Is Electroconvulsive Therapy (ECT) Effective?

ECT, or shock treatment as it’s sometimes called, is a controversial topic.  Adherents describe it as safe and effective; opponents condemn its use as damaging and ineffective.  But it is still widely used in the US and in other countries.

The treatment consists essentially of passing sufficient electricity across the brain to cause a seizure.  Clients are anesthetized during the process.  It is used primarily in cases of severe depression.  Typically, shock treatment is administered twice a week until the depression remits or until no further improvement is noted in two successive sessions.  Most courses of treatment involve about eight sessions.

After shock treatment, some clients do appear to be less depressed, but this phenomenon has been interpreted differently by ECT’s proponents and opponents.  Proponents claim that the ECT treatments have clearly alleviated the depression.  Opponents claim that the apparent improvement is an example of post-concussion euphoria, and that the effects are short-lived.

The subject is vast, and an enormous volume of material has been written on the topic.  I Googled “electroconvulsive therapy” and got just over one million hits.  There is a growing body of writing from survivors who state that they were harmed by the process, but one can also find occasional reports from people who say that ECT was helpful to them.  In former years the psychiatric community claimed that there were no significant adverse effects on memory associated with ECT, but today there appears to be a general acceptance that memory loss can and does occur.

ON THE PRO SIDE

Steven Novella, MD, is a neurologist, and works as an Assistant Professor at Yale.  He’s active and influential in the skepticism movement, and has his own blog as part of the New England Skeptical Society:  Neurological blog: Your Daily Fix of Neuroscience, Skepticism, and Critical Thinking.  On March 22, 2012, he posted How Electroconvulsive Therapy Works, and he opens the article by stating:

“There is no real controversy over whether or not ECT works for depression – it is highly effective.”

This statement is linked to the abstract of a study by Diercks BG et al:  Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis which appeared in the journal Bipolar Disorder, 2012.

This meta-analysis combined the results of six earlier studies, and concluded:

“ECT appears to be equally effective for both bipolar and unipolar depression and the remission rates are encouraging, especially for bipolar depression.”

The first thing to note is that the Dierckx et al study was not designed to answer the question:  is ECT effective?  but rather to assess its effectiveness for bipolar depression versus unipolar depression.  This is a significant issue, because the only way that one can adequately assess the effectiveness of a procedure like ECT is to compare its use to a placebo.  None of the studies collated in the Dierckx et al meta-analysis were studying effectiveness as such.  But the authors did state that “…the remission rates are encouraging…,” and presumably that is the finding on which Dr. Novella is basing his claim.

I was able to find, and examine, all of the six base studies used by Dierckx et al:

  1. Medda P, et al, Response to ECT in bipolar I, bipolar II and unipolar depression. J Affect Disord 2009; 118: 55–59.
  2. Grunhaus L, et al, Response to ECT in major depression: are there differences between unipolar and bipolar depression? Bipolar Disord 2002; 4(Suppl. 1): 91–93.
  3. Sienaert P, et al, Ultra-brief pulse ECT in bipolar and unipolar depressive disorder: differences in speed of response. Bipolar Disord 2009; 11: 418–424.
  4. Bailine S, et al, Electroconvulsive therapy is equally effective in unipolar and bipolar depression. Acta Psychiatr Scand 2010; 121: 431–436.
  5. Daly JJ, et al, ECT in bipolar and unipolar depression: differences in speed of response. Bipolar Disord 2001; 3: 95–104.
  6. Sackeim, HA et al, Length of the ECT Course in Bipolar and Unipolar DepressionJ ECT 2005; 21 (3): 195-197

All six of the base studies used questionnaires and rating scales to assess depression.  The Hamilton Rating Scale for Depression was used in all cases.  Other scales used included Brief Psychiatric Rating Scale (BPRS); Clinical Global Improvement (CGI); Beck Depression Inventory (BDI); etc.

Follow-up periods after the end of treatment were:

  1. Medda P et al:             1 week
  2. Grunhaus L et al:        no follow-up
  3. Sienaert P et al:           1 week and 6 weeks
  4. Bailine S et al:             no follow-up
  5. Daly JJ et al:                1 week
  6. Sackeim et al:              no follow-up

Only study number 3 – Sienaert et al – assessed for cognitive side effects.  They administered the Mini Mental Status Exam before treatment and at one and six weeks post treatment.  The results show a small but consistent improvement in scores across time (i.e. from pre-treatment to post-treatment).  However, the Mini Mental Status Exam is not sensitive to the kind of cognitive deficits generally associated with ECT except in the period immediately following the ECT.  The Sackeim et al 2007 study The Cognitive Effects of Electroconvulsive Therapy in Community Settings,  for instance, found on average no persistent deficits in Mini Mental Status Exam scores associated with ECT, but did find significant and persistent deficits in “…memory for autobiographical events.”  This is precisely the area in which survivors of ECT have been reporting problems for decades.

DISCUSSION

I have written on the subject of ECT before, here, here, and here.  In my opinion, the evidence is clear:  ECT has no overall superiority to placebo in the treatment of depression, except in the period during and immediately after the treatment, and, in at least some cases, does a good deal of damage.

My purpose in this article is to examine the evidence that Dr. Novella adduced to support his claim that ECT “…is highly effective.”  This is important because Dr. Novella presents himself as a debunker of pseudoscience, and routinely characterizes those of us on this side of the psychiatry debate as unscientific “deniers” (e.g. Mental Illness Denial – Part IV)

People reading his sentence:  “There is no real controversy over whether or not ECT works for depression – it is highly effective,” with a link to  the Dierckx et al study would, I believe, assume that the Dierckx et al study provided some evidence for this conclusion.  In fact, this is simply not the case.  Neither the meta-analysis nor any of the base studies were designed to address the question of general efficacy.  In addition, only one of the studies (Sienaert et al) had follow-up assessment beyond one week, and none of the studies controlled for the placebo effect.  Only one of the studies (Sienaert et al) addressed the question of adverse effects, which, I suggest, must be considered in any assessment of general efficacy.

On the other hand, the evidence from randomized placebo-controlled trials is clear:  apart from some short-lived lifting of mood, ECT is not effective as a treatment for depression.  A comprehensive review of the efficacy evidence can be found in Read J. and Bentall R, The effectiveness of electroconvulsive therapy: A literature review, under the heading Comparison With Simulated-ECT For Depression (p 335).  Read and Bentall concluded:

“These placebo controlled studies show minimal support for effectiveness…during the course of treatment …and no evidence…of any benefits beyond the treatment period.” (p 333)

The authors also state:

“Since the 2004 review [Chapter on Electroconvulsive Therapy, in Models of Madness, by Read, Mosher, and Bentall, 2004] there have been no findings that ECT is effective, but significant new findings confirming that the brain damage, in the form of memory dysfunction, is common, persistent, and significant, and that it is related to ECT rather than to depression.

Few of those exposed to the risks of memory loss, and to the slight but significant risk of death, receive any benefit even in the short-term.  There is no evidence at all that the treatment has any benefit for anyone beyond the duration of treatment, or that it prevents suicide.  The very short-term benefit gained by a small minority cannot justify the significant risks to which all ECT recipients are exposed.”

And yet ECT continues – a tribute to psychiatry’s faith in its dogmas, and its enduring resistance to any evidence that challenges these beliefs.

PSYCHIATRY AND PSEUDOSCIENCE

On November 14, 2013, Dr. Novella, in an article titled Is There a Pseudoscience Event Horizon? provided a list of “typical behaviors” of pseudoscientists:

1 – Hostile to criticism, rather than embracing criticism as a mechanism of self-correction
2 – Works backward from desired results through motivated reasoning
3 – Cherry picks evidence
4 – Relies on low grade evidence when it supports their belief, but will dismiss rigorous evidence if it is inconvenient
5 – Core principles untested or unproven, often based on single case or anecdote
6 – Utilizes vague, imprecise, or ambiguous terminology, often to mimic technical jargon
7 – Has the trappings of science, but lacks the true methods of science
8 – Invokes conspiracy arguments to explain lack of mainstream acceptance (Galileo syndrome)
9 – Lacks caution and humility by making grandiose claims from flimsy evidence
10 – Practitioners often lack proper training and present that as a virtue as it makes them more ‘open’

With the possible exception of numbers 8 and 10, this list seems to me like a very accurate portrayal of psychiatry.

As mentioned earlier, Dr. Novella’s article of March 2012 opens with the claim that ECT is “…highly effective.”  The article then goes on to address the question: how does ECT work?  For this issue, Dr. Novella refers to another study, Electroconvulsive therapy reduces frontal cortical connectivity in severe depressive disorder, Perrin et al, 2012, which performed fMRI scans on nine individuals before and after ECT.  This study found that “…functional connectivity was considerably decreased after ECT…”

Given that ECT causes significant and persistent memory loss, which, incidentally, Dr. Novella acknowledges, it seems to me that the most parsimonious way to interpret the Perrin et al results is that the reduction in functional connectivity, which actually means the breaking of circuits, might be the cause of the memory loss.

Dr. Novella ignores this possibility, however, and, following the lead of the researchers, suggests instead that the individuals who received the ECT had:

“…overactive connectivity between that part of the brain that generates the emotion of depression and the part of the brain involved in cognition and concentration. In these patients, therefore, their depressed mood has a significant effect on their thoughts and ability to concentrate. ECT appears to reduce this hyperconnectivity, which should significantly reduce the symptoms of depression.” [Emphases added]

The “logic” here could be summarized as follows:  ECT alleviates depression; ECT breaks neural circuits; therefore it is these “overactive” neural circuits that caused the depression in the first place.  I suggest that this is an almost textbook example of the second item of Dr. Novella’s list of typical behaviors of pseudoscientists:

“Works backward from desired results through motivated reasoning.”

Despite the evidence of damage and ineffectiveness, psychiatry clings tenaciously to ECT.  For years, they denied that it caused memory loss, claiming instead that any such deficits were the result of the depression or, in at least one case (Fink M Psychosomatics, 2007), somatoform disorder!  (In other words, the memory loss was “all in their heads.”)

As the evidence mounted, they conceded that ECT entails some memory losses, but insisted that these were minor and/or transient.  Today they acknowledge that sometimes the memory problems are significant and persistent, but they claim that the impact of these problems is balanced by ECT’s “efficacy” as a treatment for depression.

How much longer can they continue this travesty?

  • Nick Stuart

    Excellent article Phil. I see it has been published on MiA. I have always felt that the use of scales such as the HAM-D will always favour doctors – given humans proclivity to bow down to authority figures such as doctors (as Milgram pointed out). I did read somewhere (can’t find it now), that a study done showed that reports of the effectiveness by patients when talking with a ‘non-doctor’ were far less favourable than those obtained by the clinician.

  • cannotsay

    Great article Phil!

    With respect to 8, I think that you are being too charitable to psychiatry. The “you must be a Scientologist” like of defense is still widely used by defenders of psychiatry, even by those at the top of the profession https://www.youtube.com/watch?v=4pu0iVjJGwE . They condemn all criticism of psychiatry as Scientology-like or “denialism conspiracy”. So, yes, even 8- applies to psychiatry.

  • Francesca Allan

    In this video, the APA head rightly points out that psychiatry is the only specialty of medicine with its own “hate group.” She failed to mention some of the other distinguishing characteristics of psychiatry from medicine, such as that it is the only one with the force of law behind it, the only one that necessitates a survivor community, the only one that has no objective test for any disorder it purports to treat, and the only one where outcomes are worse with treatment. I hate those Scientologists! They give all of us of a bad name.

  • Phil_Hickey

    Nick,

    Feudalism still lives! Doctors are the modern nobility?

  • Phil_Hickey

    cannotsay,

    Thanks for the encouragement.

    I gave them the benefit of the doubt on No. 8 because they do in fact have mainstream acceptance.

    Thanks for the link to the video. Quite a performance!.

    Best wishes.

  • cannotsay

    Funny, I have thought about this myself. Rather than the modern nobility, I see doctors, and psychiatrists in particular, as the modern clerics: they promise you salvation in this life if you blindly do what they say. And of course, do not dare question their “divine” authority :D.

  • Don’t you think that’s changing though? It’s mostly in older doctors you see that mentality? There is a funny book from a doctor of that era. It’s titled, “Kill As Few Patients As Possible.” I think that really was their mantra, and the reality was they did expect a god-like adoration while performing in a less than god-like fashion.

  • cannotsay

    When you mentioned “Kill As Few Patients As Possible”, I thought that you were kidding, but indeed, it shows up in Amazon… to good reviews!

    It’s difficult to say if things are changing. Maybe in areas outside psychiatry, you are right, but only because there is a booming medical malpractice business that makes doctors pay dearly for the less than god-like practices, as you put it.

    In psychiatry/psychology, I think that the increasing secularism in our society makes them de facto “clerics”. 30 years ago, when you had a problem that you didn’t want to confide to your closest family/friends, you could always go in confidence to a pastor or a priest. Now people prefer to go psychologists/psychiatrists, which is kind of dumb, since priests have a huge incentive to keep your secrets, namely, eternal damnation, while psychiatrists do not have any such incentive to keep it confidential. Losing one’s license is nothing compared to eternal fire :D.

  • And add drugs….even our children are drugged and the moms love it…as well as teachers. I was reading today in a book about Zoloft how the author struggled with it. It was helpful and yet she worried and wondered about returning to her former self…the “old self”. Yet, when a child is put on a drug there is no comparison to the “old self”. It is a placating of the wonderment and energy they exude and it’s done by doctors to recreate some children into over-achievers to satisfy the mother’s inner-needs. It feels like a type of sacrifice on some intellectual altar as we redefine what “normal” is. So I agree about a cultural shift that isn’t leading to enlightenment. Where have the dreamers gone?:)

  • cannotsay

    It all looks like “Brave New World” becoming reality. “soma” consumption now gives Big Pharma 80 billion dollars a year, so!

  • Nick Stuart

    I am currently re-reading The Manufacture of Madness by Szasz. What a great book it is. It compares the inquisition and the burning of witches to todays ‘mental health’ movement. Underneath this is the human instinct for the majority groups to stigmatise minorities. The myths may change but the underpinning thought stays the same. And the word pharmacy has its roots here http://en.wikipedia.org/wiki/Pharmakos

  • Nick Stuart

    Ha! Has Phil’s blog now become the refuge for those banned from Novella’s site?

  • Nick Stuart

    Btw, Phil, I think it was important to mention the Skeptic Movement. There has been much discussion about the activities of this group http://guerrillaskepticismonwikipedia.blogspot.com/ here http://www.newrepublic.com/article/115600/deepak-chopra-responds-pseudoscience-allegations

    This group have been dominating Thomas Szasz’s wiki page as we have become the anti-science deniers (heretics). It is strange that Jerry Coyne adopts such an attitude because of his blog post http://whyevolutionistrue.wordpress.com/2011/06/25/is-medical-psychatry-a-scam/

    Things are beginning to unravel?

  • cannotsay

    Hehehe! Indeed. That we have been banned by Novella just shows how insecure and dogmatic he and his followers are. I take it as a badge of honor for if I had not been banned, it would have been the case that Novella had not been challenged enough. Phil does a great job here debunking one of his many “blanket statements”. You might also want to know that I caught our dilettante in chief, Emil, publishing nonsense, I emailed him and he quietly changed the nonsense here http://debunkingdenialism.com/2013/11/16/scientific-reality-versus-anti-psychiatry-once-more-unto-the-breach/ . He had originally published the North Carolina procedures for involuntary commitment as THE PROCEDURES US wide. I suppose that it’s because when he searched for civil commitment procedures in the US, the NC is the first that popped up. I also imagine he doesn’t have the slightest clue of what a “Clerk of Superior Court” or a “Magistrate of District Court” is. But, that’s what he does best: dilettante stuff. He, like Novella, cherry pick and copy paste things they know nothing about pretending that a citation is the same thing as truly knowing something. I leave here a video by Richard Feynman about pseudo science. He probably had people like Novella and Emil in mind.

    https://www.youtube.com/watch?v=IaO69CF5mbY

  • Nick Stuart

    Ha! Just read this http://theness.com/neurologicablog/index.php/coyne-destroys-chopra/ . I now await Coyne destroys Novella with baited breath. .

  • Francesca Allan

    If that’s the case, Nick, then this site is going to get an awful lot of traffic. I still want to write to Novella’s superiors at his university. Censoring reasonable debate is usually frowned upon in academia.

  • Nick Stuart

    Ha! Emil.. dear Emil has deleted my comments and banned me again because I quoted Insel. I notice he now states that Szasz was a scientologist! Jeez.. But Emil, unlike Novella has no influence..his blog is ignored. (On Jerry Coynes’ psychiatry as a scam blog.. you should read the comments when he comes in to argue. It is so funny. )

    Yeh.. Feynman was to me a genius. I watch his early scientific lectures on physics on youtube – (He has adult ADHD you know.. he cannot stand still!). He had his moments with psychiatrists… have you read? Unfortunately I lack such intellect, and also I suffer from Dyscalculia and extreme borderline laziness so I struggle with the concepts of physics nowadays.. especially string theory although quantum loop gravity seems like common sense to me.

  • Nick Stuart

    Sorry Phil for derailing the thread.

  • Nick Stuart

    Well I hope Novella’s blog is outed for the scam it is. He uses his position as a ‘professor at Yale’ as an argument from authority yet complains when others use this very same tactic. Actually, I think he devalues the ‘status’ of Yale and those who are in positions of authority there should be notified.

  • Nick Stuart

    But then again I suffer from ODD so maybe an appeal to authority is just another failure. You know.. I think I have every one of the 300 mental illnesses listed in the bible. (Apart from http://en.wikipedia.org/wiki/Personality_disorder_not_otherwise_specified )

    Although that is obviously due to my agnosia. Ha! You could not make this up. Yet they did!

  • steve12

    There is a real problem with your review of the literature here. You can’t just include studies that make your point! You’re not absolved of including the articles that showed long term efficacy of the treatment because Steve Novella didn’t include them in his article.

    Any honest reading of the literature finds a mixed bag for ECT, little knowledge of mechanism, and an alternative technology with a tiny fraction of the side effects. This is a strong case that you could make that is also supported by the best available evidence.

    Something on the order of 30-40,000 people a year take their own life, and neither you nor anyone else has much to offer in the way of treatment. To require that therapies meet some pie-in-the-sky philisophical test, or the whims of those who deny that mental illness even exists, is irresponsible.

  • steve12

    “an alternative technology with a tiny fraction of the side effects”

    By this I mean TMS

  • cannotsay

    steve12,

    “Something on the order of 30-40,000 people a year take their own life,
    and neither you nor anyone else has much to offer in the way of
    treatment”

    It has been clearly established that the increase of suicide rates is coincident in time with the increase in the prescription of antidepressants, known to increase the risk of suicide. If antidepressants were any good, don’t you think we should be seeing results?

    Also, you lost the intellectual debate at Novella’s website even among pseudo sleptics like you . Here you are going to lose by a huge margin because your arguments didn’t have any merit then, and they continue to have NO merit now.

    This notion that giving people poisonous drugs is better than nothing is false.

    Novella, you, and many in the pseudo skeptic movement, are dilettantes prone to make blank statements about this and that, which, as Phil has shown with the case of ECT, they do not stand any serious intellectual scrutiny. “Trust me” is not a scientific argument. When these flaws are pointed out to you, you ban people from your discussions. That just shows how empty suits you are intellectually speaking.

  • steve12

    Even is this is so, depression exists outside of medicated people. I’s a problem that needs to be dealt with. Maybe ECT is not the way to do that, but let’s see all of the evidence, not just those studies that support a particular view.

    Tell me, cannotsay, do you lie about being a scientist here as well? Just curious. Your secret’s safe with me 🙂

  • cannotsay

    I don’t have to lie, I am a scientist and my arguments were better than yours, as many in the discussion acknowledged before I was banned by Novella when he could not take a serious intellectual discussion anymore. True dogmatic believers like you will not bow even when the evidence contradicts your claims. The fact is that Novella goes around saying things like “there is no real controversy over whether or not ECT works for depression – it is highly effective.” when it only takes the time that Phil took to show that such a blanket statement is not born out by the facts: there is controversy, and the “effectiveness of ECT” is highly disputed by respected experts.

    This shows that either Novella deliberately lies, or that the is, like you, a dilettante who passes as an expert on matters he knows very little about. I am of the opinion of the second since Novella fits the bill of the type of dilettantes Richard Feynman warned us against (you have the video in this thread that I hope you watch).

  • Sweet63

    Thanks, I didn’t know about that book by Szasz.

  • steve12

    “as many in the discussion acknowledged ”

    Yeah, sonic and mlema. Good going kid. YOu got the science deniers, and I got the scientists. Wonder why that is?

    I’m not getting back into this nonsense with you. I just want to remind you that as a scientist I know for 100% for sure that you are not one, and are therefore a liar. You’d do better in life to just be honest with people and not make up fanciful things about yourself.

    Have a nice life

  • cannotsay

    This is the problem with you, when left without arguments, your only argument is “ad hominem”, which is what you are doing here. I don’t need sonic or mlema to agree that there is not a single biomarker that has been established for any so called “mental illness”. It’s something that has been agreed to by the NIMH and the APA. Your attempts to show that there is, only proved that you have a limited knowledge of Bayesian statistics. I can ridicule here just as I did back there if you insist in repeating your ridiculous examples that, according to you but nobody else, prove that so called “mental illness” is as biological as Alzheimer’s. The advantage of having the discussion here is that no censor will prevent you from making a fool of yourself as you did back then.

    This think that “I know you are not a scientist because I am one” goes both ways. Not sure what kind of science you practice beyond generic “cognitive neuroscience” but the type of science I do is Fenyman’s. And indeed, I find your arguments shaky and worthy of malpractice in my own profession. In fact, in my own field, papers have been retracted from things that were way more minor than affirming “there is no real controversy over whether or not ECT works for depression – it is highly effective.”

    You problem, as Novella’s, is that over time you have developed group think. When challenged with actual arguments, you have nothing to offer other than “ad hominem” attacks and censorship.

  • steve12

    Anywhooo….

    I think another important step is not simply criticizing psychiatry, but offering alternatives. What do you guys propose to do for someone who is so severely depressed that can no longer take part in life?

  • steve12

    In case anyone wants to see what losing an argument looks like:

    http://theness.com/neurologicablog/index.php/the-genetics-of-mental-illness/

  • cannotsay

    Interesting you bring this up since its shows very clearly your limited knowledge on Bayesian statistics. Your ignorance makes you boast of your own fallacious arguments. No question you make such a great pal of he who goes around saying “there is no real controversy over whether or not ECT works for depression – it is highly effective.”.

    Before Novella banned me for questioning his professional credentials, we got onto a Clintonian discussion about what “validity is”. He brought a fringe paper from 2005 to justify why his notion of validity when it comes to so called “mental illness” is better than the notion of “biological/scientific” validity that has been agreed upon by both the NIHM and the APA, both of whom are also on record saying that none of the DSM labels has been shown to have the type of validity that both the NIHM and the APA aspire to.

    That of course contradicted Novella’s own claims that labels like ADHD had been shown to be “genetic/biological”. This is the problem of dilettantes. You through around stuff you know nothing about and when science debunks your stuff, you go around semantic debates instead of conceding that you were wrong in the first place. In that regard, you are very similar to religious dogmatic zealots.

  • Phil_Hickey

    steve12,

    Thanks for coming in.

    You’re correct in point out that I didn’t review all the articles on ECT. Nor could I. I started with Dr. Novella’s reference because he is an eminent member of the skeptics’ movement, and I felt that his reference might be a good starting point.

    So let’s try a different tack. You pick two studies that, in your view, establish the “long-term efficacy of the treatment,” and I will critique them to the best of my ability.

    Mixed bag.” The only mixed bag that I am aware of is a large number of studies without placebo control that find in favor of ECT, and a small number of studies with placebo that find against.

    Suicide.” Read and Bentall reviewed the ECT literature for studies that addressed the question of suicide. They tabulated their results in Table II, on page 339.

    The table speaks for itself, but Read and Bentall discuss the issue in detail, and in their conclusions state:

    “ECT does not prevent suicide.”

    Their analysis of the matter is thorough and complete. I invite you to take a look at their work (p 339-340), and post your critique here.

    Pie-in-the-sky philosophical test.” The only test that I would ask a treatment to pass is that the benefits outweigh the risks. This is the standard used throughout medical practice. Indeed, it’s probably the yardstick by which all human endeavors are judged. It’s emphatically not pie-in-the-sky, and it’s not particularly philosophical.

    the whims of those who deny that mental illness even exists.” And there we have it! Those of us who argue against the unwarranted medicalization of virtually every significant problem of human thinking, feeling and/or behaving are simply expressing our “whims.” Is this supposed to be some sort of logical argument? Is this a fitting stance for an advocate of skepticism? Steve12, please, please, please – turn the skeptical spotlight on psychiatry. It just doesn’t stand up to scrutiny.

    Again, thanks for your comment, and best wishes.

  • Phil_Hickey

    steve12,

    We “guys” offer alternatives all over the place. The first alternative is to stop
    telling people the falsehood that they are sick and that they are incapable of
    doing anything to help themselves except take neurotoxic chemicals. But on a more important point, are you seriously suggesting that psychiatric treatment reduces the risk of suicide? Please send me the link to your reference.

    Best wishes.

  • steve12

    Thanks for your rely as well.

    I don’t have time right now to get any ECT studies, but I’d be glad to later. That said, my point is not that ECT is a good treatment, but rather that the breadth of the lit needs to be reviewed.

    I think we can cut to one chase, though: Do you believe that there exists, independently of psychiatry, a biological condition that leads what psychiatry refers to as psychosis?

  • cannotsay

    I could be wrong, of course, but I doubt steve12 is able to defend his position beyond repeating “skeptic mantras”. steve12’s position, which is no different from Novella’s, has been challenged by way more “illustrious” members of the skeptic community than themselves, like Jerry Coyne http://whyevolutionistrue.wordpress.com/2011/06/25/is-medical-psychatry-a-scam/ . Funny that Novella goes to praise Jerry Coyne in a recent controversy the latter had with a defender of alternative medicine but one Jerry Coyne makes an even more compelling case against the current practice of psychiatry -including the very notion of psychiatric labels as defined by the DSM-, Novella’s answer is to keep the mantras alive.

  • Phil_Hickey

    steve12,

    I think Read and Bentall did review the breadth of the literature. But as I said earlier, I’d be happy to take a look at anything you send.

    With regards to your question, my answer is an unambiguous yes. The paradigm example is late-stage syphilis. Damage or malfunction in the brain can and does produce problems of thinking, feeling, and/or behaving. I know of no serious contender on this side of the debate who would quibble with this statement.

    But – and this is the catch – this does not establish the fact that all problems of thinking, feeling, and/or behaving are caused by brain malfunctions. The fact that cats sometimes make noises at night doesn’t mean that all nocturnal noises are caused by cats.

    I also say, very clearly, that everything a person does – from the tiniest movement of a finger to designing a building – can be understood and analyzed (in theory at least) as a series of interconnected bodily processes including neural processes. This is true of functional, productive activity, such as holding a job, caring for loved ones, growing vegetables, etc.; and it is also true of dysfunctional and counter-productive activities, such as violence, overeating, etc… Though it also needs to be recognized that our consciousness, self-awareness, and emotionality add a dimension to this neurological underlay that can’t be reduced to the mere firing of neurons.

    But – and this is where I part company with psychiatry – a person with a perfectly normal brain (by which I mean, simply, a brain free from pathology) can acquire dysfunctional and counter-productive habits. A simplistic example would be a child who is raised in a home where criminal activity is the norm will – other things being equal – acquire criminal habits, and probably qualify for a “diagnosis” of conduct disorder. A child raised by parents who are fretful, anxious, worried, etc., will likely acquire these habits also, and perhaps get a “diagnosis” of general anxiety disorder. The brain is neutral with regards to learning. It can learn counter-productive material as readily as productive. The presence of counter-productive thoughts, feelings, and/or behavior in no way establishes the existence of neural pathology, but that is precisely the position of modern bio-psychiatry. There is no requirement in psychiatric diagnosing to prove brain malfunction. It is simply assumed, an article of faith!

    Feel free to come back.

  • cannotsay

    ” I know of no serious contender on this side of the debate who would quibble with this statement.”

    Certainly not me and I made it very clear at the Novella website before I was banned.

    What many of these skeptics struggle with, because their atheism interferes with critical thinking, is that thinking in terms of a “mind” is warranted. The thing that I never understood is why atheism makes the mind irrelevant. Not because I am an atheist, but because the most prominent critic of psychiatry, Thomas Szasz, was also an staunch atheist (so much so that the American Humanist Association awarded him its most prestigious award). I have tried to explain this to these people with the software/hardware analogy in a computer, but they are unable, or unwilling, to admit the point. To them every “mind issue” is due to a dysfunctional brain, even though it is clear, from the examples you mention, but I can also give others, that it is not the case. They engage in scientific malpractice by bringing studies of behavioral correlates with brain imaging as if that proved anything. To this day, a so called “schizophrenic” brain of a death person is no different from a normal brain of a death person. Yet, brains of people with late late stage syphilis, Alzheimer’s or CJD are indeed different from normal brains. Psychiatry is the fallacy “correlation implies causation” taken to the extreme.

  • querywoman

    Psychiatric drugs, along with blood pressure and cholesterol drugs, are the easiest drugs to get in the U.S. Illnesses with symptoms are routinely dismissed as, “depression.”
    I think I am quite fortunate to have had a terrible skin disease misdiagnosed as a “delusion” after the ECT heydey. However, I was given Risperal and Seroquel, which may be as bad.
    After a fresh outbreak of my skin disease called “cellulitis” landed me in the hospital twice, I finally found a decent dermatologist.
    We are both activists. If we each get extra lives to live, we will both fight for skin disease patient rights.
    Nevertheless, the average patient goes to a patient voluntarily for help.

  • Phil_Hickey

    querywoman,

    Thanks for coming in. Psychotropic drugs are indeed easy to get. A great many physicians will write a prescription just for the asking. I think there’s also a trend to push antidepressants on people who have real illnesses under the guise that these products will help with the healing process.

    Best wishes.

  • querywoman

    Yeah, reduce the use of ECT, and they’ll push drugs on us instead. Fortunately, lobotomies have gone out of style.
    Just like if the US gets rid of waterboarding, they’ll just find another tortune method.

    After my blood sugar climbed into the diabetes level, my own symptoms stopped getting blown off.

  • JJ

    I was given ECT about 10 years ago, after a suicide attempt. I had been desperately trying to get help after a serious trauma for a few years with no success. No one, after initially evaluating me (Dx hunt), wanted to take into consideration (or even discuss) the fact that I had just escaped an abusive marriage to a man who had me literally living as a dog for months (let me emphasize, I am being literal here–I ate what the dogs ate, where they ate, and was only allowed treatment as a human…ish.. when allowed to cook and clean for he and his live-in girlfriend), before diagnosing me with a whooooole lot of junk and giving me massive amounts of psychotropics– from bipolar to generalized anxiety disorder to panic disorder to social phobia to agoraphobia to OCD to borderline (I had been abused by my ex-husband and my parents were verbally, psychologically, and emotionally abusive–aka “a pattern of unstable and intense interpersonal relationships”–because victim blaming is still in vogue in psychiatry/psychology) and PTSD (which they didn’t seem to think was very important to deal with in light of all my other disorders). At one point I was taking 16 pills a day (not 16 separate psychotropics, but various amounts of around 4 psychotropics)–lithium, depakote, topomax, seraquil, and lorazopam (okay, 5 psychotropics, 16 pills…all of which I’m positive I spelled wrong). Oh, and ambien. Things got worse (because that many psychotropics WON’T screw someone up?!). I started hearing voices telling me “it’s time” and seeing shadow people above my bed. I swallowed 90 lorazopam and chased them with alcohol to make it all stop (the symptoms that started only AFTER being put on all of that medication). They told me my only hope was ECT. That they were trying to save my life. They said it worked like re-booting a computer, and that it would have a dramatic affect on my symptoms. It did. It made them worse. I barely could remember the days as they rolled one into the next. I sometimes couldn’t remember why I was there. I’d wake up strapped down in a large room with lots of other patients going through who knows what (nope, no private space to undergo ECT, they did it in a packed room the size of a cafeteria) feeling like my head was going to explode it hurt so much, and my muscles! Holy mother of *%&^ they hurt! Then the morphine would wash over me and I’d just float away (I kind of think the morphine contributed to any uplifted mood while undergoing ECT…seriously, it’s an opiate and they gave me lots!). I’ve never had a great memory since. I can remember things I focus hard on and study, but with day to day things it’s a huge problem. Then they shipped me out of state because apparently my problems were too severe for anyone in Utah to handle. I spent 2 weeks at an awful psychiatric hospital, where I witnessed things I’m happy not to recall for you. Then I came home and started burning myself with lighters (note: I didn’t self-harm before this, and haven’t in almost 6 years). I had another suicide attempt. Eventually I gave up on the system and weaned myself–very slowly–off the psychotropics. I didn’t want to wean off unsupervised but the Dr. wouldn’t agree, so I did it myself, and just made sure to go extremely slowly. It took a very long time, because there were a lot of meds, but I did it. The irony is this: I had to lie to the Dr. and tell him I was still taking them as prescribed in order to wean myself off, and the less meds in my system the better I did (imagine that! not having massive amounts of psychotropics drenching my brain was a good thing!), and the Dr. was so very pleased with my improvement…which he, of course, attributed to the medications working as they should. Within a month of being totally weaned, he announced that I no longer needed to see him weekly, as long as I continued taking the meds as (he thought) I was. Ummmmmmmm, no. I have never hallucinated while not medicated. I have never self-harmed while not medicated. I have never attempted suicide while not medicated. And as for ECT, my mood lifted a foggy bit while undergoing it (morphine?). After that, everything got worse. The experience itself was traumatic. Frightening. I guess that doesn’t matter to them though. I still have problems, yes. I fall into dark depressions where suicidal ideation is a major feature, but I don’t get to the point where I see suicide as a real option. I don’t know if I can explain this well, but I can sort of watch the process, and go through it, knowing that it’s not permanent and that I just need to ride it out. And I do. Now I’m in college and I’m making good grades, though I’m doing so late in life. I have done a lot of work on myself, processing things I’ve been through on my own, and that has helped me more than anything. I have good days and bad days, but it’s nothing like while I was under their “care.” My life is worlds better without all those “treatments.” Sorry for spilling my psychiatric life story, but this topic is important to me. Very important. People need to know what patients really go through.

  • Phil_Hickey

    JJ,

    Thanks for coming in and sharing your tragic story. The good part is that you’re doing well today. Your account of the psychiatrist attributing your improvement to the drugs, even though you had come off them, is one I’ve often heard. If you live to be 100, and achieve all sorts of great things in your life, psychiatrists will always attribute your successes to their “treatments.” Psychiatry is not into critical self-appraisal.

    I like what you wrote about “riding out” the rough times. That’s what life is about. We all have rough times. The key is, as you say, ride them out. Psychiatry says no – take pills.

    Again, thanks for coming in. I’m sure that you’re busy with college, but I hope you will find other avenues to tell your story. It’s the survivor network that’s best qualified to critique psychiatry.

    Best wishes.

  • JJ

    You’re welcome and thank you 🙂 You’re absolutely right, riding it out is what life is all about. The funny thing is, when I initially sought help, I thought the help I would get would be talking to someone about my experiences, so that they could help me process them and develop skills for dealing with flashbacks and the like (little did I know…). I am doing well, extremely well, and it’s due to my own work on myself, not meds and ECT. I’m not surprised that you hear that a lot (about patients improving after getting off all those meds), because it’s logical–putting all those mind altering substances into our bodies can’t be good. Messing with the brain is a dangerous game, and doing so for profit is a frightening concept. Oh, and I never had heard of a survivors network before this, but I’m on a roll now lol. As for sharing my story, I intend to wright an autobiography someday. Thank you so much for this site, and for alerting me to the existence of a survivors network.

  • JJ

    By the way, I’m studying psychology lol. I want to be for someone else what I needed most all those years ago, but couldn’t find. I want to walk through people’s ups and downs with them, with compassion and while preserving their dignity and yes, their INDIVIDUALITY (something the current model doesn’t allow for–if you’re different, you’re broken)…oh, and while actually listening to them! I want to help them learn SKILLS to help themselves, instead of convincing them that they are somehow broken or defective and in need of “fixing” (and how many people, like me, have been labeled “mentally ill” for having an understandable reaction to extremely awful life circumstances, which pretty much ensures that if they don’t get out of the system fast they’ll be seriously harmed?) I want to help people see their own worth when they feel worthless. To help them see that being “different” is not necessarily a bad thing. I want to help, not harm, and I want to use my personal experiences within the “mental health” system as a guide to help me avoid harming those I want to help. Oh, and one last interesting (and fitting) tidbit: my father, who was so abusive (while thinking he could claim he wasn’t because he didn’t ever hit me), ran a psychiatric research hospital (a university hospital) for a decade–from the mid 60’s to the mid 70’s–pretty telling in and of itself, isn’t it? Desensitizing “experiments” with his own young (adopted) daughter? Sick. Yeah, I have a lot of reasons to be passionate about this. Okay, I’m done with my rant now lol. Sorry to go on and on.

  • JJ

    *Applause* I’m doing a happy dance right now.

  • JJ

    Steve12, please read my story above. People need to be taught skills and treated with compassion (validation for their very real feelings and experiences too), not loaded up with toxic chemicals, being neurologically damaged through electric shock, and being treated like they’re defective–and this is coming from someone who has been in that dark place, has attempted suicide more than once, and couldn’t get out of the dark place until I got out of this dysfunctional and abusive system and learned how to help myself. I’m now studying psychology in college so I can someday legally help (instead of harm) people in the ways I wish I could have been helped all those years ago.

  • Phil_Hickey

    JJ,

    You’re right. The vast majority of “mental disorders’ are understandable reactions to adverse experiences. I really like your phrase: “messing with the brain is a dangerous game.”.

    Best wishes.

  • Growing

    I wonder if you have any suggestions for me. I have a friend of about 60 who I’ve got to know through a 12 Step mental health recovery group. She has been getting ECT in the 7 months I have known her, every 8 weeks at first and then increased 2 months ago to (I think) every 6 weeks – much to her disappointment. She seems very desirous of participating in the program but falls offline every so often and becomes very vague. She is socially/ family isolated but has a lot of professional supports. I am starting to wonder if it is really doing her any good to be getting zapped so frequently and for so long. The thing is, in my 12 step role and in my recently required working role in a community recovery program, I am mindful of interfering in “professional” decisions. I certainly can’t afford to put the program or my employer into disrepute by influencing my friend, if that influence ends up with bad consequences. But I feel that maybe her isolated situation and extremely troubled history may cause the professionals just to see her as a case to be managed and pacified instead of as a real human person whose potential for growth is intact no matter what she has been through or done.
    Do you or any readers have any suggestions?
    Thank you,
    Growing
    (Australia)

  • Phil_Hickey

    Growing,

    Your comment touches on so many issues. Firstly, the harmful nature of psychiatric “treatment.” There is growing evidence that the primary effect of ECT is a concussion-like syndrome, and this has been widely discussed in the literature.

    Secondly, the professionals involved in your friend’s case almost certainly see her as someone who has a progressive degenerative disease, and they use this false theory to legitimize their repeated assaults on her brain.

    Thirdly, you mention that you are reluctant to interfere in “professional” decisions. I have encountered this same hesitancy from friends, family, clergy, employers, and other potential helpers. This keep-your-nose-out attitude is promoted by the mental health system. Their stance is that this is all very technical; we know what we’re doing; you amateurs will just make things worse. This is one of the great tragedies of the psychiatric mode. The old-fashioned notion of people helping people has been actively discouraged.

    Fourthly, you don’t say how long your friend has been in the system, or what other “treatment” she has received, but it is possible, perhaps even probable, that she has incurred some permanent brain damage. I strongly recommend that you read Linda Andre’s book Doctors of Deception: What They Don’t Want You to Know about Shock Treatment (2009).

    Fifthly, what can you do? I hate to be pessimistic, but maybe all you can do is be her friend. My guess is that she has internalized the notion that she needs these shocks every six weeks, and efforts on your part to dissuade her might cause her to pull away from you. In addition, the mental health system is extraordinarily resistant to criticism of any kind. Attempts on your part to promote your friend’s welfare will probably be dismissed. You will be told that you don’t know what you’re talking about; that you have allowed yourself to get too close to the “patient;” and that perhaps you’re not cut out for this kind of work.

    So, I’m not saying that you should do nothing. But be aware of the obstacles. Also the fact that your friend is going for the shock treatment voluntarily raises ethical issues. Do we have the right to persuade a person away from her chosen course of action, when we’re not entirely certain what the outcome will be? She may have reached such a state of dependency on the mental health system and its “treatments” that weaning her off these could be a daunting task. Do you have the time and energy to support her through this?

    Obviously I’m not aware of the details here. My comments and suggestions are therefore of a general nature, and perhaps some of them may be irrelevant or not applicable. With that in mind, here are some suggestions that might be helpful.

    1. Continue to befriend her.

    2. See if she might be receptive to you accompanying her to her next psychiatrist visit – just to support her – if you feel you can do that.

    3. Encourage her to stay in the recovery program.

    4. Encourage/support her in pursuing social connections.

    5. Encourage her to talk about her troubled history to someone that she trusts, e.g. clergy, counselor, social worker, etc.

    6. Encourage her to be active – especially outdoors.

    And, of course, take care of yourself.

  • Growing

    Many thanks Phil. Your suggestions are informative and reasonable. I will weigh the matter up.