Date » 2008 » January

Defending shock treatments

Jan 4 2008 | Comments 3

Thanks to Jon S. for sending me a book review of Shock Therapy from Slate.com. The review is not so much a summary of the book’s content, but an argument for ECT’s validity as a psychiatric treatment. The review is written by Barron H. Lerner, author, most recently, of When Illness Goes Public: Celebrity Patients and How We Look at Medicine. Lerner avers that over the years, ECT’s efficacy has been called into question by brief cultural moments such as One Flew Over the Cuckoo’s Nest, which he cites twice. He also writes:

Also influential was a 1974 New Yorker article by renowned medical writer Berton Roueche, who claimed that ECT caused permanent memory loss. Because the woman featured in Roueche’s essay was not a representative case, her story exaggerated the importance of a real, but limited, side effect.

Lerner cites “hundreds of studies from a wide variety of institutions” that “claimed [ECT] was effective.” He does not cite the ethical questions of research funding and compromise among ECT’s proponents, nor the most recent studies showing that ECT does not have substantial benefit beyond a few short weeks. Further research on memory loss has shown that it can, indeed, be permanent, and that cognitive deficits can be long-term.

Lerner is Angelica Berrie-Arnold P. Gold Foundation associate professor of medicine and public health at Columbia University, the same institution where Harold Sackheim, ECT’s leading proponent, works. I wonder if they ever have lunch. They’d have a lot to talk about. But that’s just a specious observation. More interestingly, in 2005 Lerner reviewed a book called The Lobotomist by Jack El-Hai, which is a medical biography of the “founder” of the lobotomy, Walter Freeman. I read that book too, and enjoyed it, though I find Lerner’s interpretation of it — as a sort of contextualized defense of Freeman’s behavior — oddly skewed. It seems Lerner is pinning some of his own opinions on El-Hai, but I’m not convinced El-Hai felt the way Lerner describes:

The physician who had been compared to the Nazi doctor Josef Mengele actually appeared to have helped many people. For example, Harry Dannecker, an Indiana man with a long history of anxiety and depression, had been suicidal before he underwent a lobotomy in 1937; during World War II, completely recovered, he worked long hours in a war-materials plant. Among the pieces of evidence stressed by El-Hai are thousands of letters from grateful patients. Freeman and Watts, one wrote, “saved my mind and set my spirit free.”

So, was lobotomy a reasonable intervention for a desperate problem or a routine cause of harm, as Christine Johnson, whose grandmother had a lobotomy in 1954, charges? …

One difficulty in assessing the procedure arises from the nature of Freeman’s research. He kept in touch with as many patients as possible, even traveling across the country to find them. Yet since he conducted no controlled studies, interpreting his data is difficult. For example, since mental illness in any particular patient may wax and wane, it is possible that some patients’ symptoms might have improved even if portions of their brains had not been cut away. And grateful letters may represent a skewed sample. Still, it is hard to deny that some patients who had been institutionalized for years lived apparently satisfactory lives after undergoing lobotomy — even, in rare cases, becoming lawyers or physicians, according to El-Hai.

Those last words are key — “according to El-Hai.” Sometimes book reviewers are able to hide behind them to propel their own points of view, which is one of the great pleasures of book reviewing. Have an opinion but risk little for having it.

Lerner is clearly an accomplished and sophisticated thinker. But he specializes in ethics. Given that focus, I’m wondering if he really did his homework when “reviewing” Shock Therapy. Maybe he’d argue he doesn’t have an agenda. If that’s true, why does Slate’s home page link to his review with the headline: “How Cuckoo’s Nest ruined shock therapy for the rest of us”?

The Body Electric’s New Look: Why shock therapy deserves its mini-revival.

liz | 11:31 AM | Uncategorized

Progressive Vermont considers involuntary meds

Jan 3 2008 | Comment 1

And Republican House Rep. Anne B. Donahue disagrees.

So we want to believe that if our community hospitals can just add a few more bolts to the doors and to forcibly inject medications into patients who don’t comply with a doctor’s treatment plan within a week, they will be able to “handle” such patients quickly and efficiently.

We are willing to build a new, cheaper non-hospital institution for those who don’t respond to medications, but we do not want to recognize that this component is primarily for our own self-interest, to allay our fears about the tiny number of those whose symptoms do include violence.

We don’t seem to be interested in understanding the need for providing both the kind of top-flight inpatient care that is needed for all highest-severity illness, and for the collaborative alternatives that we are trying to encourage among “willing” patients of every other kind.

Involuntary medication acts to divide

liz | 8:22 AM | Uncategorized

Happy news, for a change

Jan 2 2008 | Comments 0

Children%20in%20Uganda[1].jpg

From Reuters:

Gulu is a province in Northern Uganda with a population of 120,000 residents and the site of internally displaced persons camps which house more than 1 million internees. It is located about 110 miles north of the Ugandan capital of Kampala. The clinic there will represent the first sustainable psychiatric service for victims in war-torn Northern Uganda. Doctors and caregivers will treat diseases caused by mass violence and terrorism: psycho-trauma, traumatic depression, PTSD and anxiety syndromes. The clinic opening also marks the opportunity for the PCAF to operate on the frontlines of post-conflict regions and at the same time gather data on the treatment of highly traumatized Ugandans.

“This clinic will serve as a lifeline for an increased number of Ugandans suffering from psychological trauma and marks the first true test of our unique clinic model and our private/public partnership with the government, the academic community and the churches,” said Stephen Alderman, co-founder of PCAF. “It is the second leg of a three phase program to help heal the mental wounds of all survivors in this war-torn country.”

Peter C. Alderman Foundation Announces Opening of New Mental Health Clinic in Uganda

[Image is not of children who have mental illnesses. They're simply Ugandans.]

liz | 5:01 PM | Uncategorized