Posts Tagged 'electroconvulsive therapy'

New: iPad Shocking App!

DoodleSince its introduction a year ago, the StayOnTop Mobile Electro-Shock Device has quickly become a tremendous success. Even our most optimistic business plan had not predicted that the “Mobishock” (as people nicknamed it) would become this popular! Mass-produced for us by Wanquan Fengkuang Inc. in Guangzhou, China, nearly half a million Mobishocks have been sold by now.   ;-) 

    Wherever you look, in city buses, pubs, churches, college classrooms, on the street, everywhere you can now see severely depressed people pulling a Mobishock from their bag, attaching it, and quickly shocking themselves back to life. Within a minute, they’re sparkling, shining, and smiling again.

StayOnTop Mobile Electro-Shock Device

    The Mobishock will certainly remain successful for years to come. It works absolutely great. But there were a few minor problems with it.

    Several depressed customers began to complain about the Mobishock’s heaviness and bulk. And we have to admit it’s not really small, you always need to carry it around with you in a special bag. So we asked our engineers (all depressed people themselves, naturally) to develop an even better solution.

Guess what they came up with? Right: the unique, innovative

StayOnTop Shocking iPad App!  

Shocking App Presentation

    Officially released last week, April 1st 2012, the StayOnTop Shocking App can now be downloaded at a nominal price from the Apple iPad App store. The only other thing you’ll need to do, is to order the two heavy-duty plugin cables. These come with special semi-rubberized suction headpads, so you won’t even need any gel.

    The Shocking App offers you a very simple, friendly user interface. On the iPad screen, you just preselect your type of depression (“Incidental”, “Bipolar” or “Chronic”). Next you choose your desired shock level (“Moderate”, “Default” or “Extreme”). Then you hit “Go!” Of course the App will give you a loud warning beep if you forgot to properly attach the cables to your head.

User Interface

    The results are immediate and absolutely amazing. Your depression will be completely gone in a flash! But there is even more.

    Thanks to the fact that the StayOnTop Shocking App generates electrical microbursts of extremely high voltages, in a few seconds it will also kill your iPad. So it does not just free you of your depression. It will also free you of the burden of your iPad addiction!

    Another great feature of the Shocking App is that we minimized the sound nuisance for people near you. It is much less loud than the classic Mobishock. In fact, while you are shocking yourself, your friends will hear only a soft, almost pleasant sound. Click the Play button below to hear the Shocking App in action:


(if the player does not work, install Flash)

    Here at StayOnTop, we’re very proud of this remarkable achievement. This is a superb product. We are very happy to serve the depressed community with this state-of-the-art software technology, and to make you really happy, too!


• note: We regret that, due to a patent conflict that keeps lingering on, for the moment the StayOnTop Shocking App does not yet come with any form of warranty.


Q&A: ECT

DoodleI’ve decided to open a new category: Q&A (Questions and Answers). Here I will try to answer some of your questions, as brief as possible.

Question that was asked yesterday about electroshock therapy:

“Can ECT make me more depressed?”

Answer: No, usually it will not. Not by itself.

But indirectly it can contribute to depression, in two main ways:

(1) Psychologically: for some people, regular day-long hospital visits for intensive ECT treatment can be an extra tiring burden and increase your feeling that you’re a very serious case. This might make you feel more depressed.
(2) As a result of side effects: for a few people, serious effects can occur (like structural long-term memory loss) that may disrupt your daily life or even relationships. Eventually, this also can make you feel more depressed.

We all may react differently, in positive or in negative ways, so it’s hard to tell in advance what the end result will be in your particular case.

But if you think about having ECT as a last-resort treatment for depression, it makes sense to also consider the possibility of a negative end result.


 

Steampunk Psychiatry

Doodle

Sometimes, the narrow outlook of what I’ll call “brain-focused psychiatry” exasperates me. Is depression just a matter of a few loose wires in the computer within our head? Do our feelings really got stuck just because of some faulty connection, some clog in the brain?

    Sure, I won’t deny something like that can play a role, sometimes. In specific cases, a kind of malfunction in our head – something with synapses, hormones, chemicals, whatever – might be one part of a wider, complex set of problems. But there are still psychiatrists who entirely limit themselves to frantically trying to reconnect the wires, to locate that one special little button that will reboot the brain as if it were just a crashed computer.

    They remind me of medieval alchemists – you know, those bearded eccentrics who stubbornly kept searching for the one magic formula that would turn stone into gold.

The Head Of DescartesThey also remind me of the old philosophers who, in the tradition of 17th century philosopher René Descartes (above), tried to understand and analyze and chart the human body and brain as some kind of complicated machine, with virtual cogs and wheels. Most philosophers have since long abandoned such a limited view, but some psychiatrists still seem to adhere to it.

    They keep searching for that one broken cog, for that one loose wire that needs to be repaired. Maybe we should mint a new name for this kind of old-fashioned, narrow-minded psychiatry. Maybe we should call it “Steampunk Psychiatry” (if you don’t know what Steampunk is, see this Wikipedia page).

    The most extreme example of Steampunk Psychiatry is of course ECT (electroshock therapy). What this amounts to, it is like taking your grandfather’s broken old pocket watch, and shaking it violently in the hope it will start running again. Actually this can work in a few cases. When I got ECT myself several years ago, perhaps it did help me a little. But it may cause only more damage just as well. (Let me prevent misunderstandings: this image here does not show ECT. It’s more Steampunk)

Two things got me thinking about Steampunk Psychiatry today.

    The first one is a research paper in the March 2012 issue of the British Journal of Psychiatry, about an experiment by Australian psychiatrists trying to treat depression with tDCS, Transcranial Direct Current Stimulation. For a readable review of the experiment, see here.

tDCS HookupThis tDCS can be considered a milder, more modern form of ECT. Unlike ECT, it is not based on the effect of electricity-induced convulsions: rather, it uses the effects of electricity itself. It involves stimulating specific parts of the brain with currents that are weak enough to make anesthesia unnecessary. As you can see here, tDCS equipment almost looks like iPod earplugs put in the wrong places. This is Steampunk Psychiatry taken to a new level of hi-tech.

    According to the researchers, after a six weeks trial with 64 patients (where some got fake treatment to see the difference) they established that tDCS “is a safe and effective treatment for depression”. I’ll be no judge of that. But if ECT was like violently shaking your grandfather’s watch, we might say this is more like carefully poking into the broken watch with a tiny screwdriver. Perhaps it can indeed help some of us. What bothers me, is the complete lack of any wider perspective on the causes and nature of depression. Would an electric “screwdriver” really be the first thing we need?

    This brings me to my second reason for thinking about Steampunk Psychiatry. My personal reason. Over the last weeks, my own depression has become much worse again. I won’t bother you with the nasty details. I know that I’ve been vulnerable to depression relapses for the last fifteen years anyway: I cannot pinpoint exactly why I’ve been so badly depressed several times. But I do also know that this time, clearly some external factors contribute to my depression.

Finance Paperwork    To mention a few. My present network of friends may be too small for my emotional needs. I also face unexpected financial problems (an old mortgage loan I’m saddled with, has suddenly changed into a burden). For practical reasons, I’m also not happy with the place where I live today. And exactly because I had been getting better last year, I’ve now begun to miss the rewarding challenges of the university job I had to give up because of my depressions eight years ago. Also, I’ve still not been able to cut short my smoking habit, even though I know very well (cough, cough) that I really ought to quit smoking. Need I go on?

    In short, my life is not what I would like it to be, I’m not at all happy with myself. And although I do of course try changing things, it’s unlikely that I can change everything to the better right now. Taken together, all these things add considerable weight to my already present (possibly innate) depression tendencies.

    Would poking around in my brain, in the Steampunk way, be a solution here? Even if it might help a little, I doubt this would be a full and definitive solution. Any psychiatrist who would want to help me, would need to look at my life in a wider perspective: taking into account my inclinations, my habits, my practical problems, my mood swings, my family background, my activities, my environment and so on.

This does perhaps not apply to each of us, but I do think it applies to many of us.

    The problem with Steampunk psychiatrists is not what they do. Maybe some of it can turn out useful. The problem with Steampunk psychiatrists is what they don’t do. Their narrow idea of depression is to just look into it as some kind of mechanical failure, and they forget too easily about all the rest.

Freud Behind BarsOther psychiatrists, all those who have locked up themselves in different theoretical cages, often from their own perspectives make the same kind of mistake. The mistake of limitedness. The mistake of not looking beyond their own walls-of-theory, the cells that happen to confine them. This makes them too partial, too one-sided. Seeking the definitive solution in changing external circumstances. Or in adjusting the patient’s habits. In reprogramming emotional reactions. In furthering self-insight. You name it.

    Those well-meaning therapists who think they can cure serious depression with the right pills, or with a long series of probing analytical talks, or with a program of healthy walks and a natural diet, or with some form of daily-life counseling, or with some form of meditative self-relaxation, are in fact all trying to give us their own kind of short-sighted Steampunk Psychiatry.

Clogged Heart    What I would like, is for psychiatrists to come out of their limited theoretical cells and for once take a look at the rest of the world. I would like them to stop viewing their otherwise oriented colleagues as marginal idiots, and to finally begin to work all together – systematically – to create a more integrated perspective on fighting depression. To recognize that each one of them, from the Steampunk tinkerer to the Freudian listener to the Socio-counselor to the Mindful type, may be a little bit right. And, sometimes, a little bit wrong.

    Now if you’ll excuse me, I need to go. I need to do some urgent repairs. No I’m not thinking of my brain right now, that’s been taken care of already. If you want to know, I was thinking more of my heart. Who can tell me what’s broken in there?


 

Caring for an ECT Patient

DoodleSomeone wanted to know what people can do to care for a family member who is getting ECT treatment (electroconvulsive therapy, electroshocks). Here is a list of things that I think may be important.

    I hope you understand that this post is meant to be purely practical. It has nothing to do with the ongoing discussion about ECT. It is not meant to criticize, and certainly not to defend the use of ECT. For views on ECT, please see my “Shocking” posts series: (1) Waking Up, (2) Into the Void, (3) On Wheels and (4) Blast Past.

Before Deciding

Discuss ItECT will be proposed only if a patient is extremely depressed, and after all other options (therapies, medication) have failed. Unfortunately this often also means that the patient is already in such a bad state, that she may have trouble to make an objective, well-considered decision for or against accepting ECT treatment. She may react in a confused, too-impulsive or too-passive way instead of weighing arguments rationally.

    So the first thing you’ll have to do, is to actively help her making the best decision. ECT may work in some cases, but it can also have serious side effects. Some psychiatrists tend to have a blind spot for the importance of side effects such as temporary or even persistent memory loss. Therefore, some things to do:

 Be well-informed. Collect reliable background information not just from internet and psychiatrists, but if possible also arrange a few talks to get first-hand info from one or two fellow-patients who’ve already had ECT treatment in the same institution.
    Of course it’s best to do this together with the patient herself, if she’s up to it. If not, then summarize what you think is the most important info and share this with her, so she’ll be prepared in the best possible way to make her own decision.

 Insist on being present at all informative and/or preparatory discussions psychiatrists will have with the patient, so that whenever you notice she’s not quite capable of representing her own fears, hopes, wishes or interests, you will be able to participate (and if necessary, intervene) on her behalf.
    Psychiatrists will not always like this, but you should insist. After all, she’s your family; you lived together with her through her preceding years of depression; in many respects you know her better than the psychiatrist does.

 When the psychiatrist says he sees ECT as the best or even the only option, let him clearly explain why. And even if people label the situation as “urgent”, it’s always better to make the good decision after a few weeks’ delay, than the wrong decision in a hurry or panic.
    The very best thing you can do before going through, is (if you can afford it) to go with the patient herself and a full copy of her medical file to another hospital first, and ask a different psychiatrist for a second opinion. An ECT decision really is important enough to take that trouble.

 Finally, do not just make sure that the patient has been free enough to make her own decision. Once she has decided to opt for ECT, make sure this is a convinced decision, not one that still leaves her much in doubt. Serious doubt can lead to panic reversals later on.
    So if you notice the patient keeps fretting about her decision, it’s better to arrange yet another talk with the psychiatrist to relieve her from those lingering doubts.

Before Actual ECT Treatment

What can you do in the days immediately before your family member gets an ECT treatment? This depends from whether she needs to go to the hospital for her ECT only (in which case she can arrive the evening or morning before, and leave the evening or the day after) or if the ECT will be given during a longer hospital stay. Obviously, in the latter case you can and need to do less. I’ll try to cover all.

 The most self-evident thing to do is of course reducing fear and nervousness. Especially before the very first ECT treatment, it is natural for the patient to be afraid of the unknown. So clearly, the best you can in do the last two days before ECT treatment, is to stay with her, distract her a little, reassure her, and if necessary try to calm her down.
    After a few ECT treatments she’ll know what to expect, and probably be not too afraid anymore.

 If the patient is also using medication (antidepressants or otherwise) make sure that in the days before ECT, she adheres strictly to the prescribed doses and does not use extra medication (such as tranquilizers) without the ECT people knowing about it.

Bun Because ECT requires full anesthesia plus muscle relaxants every time, it is important that in the day before ECT the patient keeps to the eating-and-drinking restrictions as explained by the therapists.
    A fairly usual restriction is not to eat anything during 12 hours preceding the ECT treatment. Personally I would go a little further, just to be sure, and avoid giving the patient heavy meals during the 24 hours before treatment.

 The hospital will have told you what things to bring along – items like nightwear. A practical addition I want to add here: if for seeing clearly the patient is dependent from her glasses, put her spare glasses in the overnight bag.
    Putting on her glasses can sometimes help a patient to regain clarity in the somewhat dizzy hours right after ECT. I recommend bringing spare ones because occasionally, at that point it can be difficult to find back the original ones right away.

 We can assume psychiatrists and nurses will have done their home work properly, and will follow the rules for checking both the medical history and the patient herself.
    Still, it won’t do harm to double-check in advance if they are indeed fully informed. You might warn the therapists explicitly to watch out for some things that can cause complications when overlooked:
    (1) a brain lesion, recent concussion, respiratory problem, heart condition;
    (2) loose or metal objects such as hearing aids, contact lenses, piercings.
Maybe I should explain here that one of my own 110 ECT treatments actually had to be aborted because of an acute heart complication. The next times they gave me ECT with a lower voltage; but I do think in my case it would have been safer if that lower voltage had been used right from the beginning.

 Normally the patient needs to be present in the hospital several hours before the actual ECT preparation begins. If possible bring her yourself and stay with her for a little while.
    But do not argue with nurses or others when they tell you it’s time for you to leave. It’s better if your presence does not get in the way of medical routines (like a check-up). Your leaving in a casual way will support the patient’s feeling that she’s now in capable hands.

 The whole procedure (waiting, observations, checking, preparations, ECT, and post-ECT recovery) will take at least several hours. Often, the timing will be such that the patient needs to stay over at the hospital the night before. So if you live near enough to the hospital, just go home yourself. There’s nothing more you can do.

After ECT

Out Of Bed Again!After ECT, the patient will need several hours to recover. Awakening from the anesthesia will happen within about an hour, but regaining full clarity – and physical stability – can in my own experience take much longer.
    Especially in the first three hours or so, the patient may have a nasty headache or the numb feeling of having a brick in her head; she can also have neck or back or muscle pains as result of the convulsions induced by the ECT. In those first hours, nurses will regularly check in to keep tabs on her condition and recovery.
    Within two hours, she’ll be at least drinking a cup of tea again; after seven to ten hours, she may be well enough to go home.

 Don’t go back to the hospital to see the patient before the prearranged time; this is pointless. She needs the time to recover quietly, gradually, without being dragged out of bed or into conversations too soon. Stick to the time you agreed to beforehand with the hospital people, or wait for a phone call.

 This one is important: do not let the patient go home by herself after an ECT treatment. If you cannot fetch her from the hospital, have someone else do it or charter a taxi.
    Occasional waves of dizziness or unbalance may keep returning for one or two days after ECT; during that time the patient should absolutely not drive a car herself, and even walking through busy streets can be dangerous.
    I remember how once I had no option but to use public transport to get home after an ECT treatment. I took a bus to the station and waited on the platform. Seeing a train coming in, I took a few steps forward, but I still was so unstable that I lost my balance and nearly fell in front of the arriving train. No doubt, had I fallen there, people would have labeled it “suicide”…
    You understand, I really can not recommend this. I urge you, do try to organize the trips back home in a safer way.

Headache Back at home, make sure the patient gets a healthy mix of rest and stimulating activities. Just what we always need: so in fact, you need to do nothing special.
    During the first week a few ECT patients may get slight headaches from loud music or watching TV. Others may complain about feeling some kind of numb dullness. With some patience, this kind of thing will gradually go away.
    As far as I know, there are no objections against taking a few aspirins. Of course, letting someone take huge amounts of pain killers is never wise: so again, nothing special.
    In short, I think the best care you can give to someone after ECT is to help her return to normal habits, to normal life within a few days.

 In the rare cases where in the weeks after an ECT treatment a serious, acute physical problem will not go away (such as recurring severe headaches) or if you think something is really wrong or abnormal, then do not hesitate to call the hospital for advice.

 There is one final thing where you as a family member can play an important role: helping both the patient and her psychiatrist to evaluate the effectiveness of the ECT treatment. As a family member you are most close to the patient. So you are in an excellent position to observe – in a more intense way than the psychiatrist, and in a more objective way than the patient herself – if this ECT really works. Can you see it does make a positive difference?
    You also are in the best position to notice long-term ECT side effects. If you discover that the patient cannot really remember that wonderful vacation you took together on the Bahamas two years ago, then there is some cause for alarm.
    Your contribution as observer is especially important in the case of an ongoing series of ECT treatments over a prolonged period. Suppose that after several months of ECT you feel the patient’s depressed mood and behavior have hardly changed, that basically her depression is just as serious as before. Suppose that the patient herself, when you ask her, keeps mumbling something like “I don’t really know”.
    In that case it’s time to organize a new meeting with the psychiatrist, and to reconsider the whole thing. Then you can help the patient to do what we must do with any kind of therapy: weighing the costs against the benefits.

I hope this post, dull as it is, will be useful to some of us. If you think I forgot to note something important here, let me know.


 

Shocking 4: Blast Past

This post is part 4 of a 4-piece series about ECT.
Here are links to the other three parts:

Shocking 1: Waking Up,
Shocking 2: Into the Void,
Shocking 3: On Wheels.

Burning HeadSome eight or nine years ago, my father died. I cannot recall what illness – apart from old age – caused his death. I believe he was in hospital for a while, but I have no idea when or where or how I last saw him. People tell me I made a fine speech at his funeral service (and how in spite of being a non-believer I managed to touchingly recite a traditional psalm). But I myself do not remember anything of that funeral. Not a thing, not a place, not a face, not a word, not a feeling. I just don’t remember. Nor for that matter do I recall anything of how and where my wife and I first met, or of our wedding day. I don’t really remember the events of the day our daughter was born, or how I used to care for her when she was a child. I had to be told my wife once had a miscarriage: I didn’t remember.

    My past is broken, and with it I miss not just an important (defining and guiding) part of my own identity. Because much of the common past I am supposed to share with others is broken, important relationships are damaged as well. A past that needs to be reconstructed from what someone tells you or shows you, is never the same as a shared, remembered past. In daily life this effect is often very unsettling both for myself and for others: it can make people you ought to know well into relative strangers.

    Over the years I kept most of my skills, such as riding a bike or speaking some German and French. Probably (and maybe just because I no longer have my university job) I lost some of my academic experience and knowledge, some elements of my former professional background. But most of all I did lose the actual recollection of many specific events in my life, small and big, happy and sad, trivial or important. From writing books to family vacation trips: I have my own books on a shelf, I have old travel photos to stare at, but I don’t really remember doing all that. Since the time when psychiatrists treated me with ECT (electroshocks, see here and here and here) much of my life between age 25-55 is a blank.

    In an experiment in 1950, when electroshock therapy was still new, a researcher (Irving Janis) asked patients a series of biographical questions both before their ECT treatment, and some weeks and months later. He found that nearly all patients had forgotten parts of their personal history. Whether this memory loss was just a temporary effect or a more permanent problem, remained unclear. Later research (especially since the 1980s) confirmed that many ECT patients did experience memory loss, but such studies often show very contradictory results on the matter of the problem’s scope and permanency. For example, while in the 1990s the American Psychiatric Association claimed that only 0.5% of ECT patients suffered memory loss, official (state-required) statistics for California at the same time showed that 20% of all ECT patients were affected.

Vacation Photo Memory BlurSpeaking just for myself, I can only say that my own memory loss is substantial and real. This memory problem became apparent to me four years ago, when I stopped having frequent ECT treatments. At that time, I awoke from a long-term kind of daze induced by the combination of ECT treatments and strong medication cocktails. Regaining some clarity of mind meant I also became more acutely aware of my memory loss. Over the last four years this has remained a serious problem – my memory seems like a harddisk where some of the folders have simply been wiped. Viewing an old photo and still not being able to remember or recognize its context: a File Not Found effect.

    Just blaming ECT for this (as radical electroshock opposers usually do) may be a little bit too simple. Many other factors should at least be taken into consideration. To name an important one: it is an established fact that an extended period of severe depression may also cause memory loss by itself. As ECT treatment is usually reserved for patients with severe depression, maybe relatively many ECT patients might have developed memory problems anyway? Another factor to consider is of course that when you are getting older, your memory may also degrade just by aging. Are younger ECT patients less affected by memory loss effects than older ECT patients? I have no idea. Yet another question is about the possible results of the ongoing refinement of ECT methods and devices: over the last few decades, did recent patients experience less memory problems than earlier patients? Existing research about all such memory-related factors appears to be fragmentary, contradictory and therefore inconclusive.

    I can only conclude that within existing formal psychiatry, the problem of memory loss as a potential side effect of electroshock treatment never really got the attention it deserves. Somehow the involved psychiatrists tend to regard this problem too easily as a passing, minor effect. Apparently the main question of the effectiveness of ECT as a depression cure – a question that is still provoking heated discussion – is still overshadowing all other questions. I myself once observed an evaluation gathering where former patients met with ECT professionals. Several patients reported serious memory problems, but this did not appear a main issue here: the personal and social consequences of such memory loss were not really meant to be part of an overall evaluation.

    I feel it is very important that this problem finally gets researched in a more systematic and coordinated way. Equally important, it also should get more attention both in the daily context of regular after-ECT-care, and as a factor in the personal decision whether or not to try ECT in the first place. I myself do remember my last ECT treatments reasonably well, but the period of my first ones – some years before, when I was in very bad shape – is just a haze. So I cannot even remember how people have helped me to make a decision about accepting or refusing ECT treatment. I don’t recall anymore if (and how) I was warned about possible memory effects.

ECT    I do not belong to the group of ECT opponents who simply reject ECT under all circumstances. I am willing to accept the possibility that perhaps it may work as a kind of last-resort therapy, in suicidal depression cases where all other therapies failed. But I would certainly like to see better, more thorough research. In the meantime, for myself I am not in a position to judge whether all those electroshocks have really saved me. Maybe they did – or maybe refusing ECT would in the end have made little or no difference. Who knows? Who can tell? Not me. For some specific kinds of medication I can estimate how the price to pay (such as loss of concentration) relates to the result. But I still do not know if the price I may have paid for my ECT treatments (this long-lasting, serious, sometimes crippling loss of personal memories) was in fact worth the result.

    I want to end here with one interesting idea that came up a few times when talking with some of my fellow ECT patients. Are we sure that memory loss is just a side effect of ECT? What if it actually is the main effect, the thing that makes ECT work for some people? The thought behind this is that in a severe depression, looking back to one’s own past may often be a very traumatic experience: the depression makes one’s entire life history into something that feels somber, gloomy, futile and pointless. Both sad and happy recollections then merge into a kind of traumatic component of the depression itself, keeping you endlessly mulling over the past, again and again, in a very negative and counterproductive way. Maybe, according to this theory, ECT sometimes works because by simply eradicating memories, the shocks also erase some of the memory-associated traumatic feelings generated by depression. In that case, some kind of daily forget-everything pill might work just as well


 tip: In my own experience, when you are afflicted by memory loss, having to reconstruct your own past will often become more painful than helpful. When I see old holiday photos and my lack of memory makes me feel miserable, I stop looking at them. Sometimes I even intentionally avoid places or people that may confront me with my memory loss.
    For what it’s worth, here is my general advice. Do not keep trying forever to reconstruct your lost past: try constructing some present and future instead.


 

Shocking 3: On Wheels

This post is part 3 of a 4-piece series about ECT.
Here are links to the other three parts:

Shocking 1: Waking Up,
Shocking 2: Into the Void,
Shocking 4: Blast Past.

Rolling Hospital BedThe hospital where I got most of my electroshocks was a large one. To get me from the psychiatry ward to the surgery unit, I had to be wheeled through various long corridors, crowded halls and into elevators. Rolling along in my hospital bed, I always felt a bit like a fraud. For if I hadn’t been in my underwear and without shoes, I would have been perfectly capable of walking myself. Being wheeled in a bed is strange anyway because even when you sit up in the bed, your head is below the level of other people’s heads. Like in the photo here, this low position temporarily returns you to a child’s perspective. And of course in your bed you are fully dependent on the maneuvering skills of whoever is pulling or pushing.

    Once in the operations unit, I always was parked in a kind of waiting room alongside more bedded patients waiting for an electroshock, or for some real surgery. The waiting was for the operation room (and team) to be free and ready: sometimes this took just a little while and at other times it could take very long. My recollections are a bit hazy here, but I do remember that being left parked in this waiting room always immensely bored me. On the wall were four photo posters that showed nothing but an array of little flowers and leaves: one poster for each of the four seasons. Over the years when I in my bed frequented this waiting room, these dull posters were never replaced with something more distracting. So in due time, I came to completely associate those greenish Four Seasons with the slightly tense waiting time before getting a shock.

    Before I was wheeled on into one of the operation rooms, a nurse would appear at my bedside to do the plumbing. In my arm or my hand I got a needle with a small click-in faucet where right before the actual treatment the necessary tubes would be connected. I cannot clearly remember faces anymore, but I know that I came to fear a few nurses who sometimes had trouble hitting the right vein at the first try. I always felt relieved when I saw appear one of the others.

    In the end, after some more waiting, they would finally roll me into the operation room where usually one doctor with two assistants stood waiting for me. The thing I remember best of their last-minute preparations is when one of them rubbed a few blobs of conductive gel onto my head: this was something I really didn’t like. This gel often felt unpleasantly cold, as if it came straight from a fridge. I don’t think I felt very anxious at that point, but while they fixed things on my head I certainly did feel a bit tense. Sometimes the whole scene with all imposing equipment and people around me seemed almost surreal, as if they were enacting some play scene with me as one of the props.

    Well… thinking of that… please allow me one little joke today:

    But didn’t I promise some time ago to tell you something about pigs? ECT (Electro Convulsive Therapy) was developed in Italy in the 1930s, by the neurologist Ugo Cerletti and two of his colleagues at the Clinic for Nervous and Mental Disorders in Rome. Cerletti, who at the time was concerned more with schizophrenia patients than depression patients, already knew that epileptic fits could sometimes cause a remarkable improvement of a patient’s mental state. In the 1930s sometimes chemicals (metrazol) were used to intentionally cause such fits. But this was dangerous: once convulsions were induced in this way, it often was difficult to stop them again.

    So Cerletti was looking for a safer method to induce epileptic seizures. He already had experimented with electricity by putting electrodes in the mouth and rectum of dogs, but without much success. When he heard that a slaughterhouse in Rome was using electricity to anesthetize pigs before butchering them, he went to take a look and saw that the butchers used electrodes on the sides of the pig’s heads. He also noted that these shocks through the head did seem less harmful than shocks through the chest: unlike some of the dogs in his previous experiments, the pigs were not killed by the shocks but just left unconscious for a few minutes. Cerletti asked and got permission to conduct a extensive series of tests in the slaughterhouse, experimenting with voltages, duration, and electrodes placement.

Ugo Cerletti (1877-1963)    In 1938 he felt sure enough to try this electroshock method for the first time with a human guinea pig. This first electroshock patient was a schizophrenic vagrant who had been picked up in a confused, incoherent, hallucinating state by the police at a Rome railroad station. No one knew what to do with him, so Cerletti got the opportunity to try something new. After a few first tries where the voltage turned out to be too low, Cerletti got it right and managed to induce the convulsions he wanted: “A 110 volt discharge was sent through for 0.5 second. The immediate, very brief cramping of all the muscles was again seen; after a slight pause, the most typical epileptic fit began to take place.”

    After his convulsions the patient remained unconscious for a while, and then woke up with no apparent ill effects. The man seemed to react more coherent now, and even answered some questions. After eleven more electroshock treatments, Cerletti and his co-worker Bini declared him fully recovered: their method appeared to have worked exceptionally well. It was considered such a success that within the next two years, electroshocks were introduced in other European countries and in the US. Also by 1940, muscle relaxants came into use to prevent the bone fractures that sometimes were caused by the force of the convulsions. This was the first of a long series of other improvements (such as applying the shock under full anesthesia) that gradually led to the far less unpleasant procedure we know today.

    I am not yet finished with all I want to tell about electroshock therapy and my own ECT recollections, but for now I want to draw one important conclusion. Until today, ECT has remained a disputed method. People sometimes suggest this controversy is mainly caused by the gruesome (and by present standards unrealistic) electroshock scene in the 1975 movie One Flew Over the Cuckoo’s Nest (see my previous ECT post). But electroshocks already were controversial before that: among other things because of the side effects (more about that later, too).

    I believe there is one much more fundamental cause of all controversy. As shown by the story of Cerletti and his slaughterhouse pigs, the initial development of ECT was never firmly rooted in scientific insight, in a theory.

Eureka: the Final Understanding

    If we define science as doing experiments to test the validity of a pre-formulated theory, then what Cerletti did was not scientific research. What he did was just trial-and-error experimenting until he got the results that he wanted. Even after getting them, he could not explain exactly why his electroshocks produced those results. There was no sound theoretical base, and that theoretical base is still rather shaky today.

    ECT may have worked for many patients. A few years ago it may even have saved myself from suicide. But the reasons why it will sometimes work for depression patients, the underlying processes and mechanisms, are still not understood well enough. Of course there is progress. Recent experiments with magnetism instead of electric current, with better opportunities to limit the treatment to specific parts of the brain, appear to be promising. But I think this kind of therapy will only become less controversial, more generally accepted, after we begin to understand better what makes it work. As long as there is no satisfying theory that explains this, critics will always be able to deride both ECT therapy and its potential results as just a modern kind of witchcraft. In short: what I think that we need here, is more fundamental research.


 tip: A very minor tip… Should you ever end up being wheeled in a hospital bed for a somewhat longer trip, especially if you’re not feeling well, then staring at the walls or ceiling boards flashing by, in combination with unforeseen movements of the rolling bed, may cause nausea. If possible, ask for a position that allows you to look ahead in the direction where you are going.


 


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Today In History:

Arthur Conan DoyleMay 22, 1859 –
Birth date of Arthur Conan Doyle, the Scottish physician and writer who in his popular stories (from 1887 to 1927) created the best known detective ever: the sharply observing and deducing Sherlock Holmes.
   Doyle profiled Sherlock Holmes as an obvious bipolar character, with both manic-active and depressed-lethargic episodes. In the stories, Holmes keeps trying to overcome his periodic depressions by playing the violin (sometimes), smoking (frequently) and using cocaine (as a real addict).
   Portrayed in this way, Doyle's Sherlock Holmes probably was the first popular fiction character suffering from frequent depressions.

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