she will eat, interact, and not pose a danger to herself or others." Slip op. at 6.

One is reminded of the physician who was convinced that failure of bloodletting to produce improvement in a patient proved that not enough blood had been let.

The hospital in which Simone D. was being treated (to use the term broadly) saw no need to try even basic, benign interventions with their patient. Only briefly was she provided with a therapist who could actually understand what she was saying. Given that Simone D.'s native language is not exactly an uncommon one in the US, it is telling that no one involved in her treatment seems to have felt compelled to ensure that her linguistic needs were met. If ECT were truly viewed as a last resort in this institutional culture, one might expect at least some effort at ensuring that the available alternatives were available. Instead, she was medicated and subjected to ECT on the orders of psychiatrists who did not even speak her language. Even the fact that only very short-lived improvement (accompanied by distressing side effects) had been obtained through 148 ECT sessions (or the placebo effect, combined with a fervent desire to avoid further ECT) did not lead her treatment team to consider the possibility that ECT simply was not alleviating the underlying pathology.

Perhaps, for example, the Simone D. was not "interacting with others" (one of the stated reasons for the ECT) because "others" did not speak her language. Perhaps Simone D.'s behaviour was (as is often the case with self-injuring behaviour) a desperate attempt to gain some control in a situation in which she had none. These possibilities could have been addressed had Simone D. had access to someone with whom she could communicate. This, however, was apparently too tall an order for Creedmoor Psychiatric Center. The fact that this situation was allowed to continue for over a decade prior to the 2007 petition strongly suggests that the only thing unique about Simone D.'s case is that she had a lawyer and it caught someone's attention.

Violet Socks' comment in this thread shows a clear distrust of scientific research, yet it also references scientific studies to support her claims.

This is a rather odd claim. As you point out, she cites scientific studies. A reading of her original post and comments, as well as the work she cites, indicates that her problem is not so much with scientific research (which was not being seriously conducted in this field when ECT was developed), but with the decidedly unscientific bias against taking into account the actual experiences of those who have undergone ECT. People often see what they want to see (hence the importance of double-blind studies and multiple perspectives); a person who administers a treatment in which s/he believes, whether or not there is a rational basis for that belief, will tend on a subconscious level to interpret what s/he observes as signs of improvement. When the voice of the patient is ignored, as is so often the case, especially when dealing with severe, apparently refractory mental disorders, these uninformed outside perceptions go unchallenged. That isn't science; it's religion.

I'm confused as to why some people are comparing the brain damage done by ECT to "damage" caused by mental illness. Although it can cause a person to attempt suicide, depression does not cause brain damage. Neither does bipolar disorder, or schizophrenia, or any other mental disorder you'd care to name. Those are not physical diseases; otherwise these patients would be handed over to M.D.'s.

In either case, I have a hard time believing that erasing someone's memory with a pop and a flash - with no real way to know what else you may be scrambling - is really an effective way to treat anything.

"Neither does bipolar disorder, or schizophrenia, or any other mental disorder you'd care to name. Those are not physical diseases; otherwise these patients would be handed over to M.D.'s."

Psychiatrists have MDs.

It's really disappointing to me as a feminist mental health blogger that quite a few on this thread are denying the reality that women are diagnosed far more often with mental illness than men, and are choosing to accept the "answer" of women seeing doctors more than men. While that is true, I thought that, as feminists, we sought to move past the simple answers.

First I want to say that the Simone D. case is horrifying, and I think that Violet was right to try to bring attention to it. Whatever else I may think about ECT, I certainly think that, given its side effects, it should always be a strictly voluntary procedure. That a court can mandate it at all, let alone under circumstances as completely bizarre as those surrounding this case, is profoundly disconcerting to me.

And that's about where my sympathy for Violet's otherwise transcendentally meretricious position ends. Burstow's paper is emphatically not a study. It's a cherry-picked collection of anecdotes. It probably has some value as a qualitative assessment of ECT; but then, the only recommendation to be taken from it is that ECT should not be used coercively.

Violet makes blanket statements about ECT which are demonstrably not borne out by the current research (I'm sorry, but as far as I'm concerned a recent Lancet meta-analysis is worth any number of 30 year-old papers presented alongside work by an ideologue like Peter Breggin), and she levies personal attacks against those who disagree with her ("pro-shock reactionaries who happily parrot what they've learned in class"). She employs dishonest bait-and-switch tactics -- note the many times, both here and in her own thread, when she countered a contrary claim about ECT's efficacy with something like: "But this is about Simone D. !", only to immediately turn around and make yet more blanket claims about how ECT is dangerous, is ineffective, ought to be banned, et cetera.

This is not how you make a cogent argument! This is how you throw a tantrum.

Elise:

... her problem is not so much with scientific research (which was not being seriously conducted in this field when ECT was developed), but with the decidedly unscientific bias against taking into account the actual experiences of those who have undergone ECT.

A specious claim. Generally, the severity of depressive symptoms (in humans, at least) is gauged by self-report; that these "actual experiences" are collected and considered rigorously and not presented in demagogue-friendly anecdotal chunks ought to add to their informative weight. And incidentally:

Informed consent for ECT becomes a mirage ... Some patients do feel 'helped' by ECT. Often they have been so damaged that they cannot judge their own condition. They suffer from iatrogenic denial and helplessness.

That's from one of Breggin's articles that Violet links to. That's not just ignoring people's "actual experiences," it's denying their authority to even state them. Not to mention that it's inherently self-defeating: if ECT patients are incompetent to say they were helped, then how can we take seriously their claims about how they've been harmed?

People often see what they want to see (hence the importance of double-blind studies and multiple perspectives) ...

Hence the importance of meta-analyses of peer-reviewed studies, and hence the necessary skepticism afforded purely narrative, anecdotal accounts of the sort you were defending -- nay, insisting on -- one sentence ago.

... a person who administers a treatment in which s/he believes, whether or not there is a rational basis for that belief, will tend on a subconscious level to interpret what s/he observes as signs of improvement.

A person who criticizes a treatment which s/he strongly opposes, whether or not there is a rational basis for that antipathy, will tend on a subconscious level to interpret what s/he observes as signs of -- what? Institutional bias? The evil machinations of the patriarchy? Stupid barbarism? I don't know, I guess all of those things.

It should be added to your comment that, while the benefits are admittedly debatable (despite some anecdotal support), the harms are not.

Relevant to a discussion of involuntary ECT, but nothing else. The scope of this discussion has pretty clearly moved beyond the particular case of Simone D. and grown to include the efficacy and ethicality of ECT in general, so I feel comfortable saying this. There are plenty of medical interventions that have harmful, even debilitating side effects: chemotherapy, radiotherapy, transplant surgery, dialysis, just to name a few. But as far as I know, these practices are pretty noncontroversial. Doctors and the public are both generally aware that for some patients, even extreme interventions can be worth the associated risks. I do not understand why (I stress again, voluntary) ECT should be any different.

The plural of anecdote is not data.

True. What is interesting here is that a poster articulating a position opposed to yours said exactly the same thing in Violet's thread.

"It's really disappointing to me as a feminist mental health blogger that quite a few on this thread are denying the reality that women are diagnosed far more often with mental illness than men, and are choosing to accept the "answer" of women seeing doctors more than men."

Meredith, I think that feminists can both recognize that 1) men seek help for mental disorders less readily than women and 2) women are much more frequently diagnosed with certain mental disorders likely due to the association of women with hysteria, being 'over'emotional, etc. i think both problems exist, and contribute to this trend. and, if you think about it, are both caused by patriarchal assumptions in our society - e.g. women are at fault for being overly emotional, and men should be strong enough to deal with any problems on their own.

i think there's really two issues in violet's original post that she runs together. Is ECT an appropriate therapy, or is it barbaric, outdated, etc.? And are women diagnosed with mental illnesses frequently forced into therapies without a say in whether they wanted the treatment, or whether they thought it was helpful?

Although it can cause a person to attempt suicide, depression does not cause brain damage.

This is 100% wrong. Depression causes, or is caused by, it's hard to tell--essentially depression is brain damage. It causes/is caused by serious, cumulative changes in the amygdala and hippocampus, and is decidedly correlated with a lack of glial cells, which support and "cushion" neurons. All of these physical problems become worse and worse the longer depression is left untreated. Do some basic research before making sweeping statements. The physical aspect of depression has been well-known by scientists for quite some time.

There are plenty of medical interventions that have harmful, even debilitating side effects: chemotherapy, radiotherapy, transplant surgery, dialysis, just to name a few. But as far as I know, these practices are pretty noncontroversial.

While I had considered ignoring your post altogether because of the large volume of ad hominem and mischaracterisation of opposing viewpoints, I did want to touch on the various problems with the above statement.

Essentially, the fundamental problem here is one very similar to a logical fallacy common in creationists. "The watch is complex and someone clearly designed it, the fact that we are complex clearly means that someone designed us". Similarly, your above comment is, essentially, that:

A, B, C are extreme but undeniably beneficial, therefore D, which is much more extreme must be beneficial as well.

The problem here is that the benefits of things like dialysis, chemotherapy, etc. are quite well established, and in the cases in which they are used generally exceed the risks and side effects (and patients who disagree with the above risk assessment generally have an absolute right to withhold consent). In the case of ECT, on the other hand, the balance of evidence is completely different. The harms are clear and well documented (unless one entirely ignores, by way of example only, the experiences of those who have undergone it); the benefits, on the other hand, cannot even be said with certainty to exist at all.

Why it should whether a person voluntarily submits to ECT (though, as others have pointed out here, consent is often questionable) is not immediately clear. A treatment with no clearly established benefit doesn't suddenly become a panacea just because someone wanted it.

What is also interesting, more generally, is the underlying assumption of a lot of the pro-ECT posts here. There seems to be a general assumption that a technique should be presumed harmless and permitted until it has been proven harmful. This is, of course, absurd, and turns the precautionary principle on its head. To require more exacting proof of harm than is available for benefit is essentially to require that the general population become involuntary research subjects. The standard is, and should be, that the safety and efficacy of a treatment/medication/etc. must be demonstrated, and that the benefits must outweigh the potential risks in the relevant application. If ECT had been required to meet those standards, Simone D. (whose case shows a systemic failure in both the mental health and judicial systems in the area) would not have had to go to court at all.

Similarly, your above comment is, essentially, that:

A, B, C are extreme but undeniably beneficial, therefore D, which is much more extreme must be beneficial as well.

Patently false and utterly shameless. The comparison of my argument to "a logical fallacy common in creationists" is completely inappropriate, and a pretty transparent attempt to undermine my position by rhetoric. ECT's efficacy in at least some cases is established, not by the degree to which it is extreme, but rather by the preponderance of peer-reviewed research indicating that in a significant number of highly treatment-resistant cases of depression,
it has produced beneficial results.

Why you continue to refuse to consider said research, and instead harp on a mysterious and apparently completely authoritative "double-blind study" that despite ankathry's request you still have yet to actually cite, I can not begin to guess. It certainly does nothing to strengthen your position.

And Elise: anyone can dismiss an opponent's argument as consisting of "ad hominem and mischaracterisation of opposing viewpoints." When people are strongly at odds, it can be difficult not to see any argument that way. But I responded specifically to claims that you actually made, and cast no aspersions on your character, explicitly or implicitly, so far as I am aware. If you honestly feel that I personally attacked you, then I apologize for perhaps being too harsh; I admit that I have never really learned how to disagree politely. If, on the other hand, your accusation to that effect is just more obfuscatory rhetoric, well - in that case, this discussion isn't going to get anybody anywhere.

I was actually not referring to your mischaracterisations of my statements, but rather your comments below:

And that's about where my sympathy for Violet's otherwise transcendentally meretricious position ends. Burstow's paper is emphatically not a study. It's a cherry-picked collection of anecdotes. It probably has some value as a qualitative assessment of ECT; but then, the only recommendation to be taken from it is that ECT should not be used coercively.

Violet makes blanket statements about ECT which are demonstrably not borne out by the current research (I'm sorry, but as far as I'm concerned a recent Lancet meta-analysis is worth any number of 30 year-old papers presented alongside work by an ideologue like Peter Breggin), and she levies personal attacks against those who disagree with her ("pro-shock reactionaries who happily parrot what they've learned in class"). She employs dishonest bait-and-switch tactics -- note the many times, both here and in her own thread, when she countered a contrary claim about ECT's efficacy with something like: "But this is about Simone D. !", only to immediately turn around and make yet more blanket claims about how ECT is dangerous, is ineffective, ought to be banned, et cetera.

(emphasis supplied)

To refer to someone as making "meretricious" claims is clearly a personal attack (we need not tarry on the other equally troubling unsourced personal attacks contained in the above paragraph.

Similarly, your insinuation that my taking you to task for your above personal attacks could be merely "obfuscatory rhetoric", ironically, also falls quite nicely in the rubric of ad hominem.

The same is true of your characterisation as "shameless" of my analysis of your rather odd argument about dialysis and transplant surgery. If you deny that you were introducing those therapies for the purposes I mention, then their relevance here is hard to see.

The same might also be said of your assumption that I refuse to consider the research that you apparently believe is all-important here. The double blind study to which I was referring was already cited by someone else; I saw no need to make a duplicative post. I would, however, be interested in whether your research has turned up any similarly rigourous (e.g. multi-centre, placebo-controlled, randomised, double blind or similar) studies that have shown that the benefits of ECT cannot be accounted for by the placebo effect. If you have been holding out on us, please feel free to cite them now.

I notice that you have not disputed any of the other things in the post to which you are responding (precautionary principle, etc.).

transcendentally meretricious

At worst this consitutes hyperbole, and as you noted, I used it to describe her claims, not Violet herself. There is no sense in which this is "clearly" a personal attack. Qualitatively, it is no different from saying "so-and-so's argument is unsound."

we need not tarry on the other equally troubling unsourced personal attacks contained in the above paragraph.

Odd, since the bulk of that paragraph consists of exactly why I think my criticism of Violet is fair. Would you like dates, times, and the names of those involved in the exchanges to which I referred?

blanket statements about ECT which are demonstrably not borne out by the current research

An indisputable fact, as far as I'm concerned. Even if I'm wrong, it's completely ridiculous to claim that a simple statement to the effect of "the evidence indicates that your position is wrong" constitutes a personal attack. That would make pretty much any rational debate on any subject impossible.

dishonest bait-and-switch tactics

I absolutely stand by this statement, because that is exactly what I think she did. Pointing out someone else's dishonesty is never against the rules. You will note that I did not follow this claim with "and that makes Violet a bad person, so don't listen to her." That would have been an ad hominem attack.

Similarly, your insinuation that my taking you to task for your above personal attacks could be merely "obfuscatory rhetoric", ironically, also falls quite nicely in the rubric of ad hominem.

Possibly. I concede that that may have been uncalled for.

The same is true of your characterisation as "shameless" of my analysis of your rather odd argument about dialysis and transplant surgery.

Personal only insofar as I speculated as to your motivations for making such a bizarre claim. I think that your comparison was unsound and completely missed the point, but I in no way suggested that it or your reasons for making it undermined the rest of your argument.

The same might also be said of your assumption that I refuse to consider the research that you apparently believe is all-important here.

Now you've lost me. How on earth could that possibly be construed as a personal attack? I said what I did because in no prior post did you actually make any reference at all to any of the other research that has been cited in this thread. (See for instance, Garrett Sparks' above post, which cites the 2003 Lancet meta-analysis and a paper describing the American Psychiatric Association's position on ECT in the treatment of depression. Now, would you be kind enough to point me toward your "already cited" study that I clearly missed?) I certainly can't categorically state that you haven't at least looked at any of this research, but if you have, you've given no sign of it whatsoever, not even to disagree with it.

Anyway. Elise, there is a big, big difference between strident criticism and ad hominem attacks. Honestly, how would you prefer that I express my disagreement with you?

I notice that you have not disputed any of the other things in the post to which you are responding (precautionary principle, etc.).

Brazen coming from you, given the rather large proportion of my original post directed at you, not at Violet, that you've neglected to comment on. But if you insist:

There seems to be a general assumption that a technique should be presumed harmless and permitted until it has been proven harmful. This is, of course, absurd, and turns the precautionary principle on its head.

Of course it is absurd, and you would be quite correct, if only anyone here had actually said that ECT was not harmful. Nobody has denied that there are big, big risks associated with ECT. Personally, I'm pretty well persuaded by the research I've looked at that it's unlikely that anyone comes out of the process unscathed, and it's definitely the case that there are some people for whom the treatment provides no discernible benefits at all.

To require more exacting proof of harm than is available for benefit is essentially to require that the general population become involuntary research subjects.

I really don't understand this sentence is supposed to mean. Could you please rephrase it?

The standard is, and should be, that the safety and efficacy of a treatment/medication/etc. must be demonstrated, and that the benefits must outweigh the potential risks in the relevant application.

Quite so, but where there's evidence of any benefit at all, I happen to think that the decision as to whether "the benefits ... outweigh the potential risks in the relevant application" ought to be left to the patient and his or her physician. I don't deny that abuses of power can occur, and that some people may undergo the treatment, say, without full knowledge of its side effects, but that is a concern relevant to any medical procedure.

If ECT had been required to meet those standards, Simone D. (whose case shows a systemic failure in both the mental health and judicial systems in the area) would not have had to go to court at all.

I've already made my position on Simone D.'s case clear.

EG: I apologize for using terms that you find objectionable. My understanding was that depression was related to often-treatable chemical deficiencies in the brain, most of which we don't really understand yet. I've never heard the physical components of depression referred to as "brain damage" before - I tend to think of brain damage as loss of cognitive function and memory, as I've seen in friends who suffered drug- and chemical-related brain damage. I think its dangerous to think of those two types of brain damage as interchangeable equivalents.

On a separate note, I wonder about what's going on at the hospital this Simone D. is in; shock patients are supposed to be under anesthesia, right? But she reports that the procedure is very painful. Are they not using proper technique or is the anesthesia just not strong enough?

Anyway. Elise, there is a big, big difference between strident criticism and ad hominem attacks.

It is precisely this difference that I was attempting to point out to you. If that, as well as the definition of "meretricious", elude you so, you might do well to refrain from comment until you reach an understanding of those matters.

My understanding was that depression was related to often-treatable chemical deficiencies in the brain, most of which we don't really understand yet. I've never heard the physical components of depression referred to as "brain damage" before - I tend to think of brain damage as loss of cognitive function and memory, as I've seen in friends who suffered drug- and chemical-related brain damage.

The chemical-imbalance theory was quite common say, ten years ago, but studies don't really bear it out. It seems like SSRIs, for reasons that are unclear, help the brain to regenerate glial cells, and halt the damage in the amygdala and hippocampus--there are significant differences in degree regarding the damage seen in the brains of depression-sufferers who have been successfully treated and those who have not. Untreated depression is indeed associated with memory loss and associated cognitive problems. There's a very good overview for laypeople of the current scientific research on the neurobiology of depression in Peter D. Kramer's Against Depression, and I've checked it with other mental health professionals. But in short, I'd argue that "brain damage" is exactly the right term for what happens to someone suffering depression untreated.

All that said, I really appreciate the calm tone of your response, especially since my comment was on the hostile side, tone-wise. Thanks for taking what I wrote seriously; my tone was hostile because I have on other threads come up against people who have been very dismissive of my experiences with depression because they happen to jibe completely with modern findings.

But in short, I'd argue that "brain damage" is exactly the right term for what happens to someone suffering depression untreated.

Not to mention that depression does in some cases cause (at least apparent) cognitive and similar deficits, especially in the older population, where depression is commonly misdiagnosed as dementia ("pseudodementia"). We spent quite some time in my neuropsych courses on differentiating the two. I say "apparent" because some of the distinguishing characteristics of pseudodementia — a truly demented patient is more likely to work hard to get the "right" answer whereas a patient with pseudodementia will generally give up on it quickly — indicate that it might be more appropriate to refer to at least some apparent cognitive deficits secondary to depression as motivational deficits that impair cognitive performance.

We are implored to fear currents in the brain. What about the natural currents in the brain? If there is no electrical activity up there, you're dead. The anti-ECT posters mention nothing of amperage, voltage, frequency, or wattage. I'm unimpressed. What are typical numbers for modern ECT? How much energy is deposited in a session?

The best popular press article I have seen on ECT was "Shock and Disbelief" by Daniel Smith in the Feb, 2001 Atlantic Monthly. Unfortunately, online access is limited to subscribers. Some excerpts:

Last fall I saw a patient receive ECT at McLean Hospital, a private psychiatric facility in Belmont, Massachusetts. There, in a well-lit treatment room, attended by a nurse, a psychiatrist, and an anesthesiologist, a middle-aged man suffering from hallucinations and depression lay unconscious on his back while two electrode paddles were placed on his head. A button was pressed, and the patient's right foot twitched lightly. Shortly afterward the patient awoke and was given a snack before being escorted back to his room.

and also

A 1993 commentary in The New England Journal of Medicine stated, "Electroconvulsive therapy is more firmly established than ever as an important method of treating certain severe forms of depression." The first phase of a National Institute of Mental Health-supported study, to be published this spring, found that ECT produced a greater than 95 percent remission rate in psychotically depressed patients—vastly higher than the rate for any drug on the market. ... "ECT is the most effective antidepressant, antipsychotic, anticatatonic we have today."

The quote is from Max Fink, professor of psychiatry at Stonybrook. It's safe to say that Fink is pro-ECT.

[Peter Breggin] has been publicizing this opinion since 1979, when his first book, Electroshock: Its Brain-Disabling Effects, was published. Since then Breggin, a psychiatrist by training, has made a career out of attacking psychiatry and its methods. He has written several books arguing against the use of medication to treat mental illness, and he claims to be responsible for quashing the resurgence of lobotomy. His most recent efforts have been directed at establishing a link between antidepressants and the Columbine massacre.

The article goes on at some length about Breggin. It's a good article. I encourage others to read it.

Thank you for your analysis of the debate squip, I was a bit taken aback by some of the tactics of the debate - There is evidence for both sides and emotions will always play a big part in which side you are on.

I would hope that should ect be removed from practice, that its for sound scientific reasons and not based on emotion or anecdote - Otherwise continue to let it be an option for people. All I want is a choice should I ever find myself in that position.

For those psychiatric professional who think ECT is a good treatment for depression, why don't you just hit the patient in the head with a board? That would probably work just as well.

After the recent suicide of the author David Foster Wallace, after just have ECT, maybe those that think ECT is good should just shut up.

Psychiatry was the religion that I was raised in. My mother and father were shrinks. My brother is a shrink. When I was 15, I was put in the Menninger Foundation for running away from home. Everyone there except me was getting ECT. My father would not let them give it to me.

He may have been an asshole for committing me, but at least he saved my brain.

I saw so many people go in and out of that hideous shock world.

Or, it's better now you say?

HAH! OK, so when you get a little down in the dumps why don't you stick your tongue in a wall socket.

Psychiatry is still nothing but pompous voodoo. Arrogant assholes.