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John Read: What the Science and Evidence Tell Us About Electroshock
In this episode we discuss:
How Professor Read became interested in psychology, partly because
of difficulties in his younger years and he wanted to understand those
experiences
That his first experiences with patients in a psychiatric ward would
be that people often wanted to share traumatic experiences, but that
the psychiatrists didn’t seem that interested
That, by and large, mental health services around the world prefer
to count symptoms and to medicate rather than to understand what has
happened in a person’s life
How John came to have an interest in and research the efficacy and safety of Electroconvulsive Therapy (Electroshock)
That ECT is designed to induce a grand mal seizure and it started as a treatment for people diagnosed as schizophrenic
That the justification in the 1940s was that schizophrenics did not
suffer with epilepsy and epileptics did not suffer with schizophrenia,
so psychiatry made the leap to inducing epileptic seizures as a ‘cure’
for schizophrenia
That nowadays it is not used for people labelled as schizophrenic but it is most often used for treating depression
How actually it is not the diagnosis that is the best predictor of who gets ECT, it’s age and gender
Women aged over 60 are twice as often given ECT as men, and people over 60 are given it 2-3 times more often as those under 60
That the other rationale given for ECT treatment is the tendency for ECT to obscure traumatic memories because of memory loss
That the science and evidence tells us that after 70 years there has
never been a single study showing that ECT is better than placebo
beyond the end of the treatment period
That placebo in this sense is like sham surgery, the anaesthetic is given but not the electricity
That during the treatment (usually 3-4 weeks and an average of 8-10
sessions) roughly a third of those treated gain some lift of mood but
that even for this minority of responders, the effect wears off after a
few weeks
That this explains why some people will give anecdotal evidence that
ECT saved their life and that they tend to have repeated treatments
because they want the same life of mood
That the method used to assess success of the procedure is most
often a rating scale or a ‘clinical judgement scale’ and these methods
are open to bias
That there is not a single study that has ever shown that ECT can
‘prevent suicide’ when compared to placebo, the claims that it can are
based on anecdotal evidence
That Earnest Hemingway killed himself shortly after receiving ECT
saying “it was a brilliant cure, but unfortunately we lost the patient”
That there are temporary effects such as headaches after the
procedure, but the enduring difficulties are often with memory loss
which can be short term or longer term memories
Roughly a third of people will have serious, debilitating and
ongoing memory loss which is caused by the brain damage caused by ECT
That the Guardian newspaper reported in April 2017 that ECT use was increasing in the UK but that their figures were wrong
That a third of psychiatrists will use ECT, a third will only use it
after other options have been explored and a third will not use it
under any circumstances
That ECT can get catatonic people moving and speaking but it is not
difficult to artificially stimulate mood and it should not be seen as a
cure
That there haven’t been any placebo controlled trials of ECT since
1985 and that was the last of only four that have ever been done that
compared ECT with placebo after the end of treatment
How the fact that we do not have any successful trials showing that
ECT is effective should mean that psychiatry either puts effort into
proper research or that the procedure should be stopped
That John feels that eventually we will look back at ECT in the same
way that we now view lobotomy, blood letting, rotating chairs and the
like
How the principle should be informed consent and that people should
be able to get treatment that they feel will help them but only if they
know fully the risks and benefits and if they have been offered
alternatives
There is a low but signifiant death rate from ECT, partly down to
the general anaesthetic and partly due to cardiovascular failure because
of the induced seizure but this death rate is never mentioned to
potential patients
That it is probably down to the placebo effect of having attention
and a procedure that expectations are created and hope is raised
That there is effort being put now into transcranial magnetic
stimulation (TMS) and people can actually shock themselves using this
method
That if we have large numbers of people walking round depressed, we
really need to start asking questions about our society rather than
trying to artificially eradicate those feelings
That John’s view is that depression is largely cause by depressing
things happening to people rather than because of depressive illness and
assuming that we can identify the parts of the brain that are
‘diseased’
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