Please don’t worry. This is not going to be some kind of dumb rant against pills or the pharmaceutical industry. I just want to show you how what was considered normal in psychiatric health care 50 years ago, is seen a very different light by us today.
And by implication, how what we now think is normal, may be considered weird 50 years from now.
50 years ago, a popular tranquilizer was the drug Nembutal. It is based on pentobarbital, which as a barbiturate is rather dangerous. It’s not only addictive, easily creating drug-dependency. An actual overdose will simply be lethal. It has long remained in use as a strong tranquilizer, for example to reduce anxiety. But in modern psychiatry it has largely been replaced by other, hopefully less dangerous drugs. It is now mainly being used by veterinarians: for euthanizing animals.
In the USA, it has recently also been used as a simple way to carry out executions, replacing more complex mixtures of lethal drugs. In March 2011, Ohio prison inmate Johnnie Baston was the first to be executed by a single-drug dose of pentobarbital (see this Washington Post article). In July 2011, when already 18 people had been executed in this way, the Danish pentobarbital producer Lundbeck announced that it would no longer accept the use of its drug for execution purposes (see this Guardian article).
Flashback to 50 years ago. Here is an old advertisement that shows how back then, this same drug was promoted (and used) for psychiatric treatment of children:
For us today, this advertisement looks just weird. Not just because it presents the use of Nembutal to tranquilize children as something normal. It also looks weird by itself.
It shows a friendly slogan “when gentleness is important”. But this strangely conflicts with the crude, caricatural, in modern eyes almost disrespectful and disturbing way the child is depicted in the image. The kid looks like a little Frankenstein, a little monster. One look at him and we’re supposed to understand immediately why, yes of course, this boy does need a gentle Nembutal treatment, real quick, before he… (fill in your darkest Dracula fantasies here).
I’ll happily leave all other interpretations of this weird advertisement to you.
Now, instead of flashing back 50 years, flash forward, to 50 years from now. To 2062. How will people then look back to today’s practices of easily diagnosing unruly, not-concentrated children as “ADHD” and sedating them with medication, instead of taking adequate educational steps?
Frankly – Frankensteinly – I think those people in the future will find this way of treating children just as unbelievable and weird, as we find this old Nembutal advertisement.
We can repeat this same time-travel thought experiment for many other primitive practices within psychiatry, such as the still far too easy and liberal use of electroshocks. What will people in 2062 think of the fact that I, a depression patient, got electroshocks even after I got a heart failure during one of those treatments?
There are many more examples of still-existing psychiatric primitiveness: again, I’ll leave this little bit of thinking to you.
The point is: if we can clearly guess how 50 years from now people will find us weird, then why should we wait those 50 more years before making some simple, obvious improvements in psychiatry? Let’s be a little more critical about what we’re doing today! Let’s work a little harder! Let that future begin now!
• note: OK. I admit, maybe this whole demonstration here was a little on the demagogic side. But in essence, I don’t think it’s untrue.
Maybe I’m just too impatient? And now I come to think of that, would this impatience be one more cause of depression?
This portrait here is not Emily Autumn, who is filling the rest of this post.
Since 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. 
I’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.
They 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.
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…)
This 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.
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?
Other 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.
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.
Someone 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.
ECT 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.
• 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.
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.
• 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.
May 25, 1965 –
