From: ((Steven B. Harris))
Subject: Re: Reject ECT treatment
Date: 15 Apr 1995
Newsgroups: misc.health.alternative

In article <3m24o4$anb@ixnews1.ix.netcom.com> JHammell@ix.netcom-
com (John Hammell) writes:

> During the 4 years I spent incarcerated inside the psychiatric
>system, I didn't meet a single person who benefitted from ECT.

   This reminds me of the guy who was collecting stories of
drowning people who said they were helped by dolphins who had
pushed them toward shore.  The guy decided this behavior amounted
to intelligence, until something occurred to him one day: suppose
dolphins just push drowning people in *random* directions,
including often as not, out to sea?   **Which ones tell about the
experience later?**  It might well be a biased sample (call it
the dolphin rescue anthropic principle).

   John Hammell was not seeing an unbiased sample of patients
getting ECT, incarcerated as he was in the long term facility of
a psychiatric system.  Not only are people in such a system more
often psychotic (and thus not helped much in the long term by
electroshock therapy, otherwise known as ECT), but those that
were helped were presumably back home with their families, and
weren't talking to John.  Again, it's sort of like interviewing
people on death row as to whether or not they were deterred by
the death penalty; generally they say no, but you have to
remember that any folks that *were* deterred are probably not
*on* death row, and thus you're not interviewing THEM....

    Scott Ballantyne writes:

    >>The mother of a friend of mine was completely comatose and
withdrawn. Previously diagnosed as an extreme depressive she was
deeply in depressed and completely unresponsive to any external
stimuli. It was so bad that her body hair apparently stopped
growing (this is all my friends description, I've never seen the
case report). She was in no state to give permission and her
husband agreed to the ECT. In her case it seems to have worked -
shortly after her 2nd treatment she pulled out of her depression
and it has never been a problem since. This back in the dark ages
of the 50's, so you can imagine what it would be like.<<

   Comment: I saw several cases like that in the Neuropsych ward
at UCLA in the late 1980's-- people so depressed they could do
nothing but sit on the edge of their beds staring into space with
the most horrible expression of suffering: could not walk, talk,
respond.  We had a rule that we could only use ECT where 3
different antidepressants had failed.  But ECT is effective for
depression 80% of the time, and it works very well to jumpstart
the depressed system when there is nothing left to do.  I saw
these people who'd been zombies for months turn into normal
people in weeks.  Uniformly they said they'd been in Hell, and
generally made us swear that the next time we'd give them ECT
FIRST, and no BS-ing around.  Every person in psychiatry has such
stories.  If John Hammell will simply modify his world-view to
the idea that ECT is great for sustained, major depression but
not much else, he'll be well on his way to an approximate grasp
of reality in this matter.


                                  Steven B. Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: alt.flame.psychiatry,fl.general,alt.society.mental-health,
	soc.rights.human,alt.religion.scientology,sci.med
Subject: Re: Florida Psych Donald Rife - Sex with boys
Date: 5 Nov 1998 02:35:22 GMT

In <npBzfNAGbKQ2EwmU@cake2.demon.co.uk> simon smith
<clov@nospam.demon.co.uk> writes:
>
>In article <71ne9m$glq$1@birch.prod.itd.earthlink.net>, David James
><dfj@earthlink.net> writes
>
>>They take an individual who is somewhat depressed, or having trouble
>>with his marriage, or something like that, they take him in for a while,
>>and when he leaves the hospital, is he ready to take on the world? Heck
>>no!
>>
>>He's drooling, stuttering, unable to talk... that's the more likely
>>"after:" picture.
>
>I have spent two long periods as a patient in a standard type mental
>hospital in England and of all the many patients with depression I've
>seen leave, _not one_ has left in anything like the condition you
>describe.


   No kidding.  This guy has been One Flew Over the Cuckoo's Nest too
many times.

    Indeed, the average person admitted to the psych ward with
vegetative depression has so much psychomotor retardation that they
don't move much at all.  They just sit on the edge of the bed with a
horribly tragic look of suffering, and don't eat, drink, or talk
(much).  Sometimes their faces are swollen from crying, but by and
large they just look pasty-faced and lifeless, like they want to die.
But that's when ADMITTED, before treatment.

   After a few weeks of electroconvulsive ("shock") therepy or
antidepressants, they start of come out of it.  They eat, they start to
talk, they start to walk.  None of this is done without consent, but
by this time, people are actually eager to get on with the program,
even if they had misgivings before.  When they leave the hospital, they
typically look and act like anybody else, if a little subdued.
However, I've had more than one make me promise to admit them sooner
for the same treatment next time, rather than let them suffer as they
were before (and, take it from me, they REALLY suffer).  I had one
little lady who took my hand and would not let go until I promised to
admit her immediately for "shock therapy" if she ever got that
depressed again, and not mess around with the stupid pills.  I
promised.

                                    Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: ECT
Date: 6 Nov 1998 22:35:45 GMT

In <36434A4A.7E3AD99F@erols.com> Terri <vl-hb001@erols.com> writes:

>Do you think someone with such "severe" depression is sufficiently
>rational to give *informed* consent to a medical procedure?

   Sure.  Do you think somebody in severe pain from appendicitis is?
How about somebody who hasn't been able to breath for a minute because
of a piece of steak in the trachea?  Perhaps we should have them read
the fine print about the dangers of diaphragmatic rupture with that
Heimlich maneuver.  How about somebody unconscious because their heart
has stopped?

   "Informed consent" is a relative thing.  It's relative to how much
time you have, and what the consequences of doing nothing are.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: ECT
Date: 6 Nov 1998 23:04:38 GMT

In <364262FB.4D91565E@erols.com> Terri <vl-hb001@erols.com> writes:

>> In article <3641AA4F.47B8290F@erols.com>, Terri
>><vl-hb001@erols.com> wrote:
>>
>>>Seeing MD's tout the benefits of electroconvulsive treatment aka shock
>>>treatments aka ECT is singularly horrifying. I have seen nothing which
>>>discusses the memory loss, often permanent, which follows this
>>>supposed treatment.

   Memory loss either does not occur, or is small enough in most cases
that it doesn't bother people much.  They are far happier to out of
their suffering.

>>>I also have seen nothing which indicates that such patients are fully
>>>informed before the "treatment." Are they told that each "treatment"
>>>destroys brain cells?

   No, because there is no evidence that this is true.

>>>That the state institutions are filled with ECT-created epileptics
>>>from the days when this treatment was used as a punishment and when it
>>>was used to subdue violent patients?

    This is baloney.  I've worked in state institutions, and if they're
full of such people, they must've keep them chained in the basement
during my rotations.

    In the old days ECT was used more indiscriminantly, and in a way
which caused more memory problems (using current passed entirely
through the brain, rather than just one side).  It's not proper to
compare results from older techniques to those which are more modern.

>>>How exactly does one get informed consent from a person who is in an
>>>almost catatonic stupor from depression?

   The same way you get informed consent from any really ill patient.
You ask them.  If the person can understand what you want to do and
why, and if they want it done because they don't like consequences of
doing what they've been doing, that's good enough.

   There is some kind of myth that informed consent requires complete
information, or a person with full intellectual capacity.  If it did,
people with emotional and physical deficits would not be able to REFUSE
treatment, because one could always claim that their judgement was bad,
and they'd make a different decision if they were smarter or less
impaired.  But this is no longer acceptable.  The flip side of this
coin is that people without full information and without full mental
capability are still thought to be capable of making some decisions for
themselves.  In today's world, if the partly demented or mentally
handicapped person says he doesn't want his leg cut off for the
gangrene, it's going to take a court to decide otherwise.  However,
this means that if the same person decides he DOES want the leg off in
a reasonable situation where this is the medical recommendation, that's
good enough (unless a court decides otherwise).  You can't have it both
ways.  ECT is not administered without consent, unless under court
order.  And that's VERY rare, and does not happen to people who
actively refuse, but rather to the completely catatonic person who
can't answer either way.  Much as in the case of resuscitation.

>>>If the people who feel they benefitted from this treatment knew what it
>>>had done to them on the brain cell level would they still consent?

    People who've had it done are generally very happy with the
results.  That's the bottom line.  Intellectual deficit cannot be
demonstrated.  I've seen many a teacher and other profesional go back
to work-- something they were incapable of while depressed.

>>>ECT is cheap and quick. As with most such treatment the patient gets
>>>what he/she pays for. Buyer beware.

   More BS.  ECT is neither quick nor cheap.  It requires about 10
treatments, each of which is essentially as involved as any
outpatient-surgery requiring full anaesthesia and monitoring.  If it
were any more expensive, you've be claiming the system keeps doing it
because of all the money it makes! Antidepressants, by contrast, really
are cheap.

Another comment:

>>Hmm, I was under the impression that ECT went from "miracle cure, use it
>>for everything" to "horrible thing, never use it" to "not a first
>>choice, but sometimes the only thing that works for severe depression."
>>Which might be reasonable.

ECT is 80% effective, which beats antidepressants by 10% or so.  So
it's not first choice for obvious reasons.  But sometimes it is the
only thing which works.

>Would you consent to ECT for yourself or a loved one regardless of the
>degree of depression?

  You bet.  And for myself.

>While in some extreme cases there may be no other choice, I would argue
>that such patients are certainly not capable of giving informed consent,
>so that Dr. Harris's contention that his patients are fully informed and
>give consent is nothing more than window dressing.

   So what I actually said, above.  And in other messages.