Oldhead – it was the author herself who directed people to her website to learn more about her views. What concerns me is what is written, for example, about guns, mental health, settlers/Native Americans, etc., and saying that Alexandria Ocasio-Cortez is a “girl” and has a “ridiculous” name (it is a Spanish name – nothing ridiculous at all about it and she is a woman). I was just wondering if all this stuff was going beyond respectable right and getting into alt-right territory.
Can anyone tell me please – in the US would the content of Abrianna’s website be considered well… mainstream? To me it seems to be very far out to the right but maybe that is because I am not American? I can accept for example in the UK that more than half the population doesn’t vote the way I do and I can still have a polite conversation with them and I am not suggesting that MIA should only attract people with certain political views. I am just curious really if anyone can answer my question before I wander off to another thread.
kindredspirit have you looked at Abrianna’s website? I did wonder how the sentence about personality disorders got through the editing process on MIA as it doesn’t introduce or explain anything and just seems to be gratuitously offensive. But I didn’t want to be too negative as she is young and appears to have been through a lot. Having seen her website though I think I am going to be rather more negative and say that I think that MIA slipped up on this one.
Abrianna I see you already published this article on your website but with a different author (“Deleted_C is a 27-year-old recovering schizoeffective. After being hospitalized several times as a young adult, she has become an expert in art, personality disorders, mental disorders, psychiatry, mental hospitals, substance abuse, and mental healthcare. Deleted_C met PrettyTuff at a trade-show. Both entrepreneurs, they became great friends.” [PrettyTuff according to the photo being you])
Reply to Abrianna Peto about the Iran prisoner study. The authors did include depression (MDD – major depressive disorder) in table 3. And people with MDD outnumbered people with more standard personality disorders by 40 to 26.
Your experience in the second hospital sounds terrible. I hope the next eight were not so bad.
The article you quote is probably not a good example to support your argument, as the authors include depression and other “illnesses” as “personality disorders”, with depression being the most common disorder. I couldn’t actually see where the authors got those percentages from – table 3 has different numbers. In any case some of the crimes wouldn’t be crimes in many parts of the world (for example, “alcohol consumption”, “illicit relations”.)
An asteroid? Wasn’t it because they were too big to get into the Ark? That is what Captain Fitzroy of the Beagle said apparently.
Kindredspirit I share your concerns, although perhaps in a slightly different way.
Ekaterina thank you for this article. The question I am left asking when I look at the painting of Blanche is why didn’t one of those men get up and put their jacket over Blanche’s shoulders? As for the historical narrative of madness, I sometimes come across examples of things that defy academic views of the past treatment of insane people – examples of people being kind and generous and understanding of those who had become insane.
For a chief executive officer of a relatively small charity (income about £8 million, about 50 employees) Mark Wilson gets an unusually large salary (£160,000 – £170,000 – more than the prime minister).
I have listened to the whole thing now. No danger that he is going to even nip the hands that feed him. “Paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders.” (from his webpage at Kings College London)
Thank you auntie psychiatry for the Allan Young link.
I hope the abuse you got from reddit users hasn’t put you off taking on more cases.
When I clicked on the Manifesto link it went to article about Chicago hospital.
I thought that Matthew Parris’ article was good. He was mildly critical of ECT, suggesting that “systematic evidence of success is thin”. So someone wrote into The Times saying that there had been double-blind randomised controlled trails (I don’t know who as I don’t have a subscription to The Times) and that the inventor of convulsive therapy Meduna should rank up there with the greats of medicine.
And then in the Guardian yesterday there was a more traditional article about waiting times in mental health services for young people https://www.theguardian.com/society/2018/dec/05/take-own-life-young-people-mental-health-services
Someone from a charity was quoted as saying: “Every child who reaches out for support should be able to get the help they need”. Who could argue with that? But no-one ever says what they mean by “support” and “help”.
Be aware Rosalee that the CCHR is a Scientology organisation.
Jane, it would be nice if the answer to both your questions was yes. Hopefully there will be more cases.
I was curious to know how many hospitals in the UK are using machines made by Somatics LLC. I think most hospitals in the UK use American machines but I don’t know how it splits between MECTA and Somatics. We have our own ECT manufacturer, Ectron, a company with a sinister history in intensive ECT, but I think they nowadays make machines more for export. Anyway the first example I came across of use of a Somatics machine was Berrywood Hospital in Northampton who have a 144 page protocol on ECT. It even has a bit about the toilet facilities. Only one mention of brain damage though “… there is no evidence that even prolonged courses of ECT result in brain damage…” They do say however that seizures over 90 seconds “may be associated with neuronal damage leading to long-term memory impairment”. I wonder who decided that 89 seconds is fine and 90 seconds isn’t.
Steve am I reading the first sentence wrong?
I will second that. Great work indeed. Thanks Connor.
Thank you Connor. That must have been disappointing for them to get so far and then have their case dismissed. But hopefully there will be more cases.
Replying to Connor’s comment about it only being Somatics. So now I am confused again. I thought there were four plaintiffs.
I read the judgement but it was pretty heavy going and I got lost in the legal arguments.
“The real question is whether the particle ‘or’ is used in the disjunctive or the conjunctive sense.” There wasn’t much about ECT in it, for example, no mention of Victoria’s very high rate of use of ECT without consent.
I was shocked by this story for many reasons. You mean that medical students/doctors don’t get training on learning disabilities? Not in the however many years it takes to train a doctor? And that MPs have to debate it? And that if they do decide doctors need training it might be e-learning. In another interview Mrs McGowan expressed a hope that it would be face-to-face not e-learning. She also in another interview said how the coroner had been “ferociously protective” of the doctors who treated their son, which is something that has struck me frequently when reading the antidepaware blog. I also don’t understand how their son could have been given a drug without his consent. Southmead is a regular hospital – they had taken him to accident and emergency because he had a prolonged seizure. It doesn’t say he had been sectioned, although the doctor who administered the fatal drug was a “neuropsychatrist”.
Thanks Bonnie. I just wanted to be sure that when I mention MECTA or Somatics in future I get the description right as in “MECTA Corporation or Somatics LLC, two American ECT machine manufacturers who recently made an out-of-court settlement in a class action lawsuit in California”.
My understanding was that the court had only said there was a case to be made but I am still a bit confused about it. As for the media – my guess would be no they probably won’t retract. The story will remain the same – miracle treatment stigmatised and somehow the court case will be incorporated into the stigma.
“… I believe it would be unfair to advertise a screening of My Little Pony and swap it out with Amityville Horror without any advanced warning.”
I had a My Little Pony/Amityville Horror experience last summer. I signed up for a ‘family friendly’ walk and then was expected to listen to a talk that included horrible stuff about what a woman with a “psychosexual disorder” did to herself. So I walked out of a walk. I sent a polite email to the organisers with just the same point – that they should warn people.
My pet hate is “poor mental health”. And abbreviations. And I am beginning to dislike “resilience”.
I think British hospitals nowadays use American machines. We have our own ECT machine manufacturer Ectron Ltd but I think they make machines largely for export.
Thank you Connor for the update and for the outcome to the case.
I haven’t listened to this one yet (looking forward to it) but I have found the previous three very interesting. In my ignorance I had not even realised that there was something called global mental health that people do masters in. My reaction is along the lines of ‘what is so wonderful about what is happening here that we should be exporting it?’ although I accept that the debate is more sophisticated than that. The Lancet has just produced a ‘reducing the global burden of depression’ report. I haven’t read it but just looking at the list of references is worrying. Cipriani and Co are in there.
Those were my thoughts too oldhead – that the court decided that there was a case to answer and at that stage the manufacturers decided to pay up rather than risk a trial. But they must realise that there are more in the wings so isn’t that a rather foolhardy thing to do?
I was waiting for something to appear on the lawyers’ website. Slightly worried by the fact that their latest update on the case goes back to April. And I am not sure I really understand what is going on – have the machine manufacturers made an out-of-court settlement?
Meanwhile there is a global mental health summit in London.
“What’s more, it works much faster than SSRIs, and appears to last longer to move congestion in the brain that may be hampering the patient’s freedom of thought and feeling. It’s widely agreed that patients with depression appear to have dampened connections between certain neurons, caused by a build-up of proteins on top of cell membranes. In healthy brains, cell membranes are free and open to receive signals. In patients with depression, an overwhelming amount of G proteins pile up on top of lipid rafts – kind of like lids which sit on top of cell membranes.”
There was someone in the 1980s who won a legal case for abrupt withdrawal of benzos. I don’t know if it is more or less difficult to win a case nowadays. It is not a subject I know much about. I just thought I would add that as further evidence that people were aware of the problems in the 1980s.
I am genuinely curious to know how articles are selected for this section, given that every day there must be a lot of articles published about psychiatry and mental health. This article was published in a psychiatric journal edited by Robert Pies and the first paragraph reveals the authors’ belief in mainstream psychiatry “she stopped taking her prescribed psychotropic medications…” There is then a lot of vague stuff about poverty before we get to the well, what can they do about it, having admitted that screening for poverty isn’t much use unless you can do something about it. On an individual level it doesn’t seem to go beyond signposting for housing and benefits help. Finally they call for psychiatrists to come out onto the streets to demonstrate for higher taxes. How many are going to answer that call? One of the authors has actually spoken at some parliamentary committee so perhaps it is not just rhetoric. Okay I like the bit about higher taxes even if it is a bit unrealistic but for me the good bits are outweighed by the vignette and screening tools and biological psychiatry stuff.
Despondent, but that is one hundred per cent. And someone who is in need of practical help might, rightly or wrongly, may feel that their chances of receiving that help are better if they accept the treatment.
Doesn’t seem at all critical to me. The authors are promoting drugging, assertive community treatment or whatever it is called, etc. It is almost as if they are turning poverty into a symptom, with a screening tool, which incidentally seems to be at least partly about budgeting.
Why is this article here?
Couldn’t find any in the first three pages of google, even searching “psychiatrist manslaughter”.
I was thinking they may be on the hook for other things but not often for patients dying as a result of prescribed drugs. As far as the UK is concerned, I googled “psychiatrist struck off” and looked at the first three pages. It was sex, plagiarism, sex, sex, sex, sex, inappropriate behaviour and inappropriate behaviour and lying. One mention of a historic case where a psychiatrist who had been working I seem to remember with addicts had prescribed drugs to someone who then died. I had another go for “psychiatrist convicted” and it was illegal drugs (the Royal College podcaster), sex, sex and sex, plus one mention of a historic case of sex. Sex in these convicted cases meaning something criminal whether you are a doctor or not.
Were psychiatrists ever on the hook?
Some very good points John. Where is the talk?
I never cease to be amazed at the vast sums of money that are spent on psychiatric research. And wonder if any of it has ever been useful. So much seems to be of the “bleedin’ obvious” variety (problems at work make you depressed etc.) or just of the “what’s the point of that?” variety (I remember seeing an article from the 1940s British Journal of Psychiatry about moustaches – or have I dreamt that up?) and then millions and millions spent on the rat brain stuff.
In the UK I have noticed in a very general sort of way (just reading newspapers, etc.) the term schizophrenia being used less and psychosis more. But as rasselas.redux says with an important exception – horrible crimes. Then it is “a paranoid schizophrenic”.
Great article. But I couldn’t find anywhere in the link it saying how many prescriptions each person gets. In this link http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4329.0.00.003~2011~Main%20Features~Antipsychotics~10030
it says “There were 349,900 people (1.6% of the Australian population) who had at least one PBS subsidised prescription for an Antipsychotic medication filled in 2011.” That figure went up to 20 per cent in people aged over 75. Over half of the people were also getting prescriptions for antidepressants.
Thank you Tina for this report. I was interested to see what the person from the UK had to say. But it looked like he had wandered into the wrong meeting. As you say, he was just promoting the current legislation/review. He even talked about having been given a statement (who by? I don’t know much about how these things work). And said twice that his father is a forensic psychiatrist. And what is so marvellous about the Scottish Mental Health Act? A few facts he didn’t mention: increasing numbers of people in Scotland (population 5.3 million) detained (5422 in 2016/17); increasing numbers of people given drugs without their consent for more than two months (1559); increasing numbers of people given ECT without their consent (176 of whom 71 per cent were “resisting or objecting”, in theory all are supposed to lack capacity). And the safeguards? That just means they have to get another psychiatrist to approve it and they don’t often say no and, if it is similar to the system in England, it is a lucrative business.
I had never heard of FTAC. I had to look them up. Why do they have a .com website rather than a .org or .gov.uk?
Thank you Akiko for this article. I read the report and felt it didn’t really say anything useful. Theresa May became aware that detentions under the MHA are rising and disproportionately affect people from some ethnic minority communities so decided a review of the law was called for, although it may not be the law that is at fault, and then puts Simon Wessely in charge of it although he is hardly going to argue for less power to psychiatrists. The report says that the reasons for both the above (rising detentions and BAME groups being more likely to be detained) are “complex”. Well, obviously. And as for treating people with dignity and respect – can you make a law that says that you have to?
As for the disappointing numbers of people responding to survey, etc., could it be that having to identify as a “service user” might have put some people off, especially those who weren’t going to be appreciative of their treatment? I may be behind the times here – is “service user” a term that nowadays is universally, or near universally, accepted by people?
Not even a mention of ECT in the report. Although, to be fair, the law was changed for ECT in 2007. And how about legislating for DBS?
I got through to the end of the glossary and was surprised to find SOADs defined as second opinion associated doctors. I thought they were second opinion appointed doctors. Has it changed? It is pointless anyway the A was only inserted to avoid calling them SODs.
An item about Asperger was on the front page of the BBC website today http://www.bbc.co.uk/news/world-europe-43820794
Hans Asperger ‘collaborated with Nazis’ in WWII
(I wonder why the quotes)
So the circuits have a center and are still in there with a sporting chance. I read the spinning trial results report. It goes on in the UK (DBS for depression) but isn’t much talked about. A couple of people who had undergone psychosurgery in England in recent years did so after having DBS.
As for Carmine Pariante you can’t avoid him. He was in the Times today. Can be read here https://www.raconteur.net/healthcare/debate-antidepressants-work
There was also John Geddes from Oxford with his line about GPs being “squeamish” about prescribing antidepressants. Is it about 60 million prescriptions a year now? And about 40,000 GPs? So that is about 1,500 prescriptions for antidepressants per GP per year. Squeamish?
Perhaps they are just speaking with one voice. There is another thing I find odd about the whole business: didn’t amitriptyline come out top? And yet they seem to be silent on that. Nothing about how they should drop SSRIs and go back to amitriptyline.
I had never heard of Carmine Pariante before this. Looking for his quote I came across lots of stuff and at first sight it does look seductive – all this cutting edge science, prestigious institutions, visits from royalty, etc. And they have it all worked out – inflammation, small brains, etc. Inflammation seems to have taken over from chemical imbalances but what happened to brain circuits? And then I got a sobering thought: the world is still just the same, just as many depressed people and also I looked at his conflict of interests list and the fact that he is pals with Charles Nemeroff.
That was a feeble reply you got auntie from the SMC. I remember years ago they were promoting Helen Mayberg and her deep brain stimulation. What happened to that? But I don’t know much about SMC. The one I am following with interest is MQ.
I can’t find an example either. Pariante is definitely the putting to bed quote and Cipriani the final answer quote. Everywhere. Now Pariante is complaining about being taken out of context but it isn’t even his quote.
I have found the quote now:
“Lead researcher Dr Andrea Cipriani, from the University of Oxford, told the BBC: “This study is the final answer to a long-standing controversy about whether anti-depressants work for depression…”” http://www.bbc.co.uk/news/health-43143889
So it was one of the others who used the expression “final answer”.
Wasn’t it Michelle Obama who said that, not Barack?
As for the Royal College of Psychiatrists, I have never understood why they have charitable status.
I might not have spotted the parody if I hadn’t read the comments first. But it was funny. The bit about the water mattress tester reminds me of a follow up study (not a parody) of people who had undergone leucotomies and the only one who returned to work at their previous level was a tea-taster.
Something magical obviously happens to us on our eighteenth birthdays.
Over 60,000 detentions in a year. Yet I could only see the CQC report getting a mention in the Mirror and the Huffington Post, while for the anti-depressants it was a case of “hold the front page – someone has done a meta-analysis”. As John Naish said, you would think they had won a Nobel Prize. The CQC report did get some discussion in Parliament though.
“…it confirms that these drugs are safe and effective” (from Carmine Pariente’s comment on the SMC website). Where does the review of the literature deal with safety? Did I miss something?
Great cartoon auntie!
One of the guideline authors had nearly a page of disclosures. It is a pity the critical article in the BMJ doesn’t seem to be available to read.
In Scotland (one of the few places to publish detailed statistics on the use of ECT) the largest single group is indeed women in their fifties. It is graphically illustrated by the figure on page 3 of this report http://www.sean.org.uk/AuditReport/_docs/SEAN-Report-2017-171113.pdf?2
And, yes, various surveys have found men more likely than women to prescribe ECT.
In the Netherlands ECT nearly disappeared in the 1970s but now it is back again, along with psychosurgery and deep brain stimulation.
I think its important to show people that is misleading to talk about “small electrical impulses”. I was looking for a video of ECT which shows, for example, that the shock is strong enough to cause grimacing because of its direct action on facial muscles even if the person is anaesthetised and their muscles are paralysed. If you look at this video https://www.youtube.com/watch?v=9L2-B-aluCE
at 3.20 minutes it shows the shock being given and the man’s arms fly up. How does that happen – when he is anaesthetised and paralysed? I also thought that he seems to be having quite a violent seizure, considering he has been given muscle paralysing drugs. I recently saw someone having a spontaneous seizure and it didn’t look worse than that.
A reply to Luc
As Connor pointed out to me, the million figure comes from the defendants (the ECT machine manufacturers) and is obviously absurd.
Yes, a possible explanation would be that they are getting confused between treatments and people. Or perhaps they are trying to convince people that ECT is an incredibly common treatment, or they may have extrapolated from one hospital that uses an unusually high amount of ECT.
The figure usually quoted by psychiatrists in US is 100,000 a year but this is a very old estimate. No-one knows how many people actually undergo ECT in the US because most states don’t keep count. Texas (pop about 28 million) is an exception and collects and publishes figures – about 2 to 3 thousand people a year. But it would be dangerous to extrapolate to the whole US, as ECT is characterised by wide variation in its use.
Could I just point out a couple of things about your reasoning. In the US, ECT is used predominantly as a treatment for depression – you don’t have to have been diagnosed as psychotic (and there is an almost limitless number of people who can be diagnosed as depressed). Of course it is used on people with other diagnoses as well – schizophrenia, children with autism, older people with dementia. Another point to bear in mind is that people often have multiple courses of ECT, or are on maintenance ECT, so will appear in the statistics for more than one year.
There’s me fallen at the first hurdle – spotting the difference between the plaintiffs and the defendants! Can you challenge them if they are talking rubbish? A million a year is patently absurd. Where do the get it from? Even 100,000 a year is I think a very (decades) old estimate. If you look at Texas, where they actually count, it is a much lower rate. Does California keep statistics?
Another bit of rubbish the defendants say: “ECT is a medical procedure performed under general anesthesia in which small electric pulses are passed through the brain… ” Would it be possible I wonder to modify an ECT machine to deliver a shock exactly like in ECT but turned down to a level where it is a slightly painful shock but not dangerous – like say 8 milliamps instead of 800 milliamps? And then ask the defendants what it feels like? I don’t think you would feel pulses because they come at typically 70 a second which would feel continuous I think. And then ask them to imagine it one hundred times bigger, which is what ECT is.
Connor, bottom of page 7 of the Joint report: “In the United States, over one million patients are estimated to receive ECT each year.” What?! I think psychiatrists say one hundred thousand a year in the US, although even that is just a wild guess rather than based on any actual figures. I have seen them say a million in the world every year – another wild guess. Or maybe they are talking about the number of individual treatments per year in USA, that is, each person having about 10 treatments?
No, don’t waste your time explaining to me. Just win the case!
I’m not sure I understand all the legal stuff but best of luck anyway.
About anaesthesia raising the threshold. That would explain why less energy was being used in the examples I gave.
Maybe what Stephen Gilbert said in the first place is true
“What I’ve read about modern day shock is that it’s actually much more dangerous than in the old days because of the anesthetic that they use now. Supposedly it raises the threshold that is required for the actual seizure to take place, meaning that it takes more electricity to get beyond the threshold.”
“Colleagues in various departments suggested alarming possibilities, which included some alteration to the type of fit; over-heating the tantalum plate and so, as it were, cooking the brain; bending the plate during the fit, and also depositing tantalum around it electrolytically”. None of these seemed sufficiently likely to contra-indicate treatment…”
Anyway – another example: “the usual dosage in this series was 18 joules…. the usual duration of the shock is variable, lasting about 0.35 sec…” R.Kauntze and G. Parsons-Smith 1948 Cardiovascular changes following electro-convulsive therapy. Heart vol 10 pp 57-62.
According to his website he is on (or at least he was in 2013) an SNRI antidepressant and a mood-stabiliser. http://www.stephenfry.com/2013/06/only-the-lonely/
When he was younger it was cocaine and alcohol.
What rational_moderation said was “In the old days they just took current directly from the wall, 60 hz alternating current, to deliver ECT. Now they actually give a series of brief electrical pulses so it’s much less energy.” Energy is measured in joules, and I found some examples from 1940s and 1950s of shocks using 10 – 20 joules of energy. If you want to see how much energy modern machines deliver go to the Thymatron specification page http://www.thymatron.com/downloads/somatics_color_low-res.pdf
maximum output 99.4 joules (or double with double-dose model). Psychiatrists are advised to set %energy dial to patient’s age, which would be more than 10-20 joules for adults.
Or perhaps rational_moderation could find an example of someone in recent years being treated with “much less energy” than 10-20 joules?
A reply to rational_moderation’s questions. In order to convert joules to millicoulombs (energy to charge) I was using Charles Kellner’s co-efficient of 5.7. Yes, the resistance is unknown, so the co-efficient is based on assuming an average resistance (Charles H. Kellner, Electroconvulsive therapy, in Brain stimulation in psychiatry, Cambridge 2012 pp 3-16). The 1950s example I gave is from an article published in the Journal of Mental Science in 1951 vol. 97, An account of E.C.T. given to a patient with a tantulum plate in his skull, by Humphry Osmond pp 381-387. The man was given seven treatments with 17, 12, 10, 10, 10, 10, 10 joules.
All else being equal, brief-pulse currents are accepted as more efficient at producing seizures than sine-wave. But all else isn’t equal; other parameters have changed. For example, nowadays people receive shocks lasting several seconds while in the early days they lasted a fraction of a second. Is sine-wave for half a second better or worse than brief-pulse for 6 seconds?
I pointed out that a minority of New York hospitals were using sine-wave equipment into late 90s early 2000s to show that it is not a simple question of olden days v modern times. Some countries of course still use sine-wave equipment.
It is not the case that modern ECT uses “much less energy” than before. If anything it is more energy.
Correction: it is charge not energy that is measured in millicoulombs. Energy is measured in joules.
At the end of the article that you quoted the authors give two examples of calculating the electrical charge – one of 63 millicoulombs and one of 163 millicoulombs. Those are both fairly low charges but the second one a fairly typical one. Now let’s look at the charge used in the 1950s. One article for example described a patient as receiving ECT with energy of between 10 to 17 joules. Slight problem – we have to convert joules to millicoulombs. Charles Kellner (and for once I will believe him) says to multiply by 5.7, which means 1950s patient got about 60 to 100 millicoulombs. So less energy in the 1950s than nowadays. Why – if the waveform is more efficient? Mainly I think because the duration of the shock has increased considerably since the early days of ECT. Nowadays people usually get shocks lasting several seconds while in the early days it was usually a fraction of a second.
Interestingly, in a survey published in 2001, some hospitals in New York were still using sine-wave machines even though brief-pulse ones had been available for at least two decades.
rational_moderation where have you looked into it (the “much less energy” claim)?
I think what rational_moderation is referring to is the difference between machines that deliver an electric shock with sine-wave current and those that deliver an electric shock with brief-pulse current. They are both electric shocks, although some people misleadingly describe the latter as if they deliver a lot of little shocks rather than one big shock.
As far as energy is concerned, modern ECT delivers just as much, if not more, than olden days ECT. The convention is to measure ECT energy in millicoulombs and the number of millicoulombs has not decreased over the years.
The proof of the pudding is in the eating, and when people have done experiments with the different wave-forms there has not been an enormous difference between sine-wave and brief-pulse, less for example than between bilateral and unilateral electrode placement. Which is probably one of the reasons why psychiatrists took so long to switch wave-forms and why in some countries sine-wave is still used. And of course people who have ECT today experience similar effects on memory, etc., to those who had ECT many decades ago.
Thank you Philip for this article. I have just checked out the editorial board of the Journal of ECT. Forty men and eight women. They did some years back publish an article by someone who had experienced memory loss after ECT. I can’t remember her name but I do remember she had met Mother Teresa and couldn’t recall it after ECT. I wonder if they would say now that they shouldn’t have published that article? By the way it is the late Ian Reid https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046795/.
A very interesting report. And so sad about Jim. I have only read the abstract to the Lancet article as I don’t have access to the whole article but I am wondering why it took 30 authors to write the article. I know it was multicentre but I don’t think there were any centres in UK were there? yet Keith Matthews from Dundee in Scotland is listed as author.
I once won a competition and the prize was a ticket to a David Nutt lecture. I remember he was talking about ecstasy and said it had never killed anyone. A member of the audience queried this statement and Nutt said it wasn’t ecstasy that killed but drinking too much water. I didn’t find that very convincing.
As for Scott’s article, I couldn’t see how MDMA is going to be different from any other drugs. Perhaps, Scott, you could make it a bit clearer?
Thank you for this article Don. I have noticed that most of the big names in ECT seem to be men. In the early days of ECT perhaps there weren’t that many women psychiatrists, but I would have thought there were more nowadays.
Thank you Philip for providing me with such a laugh. I had seen the abstract and was struck by the admission that they are trying to change thoughts and behaviour, rather than curing or even treating diseases, but I hadn’t got around to going down to the library to read the whole thing. Presumably that 4 per cent of medical graduates include those who don’t cut the mustard in other disciplines or want an easy ride to a consultancy. I wonder if there are many people who actually start out wanting to be psychiatrists?
Oldhead – it was the author herself who directed people to her website to learn more about her views. What concerns me is what is written, for example, about guns, mental health, settlers/Native Americans, etc., and saying that Alexandria Ocasio-Cortez is a “girl” and has a “ridiculous” name (it is a Spanish name – nothing ridiculous at all about it and she is a woman). I was just wondering if all this stuff was going beyond respectable right and getting into alt-right territory.
Can anyone tell me please – in the US would the content of Abrianna’s website be considered well… mainstream? To me it seems to be very far out to the right but maybe that is because I am not American? I can accept for example in the UK that more than half the population doesn’t vote the way I do and I can still have a polite conversation with them and I am not suggesting that MIA should only attract people with certain political views. I am just curious really if anyone can answer my question before I wander off to another thread.
kindredspirit have you looked at Abrianna’s website? I did wonder how the sentence about personality disorders got through the editing process on MIA as it doesn’t introduce or explain anything and just seems to be gratuitously offensive. But I didn’t want to be too negative as she is young and appears to have been through a lot. Having seen her website though I think I am going to be rather more negative and say that I think that MIA slipped up on this one.
Abrianna I see you already published this article on your website but with a different author (“Deleted_C is a 27-year-old recovering schizoeffective. After being hospitalized several times as a young adult, she has become an expert in art, personality disorders, mental disorders, psychiatry, mental hospitals, substance abuse, and mental healthcare. Deleted_C met PrettyTuff at a trade-show. Both entrepreneurs, they became great friends.” [PrettyTuff according to the photo being you])
Reply to Abrianna Peto about the Iran prisoner study. The authors did include depression (MDD – major depressive disorder) in table 3. And people with MDD outnumbered people with more standard personality disorders by 40 to 26.
Your experience in the second hospital sounds terrible. I hope the next eight were not so bad.
The article you quote is probably not a good example to support your argument, as the authors include depression and other “illnesses” as “personality disorders”, with depression being the most common disorder. I couldn’t actually see where the authors got those percentages from – table 3 has different numbers. In any case some of the crimes wouldn’t be crimes in many parts of the world (for example, “alcohol consumption”, “illicit relations”.)
An asteroid? Wasn’t it because they were too big to get into the Ark? That is what Captain Fitzroy of the Beagle said apparently.
Kindredspirit I share your concerns, although perhaps in a slightly different way.
Ekaterina thank you for this article. The question I am left asking when I look at the painting of Blanche is why didn’t one of those men get up and put their jacket over Blanche’s shoulders? As for the historical narrative of madness, I sometimes come across examples of things that defy academic views of the past treatment of insane people – examples of people being kind and generous and understanding of those who had become insane.
Latest annual report on the Charity Commission website
http://apps.charitycommission.gov.uk/Accounts/Ends21/0001045921_AC_20171231_E_C.pdf
page 29 for salary details
Previous annual reports
http://apps.charitycommission.gov.uk/Showcharity/RegisterOfCharities/FinancialHistory.aspx?RegisteredCharityNumber=1045921&SubsidiaryNumber=0
For a chief executive officer of a relatively small charity (income about £8 million, about 50 employees) Mark Wilson gets an unusually large salary (£160,000 – £170,000 – more than the prime minister).
I have listened to the whole thing now. No danger that he is going to even nip the hands that feed him. “Paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders.” (from his webpage at Kings College London)
Thank you auntie psychiatry for the Allan Young link.
I hope the abuse you got from reddit users hasn’t put you off taking on more cases.
The manifesto can be read here
https://mhe-sme.org/wp-content/uploads/2018/12/MHE-Manifesto-EU-Elections-2019.pdf
When I clicked on the Manifesto link it went to article about Chicago hospital.
I thought that Matthew Parris’ article was good. He was mildly critical of ECT, suggesting that “systematic evidence of success is thin”. So someone wrote into The Times saying that there had been double-blind randomised controlled trails (I don’t know who as I don’t have a subscription to The Times) and that the inventor of convulsive therapy Meduna should rank up there with the greats of medicine.
And then in the Guardian yesterday there was a more traditional article about waiting times in mental health services for young people
https://www.theguardian.com/society/2018/dec/05/take-own-life-young-people-mental-health-services
Someone from a charity was quoted as saying: “Every child who reaches out for support should be able to get the help they need”. Who could argue with that? But no-one ever says what they mean by “support” and “help”.
Emil Gelny?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206950/
Be aware Rosalee that the CCHR is a Scientology organisation.
Jane, it would be nice if the answer to both your questions was yes. Hopefully there will be more cases.
I was curious to know how many hospitals in the UK are using machines made by Somatics LLC. I think most hospitals in the UK use American machines but I don’t know how it splits between MECTA and Somatics. We have our own ECT manufacturer, Ectron, a company with a sinister history in intensive ECT, but I think they nowadays make machines more for export. Anyway the first example I came across of use of a Somatics machine was Berrywood Hospital in Northampton who have a 144 page protocol on ECT. It even has a bit about the toilet facilities. Only one mention of brain damage though “… there is no evidence that even prolonged courses of ECT result in brain damage…” They do say however that seizures over 90 seconds “may be associated with neuronal damage leading to long-term memory impairment”. I wonder who decided that 89 seconds is fine and 90 seconds isn’t.
Steve am I reading the first sentence wrong?
I will second that. Great work indeed. Thanks Connor.
Thank you Connor. That must have been disappointing for them to get so far and then have their case dismissed. But hopefully there will be more cases.
Replying to Connor’s comment about it only being Somatics. So now I am confused again. I thought there were four plaintiffs.
A new (critical) book about ECT
http://www.therealpress.co.uk/2018/11/08/youll-end-up-in-saint-nicks-and-other-reasons-i-wrote-a-critical-a-z-of-electroshock/
It was published in June, but I only just came across it. I haven’t read it.
Is it this page http://www.thymatron.com/catalog_cautions.asp ? Are they trying to shift the blame onto the doctors? Is it enough to cover them legally?
You can see the full line-up here
https://www.rcpsych.ac.uk/traininpsychiatry/conferencestraining/courses/ecttraining.aspx
if you click on “View the latest programme”
I read the judgement but it was pretty heavy going and I got lost in the legal arguments.
“The real question is whether the particle ‘or’ is used in the disjunctive or the conjunctive sense.” There wasn’t much about ECT in it, for example, no mention of Victoria’s very high rate of use of ECT without consent.
I was shocked by this story for many reasons. You mean that medical students/doctors don’t get training on learning disabilities? Not in the however many years it takes to train a doctor? And that MPs have to debate it? And that if they do decide doctors need training it might be e-learning. In another interview Mrs McGowan expressed a hope that it would be face-to-face not e-learning. She also in another interview said how the coroner had been “ferociously protective” of the doctors who treated their son, which is something that has struck me frequently when reading the antidepaware blog. I also don’t understand how their son could have been given a drug without his consent. Southmead is a regular hospital – they had taken him to accident and emergency because he had a prolonged seizure. It doesn’t say he had been sectioned, although the doctor who administered the fatal drug was a “neuropsychatrist”.
Thanks Bonnie. I just wanted to be sure that when I mention MECTA or Somatics in future I get the description right as in “MECTA Corporation or Somatics LLC, two American ECT machine manufacturers who recently made an out-of-court settlement in a class action lawsuit in California”.
My understanding was that the court had only said there was a case to be made but I am still a bit confused about it. As for the media – my guess would be no they probably won’t retract. The story will remain the same – miracle treatment stigmatised and somehow the court case will be incorporated into the stigma.
“… I believe it would be unfair to advertise a screening of My Little Pony and swap it out with Amityville Horror without any advanced warning.”
I had a My Little Pony/Amityville Horror experience last summer. I signed up for a ‘family friendly’ walk and then was expected to listen to a talk that included horrible stuff about what a woman with a “psychosexual disorder” did to herself. So I walked out of a walk. I sent a polite email to the organisers with just the same point – that they should warn people.
My pet hate is “poor mental health”. And abbreviations. And I am beginning to dislike “resilience”.
And a case from Australia
https://www.abc.net.au/news/2018-11-01/human-rights-must-be-upheld-forced-shock-ect-therapy-court-rules/10454750
AF: “We need to tame the pharmaceutical industry. They should not be advertising directly to consumers. That happens only in the US and New Zealand, and both countries have remarkably high rates of antidepressant use.”
According to this article https://www.newshub.co.nz/home/lifestyle/2018/08/interesting-but-concerning-nz-antipsychotic-use-up-50-percent-in-under-a-decade.html
New Zealand has a much lower rate (approx. 1 in 13) of antidepressant use than the UK and I don’t think drugs are advertised to the public in the UK.
I think British hospitals nowadays use American machines. We have our own ECT machine manufacturer Ectron Ltd but I think they make machines largely for export.
Thank you Connor for the update and for the outcome to the case.
I haven’t listened to this one yet (looking forward to it) but I have found the previous three very interesting. In my ignorance I had not even realised that there was something called global mental health that people do masters in. My reaction is along the lines of ‘what is so wonderful about what is happening here that we should be exporting it?’ although I accept that the debate is more sophisticated than that. The Lancet has just produced a ‘reducing the global burden of depression’ report. I haven’t read it but just looking at the list of references is worrying. Cipriani and Co are in there.
Those were my thoughts too oldhead – that the court decided that there was a case to answer and at that stage the manufacturers decided to pay up rather than risk a trial. But they must realise that there are more in the wings so isn’t that a rather foolhardy thing to do?
I was waiting for something to appear on the lawyers’ website. Slightly worried by the fact that their latest update on the case goes back to April. And I am not sure I really understand what is going on – have the machine manufacturers made an out-of-court settlement?
Meanwhile there is a global mental health summit in London.
I didn’t quite understand what was being said here
https://breggin.com/huge-breakthrough-in-lawsuits-against-electroconvulsive-therapy-ect-manufacturers/
Has the case actually been settled? Have the plaintiffs won?
I didn’t see it either Julie.
I can take what the Daily Mail says about lids on cell membranes with a pinch of salt but I actually found the Guardian article quite seductive.
Now psychiatrists are experimenting with ketamine on children
http://www.dailymail.co.uk/health/article-6020211/Scientists-test-ketamine-CHILDREN-depression.html
“What’s more, it works much faster than SSRIs, and appears to last longer to move congestion in the brain that may be hampering the patient’s freedom of thought and feeling. It’s widely agreed that patients with depression appear to have dampened connections between certain neurons, caused by a build-up of proteins on top of cell membranes. In healthy brains, cell membranes are free and open to receive signals. In patients with depression, an overwhelming amount of G proteins pile up on top of lipid rafts – kind of like lids which sit on top of cell membranes.”
So now we know.
Yes, in February he was quoted:
‘Andrea Cipriani, from the university’s Department of Psychiatry, said: “Under-treated depression is a huge problem and we need to be aware of that. We tend to focus on over-treatment but we need to focus on this.” ‘
The million more came from John Geddes.
https://www.express.co.uk/life-style/health/922423/depression-news-antidepressants-drugs-work-study-oxford-university-UK-mental-health
Anyone seen the headlines today?
http://www.dailymail.co.uk/news/article-5976587/Doctors-prescribe-pills-depression-70-000-children.html
(it is actually a Times story but The Times has a paywall)
Andrea Cipriani quoted as saying “‘People are prescribing antidepressants to people who don’t really need them, who have low mood. ‘It’s important people are aware that antidepressants aren’t a quick fix.’”
There was someone in the 1980s who won a legal case for abrupt withdrawal of benzos. I don’t know if it is more or less difficult to win a case nowadays. It is not a subject I know much about. I just thought I would add that as further evidence that people were aware of the problems in the 1980s.
I am genuinely curious to know how articles are selected for this section, given that every day there must be a lot of articles published about psychiatry and mental health. This article was published in a psychiatric journal edited by Robert Pies and the first paragraph reveals the authors’ belief in mainstream psychiatry “she stopped taking her prescribed psychotropic medications…” There is then a lot of vague stuff about poverty before we get to the well, what can they do about it, having admitted that screening for poverty isn’t much use unless you can do something about it. On an individual level it doesn’t seem to go beyond signposting for housing and benefits help. Finally they call for psychiatrists to come out onto the streets to demonstrate for higher taxes. How many are going to answer that call? One of the authors has actually spoken at some parliamentary committee so perhaps it is not just rhetoric. Okay I like the bit about higher taxes even if it is a bit unrealistic but for me the good bits are outweighed by the vignette and screening tools and biological psychiatry stuff.
Despondent, but that is one hundred per cent. And someone who is in need of practical help might, rightly or wrongly, may feel that their chances of receiving that help are better if they accept the treatment.
Doesn’t seem at all critical to me. The authors are promoting drugging, assertive community treatment or whatever it is called, etc. It is almost as if they are turning poverty into a symptom, with a screening tool, which incidentally seems to be at least partly about budgeting.
Why is this article here?
Couldn’t find any in the first three pages of google, even searching “psychiatrist manslaughter”.
I was thinking they may be on the hook for other things but not often for patients dying as a result of prescribed drugs. As far as the UK is concerned, I googled “psychiatrist struck off” and looked at the first three pages. It was sex, plagiarism, sex, sex, sex, sex, inappropriate behaviour and inappropriate behaviour and lying. One mention of a historic case where a psychiatrist who had been working I seem to remember with addicts had prescribed drugs to someone who then died. I had another go for “psychiatrist convicted” and it was illegal drugs (the Royal College podcaster), sex, sex and sex, plus one mention of a historic case of sex. Sex in these convicted cases meaning something criminal whether you are a doctor or not.
Were psychiatrists ever on the hook?
Some very good points John. Where is the talk?
I never cease to be amazed at the vast sums of money that are spent on psychiatric research. And wonder if any of it has ever been useful. So much seems to be of the “bleedin’ obvious” variety (problems at work make you depressed etc.) or just of the “what’s the point of that?” variety (I remember seeing an article from the 1940s British Journal of Psychiatry about moustaches – or have I dreamt that up?) and then millions and millions spent on the rat brain stuff.
In the UK I have noticed in a very general sort of way (just reading newspapers, etc.) the term schizophrenia being used less and psychosis more. But as rasselas.redux says with an important exception – horrible crimes. Then it is “a paranoid schizophrenic”.
Great article. But I couldn’t find anywhere in the link it saying how many prescriptions each person gets. In this link
http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4329.0.00.003~2011~Main%20Features~Antipsychotics~10030
it says “There were 349,900 people (1.6% of the Australian population) who had at least one PBS subsidised prescription for an Antipsychotic medication filled in 2011.” That figure went up to 20 per cent in people aged over 75. Over half of the people were also getting prescriptions for antidepressants.
Thank you Tina for this report. I was interested to see what the person from the UK had to say. But it looked like he had wandered into the wrong meeting. As you say, he was just promoting the current legislation/review. He even talked about having been given a statement (who by? I don’t know much about how these things work). And said twice that his father is a forensic psychiatrist. And what is so marvellous about the Scottish Mental Health Act? A few facts he didn’t mention: increasing numbers of people in Scotland (population 5.3 million) detained (5422 in 2016/17); increasing numbers of people given drugs without their consent for more than two months (1559); increasing numbers of people given ECT without their consent (176 of whom 71 per cent were “resisting or objecting”, in theory all are supposed to lack capacity). And the safeguards? That just means they have to get another psychiatrist to approve it and they don’t often say no and, if it is similar to the system in England, it is a lucrative business.
Has anyone been following the Evening Standard’s series on opioids and the Sackler family? I was unaware of it until yesterday when I spotted a headline on a newstand.
https://www.standard.co.uk/news/uk/the-sackler-files-how-the-tax-haven-of-bermuda-played-key-role-in-10-billion-family-fortune-a3836421.html
I had never heard of FTAC. I had to look them up. Why do they have a .com website rather than a .org or .gov.uk?
Thank you Akiko for this article. I read the report and felt it didn’t really say anything useful. Theresa May became aware that detentions under the MHA are rising and disproportionately affect people from some ethnic minority communities so decided a review of the law was called for, although it may not be the law that is at fault, and then puts Simon Wessely in charge of it although he is hardly going to argue for less power to psychiatrists. The report says that the reasons for both the above (rising detentions and BAME groups being more likely to be detained) are “complex”. Well, obviously. And as for treating people with dignity and respect – can you make a law that says that you have to?
As for the disappointing numbers of people responding to survey, etc., could it be that having to identify as a “service user” might have put some people off, especially those who weren’t going to be appreciative of their treatment? I may be behind the times here – is “service user” a term that nowadays is universally, or near universally, accepted by people?
Not even a mention of ECT in the report. Although, to be fair, the law was changed for ECT in 2007. And how about legislating for DBS?
I got through to the end of the glossary and was surprised to find SOADs defined as second opinion associated doctors. I thought they were second opinion appointed doctors. Has it changed? It is pointless anyway the A was only inserted to avoid calling them SODs.
An item about Asperger was on the front page of the BBC website today
http://www.bbc.co.uk/news/world-europe-43820794
Hans Asperger ‘collaborated with Nazis’ in WWII
(I wonder why the quotes)
So the circuits have a center and are still in there with a sporting chance. I read the spinning trial results report. It goes on in the UK (DBS for depression) but isn’t much talked about. A couple of people who had undergone psychosurgery in England in recent years did so after having DBS.
As for Carmine Pariante you can’t avoid him. He was in the Times today. Can be read here https://www.raconteur.net/healthcare/debate-antidepressants-work
There was also John Geddes from Oxford with his line about GPs being “squeamish” about prescribing antidepressants. Is it about 60 million prescriptions a year now? And about 40,000 GPs? So that is about 1,500 prescriptions for antidepressants per GP per year. Squeamish?
Perhaps they are just speaking with one voice. There is another thing I find odd about the whole business: didn’t amitriptyline come out top? And yet they seem to be silent on that. Nothing about how they should drop SSRIs and go back to amitriptyline.
I had never heard of Carmine Pariante before this. Looking for his quote I came across lots of stuff and at first sight it does look seductive – all this cutting edge science, prestigious institutions, visits from royalty, etc. And they have it all worked out – inflammation, small brains, etc. Inflammation seems to have taken over from chemical imbalances but what happened to brain circuits? And then I got a sobering thought: the world is still just the same, just as many depressed people and also I looked at his conflict of interests list and the fact that he is pals with Charles Nemeroff.
That was a feeble reply you got auntie from the SMC. I remember years ago they were promoting Helen Mayberg and her deep brain stimulation. What happened to that? But I don’t know much about SMC. The one I am following with interest is MQ.
I can’t find an example either. Pariante is definitely the putting to bed quote and Cipriani the final answer quote. Everywhere. Now Pariante is complaining about being taken out of context but it isn’t even his quote.
I have found the quote now:
“Lead researcher Dr Andrea Cipriani, from the University of Oxford, told the BBC: “This study is the final answer to a long-standing controversy about whether anti-depressants work for depression…””
http://www.bbc.co.uk/news/health-43143889
So it was one of the others who used the expression “final answer”.
Carmine Pariante is now saying he was quoted “out of context”.
“At the time, I was widely quoted as saying this was the “final answer” on the subject – a comment that was taken very much out of context.”
http://www.dailymail.co.uk/health/article-5540281/Happy-pill-anti-depressants-really-help-tackle-chronic-pain-dont-actually-make-happy.html
Wasn’t it Michelle Obama who said that, not Barack?
As for the Royal College of Psychiatrists, I have never understood why they have charitable status.
I might not have spotted the parody if I hadn’t read the comments first. But it was funny. The bit about the water mattress tester reminds me of a follow up study (not a parody) of people who had undergone leucotomies and the only one who returned to work at their previous level was a tea-taster.
Something magical obviously happens to us on our eighteenth birthdays.
Over 60,000 detentions in a year. Yet I could only see the CQC report getting a mention in the Mirror and the Huffington Post, while for the anti-depressants it was a case of “hold the front page – someone has done a meta-analysis”. As John Naish said, you would think they had won a Nobel Prize. The CQC report did get some discussion in Parliament though.
“…it confirms that these drugs are safe and effective” (from Carmine Pariente’s comment on the SMC website). Where does the review of the literature deal with safety? Did I miss something?
Great cartoon auntie!
Another case in South Carolina
http://caselaw.findlaw.com/sc-court-of-appeals/1888447.html
One of the guideline authors had nearly a page of disclosures. It is a pity the critical article in the BMJ doesn’t seem to be available to read.
In Scotland (one of the few places to publish detailed statistics on the use of ECT) the largest single group is indeed women in their fifties. It is graphically illustrated by the figure on page 3 of this report
http://www.sean.org.uk/AuditReport/_docs/SEAN-Report-2017-171113.pdf?2
And, yes, various surveys have found men more likely than women to prescribe ECT.
In the Netherlands ECT nearly disappeared in the 1970s but now it is back again, along with psychosurgery and deep brain stimulation.
I think its important to show people that is misleading to talk about “small electrical impulses”. I was looking for a video of ECT which shows, for example, that the shock is strong enough to cause grimacing because of its direct action on facial muscles even if the person is anaesthetised and their muscles are paralysed. If you look at this video
https://www.youtube.com/watch?v=9L2-B-aluCE
at 3.20 minutes it shows the shock being given and the man’s arms fly up. How does that happen – when he is anaesthetised and paralysed? I also thought that he seems to be having quite a violent seizure, considering he has been given muscle paralysing drugs. I recently saw someone having a spontaneous seizure and it didn’t look worse than that.
A reply to Luc
As Connor pointed out to me, the million figure comes from the defendants (the ECT machine manufacturers) and is obviously absurd.
Yes, a possible explanation would be that they are getting confused between treatments and people. Or perhaps they are trying to convince people that ECT is an incredibly common treatment, or they may have extrapolated from one hospital that uses an unusually high amount of ECT.
The figure usually quoted by psychiatrists in US is 100,000 a year but this is a very old estimate. No-one knows how many people actually undergo ECT in the US because most states don’t keep count. Texas (pop about 28 million) is an exception and collects and publishes figures – about 2 to 3 thousand people a year. But it would be dangerous to extrapolate to the whole US, as ECT is characterised by wide variation in its use.
Could I just point out a couple of things about your reasoning. In the US, ECT is used predominantly as a treatment for depression – you don’t have to have been diagnosed as psychotic (and there is an almost limitless number of people who can be diagnosed as depressed). Of course it is used on people with other diagnoses as well – schizophrenia, children with autism, older people with dementia. Another point to bear in mind is that people often have multiple courses of ECT, or are on maintenance ECT, so will appear in the statistics for more than one year.
There’s me fallen at the first hurdle – spotting the difference between the plaintiffs and the defendants! Can you challenge them if they are talking rubbish? A million a year is patently absurd. Where do the get it from? Even 100,000 a year is I think a very (decades) old estimate. If you look at Texas, where they actually count, it is a much lower rate. Does California keep statistics?
Another bit of rubbish the defendants say: “ECT is a medical procedure performed under general anesthesia in which small electric pulses are passed through the brain… ” Would it be possible I wonder to modify an ECT machine to deliver a shock exactly like in ECT but turned down to a level where it is a slightly painful shock but not dangerous – like say 8 milliamps instead of 800 milliamps? And then ask the defendants what it feels like? I don’t think you would feel pulses because they come at typically 70 a second which would feel continuous I think. And then ask them to imagine it one hundred times bigger, which is what ECT is.
Connor, bottom of page 7 of the Joint report: “In the United States, over one million patients are estimated to receive ECT each year.” What?! I think psychiatrists say one hundred thousand a year in the US, although even that is just a wild guess rather than based on any actual figures. I have seen them say a million in the world every year – another wild guess. Or maybe they are talking about the number of individual treatments per year in USA, that is, each person having about 10 treatments?
No, don’t waste your time explaining to me. Just win the case!
I’m not sure I understand all the legal stuff but best of luck anyway.
About anaesthesia raising the threshold. That would explain why less energy was being used in the examples I gave.
Maybe what Stephen Gilbert said in the first place is true
“What I’ve read about modern day shock is that it’s actually much more dangerous than in the old days because of the anesthetic that they use now. Supposedly it raises the threshold that is required for the actual seizure to take place, meaning that it takes more electricity to get beyond the threshold.”
“Colleagues in various departments suggested alarming possibilities, which included some alteration to the type of fit; over-heating the tantalum plate and so, as it were, cooking the brain; bending the plate during the fit, and also depositing tantalum around it electrolytically”. None of these seemed sufficiently likely to contra-indicate treatment…”
Anyway – another example: “the usual dosage in this series was 18 joules…. the usual duration of the shock is variable, lasting about 0.35 sec…” R.Kauntze and G. Parsons-Smith 1948 Cardiovascular changes following electro-convulsive therapy. Heart vol 10 pp 57-62.
According to his website he is on (or at least he was in 2013) an SNRI antidepressant and a mood-stabiliser. http://www.stephenfry.com/2013/06/only-the-lonely/
When he was younger it was cocaine and alcohol.
What rational_moderation said was “In the old days they just took current directly from the wall, 60 hz alternating current, to deliver ECT. Now they actually give a series of brief electrical pulses so it’s much less energy.” Energy is measured in joules, and I found some examples from 1940s and 1950s of shocks using 10 – 20 joules of energy. If you want to see how much energy modern machines deliver go to the Thymatron specification page http://www.thymatron.com/downloads/somatics_color_low-res.pdf
maximum output 99.4 joules (or double with double-dose model). Psychiatrists are advised to set %energy dial to patient’s age, which would be more than 10-20 joules for adults.
Or perhaps rational_moderation could find an example of someone in recent years being treated with “much less energy” than 10-20 joules?
A reply to rational_moderation’s questions. In order to convert joules to millicoulombs (energy to charge) I was using Charles Kellner’s co-efficient of 5.7. Yes, the resistance is unknown, so the co-efficient is based on assuming an average resistance (Charles H. Kellner, Electroconvulsive therapy, in Brain stimulation in psychiatry, Cambridge 2012 pp 3-16). The 1950s example I gave is from an article published in the Journal of Mental Science in 1951 vol. 97, An account of E.C.T. given to a patient with a tantulum plate in his skull, by Humphry Osmond pp 381-387. The man was given seven treatments with 17, 12, 10, 10, 10, 10, 10 joules.
All else being equal, brief-pulse currents are accepted as more efficient at producing seizures than sine-wave. But all else isn’t equal; other parameters have changed. For example, nowadays people receive shocks lasting several seconds while in the early days they lasted a fraction of a second. Is sine-wave for half a second better or worse than brief-pulse for 6 seconds?
I pointed out that a minority of New York hospitals were using sine-wave equipment into late 90s early 2000s to show that it is not a simple question of olden days v modern times. Some countries of course still use sine-wave equipment.
It is not the case that modern ECT uses “much less energy” than before. If anything it is more energy.
Correction: it is charge not energy that is measured in millicoulombs. Energy is measured in joules.
At the end of the article that you quoted the authors give two examples of calculating the electrical charge – one of 63 millicoulombs and one of 163 millicoulombs. Those are both fairly low charges but the second one a fairly typical one. Now let’s look at the charge used in the 1950s. One article for example described a patient as receiving ECT with energy of between 10 to 17 joules. Slight problem – we have to convert joules to millicoulombs. Charles Kellner (and for once I will believe him) says to multiply by 5.7, which means 1950s patient got about 60 to 100 millicoulombs. So less energy in the 1950s than nowadays. Why – if the waveform is more efficient? Mainly I think because the duration of the shock has increased considerably since the early days of ECT. Nowadays people usually get shocks lasting several seconds while in the early days it was usually a fraction of a second.
Interestingly, in a survey published in 2001, some hospitals in New York were still using sine-wave machines even though brief-pulse ones had been available for at least two decades.
rational_moderation where have you looked into it (the “much less energy” claim)?
I think what rational_moderation is referring to is the difference between machines that deliver an electric shock with sine-wave current and those that deliver an electric shock with brief-pulse current. They are both electric shocks, although some people misleadingly describe the latter as if they deliver a lot of little shocks rather than one big shock.
As far as energy is concerned, modern ECT delivers just as much, if not more, than olden days ECT. The convention is to measure ECT energy in millicoulombs and the number of millicoulombs has not decreased over the years.
The proof of the pudding is in the eating, and when people have done experiments with the different wave-forms there has not been an enormous difference between sine-wave and brief-pulse, less for example than between bilateral and unilateral electrode placement. Which is probably one of the reasons why psychiatrists took so long to switch wave-forms and why in some countries sine-wave is still used. And of course people who have ECT today experience similar effects on memory, etc., to those who had ECT many decades ago.
Thank you Philip for this article. I have just checked out the editorial board of the Journal of ECT. Forty men and eight women. They did some years back publish an article by someone who had experienced memory loss after ECT. I can’t remember her name but I do remember she had met Mother Teresa and couldn’t recall it after ECT. I wonder if they would say now that they shouldn’t have published that article? By the way it is the late Ian Reid https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046795/.
A very interesting report. And so sad about Jim. I have only read the abstract to the Lancet article as I don’t have access to the whole article but I am wondering why it took 30 authors to write the article. I know it was multicentre but I don’t think there were any centres in UK were there? yet Keith Matthews from Dundee in Scotland is listed as author.
I once won a competition and the prize was a ticket to a David Nutt lecture. I remember he was talking about ecstasy and said it had never killed anyone. A member of the audience queried this statement and Nutt said it wasn’t ecstasy that killed but drinking too much water. I didn’t find that very convincing.
As for Scott’s article, I couldn’t see how MDMA is going to be different from any other drugs. Perhaps, Scott, you could make it a bit clearer?
Thinking of ER (number 8) has anyone seen this article by the director of NIMH?
https://www.nimh.nih.gov/about/director/messages/2017/on-being-ill.shtml
I find it rather frightening. Supposing someone who had broken their ankle said “Well since you ask…” what would they do?
Thank you for this article Don. I have noticed that most of the big names in ECT seem to be men. In the early days of ECT perhaps there weren’t that many women psychiatrists, but I would have thought there were more nowadays.
Thank you Philip for providing me with such a laugh. I had seen the abstract and was struck by the admission that they are trying to change thoughts and behaviour, rather than curing or even treating diseases, but I hadn’t got around to going down to the library to read the whole thing. Presumably that 4 per cent of medical graduates include those who don’t cut the mustard in other disciplines or want an easy ride to a consultancy. I wonder if there are many people who actually start out wanting to be psychiatrists?