[nickbarnwell]

There is a both a large and strong evidence base for the usage of ECT in cases of severe, treatment resistant depression. Many aspects of modern medicine can be made to sound barbaric with the right framing; those who disparage ECT are not so quick to characterise chemotherapy as “poison by any other name” or dialysis a “vampiric ball and chain”.

By the time ECT is on the table, every other option is exhausted and the sufferer has been through multiple acute hospitalisations for suicidal ideation, if not unsuccessful attempts.

It is certainly fair to say the effect is not always permanent, that maintenance courses are a burden, and that their long-term efficacy does not justify the risks of the procedure itself or the anaesthesia it requires. Nonetheless, for someone who has been depressed for many years, plagued by crippling ennui and a nihilistic view of existence not even Schopenhauer’s grimmest passages can match, any respite is welcome. To deny them that option, with full knowledge of the risks, is to deny them agency.

[candiodari]

And yet from the article ...

"But he acquiesced when told that if he resisted, the hospital would seek a court order to overrule him."

Are you claiming they would do this, yet have the deeply depressed patient's honest agreement ?

I don't buy that. This was forced, under threat of force. To protect the hospital against having a successful suicide attempt on their record.

Symptoms return. Normal cognitive function does not. That tells you more than enough. This person is now (hopefully lightly) mentally handicapped, and this has been done to her under threat.

You might as well shoot the person. That has the same demonstrated effect. Seriously. Shooting someone with mental problems can fix those mental problems, many documented cases of that happening.

(edit: corrected language)

[jdietrich]

>You might as well shoot the person. That has the same demonstrated effect.

This is ludicrous hyperbole. The majority of people who receive ECT are successfully treated and go on to live fulfilling lives. ECT is an evidence-based treatment for a life-threatening medical condition.

[candiodari]

If it truly was, then why was that person threatened into doing it ? If what you're saying is true, then what possible motivation could the doctor have to threaten his patient into accepting this treatment ? (I get that someone else had to say "yes", but that doesn't change the situation)

Second, I resent psychologists using "evidence based" as a term. This, one might think, implies that they have proof. Well no, no proof. It doesn't mean that.

Ok, but surely it means that they have double blind statistical studies ? I mean, that makes "evidence" very misleading, but ... Yes, but those studies say there is no effect beyond placebo (in fact there are valid studies that say that all of psychiatry does not survive a double blind study). So statistical analyses actually says this does not work.

Ok, so what does "evidence based" mean ? Well, it means they have a few anecdotes of mostly temporary improvement (and lots of anecdotes of disastrous outcomes, conveniently left out). Which certainly exist for shooting depressive patients as well. Also they exist for not doing anything.

So why did the doctor force this treatment on her ? Well, to get her out of his clinic. You see, the way you get fired in a psychiatric department is to have a few patients commit suicide in the department. And observation and isolation only helps for so long. In practice, given 4-12 weeks of trying people successfully commit suicide, even under 24 hour observation with no tools in an isolation cell. This patient had gotten really close to doing that, as mentioned in the article (which, incidentally, would be the conditions this patient was held in prior to her getting asked if she'd agree to this treatment. Which of course also means she is mostly happy with the treatment because it got her out of an isolation cell, and still lives under threat of returning to those conditions. Reality of psychiatric patients).

So this is fact: this doctor forced permanent brain trauma on a patient because he was calculating that this trauma would temporarily prevent the patient from committing suicide, long enough so that she'd be out of his department before she actually succeeds.

So reality is simply that this patient was forced to get ineffective treatment that introduced permanent brain trauma against her wishes, with the decision made under extreme stress (introduced by this doctor), and under threat. That she got lucky and seems to be happy with it does not change that. PLUS she might merely be happy that it got her out of the isolation cell she was forced into for weeks/months before.

So let's go through your statement: > The majority of people who receive ECT are successfully treated If you don't count the permanent cognitive impairment, and the fact that most would have recovered without any help, then sure "successfully".

> and go on to live fulfilling lives.

Nope, most relapse. Unless you count redoing suicide attempts after ~4 months a sign of a fullfilling life. But of course, that's long enough to get them out of the hospital and let the doctor/hospital "not be responsible".

> ECT is an evidence-based

Nope. I know this term "evidence-based" is used in psychiatric literature, but that doesn't change the fact that it's bullshit, as explained.

> treatment for a

Nope. This is not a treatment by medical standards. For that to be the case there would need to be validation. This wouldn't even satisfy the standards for "experimental treatment", as that would require case-by-case review of an ethics board, which hasn't happened here.

> life-threatening

Nope. The vast majority of patients recover from this without any help. So it was not life threatening. Or at least, not any more

> medical

Nope, psychiatry is still not considered part of medicine by doctors.

> condition.

Well this is the only word in your sentence that was actually correct.

[jdietrich]

>Nope, psychiatry is still not considered part of medicine by doctors.

Psychiatry is a branch of medicine. Psychiatrists are medical doctors. Psychiatric disorders are recognised as diseases by the World Health Organisation in the International Classification of Diseases. The Merriam-Webster dictionary defines psychiatry as "a branch of medicine that deals with mental, emotional, or behavioural disorders". Psychiatrists are eligible for full membership of the American Medical Association, the British Medical Association and every other medical association I am aware of, because they are medical doctors.

The rest of your comment is just as wrong as this sentence and just as readily debunked. Due to the length of your comment and the sheer density of falsehoods, I am not inclined to debunk it point-by-point; I would suggest that anyone with an interest in the topic should consult the National Institute for Clinical Excellence's Technology Appraisal on ECT.

https://www.nice.org.uk/guidance/ta59

[candiodari]

Psychiatrists are medical doctors because they need to responsibly prescribe medication. That's all.

That doesn't mean it is considered medicine.

You still haven't explained why the threat of force (and thus force) was used against this patient ... to enforce an elective treatment that results in permanent cognitive damage. I am very curious how you'll explain that one.

(I would like to point out that any treatment that does not prevent death or long-term injury is one that's considered elective)

[mattkrause]

“Force” is a mischaracterisation.

Medicine generally relies on “informed consent”: you have the right and responsibility to know and understand the treatments you are receiving and their possible effects.

Mental illness is tricky because the condition itself impairs patients’ ability to provide this consent. Maybe you’ve got extreme lassitude and refuse everything, for example, even contradictory options. Maybe you clearly do not understand the options presented to you.

Nevertheless, we also don’t want doctors making decisions unilaterally, so the next best thing is to involve a third party. If the patient has a guardian, it’s their call. If you don’t, a court can act as one temporarily, with the idea being that they’ll get you to a state where you can take over. Obviously, this isn’t ideal, but it’s not clear what would be a better approach.

[DanBC]

> successful suicide

Clumsy language like this is a sign that you don't know as much about this subject as you think you do.

[jdietrich]

I don't know why this is being downvoted; the correct term is "completed suicide", because "successful suicide" implies that death is a desirable outcome.

https://www.samaritans.org/documents/1/Samaritans_Media_Guid...