Talk:Electroconvulsive therapy/Archive 3

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Side effects and complications

THe adverse effects section of this article needs to reflect a more rounded approach to Sackheim's 2007 study of cognitive effects of ECT. A careful analysis of the study shows that Sackheim found that ECT routinely increased cognitive function, except for autobiographical memory, choice reaction time, and simple reaction time, on all the major cognitive tests he devised after 6 months, compared to the patients baseline level. The simple reaction time slowing was only showed in the patients who recieved bilateral sine wave ECT, which by and large is an outdated approach and given to a very small minority of patients in the United States; almost never in private hospitals. The choice reaction time was the only test that showed a clear decrease from the baseline with no indications of improvement. More study should be taken to see how it was affected. However, it should be noticed that even simple reaction time function was improved from the immediate post-ECT time period, and can be predicted to return to baseline levels in time. One should also note that in right, unilateral pulse ECT, all major cognitive functions, including memory were increased compared to pre-ECT levels.

I have edited this section, keeping in mind the Wiki guidelines on how to deal with controversy - to say who says what - and also to use secondary sources in preference to primary ones where possible. So I replaced all the early references with an article by John Friedberg which lists them nearly all. But I have kept the original references so there is no need to type them out again if people want them back. And I replaced mentions of various primary sources on brain damage, just about all of which were misquoted, with several major reviews of the literature. But likewise I kept the references in case any one thinks there is something that is important enough to keep - as long as it is quoted correctly. I was going to say that the issue of persisting retrograde amnesia (gaps in the memory) is controversial with some psychiatrists saying it doesn't occur but I couldn't actually find an example. Does anyone know of a recent (since 2000 say) published example of a psychiatrist saying that memory returns to normal, no gaps or anything?Staug73 18:19, 7 March 2007 (UTC)

I changed it to side-effects (things that can happen routinely), because actually there isn't anything about complications (when things go wrong).Staug73 18:20, 7 March 2007 (UTC)

Overall, I like the changes you've made, and the section reads much more coherently. However, I have to disagree with the slant the article now puts on cognitive deficits.

First, the Philpot study which is now the main reference in the section I cannot find on Pubmed nor Ovid, which raises serious doubts in my mind as to its validity. I can find Michael Philpot's other work, but this paper essentially doesn't exist in the largest of the scientific reference tools.

Further, no distinction is made between types of ECT in discussing them. Brief-pulse ECT, for instance, had only one un-peer-reviewed report of persistent retrograde amnesia in the literature in 2002 (Abrams R. Does brief-pulse ECT cause persistent or permanent memory impairment? J ECT. 2002 Jun;18(2):71-3. PMID 12195133), and repeated attempts to replicate that report (Calev et al 1991. Early and long-term effects of electroconvulsive therapy and depression on memory and other cognitive functions.; Sackeim et al 1993. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.; Sackeim et al 2000. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities.; Lisanby et al 2000. The effects of electroconvulsive therapy on memory for autobiographical and public events.) had failed.

I therefore think it's pretty misleading to claim "most psychiatrists now are prepared to admit that people may be left with persistent retrograde memory loss". I'd also like to see the (long-term, objective) study by Squire et al (PMID 7458573) put back in, as although it's 15 years old, it's arguably a whole lot more valid than asking people with serious mental illness how their memory is (which is not to say that is invalid, merely that as a research technique it leaves a lot of room for improvement.

I very much like what you've done with the section on structural brain changes, although I feel that at least the prospective study referenced <ref>{{cite journal | author=Coffey C, Weiner R, Djang W, Figiel G, Soady S, Patterson L, Holt P, Spritzer C, Wilkinson W | title=Brain anatomic effects of electroconvulsive therapy. A prospective magnetic resonance imaging study | journal=Arch Gen Psychiatry | volume=48 | issue=11 | pages=1013-21 | year=1991 | id=PMID 1747016}}</ref> should be restored, as should mention of the fact that brain abnormalities are common in schizophrenia and other mental illness: something like: Although some work has found brain abnormalities in those who have had ECT<ref name="colon">Colon EJ, Notermans SLH (1975) A long-term study of the effects of electro-convulsions on the structure of the cerebral cortex. ''Acta Neuropathologica (Berlin)'' 32:21-5. PMID 1146505.</ref>, it is not known whether these were present before the treatment, as many schizophrenics have abnormal brain anatomy as part of their condition,<ref>{{cite journal | author=Turner J, Smyth P, Macciardi F, Fallon J, Kennedy J, Potkin S | title=Imaging phenotypes and genotypes in schizophrenia. | journal=Neuroinformatics | volume=4 | issue=1 | pages=21-49 | year=2006 | id=PMID 16595857}}</ref><ref>{{cite journal | author=Honea R, Crow T, Passingham D, Mackay C | title=Regional deficits in brain volume in schizophrenia: a meta-analysis of voxel-based morphometry studies. | journal=Am J Psychiatry | volume=162 | issue=12 | pages=2233-45 | year=2005 | id=PMID 16330585}}</ref>, <ref>{{cite journal | author=Keshavan M, Diwadkar V, Montrose D, Rajarethinam R, Sweeney J | title=Premorbid indicators and risk for schizophrenia: a selective review and update. | journal=Schizophr Res | volume=79 | issue=1 | pages=45-57 | year=2005 | id=PMID 16139479}}</ref>, <ref>{{cite journal | author=Tanskanen P, Veijola J, Piippo U, Haapea M, Miettunen J, Pyhtinen J, Bullmore E, Jones P, Isohanni M | title=Hippocampus and amygdala volumes in schizophrenia and other psychoses in the Northern Finland 1966 birth cohort. | journal=Schizophr Res | volume=75 | issue=2-3 | pages=283-94 | year=2005 | id=PMID 15885519}}</ref> as do some depressive patients<ref name="Dolan1986">{{cite journal | author=Dolan R, Calloway S, Thacker P, Mann A | title=The cerebral cortical appearance in depressed subjects. | journal=Psychol Med | volume=16 | issue=4 | pages=775-9 | year=1986 | id=PMID 3823294}}</ref>Nmg20 22:09, 7 March 2007 (UTC)

I have restored the Calloway CT study and the Coffey MRI study. Also exchanged the Rose not in Pubmed study for one that is (although I don't think that it matters much). I was quoting the study to show that it is a "significant minority" who experience persistent memory effects, rather than "everyone" or "hardly anyone". I will put the Squire study back in although I think it needs a bit of background. Also the Lisanby study. I will add "bilateral" to the bit about memory loss. In the UK about 95 plus per cent of patients receive bilateral ECT, so discussions about unilateral are largely academic. I think the section is getting a bit long. I might split it into memory/structural.Staug73 12:11, 10 March 2007 (UTC) Re unilateral/bilateral: in the US the proportion of people given unilater is slightly larger, about 25 per cent I think, but still a minority. I have a feeling Australia and the Scandinavian countries might use unilateral more frequently. I didn't put back the articles about neuroimaging and schizophrenia as the vast majority of ECT patients in Western countries are being treated for depression not schizophrenia, and anyway I think the point is covered the description of the Calloway and Coffey studies.Staug73 12:37, 10 March 2007 (UTC)

70% women

The sentence "About seventy percent of ECT patients are women" doesnt mean anyting without a reason behined it. Please explain why this is true. This comment was added at 09:05 on 10th March 2007 by User:65.39.21.249. New comments go at the bottom of the page; four tildes like this ~~~~ will sign your name and datestamp your comments.

It's an observational piece of data backed up by a reference; I'm afraid I don't know why it's true, but perhaps the paper cited suggests a reason? Nmg20 09:07, 10 March 2007 (UTC)

I believe it might do with women being more willing to seek professional medical help than men. In general, women will tell others if they suffer from depression, whereas men will usually keep it to themselves and eventually commit suicide instead of seeking help. Something about societal roles and pressure. I'm not a psychologist, so take it for what it's worth. =) Jumping cheese ^Cont@ct 05:29, 17 March 2007 (UTC)

another possibility is that more women have severe depression then men.--scuro 20:50, 5 May 2007 (UTC)

Yet another possibility: most electroshock docs are men. The farther away from the doctor that a patient is, in terms of gender, race, faith, socioeconomic status, etc., the more likely it is that a psychiatric label is applied and a treatment course either recommended or forced upon the patient. JuneTune2 17:56, 19 May 2007 (UTC)

That idea doesn't hold true. Blacks are "vastly under represented" in those who have had ECT. Sounds like if you don't have the dough you don't get the treatment.--scuro 20:19, 19 May 2007 (UTC)

In Canada, medical care is free. And, even in the United States, I would wager that unwanted electroshock is a regular and free occurrence in state mental hospitals. That one particular race is "vastly underrepresented" (if true) does not demolish the theory I stated above. JuneTune2 22:12, 19 May 2007 (UTC)

Rudorfer in Chapter entitled Ecectroconvulsive therapy states, that more then one 1/3 of the patients were 65 years of age or older which he attributes to the "well recognized advantages of ECT in the elderly". He states," as depression is diagnosed more commonly in women then in men, it is not surprising that most individuals who receive ECT are women". About race he states, "that ECT is predominantly used for the treatment of white individuals". Stating in a 1986 sample that African Americans made 23% of total inpatient sample but only 1.5% percent of the ECT subjects. As for state hospitals he said, "In contrast to it's origins in the public mental health sector, in the US ECT now is primarily a treatment offered in private general and psychiatric hospitals...relatively few public institutions provide ECT".--scuro 12:54, 21 May 2007 (UTC)

It could also be due to the greater proportion of women who suffer from clinical depression. 50% more women than men have the condition, which would mean that - assuming equal numbers have severe enough disease to progress to ECT - you'd expect 66% or so of those undergoing ECT to be women. I think that's close enough to 70% for me to disregard the idea there are sinister forces at play. Nmg20 13:24, 21 May 2007 (UTC)

Yes, thank you Nmg20. No one notices that women are more likely to have depression in the first place. Take all depressed patients, treat a random sampling of them with ECT, and the percentage people belonging to one group that treated with ECT will be the same as the percentage of people in that group in the first place.--Loodog 03:01, 2 June 2007 (UTC)

50% more women than men have the condition - you'd expect 66% or so of those undergoing ECT to be women. I think you need to take another look at the maths.Staug73 13:01, 2 June 2007 (UTC)

Say you have 40 men with clinical depression; you then expect 50% more women, i.e. an additional 20, giving you 40 men and 60 women. So 60%, not 66% - so I was a little out - but the difference is still far from dramatic, and certainly not enough to support any wild accusations about it being due to men prescribing the treatment... Nmg20 13:31, 2 June 2007 (UTC)

What the article actually says is: About seventy percent of ECT patients are women. This is largely, but not entirely, due to the fact that women are more likely to receive treatment for depression. It doesn't sound terribly wild to me.Staug73

I'm not sure I see what your point is? I'd suggest any discussion of why more women get treated (it's only up until 50-odd, I think), belongs in articles about depression... Nmg20 14:18, 2 June 2007 (UTC)

My point is this: you were saying that the statistics do no support "wild accusations". I was saying that the article is not making any wild accusations, but merely reporting the situation accurately.Staug73

That was directed at User:JuneTune's post above - "The farther away from...." etc. The information should definitely be in there - but this whole thread on the discussion page seems to me a bit of a waste of time. Nmg20 20:53, 3 June 2007 (UTC)

Is the article biased?

It is totally banned in some countries due to significant questions about its benefit. I do not see a mention of countries who have decided that it is unethical to treat patients with this method. I question the positive slant in the article and request that the article be edited to reflect the true controversy on this topic. —Preceding unsigned comment added by 203.59.117.96 (talk • contribs)

I don't think there are any countries where ECT is totally banned, that is where the government has told psychiatrists that they must not use ECT. There are one or two where psychiatrists have decided to stop using ECT, for example Slovenia.[1] I will put something about Slovenia in the current use section. Staug73 14:15, 18 March 2007 (UTC)

I have added Slovenia to the current use section, and also added quite a bit to the controversy section. Footnotes for Cameron and Bailey to follow.Staug73 18:37, 20 March 2007 (UTC)

The article is totally pro-electroshock. Giving it a pretty name doesn't make it anything more than zapping a persons brain to erase why they feel bad. Its a barbaric practice, and should be treated as little better than drilling holes in peoples heads to let the spirits out.

I think the "drilling holes" you're talking about is called Trepanation [2], and it wasn't really used to "let the spirits out." Osillaj 00:59, 17 May 2007 (UTC)

Effectiveness

I have removed 74.33.121.113's addition pending a more specific source. 74.33.121.113 was it an article you read on ect.org? If so, which one?

"ECT.org reports that 80 percent see results with a full treatment. A full treatment usually consists of 3 treatments a week for 2 to 4 weeks"

I take the point that the Surgeon General is quoting typical figures, and that individual pieces of research have come up with higher or lower figures. I will find a couple of examples.

The number and frequency of treatment is already covered in overview and in current use.Staug73 10:59, 24 March 2007 (UTC)

Footnotes in famous people

I have removed footnote 61 as it was the only footnote in the famous people section. I think it is enough to click on the name and then people can find books etc. Many of the people on the list wrote books, have websites etc, if they all had a footnote there would be 100s. I think it would be a good idea to keep this section footnote free. What do other people think? Also you need to say why someone is famous (I have called Andy Behrman an American writer). I am not sure if he actually belongs in this section - all the other people were famous for something other than having had ECT. Is Andy Behrman famous for anything?Staug73 14:38, 16 April 2007 (UTC)

I have removed Andy Behrman from the famous people section and instead put in a quote from his book in the nonfiction section, with a footnote to the book (not a personal website)as per wiki guidelines. If anyone wants Andy Behrman back in famous people please could they explain why. I removed him because the only thing he was known for before writing Electroboy was getting convicted in a fraud case.Staug73 17:39, 18 April 2007 (UTC)

POV

ECT is the most effective treatment for depression. It is commonly utilized and medically accepted. This article does not reflect that. Also this is crap:

The 1970s saw psychiatrists becoming defensive and for the next three decades persistent memory loss was dismissed as mild and infrequent or a figment of the patient's emotional state.[57] It is only in more recent years that some psychiatrists are again acknowledging the existence of persistent memory effects after ECT, with a recent article by a Dublin neuropsychologist and psychiatrist even suggesting that ECT patients who experience severe effects should be offered some form of cognitive rehabilition.

1. "Pychiatrists becoming defensive"?
2. One article constitutes a changing paradigm?

"The controversy is also fueled by the fact that no-one knows how ECT works."

• No one knows how any psychiatric drug treatment works.

"...until the mechanism of action is more fully understood, ECT remains vulnerable to the accusation from some critics that it works by inflicting brain damage on patients."

• God, so does anything. Until the mechanism for caffeine is understood, it remains vulnerable to accusation from some critics that it works by inflicting brain damage on users.

"Formal neuropsychological testing has documented permanent neuropsychological deficits in ECT patients,[8] including an IQ loss of more than 30 points in one."

• Says one study. Depression is shown to result in IQ loss.--Loodog 04:36, 27 April 2007 (UTC)

I have removed the paragraph in controversy on mechanism of action (and with it the tag), as the main point - that it doesn't have a clearly understood mechanism of action - is covered in the mechanism of action section. But I think the paragraph on memory loss should stay as memory loss is an important source of controversy. I have removed the word "defensive". The Dublin article wasn't intended to illustrate the point that some psychiatrists acknowledge persistent memory loss (there are a number of articles that do that); it was intended to illustrate a point about "controversy" with the quote from the authors. I hope I have made that more clear by dividing the sentence. I will add a few footnotes. I don't want to clutter the article with footnotes but will definitely put one in for the early ideas about memory loss, and a couple for the persistent memory loss bit.Staug73 10:33, 28 April 2007 (UTC)

I have now removed the historical element in the bit on memory loss and controversy and reduced it to the minimum - with sources.Staug73 11:44, 28 April 2007 (UTC)

By the way, I agree that ECT is "commonly utilized and medically accepted" and I think the article makes that clear (see for example the first paragraph of the controversy section). But I think the controversy section also needs to try and explain why ECT retains a negative public image.Staug73 11:55, 28 April 2007 (UTC)

I have added a POV tag to the ETC section. I have aleady posted reasons for doing so here.

http://en.wikipedia.org/wiki/Talk:Anti-psychiatry#POV_ECT.2C_Misleading --scuro 21:57, 28 April 2007 (UTC)

I have removed the POV tag pending an explanation on this page (not on the discussion page of another article) of where Scuro thinks neutrality has gone astray. Scuro, it would be helpful if you could explain which particular sentences you have a problem with and why. This is Staug73 - I can't log in. —The preceding unsigned comment was added by 81.102.15.210 (talk) 14:18, 29 April 2007 (UTC).

This section and in fact the whole article...has story telling going on. We are lead along from horrors of the past to current problems in some country like Turkey. It is one sided. This article lacks objective balance and exudes bias. By tainting the present with past practices the authors create bias, when in fact current ETC practices are considered save and effective when used properly. What this article desperately needs is a history section. Then the many subsections can be edited and all the history can be put in the history section. Perhaps the authors can self edit, I'm afraid I'd make major edits.--scuro 17:07, 29 April 2007 (UTC)

I think the article is leaning a little too far towards accentuating the downsides of the treatment - whether it's actually POV as it stand I don't know; my inclination is not. I'd be very happy to see a rewrite done, though, even if it involves "major edits" - having an idea of how you'd like the article to be at least would give us specifics to discuss, and probably a healthy selection of pro- and con- literature from the scientific press to review... Nmg20 20:34, 29 April 2007 (UTC)

Then with your blessing I'll try a "history edit" soon. I'll rename the "origins of ETC" to "the history of ETC". Generally I'll move things around into that section and prune the repetitive material. Some material that is highly dependent for relevance on the history stuff may also get cut. That may go a long way to bringing neutrality to the article.--20:42, 29 April 2007 (UTC)

"Many studies from the 1940s, 1950s and early 1960s found evidence of damage to the brain." This article spends disportionate time on long discredited work from decades ago, giving the appearance that ECT still wildly controversial today. This needs reweighting.--Loodog 04:37, 30 April 2007 (UTC)

Actually, no, electroshock is still wildly controversial today. JuneTune 23:20, 12 May 2007 (UTC)

Care to reference the "wildly controversial" present day claim?--scuro 21:35, 13 May 2007 (UTC)

In countries where ECT is not practiced humanely, I'm sure it's controversial. Among people who still think ECT is administered without anesthesia in this country, I'm sure it's controversial. But, even looking at the "recent survey in the UK", psychiatrists and nurses in mental health give no credence to "wildly controversial". I'd hesitate to even add the psychologists' opinions since they aren't medical doctors, except it could argued they too are mental health professionals. Until anyone finds better, I'm just going to start throwing the first surveys I find on google regarding concensus.--Loodog 22:51, 13 May 2007 (UTC)

And on that note, looky what I found regarding concensus: results of 67 Texas state hospital psychiatrists surveyed. Highlights:

• 94% thought ECT should be available to their patients
• None thought ECT was "unacceptably dangerous"
• 92% would consider use of ECT on themselves or family member if clinically indicated--Loodog 23:07, 13 May 2007 (UTC)

Loodog, electroshock is controversial even when it's practiced "humanely" (by which I guess you mean under anaesthesia). It "could be argued" that psychologists are mental health professionals? Wow, talk about going out on a limb, there! Electroshock is opposed by most psychiatric survivor groups and dissident mental health professionals, among others. There have been various cites on this talk page to survivor groups where it's much discussed but, if you want me to, I'll cite them again. Quoting psychiatrists saying "Rah! Rah! Bring it on!!!" about electroshock isn't very compelling. We should be listening to neuroscientists, researchers not industry-sponsored, electroshock survivors, etc. JuneTune2 22:59, 19 May 2007 (UTC)

I cited a source, have you?--Loodog 00:25, 23 May 2007 (UTC)

controversy [2]

Created new article for this section. It was getting very large. --scuro 02:18, 30 April 2007 (UTC)

Intro

I have made a few changes to the intro, which should serve as a brief explanation of ECT for readers with a short attention span, and not at least put off readers who want to continue with the article. I think it is important to keep the intro (and possibly overview) free from footnotes. I have removed the sentence about catatonia because only a small minority of ECT patients have the diagnosis of catatonia and it rather repeated an earlier sentence about ECT usually being used where drugs have failed. I have adjusted the sentence about "minority of health professionals...etc" to more accurately reflect what has emerged from various surveys. The bit about patients being divided in their opinions of ECT comes from a wide range of sources for example the NAMI-NIMH consensus conference which is in the list of internet sources if anyone wants to check.Staug73 13:43, 30 April 2007 (UTC)

I also removed "the perceived benefits of the disorder" because it doesn't make sense. And "for a very small minority" re memory loss because the research cited later in the article show that it is a large minority. But I think we should keep the intro simple and not start arguing over percentages. In fact I think it would be okay to remove the 3rd paragraph as it is all covered later.131.111.164.231 14:54, 30 April 2007 (UTC)

I slightly changed the wording to high rate of relapse in order avoid using "some" which has been queried elsewhere in the article.

Citations

I see now that some people think that the article doesn't have enough footnotes. For the time being I am removing the citation tags because they don't improve the article. I will explain individual instances here, and then people can decide which footnotes they want to include. Could I ask people though to read the wiki guidelines on citing sources and to think carefully about whether a particular footnote is really necessary.

Overview:

As a result of continuation/maintenance ECT or numerous short courses of ECT some people have large numbers of treatments[citation needed].

I put in the sentence about large numbers of treatments because I didn't want readers to be left with the impression that people have six treatments and that anyone who says they had 100 treatments is lying. The information comes from a wide variety of sources: some clinical trials give details of previous ECT and you will see ranges for individual patients from 1 to lots. (for example in the Calloway and Pippard references cited and probably also in the more recent Texas statistics though I will have to check that). And two recently published books describe the authors experiences of large numbers of ECTs - Jonathan Cott's and Cathy Wield's. For example I could put in a footnote along the lines of: "British doctor Cathy Wield described her experience of over 100 ECTs in her book Life after Darkness... Or would people prefer a more academic reference?

Older depressed patients are more likely to receive ECT than younger ones[citation needed]. This is covered in the Rudorfer reference, under "Age". Also, there are statistics from Scotland which show that older people who are admitted to hospital with a diagnosis of depression are 3x as likely to receive ECT as younger ones.

In Asian, South American, and African countries ECT is still commonly used as a treatment for schizophrenia as well as depression and, in some hospitals, is still given without anaesthesia or muscle relaxants[citation needed].

There is a reference to Turkey in another section. There was a survey of ECT in Asia published a few years ago in, I think, the Journal of ECT. I will track down the reference, also one for Africa and South America.

In spite of seventy years of research, no-one understands exactly how ECT works[citation needed][original research?]. The most commonly accepted theory is that ECT's mechanism of action is similar to that of antidepressant drugs and involves neurotransmitters, in particular dopaminergic, serotoninergic and noradrenergic systems[citation needed].

Both these are from Rudorfer, or is someone disputing the "most commonly accepted" bit? I think Rudorfer treats them all equally so I will take that bit out.

So, that is several footnotes fixed with Rudorfer. It just leaves a couple which will be there in a day or two.Staug73 14:20, 30 April 2007 (UTC)

The general rule is throw in every reference you have. If you have a specific fact, cite the reference for that. If you are mentioning too many things from too many sources to where it becomes cumbersome to source every sentence respectively, you can always list the references consulted at the end of the article without specific page numbers (thought that'd be nice). Remember verifiability, not truth!

As for the fact tags, I'm putting them back in. The fact tags aren't there to make the article look better; they're there to alert readers of the lack of sources, and to encourage other editors to find the appropriate sources and insert them. Removing them defeats both of these purposes.--Loodog 15:00, 30 April 2007 (UTC)

Citations-a rebuttal

I see now that some people think that the article doesn't have enough footnotes. For the time being I am removing the citation tags because they don't improve the article. - This statement is simply wrong. Articles in Wiki are not static. They change, they are living documents. They improve over time because people with different viewpoints communicate and reach an understanding. Different authors have a net additive effect to the quality of an article. A citation is a request for information or communication. To eliminate them is to zap the life out on an article.

Citation request #1 As a result of continuation/maintenance ECT or numerous short courses of ECT some people have large numbers of treatments[citation needed].

I put in the sentence about large numbers of treatments because I didn't want readers to be left with the impression that people have six treatments and that anyone who says they had 100 treatments is lying. The information comes from a wide variety of sources: some clinical trials give details of previous ECT and you will see ranges for individual patients from 1 to lots. (for example in the Calloway and Pippard references cited and probably also in the more recent Texas statistics though I will have to check that). And two recently published books describe the authors experiences of large numbers of ECTs - Jonathan Cott's and Cathy Wield's. For example I could put in a footnote along the lines of: "British doctor Cathy Wield described her experience of over 100 ECTs in her book Life after Darkness... Or would people prefer a more academic reference?

I asked for the citation to get a sense of the quantity ("large numbers") of ETC therapies that one person could have, but more importantly to learn what segment of the ETC population ("some") have "large numbers" of treatments.

Citation request #2 Older depressed patients are more likely to receive ECT than younger ones[citation needed].

This is covered in the Rudorfer reference, under "Age". Also, there are statistics from Scotland which show that older people who are admitted to hospital with a diagnosis of depression are 3x as likely to receive ECT as younger ones.

I scanned the article again and didn't see that citation. Really a fellow editor shouldn't have to go on goose chase...provide the citaton or at least post it in discussion. Sometimes a reader or fellow editor will want to look at the source. They may neither question the validity of information or the source for the information. They may simply want to see the information because they believe they can state the information better or in a more neutral way and that is easier to do with the citation where the information came from.

Citation request #3 In Asian, South American, and African countries ECT is still commonly used as a treatment for schizophrenia as well as depression and, in some hospitals, is still given without anaesthesia or muscle relaxants[citation needed].

There is a reference to Turkey in another section. There was a survey of ECT in Asia published a few years ago in, I think, the Journal of ECT. I will track down the reference, also one for Africa and South America.

A broad sweeping world statement of present ETC use requires excellent reliable sources that are in a position to make that judgement and have clearly done so.

Citation request #4?, #5?, #6?, #7?, #8?, #9, ...etc...where are they? All obliterated with not even the courtesy of a mention as to why they were deleted. Wikipedia has a policy on consensus for a reason. Will my citation requests be reinserted or do I simply undo all edits with an undo back to last night's version? --03:32, 1 May 2007 (UTC)

I am adding citations. You will find the Rudorfer discussion of age at the bottom of column one of page 1868 of his chapter which is now footnote one. As a footnote that is probably sufficient but there were similar findings from a survey in Scotland, which I will add tomorrow.Staug73 15:37, 1 May 2007 (UTC)

Psychological effects

In addition to the physiological effects, ECT may also have adverse psychological effects, counterproductive to its commonly stated goal. These effects may include post-traumatic stress disorder. Instances of such a case have been recorded by David Armstrong.

I didn't want to cut this bit as I didn't put it in, but I am anxious to remove the "unsourced statement" tag so I have moved it here. Following the link, it appears that this is an unpublished paper. Perhaps someone would like to find a published reference.131.111.164.231 15:40, 30 April 2007 (UTC)

Techniques and equipment

"It took many years for these modifications to be widely adopted and even today they are not universally used. In the USA and the UK for example, bilateral electrode placement is still used more commonly than unilateral, with many psychiatrists finding bilateral more effective and easier to use although there is widespread agreement that it causes more memory loss than unilateral." Someone queried this, but I am not sure which bit they are querying. I have moved the Kiloh footnote to the end of the sentence as they discuss this at some length (the fact that unilateral is not widely used although it is generally considered to be less damaging). Of course Kiloh doesn't include the latest figures for electrode placement in UK and USA but the USA figures are in the next sentence. In the UK electrode placement is nearly always bilateral - I think the reference is somewhere in the article (current use?) but if people think it is important I can reword this bit and put in another footnote.131.111.164.231 15:49, 30 April 2007 (UTC)

Sorry, ref to UK electrode placement seems to have disappeared. I will put one in soon. Meantime you can see it [here http://sean.org.uk/AuditReport/Phase1] - "bilateral electrode placement was the treatment of choice..." (near bottom of page under "ECT practice" in Results section)Staug73 16:05, 30 April 2007 (UTC)

Controversy [3]

I have reinstated a brief mention of surveys showing extent of different views, and a short quote from consensus panel summarising reasons for controversy. Staug73 16:43, 30 April 2007 (UTC)

you may think a citation isn't needed

You may think a citation in not needed or that something is obvious but I have inserted a request for citations for information which seemed far fetched, biased, or extraordinary. No one should be removing citation requests without first getting a consensus in discussion. Granted, when things are explained in discussion obvious ideas to you may become obvious to all...but we are no where near that step.

Now we have a problem. I believe the article has major POV problems. It will take several edits to get it to a more neutral POV. The first step was to ask for citations where information was possibly used in a POV way. These citation requests have been removed without consensus. I'd ask that the person(s) responsible for doing this reinsert the citations. The only other solution is to revert the article back to last night when the citations were put in. If I did that all edits since then would be obliterated.

I'D ASK THAT ALL EDITORS HOLD OFF ADDITIONAL EDITS ON THE ETC ARTICLE UNTIL THIS ISSUE IS RESOLVED. YOUR EDIT MIGHT GET DELETED.--scuro 00:04, 1 May 2007 (UTC)

a warning to delete happy editors

Do not remove citations or POV labels on the article without consensus. From here on in I will be issuing warnings on talk pages and seeking further assistance if necessary to stop these practices. --scuro 00:09, 1 May 2007 (UTC)

A FURTHER WARNING - do not remove a POV tag without consensus. A personal warning in a user talk page has been issued. Further actions will be taken if necessary. Two current editors see this article as currently being biased. So many changes have been made so rapidly. For the time being I am simply trying to protect POV tags and citation requests.

I see bias occurring in many places in the article. Information is taken out of context or used to make "global" pronouncements. Information is used in a leading way. I'm sure as I have time to study the content and citations of this article this weekend I can spell it out more clearly. Happy delete editors - leave the POV tag alone. --scuro 03:43, 2 May 2007 (UTC)

I have reverted the article back to predelete version

Sorry to do this to some editors but no one should delete citation requests and no one wanted to reinsert them into the current article. --scuro 16:46, 1 May 2007 (UTC)

I had just finished adding footnotes when you reverted. If you had checked the history page you would have seen a long list done this afternoon. I had looked back to your version of 12:02 30 April, noted all your citation requests and then either supplied at least one reference, or changed or removed text so that a footnote wasn't needed. By the way the two footnotes at the end of paragraph on anterograde/retrograde amnesia (Benbow and Rudorfer I think) cover all the points in that paragraph. I don't think I have missed any of your citations, but let me know if I have. Since all the citations you requested have been provided I shall now remove the NPOV tag. If you wish to re-instate it, please be specific about which sentences are NPOV.Staug73 17:01, 1 May 2007 (UTC)

the intro

"but has a high rate of relapse"-this needs a good citation and "high" needs to be defined.

"A small minority of psychiatrists, a larger minority of other mental health professionals and a majority of the general public are skeptical of it's overall benefits and it remains a controversial treatment[citation needed]. Those who have undergone ECT treatment are divided in their opinion of it[citation needed]"

A study from Britan or Australia doesn't cut it as a source for any of the above statements. What happens there doesn't necessarily happen in the rest of the world. Reword, provide further citations, or delete that section. The statement, "divided in their opinion" does state anything. Society is virtually divided in their opinion on most intervention...eg counselling. Reword or delete. that sentence.--scuro 12:10, 2 May 2007 (UTC)

I have removed the above paragraph because it was slightly clumsy, the points are covered in more detail elsewhere and I think it is important to keep the introduction brief, factual and footnote-free. I have inserted "controversial" into the first paragraph because it accepted by virtually everyone that ECT is controversial. For references see the controversy section. Plus I have removed the POV tag as the article is now impeccably sourced and neutral. If anyone can spot any POV statements please draw them to my attention and I expect there is something we can do about them.Staug73 13:40, 2 May 2007 (UTC)

In reading the Rudorfer overview, the effectiveness of the treatment is repeatedly mentioned, especially if the treatment is individualized for the patient and the treatment is used for specific disorders where it has been shown to be effective. eg an acute episodic case of depression. In some instances ETC should be the first line of treatment when the patient is an immediate danger to themselves...eg suicide. What can be regarded as the intro's only mention of the effectiveness of the treatment would be the line, "but it has maintained an important place in psychiatry". Changes should be made...any objections? --scuro 13:56, 5 May 2007 (UTC)

Controversy [4]

I have returned a few of the controversy paragraphs, as I think the article had become a bit dull without them.Staug73 15:35, 2 May 2007 (UTC)

Well done. The controversy section is the most important one of this article. As M. H. wisely stated in your talk page, povs are so polarized here—:

"The article is totally pro-electroshock. Giving it a pretty name doesn't make it anything more than zapping a persons brain to erase why they feel bad. Its a barbaric practice, and should be treated as little better than drilling holes in peoples heads to let the spirits out."

A later comment states:

"ECT is the most effective treatment for depression. It is commonly utilized and medically accepted. This article does not reflect that."

—that "the phrase between a rock and a hard place comes to mind." Cesar Tort 16:29, 2 May 2007 (UTC)

Psychological effects

I have put this section back even though I didn't put it in because I don't think it should have been removed. Could I draw attention to the Information suppression section in the Wikipedia:NPOV tutorial especially "Entirely omitting significant citable information in support of a minority view, with the argument that it is claimed to be not credible." That said, I am not convinced that the Breeding quote is in the right place or presented in the right way. I will give it some thought.Staug73 16:06, 2 May 2007 (UTC)

DO NOT REMOVE POV TAG UNILATERIALLY

At least two editors see multiple POV issues with the article. Personally, I see bias in many sections of the article. I am estimating that it would take me hours to research, and then list all all the potential POV issues of the article in one post. Instead of one large post, I'm going to work from top to bottom. This morning I started with the intro. From my perspective this section no longer has POV issues. Thank you for editing the intro. I'll go down each section as I have time. This process will take several days. DO NOT REMOVE THE POV TAG UNTIL THIS PROCESS IS COMPLETE. In fact, the unilateral removal of citation requests and POV tags has slowed me down significantly in that I have to respond to this as I am doing now. --scuro 16:38, 2 May 2007 (UTC)

treatment section

The main Rudorfer citation is excellent. It is very information and appears to be unbiased. The first paragraph in the treatment is generally good. It could include further info to illuminate readers about the procedure. Rudorfer has a lot more to say on this topic. I've made a few other minor changes. I hope that others will see that generally they add to the article. --scuro 04:05, 3 May 2007 (UTC)

I think that Rudorfer is especially good on the demography of ECT. I have made a couple of slight changes to the following sentences which I think slightly misrepresented Rudorfer.

"In Western countries ECT is usually given as a treatment for acute cases of depression or occasionally used in treatment of schizophrenia and other psychiatric disorders that have not responeded to treatment. As a result it has been called, "the treatment of last resort".[1] "

Firstly I don't think Rudorfer says that ECT is used for "acute" depression. Indeed many of those who have ECT have "chronic" or "recurrent" depression. Re the last resort - I could find 3 mentions of this term. One concerned schizophrenia, the other two depression and I think it is very important to keep them in context. The first comes near the end of the discussion of indications which starts at the bottom of page 1868. Rudorfer explains how guidelines distinguish between first-line indications (not common) and second-line indications, that is where a patient doesn't respond to drugs or their condition deteriorates in spite of drug treatment. He points out that deciding the point at which to use ECT requires individualized interpretation etc and then says: Even where ECT is not used as the treatment of first choice, its introduction sooner in the decision tree rather than being reserved as "last resort" may spare the patient multiple medication trials...." The other mention of "last resort" comes later and says "Given the still widespread view of ECT as a treatment of last resort it is not surprising that failure to respond to ECT is often regarded as synomous with "hopeless case". In fact, most patients have other, if less attractive treatment alternatives available at the time ECT is initially selected, a fact which can be called upon in the event that ECT is not successful".

So I think that what I have said accurately reflects what Rudorfer says: occasional circumstances in which ECT may be considered as treatment of first choice, almost always though used as second-line treatment if medication fails with different views about when exactly to use it with no hard and fast rules (Rudorfer himself seems to favour a sooner rather than later approach - it is of course these different views which account for a lot of the variation in ECT rates) and the concept of "last resort" not altogether appropriate as other alternatives do exist.Staug73 15:07, 3 May 2007 (UTC)

Minority patients

I have moved a sentence from Current use to Treatment to replace this sentence: "The vast majority of ETC paitents are also white." I think minority is a more appropriate term (isn't it the one that Rudorfer uses?). Statements like this very much need footnotes. It had a footnote in Current use which I have just moved with it. I think it is important to specify which country you are talking about as well, Rudorfer is only referring to the US. Don't forget this is an English language encyclopedia, not just American. In the UK, for example, the situation is slightly more complicated. The statistics I have seen would suggest that white people are overrepresented among consenting ECT patients but not amongst non-consenting patients. But I don't think the UK statistics are sound enough to mention them in the article. Staug73 14:10, 3 May 2007 (UTC)

The minority issue is a key issue. For those who believe that ECT is still used to control patients as illustrated in past media depictions, US statics clearly show otherwise. Rutdorfer states of 1986 stats, "African American patients were grossly under represented among ECT subjects". Who typically are the abused?...the minority. When one further reads his overview it is clear that the poor are disadvantaged in receiving such treatment because of the cost and the current very low rate of administration of this procedure in public institutions. I'll make changes to this section using the term, "African American", unless there are objections.--scuro 16:45, 5 May 2007 (UTC)

Controversy over controversy

I have moved a few sentences from the controversy section to what seemed to be the most appropriate section in the rest of the article, and deleted everything that might be considered historical, that is, from 1940 to 1980. I have also written something for the new controversy article. I very much hope that people are satisfied with this. I don't mind if the controversy section here goes or stays.Staug73 17:23, 3 May 2007 (UTC)

For those who think that the controversy section does not tell the whole story the subsection would be a good intro into the topic and link to the ETC therapy controversy article.--scuro 00:48, 4 May 2007 (UTC)

There have recently been some disagreements over whether or not this article is NPOV - also about whether or not it should have a controversy section. Any comments on this or anything else relating to the article would be welcome.Staug73 15:18, 5 May 2007 (UTC)

The article has bias. That's not to say that positive changes havn't been made in that regard. How does it have bias? Not so much in making obviously biased statements but my perception is that positive information about the procedure is minimized. I'll be posting in the discussion area about this. I had put a POV tag on this article several times and it has been removed as many times unilaterally and without discussion. Not a good sign for a community of editors and for the status of the article. I've given up on that, partly because it is pointless but also in part because some editors such as Staug are working on the principle of good faith and to better the article.

Finally I have no problem with a controversy section as long as it is brief. What I see in that section now could probably be integrated in some way into the main article with the caveat that these views would have to be balanced...e.g. negative findings from a report of 1985 is over 20 years old and that is an eon in the mental health field. A good history section could illustrate past controversial practices and still be informative. Controversy to me would be more along "faith" held beliefs that are unsupportable and typical of the Antipsych critics such as John Breeding. He stated that, "Electroshock always causes brain damage". --scuro 16:26, 5 May 2007 (UTC)

On second thought if a whole section of the article has the musings of John Breeding, this article could have major POV issues. I've tended to work top down on edits...who knows what other skeletons lurk in the bottom of the article. As I read through the article again, I am struck at how always ECT is cast in a negative light or at least no aspect of it is shown in a positive way.--scuro 20:38, 5 May 2007 (UTC)

John Breeding

Is not a good source for main sections of this article because he represents neither a minority or majority viewpoint. His opinion should be considered a fringe opinion neither based on current research nor the established viewpoint in that field. As quoted above he believes, "Electroshock always causes brain damage". The Psychological effects section which were observations of his, were moved to ECT controversy article. --scuro 20:33, 5 May 2007 (UTC)

History of ECT

Changed the title from an origin of ECT to a history of ECT. This section should go right up to the present day. This history should be a synopsis of major events and not go into specific details that have little of no relevance to the topic. For instance we learn that in the first experiments of ECT electrodes are attached to a dogs anus. The history of ECT will be long enough without such details. Someone has done a lot of work. Perhaps this material should be inserted in the Ugo Cerletti article. More edits to come. --scuro 22:22, 5 May 2007 (UTC)

Unsure of what to do with this line. "The convulsive therapies, together with insulin coma therapy, were sometimes referred to collectively as shock therapy. ECT is the only form of shock therapy still practiced by psychiatry". If this could be dated it could be left in the history. Does it belong some where else?--scuro 04:54, 6 May 2007 (UTC)

Mechanism of action section as an example of bias

While it is true that the exact mechanism that causes the therapeutic effect of ECT is unknown, a wide body of overwhelming evidence through clinical studies and other evidence have shown that the actual controlled convulsion is the mechanism that gives patients the therapeutic effect. Is any of this mentioned at all in the the mechanism section, NO. Yet this information is not hard to find. I'm sure I could find a half dozen citations from excellent sources to back that conclusion.

What do we get in the mechanism of action section instead? First, we get the earliest ideas of the first person to use ECT. This approach is totally backwards. You should start with recent findings and give this information the most weight because it is most relevant to the topic and the readers. The oldest thoughts on a topic should be at the end of a section and receive the least amount of weight, if any at all. In this case the idea has no relevance to the topic and should have been omitted. The appropriate place for this information would have been on the article of this scientist.

Secondly, we don't get any sense what the current scientific community believes to be the most probable mechanism that causes the therapeutic effect. All four probable mechanisms are given equal weight in that they are only mentioned and not explored, even though in all likelihood the scientific community has probably focused on one theory and ignored one or more other theories. So instead of learning what scientists currently think, the section finishes with all the possible reasons why the exact mechanism is unknown. Thus the general reader will most likely be confused by the information presented since without context old ideas do not relate to new ideas. Furthermore the reality of the current situation has been omitted and at best the reader will think that nothing of importance is known about the mechanism of action.

This is how an article can be highly biased even though it generally is factual and has good citations. --scuro 14:19, 6 May 2007 (UTC)

While I can't say anything much about your statements regarding the incompleteness of this section, I strongly disagree with your contention that presenting the earliest ideas first is totally backward. I think that for many topics, presenting information in historical order is by far the most reasonable. I think the section reads well at the moment. You claim that you could find a "half dozen citations from excellent sources" - please do so, it would help this section. Doctormatt 00:55, 8 May 2007 (UTC)

So if we were talking about ADHD for example we would start the converstation perhaps like this..."Minimal brain damage..."!?!??? The only time I would EVER start any conversation about ADHD and mention MBD in the first sentence is if the topic was the history of ADHD. The same holds true with the Mechanism of action for ECT. Readers don't want to know first about the musings of some early protagonist of the procedure long since dead and totally irrelevant to modern ECT. They want to know how it works now, they want it explained in a contemporary and clear way, and they want that information first. This is also the way that Wikipedia wants it. Perhaps you should read this policy from Wikipedia in this regard, you may then understand my objection better. ->http://en.wikipedia.org/wiki/WP:UNDUE#Undue_weight

--scuro 02:52, 8 May 2007 (UTC)

Yes, I've read that and I agree: the section needs improving. My only point was that presenting information in historical order is not always a bad way to go. That's just my opinion. Feel free to rewrite the section with a structure more to your liking; I look forward to reading it. Doctormatt 03:03, 8 May 2007 (UTC)

You shouldn't presume to speak for all readers, Scuro. Given the correct formatting, it is certainly possible to place "Minimal Brain Damage" very close to the top. For example, the 1st paragraph can go "ADHD is a neurological disorder. Previously thought to be due to low-level Brain Damage, that theory is now generally discredited and most psychiatrists believe it to be due to inadequate quantities of dopamine in the brain (for example)." --Kazuaki Shimazaki 03:20, 8 May 2007 (UTC)

Kaz, Wikipedia is not a democracy. There is a right way to do things, I am happy if you and other editors agree with me. Consensus is desired but not necessary for an edit to be excellent. For your interest I have included the first paragraph of Wikipedia's ADHD article.

Attention-Deficit/Hyperactivity Disorder (ADHD) is generally considered to be a developmental disorder, largely neurological in nature, affecting 3–5 percent of the population.[1][2][3][4] The disorder is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity.[5] ADHD initially appears in childhood and manifests itself with symptoms such as hyperactivity, forgetfulness, poor impulse control, and distractibility.[6] ADHD is currently considered to be a persistent and chronic syndrome for which no medical cure is available. ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults. It is believed that around 60% of children diagnosed with ADHD retain the disorder as adults.[7] Studies show that there is a familial transmission of the disorder which does not occur through adoptive relationships. Twin studies indicate that the disorder is highly heritable and that genetics contribute for about three quarters of the total ADHD population. While the majority of ADHD is believed to be genetic in nature, roughly about 1/5 of all ADHD cases are thought to be acquired after conception due to brain injury caused by either toxins or physical trauma prenatally or postnatally.

No where does it state the term MBD. In fact, you would probably only find that term in the history section.--scuro 03:32, 8 May 2007 (UTC)

Red herring. I'm show how it might structurally be done, not that it was the choice taken by the team that's working on ADHD. --Kazuaki Shimazaki 03:47, 8 May 2007 (UTC)

very VERY scary

Wikipedia is the first entry listed when one searches google under the term(s) electroconvulsive or electroconvuslsive therapy. This article still has a ways to go to even being simply an acceptable source of information...and that opinion comes from someone who isn't even remotly an expert in this field. --scuro 18:49, 6 May 2007 (UTC)

The is pretty much the case with any google search, which is why there are so many people keen to insert their POV into our articles. Perhaps you should request a peer review of this article to get some outside input. Rockpocket 19:30, 6 May 2007 (UTC)

Intersting concept...peer review, how would Wiki do this, and who would be the "peers"? Ideally several people in field who are familiar with the procedure would examine this article.--scuro 20:32, 7 May 2007 (UTC)

Well, whatever we do, let's make sure that firsthand observers are excluded. They might not be, you know, NPOV. We are, I can assure you, "familiar with the procedure."JuneTune 04:18, 11 May 2007 (UTC)

I'm not quite sure what JuneTune means - sarcasm doesn't come across too well on the written page. Everyone is welcome to contribute to a peer review. See Wikipedia:Peer review for how to request one. Rockpocket 05:57, 12 May 2007 (UTC)

Hi, Rockpocket. Yes that was sarcasm. Unfortunately, I don't think that everyone is in fact welcome to contribute to a peer review and I base this conclusion on the fact that clearly everyone is not welcome to contribute to articles or talk pages. There are many Wikipedians who seem to disregard any authority or viewpoint that comes with firsthand knowledge of psychiatric assault. If I am wrong, and there is a peer review, I would be delighted to be included in that process. JuneTune 00:23, 14 May 2007 (UTC)

Yes, I see what you mean now. I am afraid you do have a point. Its very difficult to edit articles from a neutral point of view - as our policy demands - when one has been so closely involved witht he subject in such a negative context. Editors who insert critical firsthand knowledge into articles do tend to be marginalised because it rarely meets our reliable source criteria, and on the odd occasion it does, there are then conflict of interest concerns. If your aim is to share your negative experiences, then this really isn't the place for you. Nevertheless, your opinion is still welcome at a peer review, as long a you have comments that can improve the article, bearing the 5 pillars in mind. Rockpocket 01:17, 14 May 2007 (UTC)

With respect, even when I do meet Wikipedia's criteria, my suggestions are usually rejected out of hand. My aim is not to "share [my] negative experiences," but rather to ensure that psychiatry-related articles on Wikipedia are not merely advertisements for Big Pharma and biological psychiatry. I try to point out the flaws being put forward by mainstream psychiatry and regurgitated into Wikipedia articles. I would have thought Wikipedia would benefit from a more balanced approach, i.e. input from all sides. Trouble is, a reliable source (e.g. ICSPP) isn't give much credence if it doesn't fit in with the herd mentality of Wikipedia. JuneTune 04:20, 14 May 2007 (UTC)

Remember our criteria for inclusion is "verifiability, not truth". Its not our job to critique "flaws being put forward by mainstream psychiatry", its our job to record the mainstream view and then record other significantly notable minority views, affording each the commensurate weight. Even if the mainstream is hopelessly flawed (in your opinion), than Wikipedia will be hopelessly flawed too. While we certainly do benefit from having all editors of all POV's contributing, those with minority POVs often struggle at accept that their take on the issue is not afforded equal weight on Wikipedia. That does seem unfair and to some extent it is unfair - but its how Wikipedia works. So, if largely reflecting the mainstream view is herd mentality, as you put it, then you either have to follow the herd or your are oging to be in for a tough time. However, even if you don't like the fact that the mainstream gets more coverage, you still can put your efforts into making sure the minority views are reflected accurately. Surely that is better than not engaging at all? Rockpocket 04:43, 14 May 2007 (UTC)

I wasn't suggesting it was up to Wikipedia to critique mainstream psychiatry (or at least I didn't mean to suggest that). I'm not troubled that my minority POV isn't given equal weight -- that's why it's a *minority* view. The herd mentality that I refer to is the very rude and condescending tone of many Wikipedians when people such as myself try to, as you put it, make sure that the minority views are reflected accurately. Is confronting that hostility and condescension better than not engaging at all? I don't know. JuneTune 05:07, 14 May 2007 (UTC)

Then I agree with you. Often editors will treat new editors who are open about their minority views with suspicion, which is very unfortunate and in violation of WP:AGF and WP:BITE. In their defence, it is because we are fighting a continuing battle with people seeing Wikipedia as the perfect place to promote minority views, rather than just record them. Nevertheless, that doesn't excuse the fact that they often drive away those that can help us. The only way we will get the best articles is to have people of all persuasions contribute their knowledge; since misrepresenting minority views is as harmful as promoting them. I can only ask that you do stick it out and don't let those rude people drive you away. Rockpocket 05:20, 14 May 2007 (UTC)

Well, Rockpocket, I really appreciate your input here and I'd like to stay. I will do my very best to follow the Wikipedia mandate. JuneTune 03:13, 15 May 2007 (UTC)

Research into structural brain damage section - another example of bias

Again we are introduced to this section with conclusions drawn from the 1960's!?!, 1950's???!??, and 1940's????!!!!!! It's simply remarkable that findings from these times are given such prominence and weight. As summarized in the history section, the procedures and actual equipment has change significantly even from the 1980's on. We then once again get a backwards introduction to the topic starting with distant historical information that is generally irrelevant to our contemporary understanding of the topic as related to modern use. We end this section with subtopics to brain damage that don't really tackle the serious topic at hand.

Here is some info and citations from contemporary studies.

http://ajp.psychiatryonline.org/cgi/content/abstract/151/7/957 Devanand et al., 1994

" The purpose of this study was to evaluate whether ECT causes structural brain damage. METHOD: The literature review covered the following areas: cognitive side effects, structural brain imaging, autopsies of patients who had received ECT, post-mortem studies of epileptic subjects, animal studies of electroconvulsive shock (ECS) and epilepsy, and the neuropathological effects of the passage of electricity, heat generation, and blood-brain barrier disruption. RESULTS: ECT-induced cognitive deficits are transient".

http://www.omh.state.ny.us/omhweb/ect/index.htm

Even in such cases, the memory impairment does not interfere with mental functioning or cause persistent deficits in the formation of new memories or disrupt with basic cognitive functions, such as intelligence (Sackeim et al., 1992, 1993, 2000). There is a clear absence of any evidence that ECT causes damage to neurons or other brain cells (Devanand et al., 1994)

--scuro 23:08, 6 May 2007 (UTC)

Generally, ideas are explained in historical order, to show the evolution of ideas through time and to show old ideas were falsified in turn. I certainly remembered being taught caloric theory before kinetic molecular, and almost everyone learns Newton before Einstein. No one gets the idea that the one taught before is weightier. I don't think anyone but you ever considered it a problem. The 40s-60s section had already been reduced to minimal length (about 1-2 sentences - the minimum to convey that old studies did say there was brain damage). --Kazuaki Shimazaki 01:54, 8 May 2007 (UTC)

As for your quotes - your second site gives a "Page Not Found". Devenand's study has also been criticized by Breggin for:

"When Devanand and his associates [68] reviewed “Does ECT Alter Brain Structure?”, they concluded that animal studies do not prove brain damage. They accomplish this by dismissing the best studies. Hartelius, for example, is criticized for applying a series of four ECTs with each one spaced at 2 h. But there is no reason to assume that this method is more damaging than larger numbers of ECTs spaced over longer intervals. As presently used, multiple-monitored ECT inflicts four electroconvulsive shocks within the space of approximately one hour. In addition, it is extremely misleading to focus on that particular group of subjects within Hartelius’ study. One group of animals in the Hartelius study were given one ECT per day for 4 days and others were treated “with clinical frequency” (three per week)." (Breggin, 1998)

This is hardly a ignorable factor in a literature review. The results of countless pages of research are compressed into a mere 13 pages, which makes for a very lossy and easily distortable (by the reviewer, either accidental or purposeful) compression. The abstract is a lossy compressed version of this. Note how the site then purifies it further to say "clear absence". Devanand was batting away and rationalizing the damage reports in his lit review, but the reports were still there, so if you assume the criticisms were valid the best you can say is "Not Proven". But not clear absence!!!! --Kazuaki Shimazaki 01:54, 8 May 2007 (UTC)

You are quoting Peter Breggin?...enuf said. Breggin is total fringe and virtually ignored with regards to every aspect of mental health within the many fields that encompasses. The only time he could be considered either minority or majority viewpoint is if the topic is Anti-psychiatry...or say his self proclaimed disorder, DADD. The acronym stands for Dad Attention Deficit Disorder and by the way the viewpoint blames misbehaving child on father's who don't have enough time for their children in a Steven Speilberg/ Robbin Williams type of way.

The link is fixed.--scuro 03:18, 8 May 2007 (UTC)

Scuro, I know (reading your Contribution History and Userpage) you don't have a lot of faith in Breggin and a lot of faith in conventional psychiatry. Please understand not everyone agrees to the same extent. Do remember that while some judges have certainly thrown out Breggin's testimony, others have taken it in and they won on it, thus it was assessed to be of greater credibility than the defendant's testimony. --Kazuaki Shimazaki 03:28, 8 May 2007 (UTC)

Further, the question is his point, which I believe is likely to be valid, rather than the man. There is certainly an apparent reluctance in modern studies to blame ECT. For example, Coffey notices brain changes after ECT. It may be ECT or it may be natural disease progression. Apparently, he doesn't even attempt to isolate the factors (nor did anyone else after him, apparently) and just concludes it is probably the natural disease. To be fair, he did make a mention of the ECT possibility, but with his conclusion, in no time the token mention will be quietly lost in compression. --Kazuaki Shimazaki 05:34, 8 May 2007 (UTC)

As for Sackheim quotes, quoting them now is a particulary disingenous since his 2007 study, in which according to him, no proper studies have been done regarding the persistent deficits. One has to wonder how does he justify being so confident in his previous statements, then... --Kazuaki Shimazaki 05:34, 8 May 2007 (UTC)

Yes scuro: I agree with Kazuaki Shimazaki. ECT advocates sometimes claim the addition of anesthesia, a muscle paralyzing drug, and oxygenation (making the "patient" breath air or 100% oxygen) prevent ECT-caused brain damage. You seem to say that ECT is safe today. But neither anesthesia nor muscle paralyzing drugs nor breathing oxygen stop what the electricity does to the brain. Autopsy study, EEGs, and observation of those who have received ECT indicate those given ECT with anesthesia, a muscle paralyzing drug, and forced breathing of air or oxygen experience the same brain damage, memory loss, and intellectual impairment as those given ECT without these modifications. —Cesar Tort 05:08, 8 May 2007 (UTC)

As an expert in the court of law Peter Breggin has zero credibility. Two seperate judges have stated that he failed the Frye Standard and the Daubert standard which is damning indeed. He is irrelvant beyond the few anti-psychiatry and Scientology advocates that quote him. No scientist or public insititution will use or quote any of his "research". He fails the Wiki standard also. http://en.wikipedia.org/wiki/Wikipedia:Reliable_sources#Scholarly_and_non-scholarly_sources I'm not going to waste further time examining any idea that he presents. Find reliable sources and quote from them... that is the Wikipedia way. If you want to make observations about Sackheim that should be considered for article improvement, support them with reliable quotes. Otherwise personal musings have a better fit with blogs and message boards.

Cesar, before you can claim anything and you claimed A LOT in the previous post, find a reliable source to support what you say. I've claimed nothing. I've merely provided information from reliable sources. If you have reliable information that supports the view that ECT causes brain damage post and source it. I'd welcome that both on a personal level and Wikipedian level. Then perhaps we could assess the weight of the two viewpoints, document that, and move on with this article. I'm indifferent to the possibility that ECT could cause brain damage, but I have very strong views on POV pushing.--scuro 10:28, 8 May 2007 (UTC)

The quotation above came from a paper in The International Journal of Risk & Safety in Medicine 11 (1998) 5-40. Thus, it actually would fall inside the Reliable Source area by the section you just quoted. --Kazuaki Shimazaki 12:40, 8 May 2007 (UTC)

And really, what does that matter compared to the point he made. Is it potentially valid? Very likely. It is undeniable there were studies in the past that reported damage. To obtain his conclusion of no damage, it is inevitable Devenand had to do a lot of batting and rationalizing. And of course his methods can be attacked. I did not say Breggin was necessarily correct, but the criticism has been made. It is logically plausible and accepted by a journal. --Kazuaki Shimazaki 12:40, 8 May 2007 (UTC)

For Sackheim, there is really nothing one needs to do but keep his eyes open and spot the contradiction for himself. --Kazuaki Shimazaki 12:40, 8 May 2007 (UTC)

Everything becomes more palatable when it doesn't come from Breggin. He has a blinding bias. Do we have a reliable source who basically states the same thing?--scuro 03:10, 9 May 2007 (UTC)

The only blind people are those who, without biomarkers, claim that mental disorders are biomedical entities and treat them with brain-damaging therapeutics such as electroshocks. Breggin is the exception among his blind colleagues. —Cesar Tort 03:56, 9 May 2007 (UTC)

The judges in the trials where Peter Breggin testified as an expert witness apparently didn't consider him to have "zero credibility." As an electroshock survivor, I believe I'm qualified to comment. Electroshock causes brain damage. It happened to me and it happened to thousands of other survivors. The "sham ECT" trials disprove the alleged therapeutic benefits. Electroshock does have an effect on the profoundly depressed but so would spraying them down with cold water. JuneTune 18:29, 9 May 2007 (UTC)

While your story is compelling it is not citable. That is what Wikipedia is all about. If you find something that you believe to be untrue, find a citable source, and bring this to discussion. I am open to considering citable information.--scuro 19:33, 9 May 2007 (UTC)

A lot going on here, so in brief(ish)...

Old references. We've been through the from the 40s, 50s, and 60s before, in the Archives. I purged quite a few which were misrepresentations of what the articles actually said (benefits of having a well-stocked university library to hand) after I got heartily sick of people leaping onto the page and posting ghastly cut-and-pastes from POV websites (see the section titled "Latest cut-and-paste job" above). I should say at this point that this is not an accusation I would level at any of those I've noticed editing the article recently - in particular, while some of the discussion on here has got quite heated, Staug73 and scuro both seem to be working reasonably and hard, albeit in opposition, to improve the state of the article. Anyway - my view on references more than 30 years old, keeping in mind the tendency in the past for people to post them up clearly without having read them is, as I said above, that they should provide verbatim quotations from the articles in question to explain why they support the position they're adopting. If they can't do that, then given the difficulty I had in obtaining these things at one of the largest scientific libraries in the UK, I feel we should assume they haven't been read.

Brain damage. Again, I was one of the posters in a discussion of an earlier version of the article which is now in the archives under "Regarding citations". I won't repost it, because it's long and I think a little dry, but it does summarise several of the articles from the 70s and 80s, and some more recent ones. My favourite was the paper (Marcheselli et al 1996) which had been used to support ECT causing brain damage and was actually about rats who got kainic acid and whose brains weren't assessed at all... If we decide to reinstate some of the evidence for brain "changes" actually being pre-existing damage, due to cerebrovascular disease (due in turn to the high rates of smoking, alcoholism, and poor self-care among the groups most likely to develop mental illness), or indeed a summary of the problems with existing research into structural brain changes and ECT, those posts may be useful. This would address Kazuaki's concern that the article relies on one review - it doesn't, it's simply that the detailed references have all been removed of late.

Isolating the cause of the changes. This is related to the points I've raised above, but Kazuaki also points out that no one has attempted to isolate the factors responsible for brain changes - that's not quite true, as there are serious problems designing any study to isolate them.

Oxygenation and anaesthesia. We've been here before, too, Cesar - can you explain, please, how and why "what the electricity does to the brain" causes lasting damage? A lot of your posts here are basically just antipsychiatry shouting unburdened by any sort of evidence - doctors take decisions on clinical grounds the whole time - so why aren't you complaining about children having their abdomens opened up because a doctor is afraid they have appendicitis? What is the difference between that and a doctor deciding on similarly clinical grounds that someone is depressed enough to be considered for ECT?

Nmg20 00:56, 10 May 2007 (UTC)

• “...so why aren't you complaining about children having their abdomens opened up because a doctor is afraid they have appendicitis?”

If you cannot see the difference between a behavior unapproved by society (such as suicide attempts, etc.) and a genuine illness, I give up. I will now unwatch this page and hope that others will have the patience to discuss with you.

Good bye ;)

—Cesar Tort 01:19, 10 May 2007 (UTC)

Murder by a schizophrenic is merely a behavior disapproved of by society. What we're arguing now has nothing to do with ECT, science, or psychiatry. We're in philosophy now. Where no argument ever has an ending because the debate isn't over what is, but what ought to be.--Loodog 00:33, 11 May 2007 (UTC)

Thank you Nmg20. --scuro 02:44, 10 May 2007 (UTC)

While your story is compelling it is not citable. That is what Wikipedia is all about. If you find something that you believe to be untrue, find a citable source, and bring this to discussion. I am open to considering citable information.--scuro 19:33, 9 May 2007 (UTC)

The trials where Breggin testified should be easy enough to find. Most recently, I believe the makers of Paxil were forced to pay up. As for the "sham ECT" trials, the cite I have is from EHPP so I guess you would reject that out of hand. I'll try to see what I can find online and then you can attempt to discredit it because it doesn't accord with what Big Pharma publishes. Nice doing business with you, Scuro. JuneTune 00:14, 11 May 2007 (UTC)

June, why debate...Breggin fails as a reliable source at Wikipedia on so many levels. Can't you find a better source..or is he the only one who states what you wish to quote on this topic?--scuro 02:54, 11 May 2007 (UTC)

I debate because you're publishing falsehoods. You claim that Breggin has zero credibility in a courtroom while it's perfectly easy to confirm that Breggin has testified successfully many times on behalf of plaintiffs harmed by psychiatric assault. That doesn't equate to zero credibility. No, Breggin is not my only source on this subject but he's likely the most well-known and I'm not going to throw him out because you don't like him. A recent EHPP article confirmed that electroshock has almost no benefits and unacceptable risks. I'll try to find that online for you. It's not by Breggin, I believe the researcher's name was Powell. Then you, no doubt, will attempt to discredit Powell (or whatever his name is) on the basis that his findings don't agree with your POV. JuneTune 04:27, 14 May 2007 (UTC)

JuneTune - it's very hard for anyone to deal with your sources in any fashion, dismissive or otherwise, unless you actually cite them! Can you point the readers of the page to somewhere we can find articles by this Powell fellow, and to where we can establish what EHPP is? Thanks. Nmg20 09:31, 14 May 2007 (UTC)

Hi, Nmg20. EHPP is published by the International Center for the Study of Psychology and Psychiatry. ICSPP has its own Wikipedia page. Only some of EHPP's articles are available online and, then, only to paid subscribers. I was hoping to find that article from another on-line source but haven't been able to so far. JuneTune 03:26, 15 May 2007 (UTC)

ICSPP was founded by Breggin. Need I say more.--scuro 03:53, 15 May 2007 (UTC)

No, not if you want to assert that the entire membership of ICSPP, including practicing psychiatrists, psychologists and social workers must be completely disregarded because you don't approve of the founder of ICSPP. However, if you want to actually explain WHY this should be so, then, yeah, I guess you need to say more. 208.181.100.20 17:18, 15 May 2007 (UTC) (JuneTune)

Thanks, JuneTune - for future reference, it's quite nice to put things like ICSPP in double square brackets ([[ ]]) even on talk pages so it links to the relevant page on wikipedia. On the EHPP front, while of course free sources are preferable, many of us can access paid subscription articles through institutional subscriptions, so if you can post Pubmed citations, it's really useful. A free online source is certainly best, but if an article isn't free, a paid source is better than none! Nmg20 09:53, 15 May 2007 (UTC)

Will do, Nmg20. 208.181.100.20 17:18, 15 May 2007 (UTC) (JuneTune)

Here is the offending quote,"As an expert in the court of law Peter Breggin has zero credibility. Two seperate judges have stated that he failed the Frye Standard and the Daubert standard which is damning indeed". Anyone having failed those two standards would have zero credibility in my humble opinion. But it is not just that...there are other reasons he is not reliable. His "research" doesn't pass the mustard...his website doesn't pass the mustard...for a reliable source. No one builds upon his ideas or "research" outside of other anti-psychiatry groups/people and fringe groups and religions such as Scientology. Those groups also tend to be the ones that quote him liberally.

Finally, I "don't attempt to discredit" your sources. I look at each one separately. "Show me the beef", in other words give me a source of substance, and I'll gladly consider your points.--scuro 12:51, 14 May 2007 (UTC)

Scuro, I acknowledge that Breggin is not always accepted as an expert witness. However, he more often IS accepted as an expert witness thus it's disingenous, to say the least, to claim that he has "zero credibility." Your comment is libelous. Contrary to your statements here, many researchers have expanded on Breggin's work. Have you heard of Grace Jackson or Louis Wynne or Al Galves or Elliot Valenstein? Have you read about the Rosenhan (sp?) experiment in the 1970s? Have you read the survivor testimony of ex-mental patients? Did you read Gary Greenberg's recent article in Harper's Magazine titled "Manufacturing Depression"? These people and many, many more seriously question psychiatry as a scientific endeavour. We're not a fringe group of nutters -- we have legitimate concerns with psychiatry's social engineering experiments. JuneTune 03:26, 15 May 2007 (UTC)

I also acknowledge that Breggin has won court cases but more recently has lost more then he won and seems to have stopped giving testimony. This could be due to his age or simply that he now developed a reputation. There has been so much damning commentary about his creditability from judges that I have no fear about my "libelous" statements. See the Peter Breggin article under the subsection "expert witness". That article lists only the most noteworthy commentary.

It is laughable that you state others have expanded on his research. He hasn't done one experiment where he derived his conclusions from the Scientific method. He does overviews. He cherry picks info to build his antipsychiatry POV.

I also acknowledge your legitimate concerns but as long as you hang your hat on Antipsychiary experts such as Breggin, Baughman, or Null, no one will take your viewpoint seriously outside of Antipsychiatry and Scientology circles.

Can you not find one other mainstream researcher or critic to make your case?--scuro 10:20, 15 May 2007 (UTC)

I have already listed above several important authors on this subject, all of whom you apparently have decided to disregard. I am not "hanging my hat" on anything or anybody. Your tone is offensive. Please think before you type. 208.181.100.20 17:18, 15 May 2007 (UTC) (JuneTune)

Thinking more about Breggin...it's better if other sources can support a contention, like say the idea that modern ECT causes brain damage. If Breggin is your only source, you are on very shaky ground. Best would be say the NIMH, or any other national/international insitution that stated this claim. Extraordinary claims require extraordinary support.--scuro 16:27, 14 May 2007 (UTC)

But there's the rub, Scuro. Mainstream psychiatric organizations are pro-treatment, pro-Big Pharma so of course they're going to support psychiatric assault. Step back a few paces and think about it. Contending that putting people to sleep and zapping them with electricity *doesn't* cause brain damage is the only extraordinary claim being made here. Read Wendy Funk's survivor testimony, if you give a damn.JuneTune 03:26, 15 May 2007 (UTC)

http://www.idiom.com/~drjohn/amjpsych.html Here's one from the American Journal of Psychiatry, 1977. JuneTune 03:31, 15 May 2007 (UTC)

1977...I wore disco pants back then and had a polyester silk shirt with brown and red flowers.

I fail to see what your wardrobe has to do with serious research. Please clarify. Do you have any valid, repeat: valid, criticism of the article? No, I didn't think so. Very little has changed in the "science" of electroshock since 1977 -- minor tweaking of electrics, improvements in anaesthesia. The article is still relevant. Grow up, Scuro. 208.181.100.20 17:18, 15 May 2007 (UTC) (JuneTune)

June, we are not going to agree. I see no giant conspiracy("big pharma"/national institutions/and who knows who else). I don't think the mental health field is squeaky clean but they have made an effort to improve and the results are very noticeable. Is there room for lots of improvement? Sure...this field is still very young and will continue to improve as we learn more. ECT is a great example. But because of past history, that doesn't mean I'm going to hang my hat on the wildly irresponsible musings of Breggin. I believe he is biased to the core. You disagree and think he is respected....lets leave it at that.--scuro 04:04, 15 May 2007 (UTC)

We're not talking about Breggin anymore, Scuro. I mentioned other work in the field. I acknowledge that Breggin is controversial and I think such controversy is predictable. If you truly don't see a problem with Big Pharma driving a medical specialty, then I guess you're right -- we disagree and should leave it at that. Psychiatry is not "still very young" and electroshock is indeed its finest example -- example of psychiatric assault, that is. 208.181.100.20 17:18, 15 May 2007 (UTC) (JuneTune)

Can I call a time-out here? What with the to-ing and fro-ing between you both, I've lost track of where we are with mooted changes to the article. Am I right in thinking that the main bones of contention here in terms of inclusions to the article are:

(1) The ways in which ECT has or has not changed since its inception

(2) Whether or not ECT causes brain damage (this is two questions, really: did it cause brain damage originally, and do the modifications which have been made to the procedure make it more or less damaging?)

(3) Whether there is a conspiracy between big pharma and ?psychiatrists to medicate people who would be better off without medication (Can we clarify how this applies to the ECT article, please? It strikes me that unless you're suggesting a link between the manufacturers of ECT machines and psychiatrists, we might be able to drop this?)

(4) The extent to which the ICSPP and EHPP should be cited in the article.

Is that fair? If so, perhaps you can both say so here and we can debate each point separately on this page - at the moment we're not really getting anywhere with regards to changes to the article, IMHO. Nmg20 17:48, 15 May 2007 (UTC)

Thanks, Nmg20. With respect to your points above, I believe (1) is relevant and belongs in electroshock history. Ditto (2) belongs in controversy. (3) I agree isn't relevant to this article, I don't think. (4) Dissenting voices belong in the controversy section. I see no reason not to include a link to the article reporting brain damage from electroshock in the controversy section. I'd like the controversy section to be a fair-minded representation, not relegated to "fringe" status, as Scuro apparently would like to see. 208.181.100.42 19:11, 15 May 2007 (UTC) (JuneTune)

I believe in the introductory paragraph that electroshock should be referred to as a controversial treatment. Even Scuro would likely acknowledge this. 208.181.100.42 19:29, 15 May 2007 (UTC) (JuneTune)

These are my opinions, I'm open to further discussion.

1) agree with June 2)I see the controversy section differently. If brain damage really still is an issue that one can cite from reliable sources, then it belongs in the main article. If ECT did cause brain damage then this separate bit of info probably should make it in the history section. 3)Dissenting voices can be in main article if their contentions are legit and can be sourced properly. The controversy section should be a synopsis of all unsupportable viewpoints. Not minority viewpoints. Those who want to expand on this type of information can do so without restrictions in the Controversy of ECT article. 4)The ICSPP or the EHPP should not be mentioned at all beyond possibly a quick mention in the controversy section...that is unless say a mainstream newspaper like the NYT supports their info.

Finally if you can source that ECT is still considered controversial I have no problem having that in the intro. I believe I have read it described as such, even at the NIMH. You would have to make the citation on the article but should make it in discussion. It's not what I think it's what Wiki wants.--scuro 21:28, 15 May 2007 (UTC)

Thanks, folks. My thoughts:

(1) We seem to have agreement here - presumably we'll include a subsection in the history one covering the more technical changes to the procedure - e.g. anaesthesia, etc.?

(2) I think we need to cover the research into the possibility that ECT causes brain damage. To my mind where it sits depends on what the balance of evidence is - if there is current/recent evidence supporting the claim, then it's pretty clearly for the controversy section. If not, it's the history section.

(3) We're all happy to drop the conspiracy angle which has emerged on the talk page.

(4) Do you have a link to the article you mention, JuneTune? Nmg20 22:57, 15 May 2007 (UTC)

I'm very pleased to see your number (3) above, Scuro. That would be great. I disagree however that controversy = unsupportable. Minority viewpoints = controversy, okay? As ever, I totally disagree that ICSPP should be thrown out because Breggin is controversial. ICSPP includes a varied array of authors and researchers and you do a huge disservice to readers to attempt to throw them all out. I will do my best to find a free, online source supporting an ICSPP article on the subject and I trust that, when I do, that you will stand by your word and allow the cite here. As for electroshock being controversial, that should be easy to find. Nmg20, thanks for your help. By "the article" do you mean the article indicating that electroshock causes brain damage? I've posted that already. Or do you mean the "Sham ECT" studies? I'm not sure what the definition of "current/recent evidence" is. On the bipolar disorder page, a purportedly relevant cite linked to a study of twins born around 1900 in Denmark. Could we have some parity on the evidence standard, please? JuneTune2 03:18, 16 May 2007 (UTC)

From the NYT website, http://query.nytimes.com/gst/fullpage.html?res=9B0DEEDB113EF933A15751C1A961948260 JuneTune2 03:25, 16 May 2007 (UTC)

Uh-oh, Scuro, another article speaking to the controversy surrounding electroshock and it's from ... wait for it ... the NYT!!! http://query.nytimes.com/gst/fullpage.html?sec=health&res=9400EED9133BF932A05753C1A964948260 Hey, it's mainstream, so it must be right. JuneTune2 03:30, 16 May 2007 (UTC)

Scuro, thank you so much for turning me on to NYT. Here's another: http://query.nytimes.com/gst/fullpage.html?res=9B0DE3D71730F931A15752C1A961948260&sec=health&spon=&pagewanted=3 This is as easy as taking candy from a baby. JuneTune2 03:37, 16 May 2007 (UTC)

June, we can learn something from each other. You will lead us down the ICSPP garden path and show us that they do true scientific and scholarly work. If in the end though...the ICSPP, ICSPP researchers, and Breggin are not used for citations it will be because they fail the wiki reliable source standard, not because they are controversial. I do stand by word and even go one step further for you. I did some searching for you. An olive branch if you will.

As confirmed by the 1999 report of the United States Surgeon General concerning mental health, electroconvulsive therapy (ECT) can be an effective treatment, primarily for individuals with severe depression, some acute psychotic states, and mania.[i] However, there are risks of memory loss and other cognitive damage, and the administration of ECT is controversial and stigmatized...from http://www.mentalhealthamerica.net/go/position-statements/p-31 The organization and website look legit although I haven't really looked under the hood. Perhaps others are familiar with this organization?

Your citation June is from 1987 but that is really not the main problem, it looks to be a letter to the editor which can not be used as citation to support brain damage.

I think we have also have a different definition of the term "controversial" and "minority". To me, in Wikiland, minority viewpoint would be a significant and citable source that disagrees with the mainstream viewpoint. I'm not totally up on Autism but lets say minority viewpoint would be that diet causes Autism. A controversial viewpoint is that Autism is fake. In Wikiland, the controversial info is to be underweighted and given very little prominence if it is even included on the page. After all that info is controversial, divisive, and can be offending. For more info look here ->WP:NPOV - (check undue weight section). A controversy section could be a good lead to the Electroconvulsive therapy controversy article. That would be a reason for it's existence on the ECT page.--scuro 03:54, 16 May 2007 (UTC)

Scuro, Scuro, Scuro. You claim to extend an olive branch and then you accuse me of leading you down the "ICSPP garden path." ICSPP is a respectable organization (yes, even though you don't like the founder) composed of authors and researchers with many, many differing viewpoints. What they do have in common is extreme skepticism of mainstream biological psychiatry. Thank you for "going one step further," however the brain damage associated with electroshock is well-established, i.e. you don't have to search high and low to confirm this. Why else would people suffer varying degrees of memory deficit if not for brain damage? What on earth else causes severe memory loss? With respect to the site you mention, I've never heard of www.mentalhealthamerica.net. I concur that ONE of my cites may not reach the Wiki standard. But what about the others, Scuro? I'm unsure what to think about your definitions of "controversial" and "minority" and would appreciate some input from others (calling Nmg20!). Anti-psychiatry, for want of a better word, is both controversial and a minority position. Indeed, its minority position is what makes it controversial. Follow the herd, everybody get into line. Lastly, and seriously, thank you for your obvious efforts in coming to a compromise with a viewpoint that clearly appalls you. JuneTune2 23:18, 16 May 2007 (UTC)

What's wrong with being a sheep? It's better than being a whack job. Anyways, the fact that ICSPP was founded by Breggin makes me question if it can be used as a source. =) Jumping cheese ^Cont@ct 00:15, 17 May 2007 (UTC)

If by "being a whack job" you mean critically assessing traditional wisdom, then I'd have to disagree: I would prefer not to be a sheep. Try to remember that ICSPP isn't one person. You don't like Breggin, fine. (Actually, not fine, you do the man a disservice. But for the purposes of this article, he's mostly excluded and that's fine.) However, your writing off of the entire contributorship of ICSPP on this basis is ridiculous. As just one example, Grace Jackson has written extensively on the action of psychoactive drugs and the need for informed consent. Grace is a serious and credible researcher yet you'd throw her out in a minute because you don't approve of the founder of ICSPP. Is that a reasonable position to take, Jumping cheese?

"What on earth else causes severe memory loss?" Ignoring that this is logically an Argument from ignorance, the answer is plenty.--Loodog 00:23, 17 May 2007 (UTC)

Come on, Loodog. Has thyroid dysfunction been linked to electroshock patients? We're talking about severe memory loss IMMEDIATELY AFTER electricity has been run through a patient's brain. Let's look at the most obvious possibility first -- that electroshock caused the memory loss. No, I am not contending that brain damage is the only cause of memory loss. I was discussing only memory loss post-electroshock and it's pretty ignorant of you to imply otherwise. JuneTune2 14:39, 17 May 2007 (UTC)

If your point is that ECT causes memory loss, then you're undermined your point that it's through brain damage. And commited another Argument from ignorance.--Loodog 04:34, 20 May 2007 (UTC)

June my cohort on the ECT article, it was an olive branch. There was no accusation, simply a misunderstanding of my communication. I made you the offer to lead us down the ICSPP garden path. You are right, my opinion is jaded with regards to the ICSPP. My intention was to look at this organization critically one more time through your "fresh" eyes.--scuro 02:27, 17 May 2007 (UTC)

Scuro, put yourself in my shoes: you're offering me the chance to take you down the "ICSPP garden path." Your wording very clearly implies that it's hogwash. I can type until I'm blue in the face and give you the work of non-Breggin ICSPPers but if your mind is already closed (i.e. if you've decided that it's a garden path going nowhere) then what would be the point? I'm pretty sure I understood your communication. If you really want to offer an olive branch, then please try to judge individuals' contributions on their merits -- don't tar them all with the same brush. JuneTune2 14:39, 17 May 2007 (UTC)

My understanding of "garden path" was such that it had several definitions one of which would be like the ideal path. I tried to look up defintions of the phrase and I couldn't find a clear answer to multiple meanings. I can see where you would interpret the sentence as such and I am sorry that I didn't use a phrase that couldn't be so easily misunderstood. Regardless, my intent was noble. Finally June, mind is always open to new info, now don't go tarring me with as judgemental and closed minded!! I do want this discussion area to work as it should, it's been dysfunctional since I came to the page. Post the research and I will look at it. How would I know if it came from an ICSPP member? --scuro 16:54, 17 May 2007 (UTC)

Fair enough, Scuro, "garden path" it is, then. First of all, I'm putting forward again the article you dismissed because it was published in 1977. Do you have any VALID criticism of that article? Lastly, re: ICSPP membership being known, you are quite right and I'll see what I can find. JuneTune2 17:20, 17 May 2007 (UTC)

From http://psychrights.org/Research/Digest/Electroshock/AndreBibliography.htm is excerpted the following:

1. Templer DI, Veleber DM. Can ECT permanently harm the brain? Clinical Neuropsychology 1982; 4(2): 62-66

“Our position remains that ECT has caused and can cause permanent pathology.”

2. Colon EJ, Notermans SLH. A long-term study of the effects of electro-convulsions on the structure of the cerebral cortex. Acta Neuropathologica (Berlin)1975; 32: 21-25.

An animal study done two months after shock “The results indicate a persistent change in the nuclear volume of the cerebral neurons in this area.”

“This constitutes a serious warning against the use of electroconvulsive therapy and a serious indication for the suppression of epileptic manifestations.”

3. Weinberger DR, Torrey EF, Neophytides AN et al. Lateral cerebral ventricular enlargement in chronic schizophrenia. Archives of General Psychiatry 1979; 36: 735-739.

Not an ECT study, but included patients who’d had ECT and concluded that it was associated with ventricular enlargement. “Either ECT enlarged the ventricles of the patients treated with it, or it was used with greater frequency in patients who tended to have larger ventricles.”

4. Calloway SP, Dolan RJ, Jacoby RJ, Levy R. ECT and cerebral atrophy. Acta Psychiatrica Scandinavica 1981; 64: 442-445.

A retrospective CAT-scan and case review study of 41. All patients were at least six months post-ECT. “A significant relationship was demonstrated between frontal lobe atrophy and ECT...In our opinion, this is a question of such importance that, in our opinion, the finding of a relationship between frontal atrophy and ECT justifies this brief report. It emphasizes the need for a more detailed investigation, with larger number of patients in a younger age group.”

5. Templer RI, Ruff CF, Armstrong G. Cognitive functioning and degree of psychosis in schizophrenics given many electroconvulsive treatments. British Journal of Psychiatry 1973; 123: 441-443.

The performance of former ECT patients---all of whom were at least seven years post-ECT---on cognitive tests was significantly inferior to that of control mental patients matched for age, race and education. “The ECT patients’ inferior Bender-Gestalt performance does suggest that ECT causes permanent brain damage.”

6. Shah PJ, Glabus MF, Goodwin GM, Embeier KP. Chronic, treatment-resistant depression and right fronto-striatal atrophy. British Journal of Psychiatry 2002; 180: 434-440.

MRI study of 20 patients with controls, but not an ECT study as such. “Atrophy was confirmed on volumetric analysis, the degree correlating with the cumulative number of electroconvulsive therapy (ECT) treatments received, suggesting an acquired deficit.”

“The possibility that the findings were ECT-related cannot be discounted.”

7. Diehl DJ, Keshavan MS, Kanal E, et al Post-ECT increases in T2 relaxation times and their relationship to cognitive side effects: a pilot study. Psychiatry Res 1994 (November); 54(2): 177-184.

Six patients studied while undergoing unilateral (rarely used) ECT. “The results demonstrate significant post-ECT T2 increases in the right and left thalamus, and suggest a correlation between regional T2 increase and anterograde memory impairment. These findings are consistent with a post-ECT increase in brain water content (perhaps secondary to a breakdown of the blood-brain barrier) and suggest that this process may be related to the memory impairment following ECT.”

8. Marcheselli et al. Sustained induction of prostaglandin endoperoxidase synthase-2 by seizures in hippocampus. J Biol Chem 1996; 271: 24794-24799.

ECT causes an increase in the production of inflammatory proteins in brain cells.

9. Andreasen et al. MRI of the brain in schizophrenia. Archives of General Psychiatry 1990; 47: 35-41.

MRIs demonstrated a strong correlation between the number of previous ECT treatments and enlarged ventricles (loss of brain tissue).

10. Dolan et al. The cerebral appearance in depressed patients. Psychological Medicine 1986; 16: 775-779.

Compared the brain scans of 101 depressed patients who had received ECT with the scans of 52 normal volunteers, The study found a significant relationship between ECT treatment with brain atrophy. The study also showed that the brain abnormalities correlated only with ECT, and not with age, gender, severity of illness, or other variables.

11. Figiel G, Coffey E, et al. Brain MRI findings in ECT-induced delirium. Journal of Neuropsych and Clin Sci 1990: 2: 53-58.

A well-known ECT enthusiast found that 11% of elderly patients getting ECT for depression remained delirious between ECT sessions for no discernible medical reason other than the ECT itself. 90% of these patients had lesions in the basal ganglia area of the brain, and 90% also had white matter lesions.

12. Teuber JL, Corkin S, Twitchell TE. A study of cingulotomy in man. Report to the National Commission for the Protection of Human Subjects in Biomedical and Behavioral Research. 1976.

“We found that individuals whose prior treatments had included ECT were inferior to normal control subjects and to patients <who had been subjected to psychosurgery> who had been spared ECT, and this inferiority was apparent on the following measures: verbal and nonverbal fluency, delayed alternation performance, tactual maze learning, continuous recognition of verbal and nonverbal material, delayed recall of a complex drawing, recognition of faces and houses, and identification of famous public figures. In some cases, the degree of deficit was related to the number of ECT received, patients who had been given more than 50 being significantly worse than those who had sustained fewer than 50.”  

JuneTune2 17:36, 17 May 2007 (UTC)

Phew.

Scuro: I disagree that letters to the editor are not citeable - I can't find the link to the letter in question, but assuming it's been deemed worthy of publication in a journal which meets Wikipedia criteria for inclusion, I reckon it can be included.

JuneTune: I've outlined a whole bunch of reasons below why transient and even enduring memory loss does not indicate brain damage, and Loodog's done likewise. It seems to me you're trying to change the issue here: you asked "what else but brain damage can cause memory loss" because you want to say that memory loss post-ECT equals brain damage; it simply doesn't. More to the point, for that claim to merit inclusion in the article, you need to find a published, reliable source which says so.

ICSPP - I still haven't seen any articles from this publication, and I can't help feeling that we need to take a view on them once we've seen what exactly you want to include and to what extent you want this one journal to influence the article.

I've run through the references you cited below.

Templer DI, Veleber DM. Can ECT permanently harm the brain? Clinical Neuropsychology 1982; 4(2): 62-66. This doesn't show up on Pubmed, although a few other ECT-related articles by the pair do. I'm automatically suspicious of things "cited" on webpages which can't be cross-checked on pubmed, because we have no evidence that the article actually exists. This very article has in fact been cited before on this page, and other authors have noted that it appears not to exist.

Colon EJ, Notermans SLH. A long-term study of the effects of electro-convulsions on the structure of the cerebral cortex. Acta Neuropathologica (Berlin)1975; 32: 21-25 PMID 1146505. Again, this has been dealt with before - and you selectively quote its conclusions, which also note that "there was no loss of neurons in the cortex" - in other words, no nerve cells died. It's hard to equate that to "damage".

Weinberger DR, Torrey EF, Neophytides AN et al. Lateral cerebral ventricular enlargement in chronic schizophrenia. Archives of General Psychiatry 1979; 36: 735-739. Again, this study has been dealt with on the talk page already. It concluded, as User:DocJohnny noted on 22nd January 2006, that ECT had no effect on ventricular enlargement.

Calloway SP, Dolan RJ, Jacoby RJ, Levy R. ECT and cerebral atrophy. Acta Psychiatrica Scandinavica 1981; 64: 442-445. PMID 7347109. Another which has cropped up before. This demonstrated an association between frontal lobe atrophy and ECT, but didn't suggest ECT caused frontal lobe atrophy - i.e., it could as easily be that patients who underwent ECT had more frontal lobe atrophy by virtue of their more advanced disease.

Templer RI, Ruff CF, Armstrong G. Cognitive functioning and degree of psychosis in schizophrenics given many electroconvulsive treatments. British Journal of Psychiatry 1973; 123: 441-443. PMID 4147890.

I'm sorry - I'm going to stop here. You have just reproduced the same list of articles which we went through on this page and rejected in January last year. Please don't take this the wrong way - but I and other authors have already explained why these studies are not sufficient to make the point you're trying to make (although they are certainly citeable). I'm not willing to go through them again until you:

(1) Demonstrate that you have read them, rather than merely found them on an anti-psychiatry website.

(2) Explain why research which is three decades old should still merit inclusion now in the light of more recent and more careful research.

Apologies if this sounds strongly-worded, but I don't think it unreasonable that I should object to having to go over precisely the same set of studies again. I would urge everyone involved in this mediation episode to read the relevant sections of the archives before bringing up papers for review which have already been reviewed by a number of authors. Thanks. Nmg20 01:55, 18 May 2007 (UTC)

Nmg20, I'm not familiar with the entire history of the electroshock page. Therefore, I wasn't aware that the studies I listed had been discussed already. What is the problem with the 1977 article that Scuro rejected (not included in the above list)? That article is not tainted, as you imply, by being posted on an anti-psychiatry website. Yes, I did read the article and I see no reason to disregard it. Please direct me to the "more recent and more careful research" that contradicts the 1977 article. As for the list above, I didn't "selectively quote" anything. As I stated above, the entire list was excerpted from the PsychRights website. Regardless of what biological psychiatrists say, electroshock does appear to cause brain dysfunction. Whether or not that dysfunction relates to physical damage is not clear. However, the testimony of thousands of electroshock survivors (including myself) cannot fairly and reasonably be written off. I know what happened to me and I know that I'm not alone. Lastly, your post above does not at all sound strongly-worded and I appreciate your input. JuneTune2 16:46, 19 May 2007 (UTC)

Of course, JuneTune - my frustration was mostly based around the fact that I presumed (and please do correct me if I'm wrong) that you haven't actually read the papers you cited above, but rather have found them on whatever antipsychiatry webpage the last person to post the link up got them from? I worry about citations being posted essentially from secondhand sources - when we went through the list before, it was clear that the webpage which the list had been taken from was misrepresenting a significant number of the studies cited, and that's something which could be avoided if the original papers were reviewed by the posting editors - that's what I believe to be the minimum standard for posting references, really, and I get enormously irritated by having to debunk the same list of references listed from the same websites over and over again!

In that light, thank you for posting a link to the full text of the Friedberg article, and thank you for having read it. One good/correct way to reference it in the article would be Friedberg J. Shock treatment, brain damage, and memory loss: a neurological perspective. Am J Psychiatry. 1977 Sep;134(9):1010-4. PMID 900284. In terms of the article itself, I think it's absolutely citeable with the proviso which I've outlined before that it needs to be taken in light of its limitations and of subsequent similar research. For instance, much of the article is reviewing the development of ECT as a procedure, and things like the Bini reference showing brain damage in dogs with "mouth to rectum electrode placement" is not relevant to ECT in humans, who don't have electrodes attached to their rectums and aren't dogs! The bulk of the research it cites is from unmodified shocks applied to animals in the middle of the last century, and in cases like those, there are four main reasons I don't think they are relevant:

(1) They were studies on animals not humans.

(2) They were studies during the development of the procedure and are looking at something (unmodified ECT) which is no longer performed in the Western world.

(3) They are around 50 years old, and while pathology has not changed dramatically in that time, our understanding of the changes in brain physiology which constitute permanent damage has.

(4) There are numerous more recent studies looking at human subjects, in vivo, using modern ECT techniques, and more advanced neuroimaging techniques, which fail to demonstrate similar findings in humans.

Turning to the human studies he cites, (3) and (4) above apply to all of them, and (2) to a number. In addition, and most crucially, none of the references cited are prospective, i.e. none of them can demonstrate that the subjects had normal brains prior to autopsy / investigation. They therefore provide evidence that people undergoing ECT are more likely to have brain haemorrhages (or more accurately, were more likely to in the 1940s and 1950s), but they do not prove that ECT causes these haemorrhages. Given the number of prospective MRI and CT studies of ECT patients which have not found evidence of haemorrhage since then, and given the extremely high sensitivity and specificity of neuroimaging for detecting haemorrhage, I think it would be unreasonable to say that evidence from half a century ago outweighs more recent, better designed research.

On the EEG evidence, I don't have evidence about whether seizures do actually damage the thalamus, so I'd be quite happy for you to use the study to support a statement like "Diffuse EEG abnormalities following ECT suggest damage to the thalamus"; the onus is then on others to find and cite more recent work which contradicts that.

On the memory loss front, I'd again suggest this work has been "trumped" by larger, better-designed, and more recent studies such as the ones cited in the article already.

I do think it's reasonable to say, as you do, that ECT causes brain dysfunction, although I'd disagree that "biological psychiatrists" would argue otherwise. In fact, I'm nervous about terms like "biological psychiatrist", because I've no idea what it means and I've never met anyone who's described themselves like that! Anyway - ECT certainly causes brain dysfunction because it artificially induces what is effectively an epileptic seizure, and there's no denying that's dysfunctional. I don't think, either, that the testimony of those who've undergone electroshock is being written off by anyone - however, medicine pretty much all over the world decides what is and is not an acceptable and effective treatment based on fairly stringent standards of research, and subjective testimony does not feature on that list for all sorts of reasons, chiefly that it is not empirically testable. However, it already features in the article in what I think it the appropriate place for it - where those who've had electroshock have had their views on it published, those are cited in the Nonfictional depictions of ECT section. As an aside, I would strongly resist any attempt to paint everyone who has undergone ECT as a "survivor" - while I of course support your right to describe yourself as you wish, there are plenty of people who do not and would not describe themselves in those terms, perhaps largely because it has a mortality rate close to zero. Similarly, the variety of citations from autobiographical published work currently in the article make it clear that, while some ECT patients certainly do share your views, a number do not - and so I don't think that it would be fair to suggest that "the testimony of thousands of electroshock survivors" is in any way the same as the testimony of everyone who's undergone electroshock - and to your credit, you don't attempt to do that.

Finally, I'm glad we are able to discuss this so openly and reasonably - so thank you. Look forward to your response. Nmg20 10:55, 20 May 2007 (UTC)

First off, Nmg20. I wrote my comment below about Friedberg before I read your comment above. Thanks for the explanation. As for me pulling those citations from "whatever antipsychiatry webpage the last person to post the link up got them from," I am appalled at your suggestion. www.PsychRights.org is run by the Law Project for Psychiatric Rights, a very respectable advocacy organization in Alaska run by lawyer Jim Gottstein, whom I know personally. Mr. Gottstein is spearheading the current litigation against Zyprexa, the makers of Olanzapine, a neuroleptic which killed more people from cardiovascular disease and diabetes than ever were “saved” from psychotic symptoms. You are right that I didn’t read each individual article. I should have. Lastly, yes, I am aware that some people have benefitted from electroshock. I have an aunt that used to think regular electroshock helped her. I estimate she’s had over 100 electroshock “treatments” in her life. Unfortunately, she’s now a non-verbal cabbage so I have no idea what her current thoughts on electroshock are. And, finally, I too enjoy this dialogue. JuneTune2 00:20, 21 May 2007 (UTC)

Just wanted to add: when I'm speaking of brain dysfunction, I'm not talking about during the seizure. I'm talking about lasting effects afterwards. And, as for biological psychiatry, I'm referring to doctors and researchers (notably E. Fuller Torrey) who believe that all mental illness starts and ends in the brain chemicals, thus disregarding all of the evidence indicating the value of counselling in treatment and the importance of environmental factors in the development of mental illness (nature vs. nurture). In short, I'd define a biological psychiatrist as a pseudoscientist, along the lines of an eugenicist. JuneTune2 00:26, 21 May 2007 (UTC)

I'm afraid that, reputable though you may feel this website is, it grossly misrepresents the content of the majority of the papers in that list. A number of editors, myself included, have been through the list and explained exactly why this is - I've posted the link to the archive a bunch of times above. I wish Mr. Gottstein luck in his campaign against the makers of olanzapine, but it seems to me that - even if his website hadn't misled its readers about what is in those papers - someone engaged in active legal action against a pharmaceutical company is not going to be an unbiased source on psychiatric illness.

Anyway, we appear to agree that the default standard for posting references should be that the editor has read them him- or herself, so hopefully we're done with that list?

In terms of your aunt, presumably you acknowledged her right to continue to have ECT, and that her believing it helped her made it a beneficial treatment for her? It strike me you present her case in a way that implies a link between her ECT and what sounds like dementia; this is something I'm not aware that has been suggested before.

I don't quite know what to make of your assertion that so-called "biological psychiatrists" are tantamount to eugenicists, except that I find it extraordinarily far-fetched. This is not least because looking to brain chemicals for an explanation of mood disorders simply doesn't preclude acknowledging the importance of environmental factors and talking therapies in treatment. There isn't an absolute divide between saying that neuronal transmission in the brain is the source of mood and is dependent upon the levels of neurotransmitters there, and saying that environmental factors such as loss of a loved one or job, or birth trauma, or having sympathetic family members or counsellors around can affect mood. It's patently obvious that both, and not one or the other, are true, and it's the smallest of steps from there to say that environmental factors can and do directly influence the levels of chemicals and perhaps the pattern of their release in the brain, and thus directly influence mood.

More to the point, it's something which is absolutely embraced by psychiatrists across the UK and the US. I can only speak from firsthand experience in the UK, but CBT has been shown to be extremely effective at treating a number of psychiatric conditions, particularly phobias, and is prescribed as often as it can be given the dearth of trained therapists available (thanks to under-funding of training by the government). It's also a paradigm of what I was saying above, in that the studies looking at it thus far have shown that it is most effective along with drugs rather than in isolation. Nmg20 13:41, 21 May 2007 (UTC)

Plagiarism

Scuro, if you want to lift something from a source you have to either:

1) copy it exactly, put it in quotation marks and put a footnote giving the source. or 2) put it in your own words with a footnote saying where you got in from, for example,

A recent textbook lists the following important events in the history of ECT: Task force reports published in ... and .... Articles on the electrode placement published in .... .... etc etc and then, at the end, put a reference (in this case to Rudorfer).

Just changing the occasional word, for example, "encouraged" to "recommended" isn't enough. —The preceding unsigned comment was added by Staug73 (talk • contribs) 13:31, 7 May 2007 (UTC).

The reworking of the history section wasn't complete. Citations were to follow after this task was done. Your characterization of this section isn't as black and white as you make it out to be. --scuro 16:35, 7 May 2007 (UTC)

Request for comment

This section is for people responding to the RfC

Thank you for taking the time to read this article and comment. Comments, suggestions etc on POV, neutrality, or anything else are very welcome. Someone, for example, has suggested that the article is "too historical".Staug73 15:43, 7 May 2007 (UTC)

Hi Staug,

The real culprit here is the WP “due weight” policy, as you can see in the letter I wrote to Jimbo.

That policy works with lunatic beliefs, such as conspiracy theories, paranormal claims and biological pseudosciences such as phrenology. Unfortunately, psychiatry is a widely accepted pseudoscience, just as some decades ago the pseudoscience of eugenics was accepted in the West. If WP existed then, the critics of the eugenics movement would have been marginalized due to the “due weight” policy.

Wikipedians don’t know this. They are plugged in the Matrix. As one poster put it in a public forum: [3]

“ Most skeptics seem to be the kind of fluffy-headed bimbos who say if it's orthodox among "real" scientists it must be correct. Anyone who's not ignorant of the history of science knows that orthodoxies come and go. Don't tell me about Popper or Khun, I already know (Zzzzzzzzzzzz). Yeah, I've noticed brown nosed skeptics lambast Szasz, Breggin and others. In fact, skeptics are not really educated on the subject until they've read Thomas Szasz's The Manufacture of Madness. ”

Psychiatric practice, including electroshock (euphemistically called “ECT”) is iatrogenic. I have compared electroshock elsewhere to a hammer blow on one’s head. It “cures” depression but it damages the brain. But since psychiatry is accepted in the academia, and since WP rules don’t permit to say the truth about this pseudoscience, I guess that we can reach a compromise by creating a “pov fork”.

This is tricky, since there are psychiatric forks that both represent the maistream (i.e., the pseudoscientific) pov, such as the ADHD article and the so-called “controversy” ADHD article.

On the other hand, he who has more free time and energy to fight in Wikiland has advantage. Take a close look at User:wikipediatrix fourth axiom and you will see what I mean.

—Cesar Tort 03:16, 8 May 2007 (UTC)

You're being very patronising to an awful lot of Wikipedians, Cesar. In addition, your criticisms of ECT and psychiatry are horribly sweeping, devoid of any evidence to support them beyond namechecking Szasz and Breggin, and indicative of the real problem with psychiatric practice, which is that lay people feel able to opine on it in a way they wouldn't dream of doing with, for instance, abdominal surgery.

For instance, you say that ECT "cures depression but damages the brain". That's wrong twice - first because it can but doesn't always cure depression (something which your scare quotes don't convey at all), and second because there is no convincing evidence that it damages the brain. It's also an utterly bizarre argument to adopt - ECT, for instance, is given to (among others) patients so depressed they aren't eating, moving around, or talking - their life expectancy is absolutely dire without treatment, and believe it or not, asking them about their parents or whatever you'd suggest (oddly, you fail to say) is unlikely to help. Finally, lots of generally accepted medical practices do cause damage to the body - any form of surgery involves slicing through healthy tissue, for instance, but no one is suggesting that having a hernia repaired is like a hammer blow to the solar plexus. Why is that? Nmg20 00:13, 10 May 2007 (UTC)

I know a psychiatrist who has prescribed ECT to a patient against his will. He was suicidal. Drugs take too long. Because of ECT they were able to send him home and he could continue his life. This article intently neglects success stories like this, which are more often the case. This is why psychiatrists prescribe it. It does in minutes what takes drugs weeks. These are things which have been tested in double-blinded studies.--Loodog 00:20, 10 May 2007 (UTC)

That was not a success story. You are thinking like a Christian (even if you are not). Psychiatry is politics: pure and simple. In other cultures such as ancient Rome or present-day Japan, suicide is OK. Only the fucking cultures that rose from Judaism, Christianity and Islam —i.e., the monotheists— condemn suicide. According to John Stuart Mill neither the state nor the medical institution has the right to molest the individual unless s/he harms others. The psychiatric mantra “danger to himself...” is therefore a political, not a medical, statement. And of course I patronize wikipedians and all those who have not fully digested Mill and the other classic authors that promote open societies. Involuntary psychiatry is closer to the Inquisition than to science. Just read what Cicero wrote about suicide. —Cesar Tort 00:41, 10 May 2007 (UTC)

If your beliefs are against the goals of psychiatric treatment, that's an issue for you to take up with drug or ECT-based psychiatry in general, not on the ECT page.--Loodog 00:49, 10 May 2007 (UTC)

Agreed! —Cesar Tort 00:55, 10 May 2007 (UTC)

Nmg 20, to what would you attribute short and long-term memory loss, if not to brain damage? And as for your abdominal surgery analogy, I can truthfully say that if abdominal surgery tended to destroy people (have you ever talked to somebody before and after electroshock?), then, yes, you bet, I would certainly be questioning abdominal surgery and the "doctors" who inflicted it. JuneTune 04:42, 14 May 2007 (UTC)

Transient changes in brain chemistry. There are dozens of things which can cause memory loss, including anaesthesia, use of sedative drugs (particularly barbiturates and benzodiazepines), absence seizures, changes in an individual's metabolic state... If memory loss is taken as proof of brain damage, no one would ever willingly have an operation requiring anaesthesia, they wouldn't take barbiturates or benzos, and people with some types of epilepsy would be doing damage to their brains every time they had a seizure. There is no evidence to support any of those, and more particularly there's no compelling evidence that ECT causes brain damage either.

And yes, of course I've spoken to people before and after ECT, and I've done so both in medical and personal contexts. In the medical context, in my experience its effects are frequently only a few steps off the miraculous in terms of the positive changes it can have; I'm thinking particularly of a man in his 50s who was so depressed he wasn't washing, moving, eating, and who hours after his first treatment was wandering around the ward chatting to his sister. The reason we rely not on first-hand accounts, but on science, is that different people have different experiences of ECT: you think it's monstrous, I think it is frequently miraculous. Nmg20 09:48, 14 May 2007 (UTC)

But the memory loss and other dysfunction ISN'T transient. I agree that it's not "proof" of brain damage (as in physical changes) but it's certainly indicative of dysfunction. As for those willing to have operations, please let us never forget that many electroshock survivors weren't given the choice. Nobody's denying that it can't have remarkable effects! So would sticking your finger in a light socket. So would being smacked in the head with a log. The point is that the risks outweigh the benefits. It's the alleged benefits that are transient, hence "maintenance" electroshock. I have very compelling evidence that electroshock causes brain damage: it happened to me. I realize that's not citable but you should know where I'm coming from. JuneTune2 17:38, 19 May 2007 (UTC)

(WP:SOAP)--scuro 21:17, 19 May 2007 (UTC)

Four things here, which I'll deal with in turn.

(1) Does memory loss etc. indicate dysfunction? As stated above, absolutely it does. At the same time, it must be kept in mind that patients having ECT have cognitive dysfunction to start with in that they are severely depressed or schizophrenic.

(2) Is dysfunction transient? The sources cited in the article currently suggest that dysfunction in the forms of memory loss and performance on neuropsychological assessment can be persistent, and while a lot of studies have found no enduring deficits (e.g. Criado et al 2007; PMID 17323224) probably the best recent study (by virtue of being in the BMJ) found that a third of patients reported persistent deficits (Rose et al 2003; PMID 12816822) - so I'd support the possibility of permanent deficits staying in the article. However, it would need tempered with the information that deficits tend to be "limited and tolerable" (Abraham et al 2006; PMID 16633206), that the memory of a lot of severely depressed patients is poor to begin with (Hihn et al 2006; PMID 16957535), and that large community studies have found that overall, ECT is associated with improved Quality of Life on patient self-report data (McCall et al 2006; PMID 16412519). It would also be worth acknowledging that work is going on to minimise the adverse side-effects of treatment (e.g. Kim et al 2007; PMID 17305102, Nagaraja et al 2007; PMID 17072590).

(3) The issue of consent. I accept that ECT was occasionally administered inappropriately in the past, but I don't know of any evidence that it is currently administered to unwilling patients capable of taking an informed decision regarding their treatment. So I have to fall back on asking you to provide sources demonstrating that it is, I'm afraid.

(4) The fingers-in-socket/hit-on-head-with log examples. I think this equation of ECT with overtly unpleasant and non-therapeutic experiences is a little unhelpful. Getting electrocuted or bashed in the head are deliberately emotive, so please allow me to be clear. When I say ECT can have remarkable effects, I mean that it can transiently or permanently cure the most severely affected and treatment-resistant patients of their mental illness. Nmg20 11:19, 20 May 2007 (UTC)

Nmg20, my four responses: (1) Electroshock is also given to manic patients and to non-schizophrenic psychotic patients, among others. And if the procedure is as effective as this article claims, then they shouldn't be ill afterwards, should they? So wouldn't their brain dysfunction clear up at the same time as their depression (or whatever) miraculously lifted? (2) "Limited and tolerable" is not how many electroshock survivors would describe these effects. Indeed, the many patients who have died during or immediately after the procedure surely didn't find the side effects either limited or tolerable. (3) Involuntary electroshock still occurs. Your statement "capable of making an informed decision" is the weasel out that the industry uses. You don't have to be very terribly capable to decide that you do not want to be strapped down and electrocuted. As for all of psychiatric treatment, consent is never informed -- because patients are never informed of the true risks of various procedures. Lastly, the World Health Organization recommends a world-wide ban on involuntary electroshock. That should resonate with the pro-electroshock camp. (4) As electroshock is both unpleasant and non-therapeutic, I don't see any problem equating it with other similar experiences. Electroshock can very temporarily alleviate mental illness, just like any closed head injury would likely do. The "benefits" don't last thus "maintenance" electroshock comes into play. JuneTune2 00:07, 21 May 2007 (UTC)

(1) Yup, ECT is occasionally given for bipolar disorder; I don't think it's given for psychosis except if that has been brought on by depression, schizophrenia, or bipolar disorder, though.

In terms of the question, "if the procedure is as effective as this article claims, then they shouldn't be ill afterwards, should they?", perhaps I can return to the appendix - people who have surgery to remove their appendix are ill afterwards, in a bunch of pain, and can be acutely confused in the postoperative period; that doesn't mean the surgery hasn't worked. People who have heart bypass surgery are well-known to suffer acute (Toner et al 1998; PMID 9504725) and chronic (Stygall et al 2003; PMID 14640854) cognitive deficits after surgery; that happens irrespective of how successful the surgery was. People who take aspirin can find their asthma's worse, people who take penicillin may get an upset stomach - treatments for a condition address that condition, and not any others. The person with angina who has a bypass still has atherosclerosed arteries elsewhere in their body, the person with a sprained ankle and asthma still has asthma, the person with a lung infection who takes penicillin will still be vulnerable to an upset stomach after the infection clear up.

No one fully understands yet why depressed patients tend to perform so poorly on cognitive testing - there are plenty of theories out there, but we're some way off understanding it. The fact that a treatment exists which effectively addresses their main complaint - that they feel too awful to feed/wash/clothe themselves - but doesn't improve their cognitive dysfunction and may worsen it is no reason to discard that treatment.

(2) "Limited and tolerable" is not how you would describe the side-effects of ECT. It is how published medical research of many people who have had ECT would describe it. Wikipedia is not the place for you to get your opinion of ECT published - it is a place for the review of existing independently verifiable research and for the adoption of a tone reflecting that research.

You claim that many patients die during or immediately after the procedure; may I call you on that and ask you to source the claim per Wikipedia guidelines (i.e. from a reputable, peer-reviewed medical journal, and not from a website about psychiatry, please)?

(3) I did ask for sources on involuntary electroshock; I was already aware of your opinion. Do you have any? I don't think there's much point our arguing over whether someone who (for instance) won't eat, or believes their family have been abducted by aliens and must be killed is capable of choosing the best medical treatment for them. Similarly, your claim that patients are never told of the risks of treatment is simply untrue - believe me, I fill in the forms with patients in which every risk is detailed to avoid later legal action because someone didn't realise abdominal surgery might leave a scar. Finally, you persist in equating ECT with electrocution: the two are different.

(4) Can you prove that "any closed head injury" will temporarily alleviate the effects of serious psychiatric illness? Again, please source your claims. Nmg20 14:12, 21 May 2007 (UTC)

and that's the problem

Once again we have ipov tags taken off without any sort of consensus. This time the tags were placed on sections with detailed notes in discussion that listed exact points of bias. While it is fine that editors edit the section to bring the section to a more neutrel point of view, that doesn't mean the edit is acceptable to the community of editors or even to the editor who placed the IPOV tag originally. You have to ask.

Good faith would mean possibly making the edits while leaving the tag on and then explaining the edits and seeking concensus in discussion. Or if it is a contentious issue, illlustrating the edits first in discussion seeking consensus and then editing and removing the tag. Unilaterial action is neither a good faith action nor does it build consensus. --scuro 16:43, 7 May 2007 (UTC)

intro no longer meets wiki standards

I'd ask that Staug73 undo his "neurton bomb" deletion of the intro and then seek consensus in discussion before making further edits. What we have now isn't even skelton like.--scuro 16:50, 7 May 2007 (UTC)

Here is the last version of the intro before it was mainly deleted.

Electroconvulsive therapy (ECT), also known as electroshock, is a controversial psychiatric treatment in which tonic seizures are induced by passing electricity through the brain of an anesthetized patient. ECT was introduced as a treatment for schizophrenia in the 1930s, and then became a common treatment for a wide range of psychiatric disorders. The introduction of antipsychotic and antidepressant drugs in the 1950s and 1960s along with the stigmatization of the procedure in the media led to a significant decline in the use of ECT by the 1980's. Still, many recent critical examinations of ECT by worldwide government institutions and researchers have supported the important place of ECT in modern medicine. ECT is considered to be clinically effective for severe depression that has not responded to drugs and is most often used in this regard. An estimated 1,000,000 people in the world undergo ECT every year.

It should be reinserted when the edit lock comes off. Possible edits desired to this section should suggested now or other possible introductions could be posted in this discussion subsection now.--scuro 13:06, 21 May 2007 (UTC)

I think the original introduction should be re-inserted, with any changes discussed here first.Staug73 15:28, 22 May 2007 (UTC)

Electroconvulsive therapy (ECT), also known as electroshock, is a psychiatric treatment in which seizures are induced by passing electricity through the brain of an anaesthetised patient.

ECT was introduced as a treatment for schizophrenia in the 1930s, and soon became a common treatment for a wide range of psychiatric disorders. The introduction of antipsychotic and antidepressant drugs in the 1950s and 1960s led to a decline in the use of ECT, but it has maintained an important place in psychiatry, mainly as a treatment for depression that has not responded to drugs. An estimated 100,000 people in the USA undergo ECT every year.

ECT is effective in relieving the symptoms of depression in the majority of patients but the benefits are relatively short-lived and continuing concerns about effects on memory limit its use. ECT is endorsed by professional psychiatric associations and health authorities, although some health professionals and many members of the public are skeptical and it remains a controversial treatment. People who have undergone ECT are divided in their opinions of it.

The introduction should hit on all the main points of the article but in a nutshell it should answer these basic questions which will be the questions of most readers:

• what it is and who it is used for?
• qualify if it is effective as a treatment?
• what side effects are a concern, including brain damage.

Bits can be taken from both edits. The major difference in the two edits is that Staug73's version states that the effects are short lived...and not effective. That needs to be qualified. We also get a note of skepticism from health professionals, the public, and those who have undergone the treatment. That all needs to quantified.--scuro 03:21, 23 May 2007 (UTC)

A blended new version with some additions

Electroconvulsive therapy (ECT), also known as electroshock, is a psychiatric treatment in which seizures are induced with electricity. The seizure is what has widley been accepted to cause the theraputic effect. ECT is most often used for cases of severe clinical depression which have not responded to other treatments. The treatment is performed typically on older female patients. ECT has been shown to be clinically effective in relieving the symptoms of depression in the majority of patients but the benefits can be relatively short-lived and valid concerns about effects on memory limit its use. ECT does not cause structural brain damage. Different methods and ECT technology produce different theraputic effects and impairments. Best practices have not always become standardized across the world and alarmingly even within the USA. Approximatly 100,000 people in the USA undergo ECT each year and an estimated 1,000,000 people in the world recieve ECT treatment.

--scuro 04:58, 31 May 2007 (UTC)

Wikipedia's undue weight policy and how this relates to NPOV/bias of this article

http://en.wikipedia.org/wiki/WP:UNDUE#Undue_weight

"Undue weight applies to more than just viewpoints. Just as giving undue weight to a viewpoint is not neutral, so is giving undue weight to other verifiable and sourced statements. An article should not give undue weight to any aspects of the subject, but should strive to treat each aspect with a weight appropriate to its significance to the subject. Note that undue weight can be given in several ways, including, but not limited to, depth of detail, quantity of text, prominence of placement, and juxtaposition of statements".

This is EXACTLY the argument that I have been making since I first encountered this article...and continue to make. Now can we get on with it and make the necessary changes to this article that are needed? Otherwise this article needs a NPOV tag, low quality tag...something to alert the reader that what they are reading has a marked bias.--scuro 23:32, 7 May 2007 (UTC)

Here are two different edits of the brain damage section. They are very similar and contain a lot of the same material yet convey a very different message. Placement of material and undue weight can impart a bias especially when a generally discarded notion gets a place of prominance and emphasis.

Edit #1

Research into structural brain damage

Another area of controversy is whether the effects of ECT on cognition are accompanied by structural changes in the brain. In 1982 neuropsychologists Donald Templer and David Veleber reviewed the literature on human autopsies and animal experiments and concluded that ECT has caused and can cause permanent brain pathology, whilst acknowledging that there were vast differences between individuals and that lasting damage was the exception rather than the rule. Two years later psychiatrist Richard Weiner reviewed the same literature, dismissing early studies as irrelevant to modern practice (since an unmodified convulsion without oxygenation may be a contributing factor to any damage) and concluded: "evidence that ECT, given in a contemporary fashion, typically leads to the development of brain damage and its lasting physiologic and cognitive correlates is weak". An open peer commentary attracted both agreement and criticism. In 1991 psychiatrist Davangere Devanand and colleagues covered the same ground, dismissing early studies as methodologically flawed, with an additional discussion of more recent studies using CT and MRI scans and concluded that no evidence of structural brain damage as a result of ECT has been found. British pychiatrist Stephen Calloway and colleagues found an association between a history of ECT and cortical atrophy in the frontal region in elderly depressed patients. Despite the association, cortical atrophy was found in some people who had never had ECT whilst others who had had a large number of treatments didn't have any cortical atrophy. The authors said that it was possible that ECT had caused cortical atrophy, but also possible that depressed patients with cortical atrophy are more likely to be prescribed ECT. MRI scans are more sensitive than CT scans and can exclude the possibility of severe, although not significant, brain damage. One small, uncontrolled, prospective MRI study found that a minority of patients showed changes in subcortical hypertensity six months after ECT. The authors thought these changes were probably due to the progression of cerebrovascular disease. Many of the patients had structural abnormalities before treatment.

Edit #2

Research into structural brain damage

Devanand has recently conducted several reviews to clarify if ECT causes possible brain damage. He stated, "there is a clear absence of any evidence that ECT causes damage to neurons or other brain cells". His reviews examined these areas: auopsies on ECT patients, cognitive side effects, structurial brain imaging, animal studies of electroconvulsive shock, heat generation, and blood brain barrier disruption. He concluded that ECT induced cognitive deficits are transient. He dismissed early studies as methodologically flawed, with an additional discussion of more recent studies using CT and MRI scans and concluded that no evidence of structural brain damage as a result of ECT has been found.[24] Previously, Richard Weiner had also reviewed the earlier literature, dismissing early studies as irrelevant to modern practice (since an unmodified convulsion without oxygenation may be a contributing factor to any damage) and concluded: "evidence that ECT, given in a contemporary fashion, typically leads to the development of brain damage and its lasting physiologic and cognitive correlates is weak".[25] Earlier studies including Donald Templer and David Veleber 1982 concluded that ECT has caused and can cause permanent brain pathology, whilst acknowledging that there were vast differences between individuals and that lasting damage was the exception rather than the rule.[26] British pychiatrist Stephen Calloway and colleagues found an association between a history of ECT and cortical atrophy in the frontal region in elderly depressed patients. Despite the association, cortical atrophy was found in some people who had never had ECT whilst others who had had a large number of treatments didn't have any cortical atrophy. The authors said that it was possible that ECT had caused cortical atrophy, but also possible that depressed patients with cortical atrophy are more likely to be prescribed ECT.[27] MRI scans are more sensitive than CT scans and can exclude the possibility of severe, although not significant, brain damage. One small, uncontrolled, prospective MRI study found that a minority of patients showed changes in subcortical hypertensity six months after ECT. The authors thought these changes were probably due to the progression of cerebrovascular disease. Many of the patients had structural abnormalities before treatment.[28] —The preceding unsigned comment was added by Scuro (talk • contribs) 02:32, 10 May 2007 (UTC).

The history section no longer meets wiki standards

The history section has now also been obliterated by Staug73 with no input either previously or after the deletion in discussion. Only the title is left. Considerable time was taken in creating this section.--scuro 17:01, 7 May 2007 (UTC)

Removing history

I have taken out most of the history, which will go into history section (so please leave history section alone for time being). I may have lost some footnotes etc and one or two sections need a bit of work. I will look at them tomorrow. Took out mechanism of action as it was causing so many problems! A question for any Americans - should it be "in the US" or "in the USA"?Staug73 17:40, 8 May 2007 (UTC)

You know Staug73, you do what you want with this article and then you tell everyone else what to do. Did you ever learn to play nice?--scuro 02:53, 9 May 2007 (UTC)

Staug, I've removed the history section simply because there's no content in it yet. Please add the heading when writing the section itself. Thanks.--Loodog 03:00, 9 May 2007 (UTC)

the deconstruction of this article courtesy of Staug73

Have you recently noticed about 1/2 dozen major subsections deleted or left with a sentence that ends like this, "..treatment in which seizures are induced with electricity". Furthermore have you noticed that Staug73 seems to think he owns all or part of this article? ((Electroconvulsive therapy‎; 17:29 (+14)Staug73 (Talk | contribs) (→The History of ECT - Hands off - this is MY section (for the history taken out of rest of article))

I can't contribute recently without being deleted. I can't post IPOV tags even after I make my case in discussion because they get deleted. I can't function as an editor. EVERY other Wikipedian I have encountered, even the most ardent ones have abided by basic Wikipedian rules and principles. This is verging on anarchy and I wonder why we tolerate it as a community. --scuro 02:48, 9 May 2007 (UTC)

This article is a pale shadow of its former glory. The old one wasnt necessarily perfect, but it was way more interesting. I move that it is reverted. does anyone second? --popefauvexxiii 09:42, 17 May 2007 (UTC)

No, as "glorious and interesting" as it may have been, it was and still is biased.--scuro 10:37, 17 May 2007 (UTC)

I don't know, Popefauvexxiii. Which "old" version were you referring to? I agree about it becoming duller.Staug73 13:58, 17 May 2007 (UTC)

External links section

I was wondering what is acceptable in the external links section. Does this section of an article have different rules then the rules for a citation? ECT.org, while not one the worst examples of a biased website that I have seem, certainly doesn't seem to have a NPOV. On the other hand the Electroshock Quotationary paper is clearly biased. For example, the paper opens with this dedication, "dedicated to everyone committed to ending the use of electroshock everywhere and forever".--scuro 11:31, 10 May 2007 (UTC)

Interesting that you write off anti-electroshock websites on the basis of bias but you're A-OK with pro-electroshock websites. Could it be, perhaps, that you are biased and are unwilling to tolerate any information that contradicts that bias? And, if I may ask a personal question, Scuro, why are you pro-electroshock? Have you a friend or family member that was helped by it? Do you just like the idea of it? I'm just curious why. JuneTune2 23:04, 19 May 2007 (UTC)

WP:NPA-This page in a nutshell: Comment on content, not on the contributor.

WP:SOAP-Wikipedia is not a soapbox, a battleground, or a vehicle for propaganda and advertising....You might wish to go to Usenet or start a blog if you want to convince people of the merits of your favorite views.

I admire your passion June. Yet, it's hard to communicate when one is put on the defensive by judgmental personal references or personal characterizations of information that both parties are communicating about. I'd kindly ask you to stop both practices.--scuro 23:52, 19 May 2007 (UTC)

Scuro, since you have done almost nothing in our communications to date except treat me with rudeness and condescension, I am very surprised to read this here. I certainly did not mean to personally offend you with my question above. It was more a matter of curiosity -- I'm an electroshock survivor and was harmed by the practice, thus I speak out against it. I assumed since you were so much in the pro-electroshock camp that you must have an analogous reason. That was a personal question and I shouldn't have asked it. Sorry, truly. JuneTune2 23:53, 20 May 2007 (UTC)

June, comment on the content not the contributor. I'm not personally offended but this isn't a message board. We are supposed to be advancing the state of the article. Perhaps you may have attributed some of my words in my previous post to me. The passages with quotation marks are part of the guidelines posted by Wiki, click on the links to check that. If you do want to speak out against ECT, Wikipedia isn't the place to do it. I would believe that there are many other possible avenues to do so. If on the other hand you want to make sure that this free encyclopedia cover this issue in a balanced way then you should, and are welcome to contribute....IF you follow Wikipedia standards. The standards can be found at this link (WP:5P). These standards are not absolute but rather guidelines so that we all get along, get the job done, and do the best possible job of neutrality under the circumstances.

Believe it or not, some of the things you say I agree with. There is no question in my mind that ECT causes dysfunction that may possibly be of permanent nature for some. I just haven't read enough about this subject to determine this, and who knows there might not even be a conclusive answer yet anyways. What I do know is the that the article was significantly biased when I came to it. As to your personal question...I don't mind answering. I have lived and work with people who have mental dysfunction far worse then yours...everyday of my life. Some where on this planet, someone with such a mental dysfunction is probably reading this article now. I'd like to make sure that they get as informative and balanced view of the subject as possible. It could change their life.

Finally June, I am not in the pro-ECT camp, I am in the anti-disinformation camp. When this article is finally balanced, I'll move on and not consider the subject again until some troll comes along and seeks to distort things once again. Now this is all you will get out of me June, NO questions about where I live or what my hobbies are!! :) --scuro 03:07, 21 May 2007 (UTC)

Electroshock Quotationary paper external link will be deleted unless anyone demonstrates why this link meets Wiki standards as a reliable source.--scuro 09:51, 24 May 2007 (UTC)

Is ECT.org overly biased and unsuitable as a citation link for Wikipedia or further reading link?

Subsections of the ECT.ORG website -Shock Doc Roster -ZapRap.org

Linking also to obviously biased websites

-The Committee for Truth in Psychiatry -MindFreedom.org -Dr. John Breeding - Wildest Colts -Dr. Peter Breggin -International Center for the Study of Psychiatry and Psychology -Stop Shrinks -CCHR - Coalition Against Psychiatric Assault - Critical Psychiatry - Critical psychiatry network - End Of Shock - International Association Against Psychiatric Assault - Mad in America - Mental Magazine - Overdosed America - Red Flags Weekly - The Dark Side of Psychiatry - Trust Us, We're Experts!

--scuro 11:22, 28 May 2007 (UTC)

The website fails WP:V#SELF Anyone can create a website or pay to have a book published, then claim to be an expert in a certain field. For that reason, self-published books, personal websites, and blogs are largely not acceptable as sources.

Juli Lawrence writes: History of ect.org

I began ect.org in 1995, and it’s gone through many evolutions. Despite cosmetic changes, my goals have remained constant: to provide as much information as possible about electroconvulsive therapy for anyone who wants it, and to provide a sense of community and support for those who have had ECT, good or bad. It really is that simple.To learn more about me, my own involvement with ECT, and a more detailed history, please see the original “Why I created this website” page.

Who is behind the curtain?

My name is Juli Lawrence and I started ect.org over a decade ago. You can read more about why I started it by clicking the link in the previous paragraph. There are no corporations or other organizations behind me.

The website would also fail Wiki's bias standards, "A bias is a prejudice in a general or specific sense, usually in the sense of having a predilection for one particular point of view or ideology. One is said to be biased if one is influenced by one's biases. A bias could, for example, lead one to accept or not accept the truth of a claim, not because of the strength of the claim itself, but because it does or does not correspond to one's own preconceived ideas". Also NPOV

The neutral point of view is a means of dealing with conflicting views. The policy requires that, where there are or have been conflicting views, these should be presented fairly. None of the views should be given undue weight or asserted as being the truth, and all significant published points of view are to be presented, not just the most popular one. It should also not be asserted that the most popular view or some sort of intermediate view among the different views is the correct one. Readers are left to form their own opinions.

As the name suggests, the neutral point of view is a point of view, not the absence or elimination of viewpoints. It is a point of view that is neutral; that is neither sympathetic nor in opposition to its subject.

Here are some selected quotes from the website:

This book will shed light on an industry that has fed on a plague of self deception, of defensiveness, and of outright lies. Might as well put the shock industry on official notice: the chipping away at your ivory wall continues. This time, Ms. Linda Andre will be wielding a jackhammer. I confess I’ve had a peek, and the writing is stunning. That’s not a surprise to me and won’t be to anyone who knows Linda’s skills. It may be a surprise to the “gang” (Sackeim, Ricky and friends), who won’t be able to conceive that she’s far more articulate than they are.

More on Sackheim "SHAME for playing the “violent mental patients” card with the media, as in his false claim that patients have made “death threats” on him. SHAME for telling one of his research subjects who was brave enough to confront him after losing twenty years of memory that her memory loss “couldn’t” be caused by ECT, and “must have” been caused by a stroke she had without realizing it. SHAME for telling each one of the hundreds of survivors who’ve been his subjects or who’ve contacted him, “Your losses could not possibly be due to ECT”, and then saying with a straight face and fingers crossed behind his back (in court, to policymakers, to politicians, to the media) that he has “never” seen a case of permanent ECT memory loss. Whether for fun or profit, the net effect of Harold Sackeim’s lies has been to end all scientific investigation of ECT’s effects on memory and the brain, and to effectively discredit survivors who report memory loss and brain damage, and to prevent future patients from being informed of ECT’s permanent effects. No one is more shameless than Harold Sackeim, and no one more richly deserves induction into the ect.org Hall of Shame.

Ironically the website has several links to his most recent study. to illustrate the negative effects of ECT.

--scuro 23:31, 28 May 2007 (UTC)

Spoiler warning

Please remove the spoiler warning after protection expires. This is supposed to be a serious article. Kusma (talk) 18:49, 15 May 2007 (UTC)

Quote from article by Devanand and colleagues

Could someone give me page number and paragraph from the Devanand et al article where this comes from:

He stated, "there is a clear absence of any evidence that ECT causes damage to neurons or other brain cells".

as I have been unable to find it in the article. If it is there, I stand corrected. If not, I think it should be changed to something Devanand et al actually did say.

Also, where are the other reviews? Staug73 14:21, 16 May 2007 (UTC)

I am still waiting for a reply. Perhaps I should have said: Could the person who put in the Devanand et al "quote" (I think it was Scuro) please give the page and paragraph.Staug73 13:54, 17 May 2007 (UTC)

Yes, it was me who put in the edit. Staug73, I'm glad that we are having this conversation. Personally I am a sequential type of guy and would like to finish up business at the Mediation Cabal which is on a deadline, before I tackle this.--scuro 16:35, 17 May 2007 (UTC)

The page number and paragraph number would be page #1 paragraph 1. The abstract is part of the paper. The abstract is the author's summary of their own conclusions and is written by the author. Many folks never get to read a study because they don't have access to most journals through the internet and have never gone to a library to look up papers. Here is an example of a manuscript for all to see. The abstract is clearly part of the paper. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1474811 --scuro 02:01, 19 May 2007 (UTC)

The quote is not in the abstract. You cut and pasted it from another website which wasn't even pretending that it was a direct quote from the review in question. If you want to say He states "...." then you have to say exactly what the authors said, which was slightly but importantly different. And, as I asked before, where are the other reviews you refer to? That either needs re-wording (in a 1994 review of the literature) or the other reviews need to be added to the footnote.Staug73 12:21, 19 May 2007 (UTC)

This is why I didn't want to post the information requested before the mediation cabal process was complete this Tuesday. I was afraid we would take our eye off the ball. For example, I have a reply instantly here and questions asked there are still not answered. Please read the post in the mediation cabal entitled, "Wikipedia does not require perfection".--scuro 12:49, 19 May 2007 (UTC)

The full reference for that paper is: Devanand DP, Dwork AJ, Hutchinson ER, Bolwig TG, Sackeim HA. Does ECT alter brain structure? Am J Psychiatry. 1994 Jul;151(7):957-70. PMID 8010381

If you click on the link there, you'll see that the abstract of the conclusion is "There is no credible evidence that ECT causes structural brain damage." With respect, that seems pretty cut-and-dried in terms of an accurate report of what the article says to me. Nmg20 11:33, 20 May 2007 (UTC)

How come we're now qualifying it to "structural" brain damage? JuneTune2 23:49, 20 May 2007 (UTC)

We are not "qualifying" anything, but the authors of a paper entitled "Does ECT alter brain structure?" have by definition restricted the scope of their own research. Thus, representations of that paper here need to reflect that. Nmg20 19:53, 21 May 2007 (UTC)

rehashed OLD references

I gotta say that citations from 1973 even into the early 80's doesn't cut it in the mental health field. That information is historical. For instance we have the Consensus Development Conference Statement on ECT used as one of the main external links even though I believe there was another consensus statement later. Regardless, this is the disclaimer posted on the link:

"This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong. For reliable, current information on this and other health topics, we recommend consulting the National Institutes of Health's MedlinePlus http://www.nlm.nih.gov/medlineplus/". —Preceding unsigned comment added by Scuro (talk • contribs)

Without wishing to be difficult, I'm not sure I agree. To my mind, if there were valid studies from the 70s and 80s which actually demonstrated brain damage, they should be included - so for example, I think the Colon & Notermans study (PMID 1146505) should be included, because it did demonstrate a loss of nuclear volume. However, it absolutely should not be used to support the statement "ECT causes brain damage" unless another citation can be found illustrating that a loss of nuclear volume in brain cells without death of neurons is brain damage.

The only exceptions should be where the older studies are smaller, less well-designed, or have been superseded by more recent research. For instance, a number of the ones cited above are retrospective reviews of notes, and those are clearly less valuable than prospective work (per evidence-based medicine and the criteria given there for stratifying medical evidence).

As I say, not trying to pick fights - but I don't think we should exclude research purely because of when it was done. Nmg20 14:09, 18 May 2007 (UTC)

Okay :) ...nicely said. But I even question if single studies should generally be used in Wikipedia. You can virtually claim anything based on a single study. Review studies are what should mainly be used in Wikipedia, such as Devanand's review. Single studies, even several single studies that we often see cobbled together on Wiki to support a contention, never show refuting studies or what the body of evidence about a particular research topic demonstrates. My bone of contention with old studies and especially OLD ECT studies is that they are often horribly flawed with regard to current practices or don't replicate....and most importantly are used by POV pushers.--scuro 13:33, 19 May 2007 (UTC)

Absolutely agree with that, Scuro. The article should represent the current consensus opinion based on the best research out there, and if a single study contradicts that, there needs to be a compelling reason to put it in the article - for instance, unless a loss of nuclear volume can be shown to be relevant to e.g. memory loss or cognitive dysfunction, I'd be tempted to exclude Colon & Notermans completely - except that including them under a "While some studies have found brain changes after ECT (references), none have demonstrated that these were caused by the treatment, and large-scale, prospective review studies have found that it doesn't cause brain damage (references)" might stop the same studies getting posted here every couple of months. Nmg20 11:25, 20 May 2007 (UTC)

Please tell me the problem with the Friedberg article (apart from its date). JuneTune2 23:47, 20 May 2007 (UTC)

Assume from your comment below that you're "in reluctant, partial agreement" with my assessment of this & the Colon & Notermans article that you've found my assessment of it. Do let me know if not. Nmg20 20:17, 21 May 2007 (UTC)

suggested future edit for Research into structural brain damage subsection

The most recent research questions if ECT causes any brain damage. Sackeim et al., in several recent studies concluded that while memory impairment is a possible side effect, that even when it rarely lasts for long periods, "the memory impairment does not interfere with with mental functioning or cause persistent deficits in the formation of new memories or disrupt with basic cognitive functions such as intelligence". Coffey et al., using magnetic resonance images stated, our results confirm and extend previous imaging studies that also found no relationship between ECT and brain damage. In a review of the literature Devanand et al., stated, "there is a clear absence of any evidence that ECT causes damage to neurons or other brain cells". The review examined these areas: auopsies on ECT patients, cognitive side effects, structurial brain imaging, animal studies of electroconvulsive shock, heat generation, and blood brain barrier disruption. They concluded that ECT induced cognitive deficits are transient. They dismissed early studies as methodologically flawed, with an additional discussion of more recent studies using CT and MRI scans and concluded that no evidence of structural brain damage as a result of ECT has been found.[24] Previously, Richard Weiner had also reviewed the earlier literature, dismissing early studies as irrelevant to modern practice (since an unmodified convulsion without oxygenation may be a contributing factor to any damage) and concluded: "evidence that ECT, given in a contemporary fashion, typically leads to the development of brain damage and its lasting physiologic and cognitive correlates is weak".[25] Earlier studies including Donald Templer and David Veleber 1982 concluded that ECT has caused and can cause permanent brain pathology, whilst acknowledging that there were vast differences between individuals and that lasting damage was the exception rather than the rule.[26] Stephen Calloway et al., found an association between a history of ECT and cortical atrophy in the frontal region in elderly depressed patients. Despite the association, cortical atrophy was found in some people who had never had ECT whilst others who had had a large number of treatments didn't have any cortical atrophy. The authors said that it was possible that ECT had caused cortical atrophy, but also possible that depressed patients with cortical atrophy are more likely to be prescribed ECT.[27] MRI scans are more sensitive than CT scans and can exclude the possibility of severe, although not significant, brain damage. One small, uncontrolled, prospective MRI study found that a minority of patients showed changes in subcortical hypertensity six months after ECT. The authors thought these changes were probably due to the progression of cerebrovascular disease. Many of the patients had structural abnormalities before treatment.[28]

Comments?--scuro 12:24, 19 May 2007 (UTC)

I find it amazing that when it suits psychiatry, Y can't be attributed to X (sure the brain is structurally changed but we don't know that electroshock caused it, right? Right? Right?) However, when a study appears to confirm psychiatry's POV, then X causing Y is assumed, e.g. measuring serotonin metabolites. How do those researchers suppose that electroshock survivors would be benefitted by claiming brain damage? Immediately after electroshocking a brain, memory loss and other dysfunction occurs. No, that doesn't prove brain damage but it's worth considering seriously. As far as I can tell, survivor testimony is utterly disregarded in psychiatry. JuneTune2 17:27, 19 May 2007 (UTC)

From New York Office of Mental Health link which Scuro so thoughtfully provided:

"ECT’s major side effect can be transient cognitive impairment, which takes the form of a very short-term confusion and some memory loss. The memory loss generally pertains to events preceding the treatments, and may be expected to clear over a period of days to weeks (Sackeim, 1992). In rare cases, this impairment may last for a considerably longer period--weeks to months to years. Even in such cases, the memory impairment does not interfere with mental functioning or cause persistent deficits in the formation of new memories or disrupt with basic cognitive functions, such as intelligence (Sackeim et al., 1992, 1993, 2000). There is a clear absence of any evidence that ECT causes damage to neurons or other brain cells (Devanand et al., 1994)."

So, in "rare cases" impairment may last up to years. How rare? And how could long-term memory impairment have NO effect on mental functioning? Memory is an integral part of mental functioning. Contrary to what's stated here, there isn't a lack of evidence that electroshock causes brain damage. What we do have, however, is disregard for those we deem mentally ill. Who cares if their brains become damaged? They were crazy anyway. JuneTune2 22:31, 19 May 2007 (UTC)

Further additions,edits including Staug73'suggestion and possible title change. This is actually an important section because this is the primary question that many seeking info on ECT will have.

The question of structural brain damage and current research -(possible title change)

Mental health institutions and recent research has overwhelmingly concluded that there is no evidence that ECT causes brain damage. A report of the United States Surgeon General states,"The Fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals". The American Psychiatric Association also states,"Researchers have found no evidence that ECT damages the brain".

Current research has not found any evidence of brain damage. Rudorfer et al, in a significant review within the second edition (2003) Psychiatry concluded,"...that ECT does not cause brain damage".Sackeim et al., in several recent studies concluded that while memory impairment is a possible side effect, that even when it rarely lasts for long periods, "the memory impairment does not interfere with with mental functioning or cause persistent deficits in the formation of new memories or disrupt with basic cognitive functions such as intelligence". Coffey et al., using magnetic resonance images stated, our results confirm and extend previous imaging studies that also found no relationship between ECT and brain damage. In a review of the literature Devanand et al., stated, "There is no credible evidence that ECT causes structural brain damage.". The review examined these areas: auopsies on ECT patients, cognitive side effects, structurial brain imaging, animal studies of electroconvulsive shock, heat generation, and blood brain barrier disruption. They concluded that ECT induced cognitive deficits are transient. They dismissed early studies as methodologically flawed, with an additional discussion of more recent studies using CT and MRI scans and concluded that no evidence of structural brain damage as a result of ECT has been found.[24] Previously, Richard Weiner had also reviewed the earlier literature, dismissing early studies as irrelevant to modern practice (since an unmodified convulsion without oxygenation may be a contributing factor to any damage) and concluded: "evidence that ECT, given in a contemporary fashion, typically leads to the development of brain damage and its lasting physiologic and cognitive correlates is weak".[25]

Different researchers such as Stephen Calloway et al., have found brain damage in ECT patients in specific brain regions. The shortcomings of such studies are that the findings were not consistent or they can be explained by other variables. For instance, some patients who had large numbers of treatments displayed no brain damage. These researchers have also pointed out the possibility that depressed patients could be more likely to have brain damage before the treatment began. One small, uncontrolled, prospective MRI study found that a minority of patients showed changes in subcortical hypertensity six months after ECT. The authors thought these changes were probably due to the progression of cerebrovascular disease. Many of the patients had structural abnormalities before treatment.[28]

The relevancy of old ECT research typically hinges around the following issues: the studies were done during the development stages of the procedure and examined unmodified ECT which is no longer performed in the Western world, our understanding of what constitutes permanent brain damage has changed with time, and there are numerous more recent studies looking at human subjects instead of animal subjects using modern brain scanning technology which fail to demonstrate similar findings in humans. Earlier studies such as Donald Templer and David Veleber 1982 concluded that ECT has caused and can cause permanent brain pathology, whilst acknowledging that there were vast differences between individuals and that lasting damage was the exception rather than the rule.[26]

--scuro 13:40, 21 May 2007 (UTC)

Scuro, when you cut and paste from a website you must say where it came from. The quote isn't from Sackeim, it is from the New York State Office of Mental Health webpage on ECT. So, yes, put it in quotation marks, but you must also say who said it - in this case the New York State Office of Mental Health. Anyway I think Sackeim has said something slightly different more recently, and it would be useful to include that as well. Also, Devanand et al concluded that cognitive effects were transient, except for persistent gaps in memory - an important exception that needs to be included.Staug73 13:55, 21 May 2007 (UTC)

I have been working on an edit which you may have not seen before you posted. I believe the quotation in question has been changed. Check it out and make corrections to this version in discussion if you still see fault.--scuro 14:07, 21 May 2007 (UTC)

The suggested brain damage edit above in italics specifically looks at the topic of structural brain damage. Other editors may feel that this section does not look at transient, or possibly permanent brain impairment that the procedure may cause. Such editors are welcome to develop such a section.--scuro 20:31, 21 May 2007 (UTC)

Wikipedia's undue weight policy 2 - letters to the editor, refuted studies, and Depictions of ECT subsections

• -While a link to the New York Times is a good source for a citation I question if personal letters to the editor should be used as support for a contention. Unless the author is notable this makes little sense.
• -Should old refuted or no longer relevant studies be included in detail, in subsections other then the history subsection? Would a sentence stating that earlier studies indicated..., suffice?
• -I also question if the Nonfictional depictions of ECT and Fictional and semi-fictional depictions of ECT hasn't become subsections of POV pushing. They are longer then any other subsection in the article and have taken on far too much weight in the article. The Non-fictional depiction subsection reminds me more of church or TV testimonies and not as encyclopedic entries. I wonder if they should be included in the main ECT article. Simply quoting a sentence or two from several subjects doesn't do them justice either.

Comments?--scuro 14:12, 19 May 2007 (UTC)

Ms. Andre IS notable. She's a very well known psychiatric survivor and activist. The letter to NYT should stay. As for that 1977 article (you know, when you were wearing disco pants), it may be old but it has not been refuted and it is certainly still relevant. JuneTune2 17:30, 19 May 2007 (UTC)

I can't find any reliable source that describes Linda Andre accomplishments or that states why she is notable. She may be notable in psychiatric survivor circles but that doesn't automatically make her noteworthy for a Wiki brain damage citation.

Fine, Scuro. She's just another fringe nutter that didn't want her brain zapped. Pay her no attention whatsoever. She's obviously mentally ill and can't distinguish fantasy from reality. JuneTune2 22:20, 19 May 2007 (UTC)

I did look at the 1977 abstract. The abstract speaks of a difference of volume but no loss of neurons. Using this lone study to hang your "brain damage" hat on would not suffice. Recent reviews, notably Devanand et al., didn't find that ECT causes brain damage. You would need extraordinary proof to trump the several reviews on this subject. That study has only been cited 4 times, which is also an indication that the study didn't conclude brain damage. A solid relationship between brain damage and ECT would have attracted all sorts of scientific interest.--scuro 20:38, 19 May 2007 (UTC)

On the contrary, here is the summary from that article:

American Journal of Psychiatry 134:9, September 1977. pp: 1010-1013.

The author reviews reports of neuropathology resulting from electroconvulsive therapy in experimental animals and humans. Although findings of petechial hemorrhage. gliosis. and neuronal loss were well established in the decade following the introduction of ECT. they have been generally ignored since then. ECT produces characteristic EEG changes and severe retrograde amnesia. as well as other more subtle effects on memory and learning. The author concludes that ECT results in brain disease and questions whether doctors should offer brain damage to their patients.

JuneTune2 22:20, 19 May 2007 (UTC)

JuneTune - that's not the Colon & Notermans (PMID 1146505)article you're quoting, it's the Friedberg (PMID 900284)one. I've posted my views on both above - the Colon & Notermans one merits inclusion only if changes in nuclear brain volume can be shown by another reference to be relevant to the known side-effects of ECT, and the Friedberg one I have serious reservations about as an appropriate current source except as outlined above. Nmg20 11:37, 20 May 2007 (UTC)

Hi, Nmg20. Yes, I knew that was the Friedberg article. Scuro was saying that he looked at the 1977 abstract. I assumed that he was talking about the Friedberg (1977) article as that was what we were discussing. I read your comment above about these two studies (Friedberg and Colon & Notermans) and am in reluctant, partial agreement. I'm wondering if you would be willing to acknowledge the non-scientific opinions of electroshock survivors, perhaps in the controversy section. As an aside, perhaps you'd suggest to me a reason why electroshock patients would "invent" their brain dysfunction? Do you think it increases our social status? Or maybe we just do it for fun? I know of no other medical specialty that utterly disregards its patients' point of view. JuneTune2 23:44, 20 May 2007 (UTC)

It's not really up to me, JuneTune. Wikipedia's policy on verifiability states: "Articles should rely on reliable, third-party published sources with a reputation for fact-checking and accuracy." and: "...self-published books, personal websites, and blogs are largely not acceptable as sources."

While Wikipedia's policy on original research reads: "Original research (OR) is a term used in Wikipedia to refer to unpublished facts, arguments, concepts, statements, or theories. The term also applies to any unpublished analysis or synthesis of published material that appears to advance a position"

Wikipedia just isn't the place for what you're looking to put up here.

However, the accounts of those who've been treated with ECT - both from those who would probably regard it as "testimony" and themselves as "survivors" and from those who certainly wouldn't - are as I've said already in the article under Electroconvulsive_therapy#Nonfictional_depictions_of_ECT, so the views you want to put in the article are in there, albeit that they don't have the weight you would give them.

Moving from policy to the personal, I don't think electroshock patients are inventing anything. However, they by definition don't have normal brain function to start with (I'm assuming we agree that psychosis, depression, etc. are abnormal), and so are not best placed to assess their own cognitive function before treatment. Even when self-report data is used in the literature, it doesn't support the idea that people are worse off after treatment, and objective assessment of function doesn't either (e.g. Rami et al 2004; PMID 15616173).

I would of course not suggest anyone did it for fun or for some putative increase in social status, and would appreciate it if you didn't attempt to second-guess my responses before you've given me a chance to answer. I'm afraid I'm not going to respond to the idea that psychiatry as a medical specialty ignores its patients points of view - you haven't, after all, provided a jot of evidence to support the claim, and I'm not going to try to dissuade you of your opinion. Nmg20 20:15, 21 May 2007 (UTC)

New section for structural brain damage

I have started a new section which hopefully people will keep just for discussion of how to improve the article. I have pasted Scuro’s suggested section, plus, for comparison the original section, which I think is more accurate and readable.

A few problems with Scuro’s proposed changes:

1) title – current research? There isn’t any mention of current research in the text.

2) I don’t think the section is improved by listing a lot of websites that cite Devanand et al. For example, Rudorfer, the Surgeon General and the NYOMH are all citing Devanand (although the APA cites Weiner and a couple of other articles, not Devanand). Actually some of them miscite Devanand, for example Devanand claims that the evidence that ECT causes structural brain damage is methodologically flawed, and therefore there is no credible evidence. They don’t say “a clear absence” as claimed by NYOMH. Rudorfer isn’t a significant review. In fact they are rather weak on adverse effects (for example, no mention of Squire’s work). So by all means let’s quote Devanand and perhaps say “In a much-cited review of the literature they concluded…..” but without all the repitition.

3) The NYOMH quote doesn’t belong in this section (it is about function not structure) but in any case it must be attributed to the NYOMH, not Sackheim. For example: The NYOMH, citing three studies by Sackheim et al says “…….” .

4) Devanand et al “They concluded that ECT induced cognitive deficits are transient.”. This is incorrect. They concluded that ECT-induced cognitive deficits except for memory loss, are transient.

5) I noticed that whilst retaining a the Weiner article you left out the sentence “An open peer commentary attracted both agreement and criticism”. Why? This is a perfectly verifiable sentence. I think leaving it out is an example of POV.

6) You have really mangled the Calloway study and are misrepresenting their views. Why? Have you read the study? If not, you will have to leave it alone and trust me to have accurately summarised their conclusions.

7) The Coffey study and the footnote 28 study are one and the same.

8) The bit beginning “the relevancy….” I don’t think this is accurate or necessary.

So, I would stick with the original version. If people want I will take everything pre-Devanand over to history. And perhaps it would be useful to quote Devanand’s closing paragraph in full? And add that it has been widely cited? I wouldn’t have any objections to Calloway coming out (or going to history) but I think it was Nmg who wanted it in. If it’s in, don’t alter it unless you have read it.Staug73 14:44, 22 May 2007 (UTC)

The question of structural brain damage and current research -(possible title change) Mental health institutions and recent research has overwhelmingly concluded that there is no evidence that ECT causes brain damage. A report of the United States Surgeon General states,"The Fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals".[7] The American Psychiatric Association also states,"Researchers have found no evidence that ECT damages the brain"[8]. Current research has not found any evidence of brain damage. Rudorfer et al, in a significant review within the second edition (2003) Psychiatry concluded,"...that ECT does not cause brain damage".Sackeim et al., in several recent studies concluded that while memory impairment is a possible side effect, that even when it rarely lasts for long periods, "the memory impairment does not interfere with with mental functioning or cause persistent deficits in the formation of new memories or disrupt with basic cognitive functions such as intelligence". Coffey et al., using magnetic resonance images stated, our results confirm and extend previous imaging studies that also found no relationship between ECT and brain damage. In a review of the literature Devanand et al., stated, "There is no credible evidence that ECT causes structural brain damage.". The review examined these areas: auopsies on ECT patients, cognitive side effects, structurial brain imaging, animal studies of electroconvulsive shock, heat generation, and blood brain barrier disruption. They concluded that ECT induced cognitive deficits are transient. They dismissed early studies as methodologically flawed, with an additional discussion of more recent studies using CT and MRI scans and concluded that no evidence of structural brain damage as a result of ECT has been found.[24] Previously, Richard Weiner had also reviewed the earlier literature, dismissing early studies as irrelevant to modern practice (since an unmodified convulsion without oxygenation may be a contributing factor to any damage) and concluded: "evidence that ECT, given in a contemporary fashion, typically leads to the development of brain damage and its lasting physiologic and cognitive correlates is weak".[25] Different researchers such as Stephen Calloway et al., have found brain damage in ECT patients in specific brain regions. The shortcomings of such studies are that the findings were not consistent or they can be explained by other variables. For instance, some patients who had large numbers of treatments displayed no brain damage. These researchers have also pointed out the possibility that depressed patients could be more likely to have brain damage before the treatment began. One small, uncontrolled, prospective MRI study found that a minority of patients showed changes in subcortical hypertensity six months after ECT. The authors thought these changes were probably due to the progression of cerebrovascular disease. Many of the patients had structural abnormalities before treatment.[28] The relevancy of old ECT research typically hinges around the following issues: the studies were done during the development stages of the procedure and examined unmodified ECT which is no longer performed in the Western world, our understanding of what constitutes permanent brain damage has changed with time, and there are numerous more recent studies looking at human subjects instead of animal subjects using modern brain scanning technology which fail to demonstrate similar findings in humans. Earlier studies such as Donald Templer and David Veleber 1982 concluded that ECT has caused and can cause permanent brain pathology, whilst acknowledging that there were vast differences between individuals and that lasting damage was the exception rather than the rule.[26] --scuro 13:40, 21 May 2007 (UTC)

Research into structural brain damage Another area of controversy is whether the effects of ECT on cognition are accompanied by structural changes in the brain. Many studies from the 1940s, 1950s and early 1960s found evidence of damage to the brain.[13] In 1982 neuropsychologists Donald Templer and David Veleber reviewed the literature on human autopsies and animal experiments and concluded that ECT has caused and can cause permanent brain pathology, whilst acknowledging that there were vast differences between individuals and that lasting damage was the exception rather than the rule.[14] Two years later psychiatrist Richard Weiner reviewed the same literature, dismissing early studies as irrelevant to modern practice (since an unmodified convulsion without oxygenation may be a contributing factor to any damage) and concluded: "evidence that ECT, given in a contemporary fashion, typically leads to the development of brain damage and its lasting physiologic and cognitive correlates is weak".[15] An open peer commentary attracted both agreement and criticism. In 1991 psychiatrist Davangere Devanand and colleagues covered the same ground, dismissing early studies as methodologically flawed, with an additional discussion of more recent studies using CT and MRI scans and concluded that no evidence of structural brain damage as a result of ECT has been found.[16] British pychiatrist Stephen Calloway and colleagues found an association between a history of ECT and cortical atrophy in the frontal region in elderly depressed patients. Despite the association, cortical atrophy was found in some people who had never had ECT whilst others who had had a large number of treatments didn't have any cortical atrophy. The authors said that it was possible that ECT had caused cortical atrophy, but also possible that depressed patients with cortical atrophy are more likely to be prescribed ECT.[17] MRI scans are more sensitive than CT scans and can exclude the possibility of severe, although not significant, brain damage. One small, uncontrolled, prospective MRI study found that a minority of patients showed changes in subcortical hypertensity six months after ECT. The authors thought these changes were probably due to the progression of cerebrovascular disease. Many of the patients had structural abnormalities before treatment.[18]

(1) I agree that the section heading doesn't need to say "current research" - it's implicit in something being added to the article that it's based on the best & most recent evidence, after all.

(2) Agree in principle - but could I persuade you both to start posting links to articles when you write about them? Just putting PMID and a number is sufficient. I don't want us to cut any articles without getting them looked at by a number of reviewers, and that's more easily accomplished if we don't have to dig for 'em!

(3) Nothing to add!

(4) Perhaps we should get into the habit of talking about cognitive deficits as encompassing both memory loss and impaired performance on cognitive tests? I believe these are the two areas commonly investigated post-ECT - so if we can talk about "poor cognitive function" or "poor neuropsychological test scores", we cover the one, and memory loss covers the other; "cognitive deficits" then covers both?

(5) Can we get a link to the criticism? If it's citeable here, it's presumably in the form of comments / letters to the editor of the relevant journal?

(6) Is the Calloway reference you're talking about PMID 7347109? If so, the ref should be <ref>Calloway SP, Dolan RJ, Jacoby RJ, Levy R. ECT and cerebral atrophy. A computed tomographic study. Acta Psychiatr Scand. 1981 Nov;64(5):442-5. PMID 7347109</ref>, and all it found was an (unsurprising) association between frontal lobe atrophy and ECT. The explanation of the limitations of retrospective studies such as this is perhaps a little scatter-gun at the moment - but retrospective review of case notes can't prove that ECT caused frontal lobe damage, because it doesn't look at what the frontal lobes looked like before ECT - so while Calloway is certainly citeable, that caveat needs to go in there. Unless there's a different study I'm missing which is not currently cited in the main article.

(7) Nothing to add.

(8) It's not ideal that we should have a section which explains the limitations of earlier research, but in this article - where history suggests that not having it means the same studies from the 50s, 60s, and 70s will be regurgitated into the article every six months or so - I'd like to see a blanket statement like this, with comments linking to the conversations about such articles in the archives on this page...

For the same reason, I think it's worth including Calloway. He's a relatively recent example of work which finds something interesting (frontal lobe atrophy) which has not been demonstrated to be due to ECT, and may well be indicative of pre-existing brain changes in those with severe mental illness. I'm persuadable if people want to drop it, though.

Overall, I would prefer to see this section reflect the most current evidence - i.e. that there's very little proof ECT causes brain damage - first, and then to cover the earlier studies. Devanand's conclusion may well be worth quoting in full if he's definitely the most recent/credible review on the area? Nmg20 15:31, 22 May 2007 (UTC)

1) They are not articles. Rudorfer is the footnote 1 from the article here. The NYOMH is here http://www.omh.state.ny.us/omhweb/ect/index.html. The APA is somewhere. I don't think they add anything. 4)The point is that Devanand et al were distinguishing between memory loss (persistent) and other forms of cognition (transient). But in any case Devanand isn't strong on functional. Best keep Devanand to structural. 5) This is footnote 25. I think the page numbers will include peer commentary - unless Weiner wrote 53 pages! It was peer commentary - people got to write something about Weiner's article and then get published in same issue I think but will check. 6) Yes, that's the Calloway. All the people in the study had been treated for depression, so it doesn't say anything about brains of depressed people versus brains of nondepressed people. There was an association (just an association, not an all or nothing thing) between some sort of atrophy and numbers of ECT. But, as I said, the authors said yes maybe it could be due to ECT, but no maybe it could be that depressed people who had atrophy were more likely to be prescribed ECT.Staug73 16:31, 22 May 2007 (UTC)

My first thoughts on this, more to come later:

• the original text shows undo-weight bias and also introduces controversy into the subject of the first sentence where really there isn't any.
• the title could simply be, "the question of structural brain damage"
• since this section is about structural brain damage the APA, SG, and Rudorfer are all major quotations that directly answer the question. They are not included because they did the original research but rather because they have all stated in public what they believe. The APA and the SG are two of the top American institutions in the field. Someone at both institutions would have to judge what exactly they could say publicly and would have had to critically review ALL the research. To not do so opens the possibility of lawsuits. This is why Wikipedia loves quotes from excellent sources. Rudorfer wrote Chapter 92 in highly praised two volume textbook meant for the field, called Psychiatry. It has been labeled a "flagship" textbook and was praised to the hills by The New England Journal of Medicene.
• Nothing wrong with transferring some info into the history section and a mental impairment section.
• Finally I am quite capable of assessing information, and judging that information for myself, thank you very much. I'd ask Staug73 to kindly leave any judgements about me out of the discussion area. Wikipedia clearly states this in their policy. "comment on the content not the contributor". Staug73, having left the door open I'd like to comment that as far as any superiority of judgement goes, your instance that the original biased section should stand, clearly counters your contention. --scuro 17:20, 22 May 2007 (UTC)

2)This section should have the APA an SG quote. They are much better Wikipedia wise then research. After that you could have a sentence like: The individual reviews can then be cited and left off the page. Weiner is old hat as these recent reviews indicated, it's questionable if it even belongs. It could be a very short section.--scuro 12:13, 23 May 2007 (UTC)

Another option would be to quote Devanand et al's closing paragraph in full, and then say something along the lines of Devanand et al being widely cited with a footnote to Rudorfer, APA, SG etc. Here is the paragraph: "In a survey of approximately 3,000 psychiatrists conducted by the APA Task Force on ECT and published in 1978, 41% of the respondents agreed and 26% disagreed with the statement, "it is likely that ECT produces slight or subtle brain damage". The thesis that ECT caused brain damage was based on the petechial hemorrhages found in the brains of animals given ECS in the earliest uncontrolled, nonblind studies, the very few "shadow cells" reported in one controlled study of cats given clusters of four ECSs at 2-hour intervals, and some of the early human autopsy case reports. As elucidated in this review, these early animal studies and human autopsy case reports were characterized by several fundamental flaws, including the lack of control for major confounding factors and the misinterpretation of histologic artifacts. These early methodologically flawed studies represent a small fraction of a much larger body of work, including rigorous qualitative and quantitative controlled studies using modern techniques, that has found no evidence of structural brain damage as a result of ECT."Staug73 13:54, 23 May 2007 (UTC)

My advice would be to keep it simple and current. Do we really need passages from scientific studies, especially older ones? The average reader won't know hide nor hare of the details nor will they know the relevancy of this information.

Here is a new edit reflecting these points.

The question of brain damage

Mental health institutions and the most recent research has overwhelmingly concluded that there is no evidence that ECT causes brain damage. A report of the United States Surgeon General states,"The Fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals". The American Psychiatric Association also states,"Researchers have found no evidence that ECT damages the brain"[8]. All of the recent scientific reviews on this topic which examined research using autopsies, brain imaging, and animal studies of electroconvulsive shock, have also concluded that there is no evidence that ECT causes brain damage.

The reviews would simply be cited so those readers who want more details know where to look. No need for experimental details, conclusions, or passages.--scuro 16:03, 23 May 2007 (UTC)

she is ready to be launched on the page

or not..last chance to comment or edit. Further improvements have been made.

National mental health institutions and recent research has overwhelmingly concluded that there is no evidence that ECT causes brain damage. A report of the United States Surgeon General states,"The Fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals". The American Psychiatric Association also states,"Researchers have found no evidence that ECT damages the brain". Britian's National Institute for Clinical Excellence's paper entitled Guidance on the use of Electroconvulsive Therapy states, "The six reviewed studies that used brain-scanning techniques did not provide any evidence that ECT causes brain damage"All of the recent scientific reviews on this topic which examined the body of ECT research using autopsies, brain imaging, and animal studies of electroconvulsive therapy, have also concluded that there is no evidence that ECT causes brain damage. Studies dating before the 80's which indicated the possibility of brain damage have been criticized, "as irrelevant to modern practice".. The constant current, brief pulse ECT device was introduced in 1976 and ultimately replaced the previous technology which was known for a greater degree of side effects. Current research suggests that, "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness"'. --scuro 03:21, 24 May 2007 (UTC)

Couple of things.

I'm happy with titling the section "The question of structural brain damage".

On the APA / SG stuff, I'm happy that they be used as examples of major, independent public health bodies summarising research on the topic, but would like to see the major research papers referenced too, even if only by way of "APA says X based on work by a number of researchers (references)."

I'm ambivalent about including the earlier studies, although Staug's paragraph ("In a survey...result of ECT") certainly has merits. Perhaps if we opened it with something which made the eventual conclusion more obvious - "Although early research in the field found X (petechical haemorrhages etc), more recent stuff hasn't"? I think the closing sentence, in particular, is pretty good - "These early methodologically flawed studies represent a small fraction of a much larger body of work, including rigorous qualitative and quantitative controlled studies using modern techniques, that has found no evidence of structural brain damage as a result of ECT."

Comments on Scuro's most recent suggestion below in bold italics, except some tweaks and formatting things I've just changed:

National mental health institutions and recent research has "have" (mental health inst's + recent research) overwhelmingly ("overwhelmingly" a little strong? Either we need to qualify the "brain damage" which follows with "structural", or remove "overwhelmingly", IMHO) concluded that there is no evidence that ECT causes brain damage (insert "structural"?). A report of the United States Surgeon General states, "fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals". The American Psychiatric Association also states,"Researchers have found no evidence that ECT damages the brain". Britian's National Institute for Clinical Excellence's paper entitled [Guidance on the use of Electroconvulsive Therapy] states, "The six reviewed studies that used brain-scanning techniques did not provide any evidence that ECT causes brain damage". All of the recent scientific reviews on this topic which examined (Better "reviewed")? the body of ECT research using autopsies, brain imaging, and animal studies of electroconvulsive therapy, have also concluded that there is no evidence that ECT causes brain damage. Studies dating before the 80s which indicated the possibility of brain damage have been criticized, "as irrelevant to modern practice".. The constant current, brief pulse ECT device was introduced in 1976 and ultimately replaced the previous technology which was known for a greater degree of side effects. Current research suggests that, "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness"'.Nmg20 14:57, 24 May 2007 (UTC)

As I read further into this subject, I don't think currently there really is much of a question anymore about structural brain damage being caused by ECT. There was in the past say the early 80's and before, possibly because of prior research methodology or the fact that the procedure back then was cruder using the now obsolete primitive constant voltage apparatus. Who now really is making the case that ECT causes structural brain damage? Basically only antipsychs such as Breggin and that is it. So I have no problem with the word, "overwhelmingly" because no researcher who examines this through new brain imaging or animal studies would say that there is causation. Brain impairment is a different question and really that section is the section that should be beefed up in this article because it will be far more relevant to the average reader and the conclusions are not so clear. I am suggesting to keep this section short because there is not much debate. I'd also argue against starting with "Although early research in the field found X", because that gives undo weight to past studies which basically are irrelevant due to current research which has trumped those findings.

As aside, here is another interesting recent study and a quotation from the study. http://pn.psychiatryonline.org/cgi/content/full/39/11/30-ain the field.

"Despite the limitations of this study, the absence of pathological findings provides empirical evidence that routine use of convulsive therapy does not produce structural brain damage".

Finally Nmg20, perhaps you want to put together a final draft of this section and post. If not I will tackle it, and post taking into consideration any final comments.--scuro 00:09, 25 May 2007 (UTC)

Nmg = a couple of points. Firstly the paragraph I quoted was Devanand et al's, not mine. Don't forget that some hospitals in the US and other countries still use sine-wave machines. Britain is unusual because the Department of Health told hospitals to replace sinewave machines with brief pulse in I think 1981. It took some hospitals over ten years, but eventually they all did. I think the bit about reversing changes caused by mental illness would need a better ref than an interview with Charles Kellner. I noticed he didn't provide a reference for that particular statement. As yet I think it is quite a tentative idea (still in the rat brain stage) and not widely accepted or supported by research. I think it would be better to say that Devandand et al's review has been widely cited and then list the APA, SG, NICE etc in the footnote, rather than including quotes from them all essentially saying the same thing.Staug73 18:49, 25 May 2007 (UTC)

To make it more readable and to meet some concerns the passage has been trimmed again. Most readers will identify with an institution like the Surgeon General. The SG's examination was very comprehensive and also included later research then Devanand. I've watered down Kellner, I'm sure I can dig up direct quotes from conclusions if this is still an issue. This doesn't have to diamond like before it is put in the article. It can we do this and move on?--scuro 05:13, 26 May 2007 (UTC)

The question of strucural brain damage

A number of national mental health institutions have concluded that there is no evidence that ECT causes structural brain damage. A report of the United States Surgeon General states,"The Fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals". All of the recent scientific reviews on this topic which reviewed the body of ECT research using autopsies, brain imaging, and animal studies of electroconvulsive therapy, have also concluded that there is no evidence that ECT causes brain damage. Studies dating before the 80's which indicated the possibility of brain damage have been criticized, "as irrelevant to modern practice".. The constant current, brief pulse ECT device was introduced in 1976 and ultimately replaced the previous technology which was known for a greater degree of side effects. Current research is examing the possibility that, "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness"'. --scuro 05:13, 26 May 2007 (UTC)

There are still problems. I think that, before you replace an accurate section, you have to make sure you are not introducing errors. You are still misattributing quotes. That is not a quote from Weiner. I summarised Weiner's conclusions in my own words. So you are quoting me not Weiner! The issue of brief-pulse v sinewave is complex. Some hospitals in US and elsewhere (last survey) still use sinewave. Brief pulse was first investigated in 1940s. The difference between sinewave and brief pulse is thought not to be as great as between BL and UL. The length of shocks has increased greatly over the years. Modified v unmodified seizures probably more important in old v recent studies. Think Kellner quote still needs putting in context a bit better. So - still not ready to replace existing section. In the meantime I have corrected errors re Devanand in article. Staug73 10:57, 26 May 2007 (UTC)

Shortening the subsection further to meet further concerns.

The question of strucural brain damage

A number of national mental health institutions have concluded that there is no evidence that ECT causes structural brain damage. A report of the United States Surgeon General states,"The Fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals". All of the recent scientific reviews on this topic which reviewed the body of ECT research using autopsies, brain imaging, and animal studies of electroconvulsive therapy, have also concluded that there is no evidence that ECT causes brain damage. Current research is examining the possibility that, "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness"'. --scuro 05:13, 26 May 2007 (UTC)

As to the Kellner quote, he is very citable. "Dr. Kellner is professor and chair of the Department of Psychiatry, and assistant dean for clinical research at the University of Medicine and Dentistry of New Jersey in Newark. He is also co-director of the electroconvulsive therapy (ECT) service at The University Hospital in Newark with George Petrides, MD, and was editor of The Journal of ECT from 1994–2004. Dr. Kellner’s ongoing research includes studies comparing different ECT types and methods for optimizing maintenance ECT". The direct quote is from a noteworthy individual very close to the information. This new information is directly related to the subsection. Finally how does Kellner's quote need to be put into a better "context"? What part of this sentence ("Current research is examining the possibility that...") needs further context so that the reader can understand the research is current and not definitive?--scuro 17:16, 26 May 2007 (UTC)

With 7 documented revisions, 6 editors making comment on revision, at least 25 suggestions for change, and no further concerns...the latest revision has been inserted.--scuro 11:25, 27 May 2007 (UTC)

It's simply false that there is no modern evidence that ECT causes brain damage in animals. The folowing recent Russian study (2005) used very sophisticated methods in mice and found that ECT definitively causes brain damage. I'd also like to point out that lack of evidence is not the same thing as proving that ECT doesn't cause damage, it's just lack of proof. There is almost no research looking for damage at the subcellular level, such as looking for oxidative damage to mitochondria and altered mitochondrial function. This is extemely odd given that there are countless studies checking for mitochondrial damage for a long list of neurological diseases and the aging process itself. One study that did limited evaluation of mitochondrial function after ECT 'did' find altered mitochondrial function which may be indicative of brain damage on the micro level, manifested by altered neuronal function rather than neuronal death, meaning that none of it would be revealed on MRI or basic biopsy. People must remember that ECT involves the use of subatomic energy that is very diffusely spread. Just because it's difficult to find damage on a macro scale or evidence of apoptosis does not mean that brain damage is not occurring. As an analogy, there are countless studies showing that brain mitochondria degrade as part of the natural aging process without producing lesions and mostly causing neuronal 'dysfunction' rather than measurable 'death', and yet this IS brain damage. The evidence isn't there in humans with ECT simply because it hasn't been checked for, arguably on purpose. Similarly, no one did sophisticated cognitive testing on a large sample before Sackeim and published it before this year, either, even though such tests could have been devised a half century ago. What studies there were previously assessing cognitive function used the ridiculous Mini-Mental Status Exam that askes people question such as to spell "world" backwards, what their name is, what year it is, who the president is, to draw a clock, etc. Some argue this was also intentional, as the questions on this exam are so incredibly easy that passing them means nothing other than that a person is not severely demented or delirious. Yet some researchers attempted to use this test to show that ECT does not cause lasting cognitive problems. It's very difficult to believe that it was not intentional, giving how ludicrous it is to use such a simple test to check for the typical complaints that amount to mild cognitive dysfunction. Mild cognitive impairment is unlikely to show itself on the MMSE. It will show itself on more sophisticated neruopsychological testing. The researchers know this. The more sophisticated cognitive testing was not done prior to Sackeim's study this year for the same reason that researchers have not done the most advanced testing looking at neurons at the subcellular level more thoroughly. When you consider the fact that mitochondrial function and integrity has been investigated in practically every neurological disease you can think of countless times (Alzheimer's, parkinson's, etc), and then see that practically no published research has evaluated mitochondrial function post-ECT it all starts to become clear. Oxidative damage involves transfer of electrons which electricity and 100% oxygen are known to accelerate. Mithondria are the most vulnerable to such assaults. Logic demands that investigation begin there.

Neurosci Behav Physiol. 2005 Sep;35(7):715-21.

Electroconvulsive shock induces neuron death in the mouse hippocampus: correlation of neurodegeneration with convulsive activity.

Zarubenko II, Yakovlev AA, Stepanichev MY, Gulyaeva NV.

Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, 5a Butlerov Street, 117485 Moscow, Russia.

The relationship between convulsive activity evoked by repeated electric shocks and structural changes in the hippocampus of Balb/C mice was studied. Brains were fixed two and seven days after the completion of electric shocks, and sections were stained by the Nissl method and immunohistochemically for apoptotic nuclei (the TUNEL method). In addition, the activity of caspase-3, the key enzyme of apoptosis, was measured in brain areas immediately after completion of electric shocks. The number of neurons decreased significantly in field CA1 and the dentate fascia, but not in hippocampal field CA3. The numbers of cells in CA1 and CA3 were inversely correlated with the intensity of convulsions. Signs of apoptotic neuron death were not seen, while caspase-3 activity was significantly decreased in the hippocampus after electric shocks. These data support the notion that functional changes affect neurons after electric shock and deepen our understanding of this view, providing direct evidence that there are moderate (up to 10%) but significant levels of neuron death in defined areas of the hippocampus. Inverse correlations of the numbers of cells with the extent of convulsive activity suggest that the main cause of neuron death is convulsions evoked by electric shocks.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't

PMID 16433067 [PubMed - indexed for MEDLINE] Justin997 04:26, 14 July 2007 (UTC)

Anyone from Australia, Canada.....?

Would anyone be able to add anything about other countries, for example, Australia, Canada (or anywhere else) to the current use section? It is looking a bit bare with just the US and UK and only a mention of a few other countries.Staug73 15:05, 22 May 2007 (UTC)

True, wikipedia tends to be overly United States centered, especialy here. All countries mentioned so far are: US, UK, and a bunch of countries where it has a history in flagrant human rights violations.--Loodog 15:59, 22 May 2007 (UTC)

Staug73, are you deleting info from discussion?

This section from the brain damage discussion subsection seems to have been removed by you, "all of the recent scientific reviews on topic have concluded that there is no evidence that ECT causes brain damage". Any comment?

• This was the recorded edit: Revision as of 13:55, May 23, 2007 (edit)Staug73 (Talk | contribs)

--scuro 16:18, 23 May 2007 (UTC)

The upside

An upside to all this discussion/borderline flaming is that article is getting editing attention as well as accruing sources in the process. If we can all stop trying to convince each other on the morality of ECT, the article might be able to pass a good article review.--Loodog 20:25, 23 May 2007 (UTC)

Ahhh...finding the silver lining in every situation. I agree. =) Jumping cheese ^Cont@ct 22:25, 23 May 2007 (UTC)

Upside...I never thought I would get THAT familiar with Wikipedia's five pillars.--scuro 02:13, 24 May 2007 (UTC)

different types of ECT machines and treatments

What is disturbing in reading some of the literature is that not all countries use the most up to date methods and technology. There should be a section which spells out the evolution of the procedure and what is considered best practices currently. You get tidbits of info here and there in the article.--scuro 03:02, 25 May 2007 (UTC)

Ethical Issues

Hi. I no longer edit Wikipedia articles, but I have a suggestion for this one. A major deficiency in this article, which appears to have increased controversy, is the lack of a section that discusses directly the ethical issues of electroshock. Presently, the article appears to use consequentialism as its major ethical philosophy. That is okay, but a more diverse list of philosophical beliefs about the topic should be included, in a section entitled "Ethical Issues" or some other variant of moral philosophy. Whether electroshock is effective or not, there are ethical issues involved, which seem not to be included explicatively in the present article. I recommend someone insert such a section, which could start with the pattern used in the section "Ethical Issues" in the article in MSN Encarta Encyclopedia on "Assisted Suicide." The Web address for that page is below.

<http://encarta.msn.com/encyclopedia_761589503_2/Assisted_Suicide.html#s4>

Such a section should satisfy the need for both proponents and opponents of electroshock to document their major philosophies about the topic. In the past, I personally thought Wikipedia articles were appropriate places to express my personal beliefs and now I know that is wrong. However, it would be good to express the beliefs of major religions, cultures, and philosophies about electroshock. For example, consequentialism would probably argue that the treatment is moral if it has moral consequences. (Much of the present article appears to use consequentialism.) Deontology would probably argue that the morality of electroshock is independent of its consequences. There are a myriad of ways to evaluate the treatment with philosophy.

The science of electroshock can not be determined by philosophy alone, but I do believe philosophy can be used to determine or at least politely discuss the absolute ethical status of a thing. The philosophy of electroshock is relevant and I hope someone will follow my suggestion to include a section about the ethical issues pertinent to electroshock.

Chris Dubey 14:24, 25 May 2007 (UTC)

You have a very meaty topic that would need a lot of background information so that the entry would be encyclopedic in nature and understandable to the average Joe who doesn't have a philosophy background. I've noticed that even in your brief post there was a need to explain terms. I'm not sure how that would merge into the article that still is skeletal in nature. Perhaps a new subsection linking to a larger Philosophy of ECT article would be in order.--scuro 16:57, 25 May 2007 (UTC)

Yeah, it would be a major effort, but even a start would be good. Wikipedia has many articles about philosophies, that give basic information about ones such as consequentialism and deontology. Someone could probably link to those articles for information in the proposed section, if it's created. Political philosophies would be intensely relevant, as would the article on medical ethics. I imagine libertarianism would have a strong attitude about electroshock, just to name a specific political philosophy that could be included.

Chris Dubey 00:33, 26 May 2007 (UTC)

I've created this section (somewhat belatedly!) in response to the amusing stuff someone added last night about Scientology believing ECT damages the soul (can we point out that no electrical current is passed through a point a few inches over someone's head, or would that be churlish? ;-)). As I said below, I'm not really in a position to research it, so I've just cut-and-pasted Chris' thoughts above into the article with citation requests. Please do go ahead and edit it! Nmg20 10:41, 12 June 2007 (UTC)

It's possible your definition of the word "soul" may be different. It may be more accurately described as the sub-conscious mind. If you still don't understand, you might want to start reading about "ego death" and the use of LSD or magic mushrooms in therapy and for mystical visions. It basically causes the ego to break down or split at high doses sometimes, and allows the subconscious mind to emerge into the conscious realm such that people are able to realize and process traumatic feelings. LSD and pilocybin mushrooms have been studied for various psychiatric disorders. Research has recently been started back up on mushrooms at Johns Hopkins after a number of decades. Some theorize that they actually work by a similar method as ECT by getting at the subconscious mind. However, ECT would storm and disorganize the subconscious (and some believe cause brain damage), while mushrooms would likely not cause brain damage and have more of a therapeutic or organizational effect on the subconscious by helping to consciously recall and process past trauma or misunderstanding. This may make no sense to most people, but there is supporting research, books, and a long list of case reports showing what exactly takes place, including some evidence that psychedelics have even made breakthroughs for children afflicated with severe autism by more than one research team. It seems to work by affecting the subconscious. For those who don't know much about this, before you laugh it off, you might want to read about it. For example, http://maps.org/news-letters/v07n3/07318fis.html Justin997 17:40, 14 July 2007 (UTC)

I am pleased to be able to reassure you that my definition of the word "soul" would not involve anything floating over my head. Delightful and curious though the rest of your post is, you'll forgive me if I stick to the wikipedia definition of the word, which doesn't mention magic mushrooms once. That said, I'm confident a punishing series of acid trips would allow me to come up with a more coherent definition of it that the Scientologists have managed thus far! Nmg20 18:07, 23 July 2007 (UTC)

Good. I won't comment now on the reference to Scientology... I believe queries of search engines with the words "ect or electroshock" and the name of each belief will find sources that discuss the relationships between those beliefs and the treatment. I see a small discrepancy. Consequentialism and deontology are described as religious beliefs. In generality, they are religious beliefs or religions, but, in specificity, they are philosophies, which are formal, academic studies or practices of logic, ethics, and existence. Religions make allegations about the same topics, but usually without formal reasoning. Chris Dubey 16:33, 15 June 2007 (UTC)

Here is an article that can be used as a source for some of the philosophies and/or religions. Web address: <http://www.asa3.org/ASA/topics/ethics/PSCF3-90Jones.html>. The author is D. Gareth Jones of the Department of Anatomy of the University of Otago in New Zealand. It discusses medical ethics, but I don't know the scope because I haven't read all of it. Well, if somebody would like to do the reading and the editing, you are welcome to it.

The summary states, "Two recent medical scandals in Australasia are used to highlight what may happen when important fundamental ethical principles, such as informed consent, peer review, and patient autonomy, are overlooked. Ethical codes formulated to guide the medical profession are assessed, and are found to be less useful than frequently assumed, on account of the increasing sophistication of modern medicine and of changing patterns within society. In exploring ethical principles of value, both absolute and consequentialist principles are seen to make a contribution to ethical decision-making. The first-order principles of significance are justice and love, with important second-order principles including doing good and not harm, respecting the autonomy of people, and telling the truth. A Christian contribution to bioethics lies principally in its imparting meaning to human life, in the limitation it places on scientific technique, and in the control it advocates over biomedical technology." Chris Dubey 17:01, 15 June 2007 (UTC)

Here is a tentative source for the beliefs of Scientology about electroshock. Web address: <http://www.scientology.org/html/opencms/cos/scientology/en_US/religion/catechism/pg043.html>. It states, "[...] [Scientologists] actively investigate psychiatric abuses and bring these to the attention of the media, legislators and groups concerned with protecting people from brutal psychiatric techniques. Such practices as psychosurgery, electroshock and the administration of dangerous psychiatric drugs have destroyed the minds and lives of millions of individuals." However, I see no information about a Scientological conception of soul in relationship to electroshock. If a source is found for that later, someone can add it, too. Chris Dubey 01:27, 25 July 2007 (UTC).

Staug73, what was the point of the mediation cabal that you requested?

What was the point of the mediation cabal that you requested when editors can't follow the explict directions of the mediator:

• What I've been seeing is that it's not an information dispute, but an talking dispute. For this to work, editors must discuss changes before taking action on them. Staug73, you need to discuss what and why you would make a changed before you make it. It's hard to assume good faith when other editors believe that you are, for a lack of a better word, "hurting" the article. Also please remember that the articles and sections are WP:NOTYOURS even if you contribute a good deal to it. Jac _roe 21:15, 15 May 2007 (UTC)

Now we go back to premediation behaviour with unilaterial editing with no prior discussion. Can we not follow wiki policy? WP:CON and stop disrupting the process?--scuro 14:38, 26 May 2007 (UTC)

Research into memory loss

This section needs to be cleaned up. I'm wondering why this section opens with a historical study from the 1940's? It has no relevance to current practices. --scuro 18:22, 27 May 2007 (UTC)

Reading this section my first thoughts are shouldn't it be titled, "The question of permanent memory loss", this is what the average reader will want to know about. This section again shows bias, there is only one sentence in this section about one contemporary study, all the other info is gleamed from single older studies. Also, the one and only contemporary study uses Bilateral stimulation which is associated with greater memory loss than unilateral stimulation. I haven't read this study yet but wonder if they also used sine wave stimulation which produces the highest risk of memory loss. I'm sure there is more then one contemporary study on this topic. Older studies will often not examine current best practices because they did not have the current technology or methodology in place back then. Single studies shouldn't be used anyways unless reviews or statements from institutions are not available. A single study is more relevant when it is new and hasn't been mentioned in any review.

My purpose is not make this section state that there is no memory loss. Indeed on first examination of this topic there appears there may be loss especially when particular methods are used.

This section should also specifically indicate the danger of permanent memory loss when best practices are used. --scuro 23:01, 27 May 2007 (UTC)

Some more on memory loss.

A recent study questions any conclusion drawn from the earlier study in the Wiki ECT article("In the late 1940s American psychologist Irving Janis tested ECT patients by asking them extensive and detailed questions about their lives and found that memory for autobiographical material remained impaired months after ECT").

Lisanby et al. 2000, stated this:

The amnestic effects of ECT are greatest and most persistent for knowledge about the world (impersonal memory) compared with knowledge about the self (personal memory), for recent compared with distinctly remote events, and for less salient events. Bilateral ECT produces more profound amnestic effects than RUL ECT, particularly for memory of impersonal events. http://archpsyc.ama-assn.org/cgi/content/abstract/57/6/581

Some background info from the APA on memory loss:

Over the course of ECT, it may be more difficult for patients to remember newly learned information, though this difficulty disappears over the days and weeks following completion of the ECT course. Some patients also report a partial loss of memory for events that occurred during the days, weeks, and months preceding ECT. While most of these memories typically return over a period of days to months following ECT, some patients have reported longer-lasting problems with recall of these memories. However, other individuals actually report improved memory ability following ECT, because of its ability to treat depression and thereby remove the problems in concentration and memory that depression can cause. The amount and duration of memory problems with ECT vary with the type of ECT that is used and are less of a concern with unilateral ECT (where one side of the head is stimulated electrically) than with bilateral ECT.

...and more from the Surgeon General:

More persistent memory problems are variable. Most typical with standard, bilateral electrode placement (one electrode on each side of the head) has been a pattern of loss of memories for the time of the ECT series and extending back an average of 6 months, combined with impairment with learning new information, which continues for perhaps 2 months following ECT (NIH & NIMH Consensus Conference, 1985). Well-designed neuropsychological studies have consistently shown that by several months after completion of ECT, the ability to learn and remember are normal (Calev, 1994). Although most patients return to full functioning following successful ECT, the degree of post-treatment memory impairment and resulting impact on functioning are highly variable across individuals (NIH & NIMH Consensus Conference, 1985; CMHS, 1998). While clearly the exception rather than the rule, no reliable data on the incidence of severe post-ECT memory impairment are available.

--scuro 03:13, 28 May 2007 (UTC)

I'm wondering what the "research" section is really supposed to be about. It talks about research but much of it is out of date research and isn't relevant. The section with more current research is the "side effects" subsection. I'm wondering if the side effects subsection shouldn't be more about short term and longer term side effects that eventually go away and the research section shouldn't be about permanent impairments that don't go away. The "structural brain damage" subsection could then be merged into the second subsection. --scuro 10:34, 28 May 2007 (UTC)

Any advice if research into memory loss, brain damage, and side effects, shouldn't all be merged into one section? The chief side effects of ECT is memory loss and the secondary issue that concerns a good number of people is brain damage...anyways. I'd like to clean this whole area all up or if someone else would like a go...go for it.--scuro 22:26, 29 May 2007 (UTC)

Mechanism of action -putting this section back in?

I have done a cut and paste version of this section using the predelete MofA and the current threshold section. Anyone have an opinion?

Mechanism of action

The aim of ECT is to induce a tonic clonic seizure (a seizure where the person loses consciousness and has convulsions) lasting for at least 15 seconds. A seizure is thought to be a "necessary but not sufficient" condition for successful treatment with ECT, so stimulus levels in excess of an individual's seizure threshold are recommended: about one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT. Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more severe cognitive impairment without additional therapeutic gains.Seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex. Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold. A vast amount of research has been carried out, much of it on rodents, the exact mechanism of action of ECT remains elusive. A recent textbook summarises the reasons for this: the difficulty of isolating the therapeutic effect from the plethora of effects that accompany the anesthetic, electric shock and seizure; the differences between human and animal brains; and the lack of satisfactory animal models of mental illness.

--scuro 22:41, 29 May 2007 (UTC)

final draft for new intro?

Gave it some more thought. Hope this version is accurate and balanced. I will insert it into the article tomorrow unless there are objections.

Version 2 Electroconvulsive therapy (ECT), also known as electroshock, is a psychiatric treatment in which seizures are induced with electricity. The seizure is what has widely been accepted to cause the therapeutic effect. ECT is most often used for cases of severe clinical depression which have not responded to other treatments and also commonly a first line of treatment in life threatening situations of potential self harm or neglect. The treatment is performed typically on older female patients and much more frequently in private clinics in the United States. A course of treatment typically involves about a half dozen to a dozen separate treatments. ECT has been shown to be clinically effective in relieving the symptoms of depression in the majority of patients. For the majority of the patients the benefits will be relatively short-lived and further treatments and or pharmacological intervention may be necessary. Different treatment methods produce both different results and side effects. The most common side effect is confusion and difficulty in creating new memories. These symptoms typically disappear within a half year. Another common symptom is the loss memory to some prior events that happened shortly before treatment. These memories are mostly recovered over time. Depending on the method of ECT employed, memory loss can last for greater periods of time or even be permanent. Best practices have not always become standardized across the world and alarmingly even within the USA. Approximately 100,000 people in the USA undergo ECT each year and an estimated 1,000,000 people in the world receive ECT treatment. ECT is still regarded as a controversial treatment because of the way it has often been maligned in the popular media and because of valid concerns about effects on memory. It has been widely accepted that ECT does not cause structural brain damage. --scuro 22:43, 1 June 2007 (UTC)

Well, I like it. I believe it is a factual representation of ECT...but I'm in the apparent pro-ECT lobby here compared to our other friends. In particular, is that true about often lost memories are recovered? If so, we have a good source for it? And that penultimate sentence "controversial because of media malignment" might not go over so well with the others on this page. Final sentence could maybe back off a bit by stated why this is known, rather than be stated as truth (e.g. "There is no scientific evidence to support that ECT causes structural brain damage").--Loodog 02:57, 2 June 2007 (UTC)

I've changed the wording a little on the memory sentence to better reflect the SG and APA quote in the research on memory loss section a few sections up from this one. When you read why ECT is controversial in good citable sources they often mention the popular media. That sentence also mentioned "valid concerns about effects on memory". The wording of the last sentence was also changed. --scuro 04:14, 2 June 2007 (UTC)

I think this still needs quite a bit of work on it. The English could be better. And I think that now the intro introduces some controversial aspects of ECT it needs citations. Also, I think specifics about ECT being used more in private settings in the US is a bit too US-specific for intro - why not leave it for Current use section? It would be better to say women and the elderly are over-represented in statistics rather than older women being typical. And the numbers 100,000 and million need explanation. 100,000 was an estimate based on a survey of professional practice in late 1980s. The million - you need to say where you got it from and where they got it from. As far as I am aware no-one knows much about ECT use in Africa, S America or Asia so I am a bit sceptical about this figure.Staug73 14:49, 2 June 2007 (UTC)

Staug's post must have been recently done, I didn't see it before I posted. Simply let me know what you want citations for and I will find it. Please feel free to make minor grammatical corrections on the intro within the article without first posting in discussion. Any deletion should still be discussed first in the article. --scuro 15:05, 2 June 2007 (UTC)

That's okay if you didn't see my post. I have reverted to previous version so we can reach a consensus on introduction before posting. There is no deadline. I will have another look at it and post some more concrete suggestions early next week.Staug73 15:32, 2 June 2007 (UTC)

I think there is consensus about the soundness of the content, especially after all recent concerns were met. Really the only thing needed was possibly a few citations and minor sentence structure edits. If a process is held up for several days it should be for more significant reasons. I'll be reverting this section on Tuesday if we don't hear from you by then.--scuro 16:13, 2 June 2007 (UTC)

Electroconvulsive therapy (ECT) also known as electroshock, is a psychiatric treatment in which seizures are induced with electricity. The seizure is widely accepted as the main therapeutic ingredient in the treatment.

In Western countries ECT is most often used as a treatment for severe clinical depression which has not responsed to other treatment. In exceptional circumstances it may be used as a first-line treatment. It is also occasionally used in the treatment of mania, catatonia, schizophrenia and other disorders. In Western countries women and older people are over-represented amongst ECT patients.

An estimated 100,000 people undergo ECT annually in the US [is this statistic okay - comes form 88-89 survey?]. In the US ECT is generally given in private and academic facilities; in the UK it is generally given in NHS hospitals. American psychiatrists have suggested that 1 million people worldwide receive ECT every year [but do not give a source for figure].

ECT is usually given in course of 6-12 treatments at a rate of 2 or 3 times a week. It may be bilateral (electrodes on both sides of the head) or unilateral (electrodes on one side of the head). The current may be brief-pulse or sinewave. BL causes more severe side effects than UL but is still the most commonly used form of ECT in the US and UK. ECT practice is not standardised [not quite sure what is meant by this?]

Paragraph about side effects and benefits to follow.Staug73 14:01, 3 June 2007 (UTC)

ECT is an effective treatment for the symptoms of depression but the benefits are often short-lived. Drug treatment is usually continued after a course of ECT; sometimes patients receive continuation/maintenance ECT. The acute side effects of ECT include amnesia and confusion. Confusion usually clears within hours of treatment; amnesia takes longer to clear and people may be left with persistent memory problems, especially if bilateral ECT is used. Conclusive evidence of structural brain damage due to ECT has not been found.

ECT remains a controversial treatment, partly due to its effects on memory, partly due to criticism in the media [?]

I think that includes more or less everything Scuro wanted. I didn't understand the bit about standardised treatment. Are any medical treatments standardised across world? Who sets the standards? The World Health Organisation? I haven't heard of that. Or does it mean variations in amount of ECT used and techniques used?

Re media criticism - I think Fink is the only person who still thinks this is important. For example, Rudorfer says media approaches ECT in balanced way this past decade.

Statistics - do we need to say the 100,000 is quite old? I think the million worldwide certainly needs clarification. What was the original source?Staug73 14:17, 3 June 2007 (UTC)

If required I have refs for every sentence, except million statistic and media.Staug73 14:24, 3 June 2007 (UTC)

My suggestion based on Scuro & Staug73's work - significant changes in bold italics, rationale in ((italics and double brackets)) and claims I think would be helpful referenced tagged as such.

Electroconvulsive therapy (ECT) also known as electroshock, is a [[psychiatry|psychiatric]] treatment in which seizures are induced with electricity. ((Removed "seizure is generally accepted..." - I don't think it's relevant to the intro, and it is conjecture)) In Western countries ECT is most often used as a treatment for severe [[clinical depression]] which has not responded ((spelling)) to other treatment. ((Cut "in exceptional circumstances...firstline treatment" - the intro doesn't need to cover exceptional circumstances, does it?)) It is also occasionally used in the treatment of [[mania]], [[catatonia]], [[schizophrenia]] and other disorders. ((Removed "In Western countries women and older people are over-represented amongst ECT patients." - this is Western-focused, and is a bit of a "so-what" statement sitting in the intro, IMHO.))

((I'd say that was all that was needed for an intro - the rest is even more Western-focused than what has gone before, and details of where & how it's administered are more pertinent to the provision of psychiatric care generally than to ECT specifically))

An estimated 100,000 people undergo ECT annually in the US ((User:Staug73: is this statistic okay - comes form 88-89 survey?)) ((User:nmg20: looks fine to me, esp. if we can reference it)). In the US ECT is generally given in private and academic facilities; in the UK it is generally given in [[NHS]] hospitals. American psychiatrists have suggested that 1 million people worldwide receive ECT every year (but do not give a source for figure) ((Can we reference the conference or whatever this claim was made at? If so, this could usefully go in the intro)).

ECT is usually given in course of 6-12 treatments at a rate of 2 or 3 times a week. It may be bilateral (electrodes on both sides of the head) or unilateral (electrodes on one side of the head). The current may be brief-pulse or sinewave. BL causes more severe side effects than UL but is still the most commonly used form of ECT in the US and UK. ECT practice is not standardised ((No comments here at the moment, although it could use cleaning up - in the absence of any specific factual concerns, however, that's probably best done once it's in situ))

ECT is an effective treatment for the symptoms of depression but the benefits are often short-lived. Side ((it makes more sense to deal with these as acute and chronic side-effects, not as separate entities)) effects include [[amnesia]], which may be persistent in a minority of patients, and [[confusion]], which usually clears within hours of treatment. There is no conclusive evidence that ECT causes brain damage. After treatment, drug therapy is usually continued, and some patients receive continuation/maintenance ECT. ((Restructured paragraph to follow the chronology of treatment - thus side-effects before follow-up treatments))

((Cut "ECT remains a controversial treatment, partly due to its effects on memory, partly due to criticism in the media" - I would support calling it controversial early in the article, because clearly it is, but putting it on the end of the intro suggests that is what the article is / should be interested in, and that's not what we want from it. Yes, we should deal with the controversy, but we should not be making it the focus of the article, IMHO.)) Nmg20 21:14, 3 June 2007 (UTC)

Sounds okay to me. Adverse effects rather than side effects, perhaps?Staug73 13:57, 4 June 2007 (UTC)

I have seen the million figure on several websites. I found it here quickly. http://www.massgeneral.org/pubaffairs/Issues2006/101306ect.htm

I'm wondering if suggested edits can not only be mentioned but also that a version of the section with recommended edits included is also put in the post. I'd like to make some changes to the text but will wait to see the latest version posted.--scuro 16:55, 4 June 2007 (UTC)

Thanks, folks. I've added most of the above, although removed the US-only incidence figure and details of what sort of institutions it was used in from the intro. May I suggest we move further discussion (i.e. of sections outside the intro) to a new block, so life is that little bit easier for whatever poor sod has to archive our pontification in the future? ;-) Nmg20 00:43, 5 June 2007 (UTC)

"ECT is an effective treatment for depression but the benefits are often short-lived." I would like to change this to "ECT is an effective treatment for depression but the benefits a particular session are often short-lived, requiring ongoing sessions for better effectiveness long term."

The first sentence implies it's a quickfix that can't be useful for long-term treatment.--Loodog 18:38, 5 June 2007 (UTC)

Well at least we have an intro that can sit on the page. Thanks for that Nng20. We didn't have that before and this was the quick way. On the other hand the opening could be more specific...say more, and say it better. I particularly don't like the section on electrode placement and type of current. That section is totally descriptive and the sine wave is clearly the inferior and castigated method nowadays. I don't like the, "benefits are often short lived", section also. What does "often" mean? For a good minority of paitents one treatment session will be the only time they will ever need ECT and the treatment will be effective. For others it is going to pull them out of desperate straits such as a Catatonic depression or a constant crisis suicide state. If you look at the goal of the treatment at the time it was given, ECT is a highly effective treatment.--scuro 02:24, 6 June 2007 (UTC)

My conceits exactly.--Loodog 02:30, 6 June 2007 (UTC)

I agree the current wording makes it sound ineffective in the long-term, but I'm not sure disclaiming it improves it. Can we cite a percentage of people who relapse without continuation ECT, maybe? To my mind it'd read far better to say "ECT is an effective treatment for depression, although 40% (or whatever!) relapse within 6 months unless treatment is continued." Nmg20 14:30, 6 June 2007 (UTC)

How about, "ECT has been clinically shown to be the most effective treatment for severe depression"?--scuro 16:42, 6 June 2007 (UTC)

I don't know if omitting the duration of effectiveness is a good solution either. If 60% really is the number, we can always put a qualitative word on it like "most" or "majority". E.g. "ECT is an effective treatment, with the majority of patients experiencing long-term benefits."--Loodog 23:31, 7 June 2007 (UTC)

I know that's true for treatment-resistant depression, where I think it's 70 or 80% effective - would be good to get a source for this, though... Nmg20 08:02, 7 June 2007 (UTC)

New intro: What is a "small majority"?--Loodog 21:49, 8 June 2007 (UTC)

If I read User:Loodog's post correctly, he's questioning the use of vague and unreferenced claims in the intro - and I agree! If we can't find a decent source telling us roughly what proportion of patients it works on, it shouldn't be in there. I know Andrew Solomon's book The Noonday Demon: an Anatomy of Depression cites something like the 70% figure with a reference, but I haven't got the book to hand. Nmg20 00:56, 9 June 2007 (UTC)

A "small majority" is over 50%. Is that a definitive number? No and you won't find one. I'll tell you one thing, the old sentence used the word "often", which is even more nebulous and much further off the mark. Consider this, the majority of those who are receiving treatment have, "neurovegeative signs", depression severe enough that "psychosis is evident", or are a major suicide risk. There are many factors that play into the relapse rate, especially the type of patient used in the study, placement of electrodes, and stimulus used. Ruderfor, which is cited often in the Wiki article, states this; "it is now clearly established that left untreated after completion of ECT, at least half of the patients will relapse most within six months. Other studies show a lower incidence. Edit made using "at least half"...although, "slight majority" works just as well. --scuro 03:04, 9 June 2007 (UTC)

No, actually what I was asking for was the meaning of that phrase. I would more readily understand "slight majority", which it seems was meant.--Loodog 03:07, 9 June 2007 (UTC)

okay if we are getting that picky about the wording in the above sentence...what about this "boner" sentence? It may be bilateral, with electrodes on both sides of the head, or unilateral, with electrodes on one side of the head, and the current may be brief-pulse or sinewave. --scuro 03:11, 9 June 2007 (UTC)

help needed with side effects section and research into memory loss

First off I believe these sections should be merged because memory loss is a primary symptom of ECT. Any current research not covered in a major review or primary source such as the SG webpage could be inserted directly in this section. Far too much of both of the sections rely on single studies to draw conclusions. That should be changed. There is also a lot of ground to cover here that isn't covered in either section. To start off with I have combined the sections starting with a brief intro. This section should start with the most common side effects and then go to more serious side effects. Then it should go to current research(sackeim), and then the possible difficulty of measuring all side effects. Below is a very rough 1st draft. Please feel free to liberally edit and add to it.

Side effects-version 2

The physical risks of ECT are similar to those of brief general anesthesia; the United States' Surgeon General's report says that there are "no absolute health contraindications" to its use. Immediately following treatment side effects such as headaches, confusion, and memory loss are common. These primary symptoms are often transient and dependent on many variables. Usually after weeks or months memory difficulties subside. Electrode placement and the way the electricity is manipulated significantly influences the outcome of treatment. Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with sine-wave rather than brief-pulse currents. It is more common that those with persistent losses have gotten bilateral ECT treatment. These conclusions were supported by a recent (2007) large study by Harold Sackeim and colleagues found that the methodology of certain forms of ECT routinely causes adverse cognitive effects, including cognitive dysfunction and memory loss, that can persist for an extended period.including an IQ loss of more than 30 points in one.

A challenge for researchers has been to determine the extent of impairment before treatment begins and then compare it to the degree impairment after treatment. Some researchers have questioned if standardized tests such as the Wechsler are sufficiently sensitive to minimal memory loss. In the late 1940s American psychologist Irving Janis tested ECT patients by asking them extensive and detailed questions about their lives and found that memory for autobiographical material remained impaired months after ECT. It was only in the 1970s that the work of Janis was taken up by another American psychologist, Larry Squire. Squire found that on some tests of memory a small group of patients who received bilateral ECT could perform as well seven months after treatment as they had before treatment. However, he was able to demonstrate lasting impairment of memory for events that had occurred in the two years before treatment. In addition, half of the patients had lost more remote memories, and sometimes had no recollection of them even when reminded.. More recently American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with persistent impairment for memory of public events.

A recent article by a neuropsychologist and a psychiatrist in Dublin suggests that ECT patients who experience cognitive problems following ECT should be offered some form of cognitive rehabilitation. The authors say that the failure to attempt to rehabilitate patients may be partly responsible for the negative public image of ECT.

About a 1/2 hour of editing went into that first paragraph. I'm trying to keep former material in while balancing the article and avoiding bias with undo weight or personal anecdotal information. More edits to come. --scuro 05:25, 3 June 2007 (UTC)

Again, please don't be in a rush with this. The English sounds a bit odd in places, for example I think it would be better to call memory loss etc effects of treatment rather than primary symptoms. I will have a look at it later.Staug73 14:27, 3 June 2007 (UTC)

It has been over a month since I have started working on this page. It took a mammoth effort which included the mediation cabal to get the brain damage section to state the obvious. This one paragraph is the only significant addition to the article that I have been allowed to make. Having said all that, I believe the side effects section could take several more significant edits for it to be comprehensive and accurate. Still, wording is not a reason to hold up editing, see WP:EP. For instance you could make a case that the word, "primary" isn't the best word to use. You could be right or wrong in your assumption. That word conveys a meaning that is lost as soon as you use the phrase, "effects of treatment". There are many possible effects to a treatment of ECT such as vomiting but vomiting is not the most common symptom or the major symptom of ECT treatment. To wait for the wording and phrasing to be perfect in each possible addition doesn't follow Wiki policy. Such editing can be done right on the page as long as material isn't also deleted. As soon as the content is good it should go on the page because it will replace a skeletal section, a section with bias, and or a section that is is missing pockets of information that can be vital to the understanding of a subject. Bottom line, no one should have to wait a month to add a paragraph of excellently cited material. If the content is good it goes on the page. --scuro 15:31, 3 June 2007 (UTC)

I have put in a reference to the Lisanby et al study to illustrate concern about memory. See the first paragraph of the study.Staug73 14:37, 4 June 2007 (UTC)

Edits made on article as suggested in "article structure" section. This edit was done more to join ideas and sections together to give it a better flow.--scuro 05:45, 9 June 2007 (UTC)

Article structure

As it stands, the article to my mind gets a bit too technical a bit too quickly. The Wikipedia style guide for medical articles might help here - given that this is fundamentally a medical treatment, albeit an emotive and hotly-contested one, would it make sense to use the guide for "Drugs" as a start? We could then open with the indications for the treatment, along with any solid data we can find on who actually gets it (e.g. support for that 70% women figure, a little on racial divides, what conditions are most commonly represented)? We could then follow "chronologically" through the course of a treatment, ending on the cultural depictions etc?

What I'm suggesting would therefore look something like:

1. Introduction
2. Indications (who gets it, when, and why / at what point ~=Section 5 When is ECT used?)
3. Administration (section 1, Treatment procedure plus 4, the unedifyingly titled "ECT machines", and 9 Current use)
4. Adverse effects (combo of sections 7 Side Effects and 8 question of structural brain damage)
5. Mechanism of action (section 3 Mechanism of Action)
6. Legal status (Pull out relevant stuff from section 9, section 10 informed consent, section 11 involuntary ECT and perhaps section 12 history)
7. History (section 12)
8. Role in culture (with subsections covering sections 13-15)
9. References

I'm obviously amenable to moving some of these around - for instance, we may want to move mechanism ahead of adverse effects on the basis that the latter may make more sense after the former, but I've left them as they are for drugs in WP:MEDMOS for now. At the moment I think one of the problems we're having is that it's become bloated with a lot of sections which really don't merit full headings (ECT machines as section 4? Really? Zzzzz.) Thoughts? Nmg20 00:57, 5 June 2007 (UTC)

I agree with everything that you stated. I know with medication there is a standard format to be used with recommended subsections, and the specific order of the subsections. Is there such a thing for nonpharmaceutical treatments? --scuro 16:26, 6 June 2007 (UTC)

Thanks - I don't know of a standard format for nonpharm treatments - it's something which could usefully be added to WP:MEDMOS, in fact - I'll ask / suggest it there. Anyone else have thoughts on the above structure? Nmg20 08:03, 7 June 2007 (UTC)

Can we simply use the standardized format (subsection order) of the pharm treatments that are relevant to ECT? Does that format mesh with what you suggested?--scuro 12:34, 7 June 2007 (UTC)

Roughly. I've left out "overdose", "pharmacodynamics" and "pharmacokinetics", for instance, and included a couple of sections relevant to ECT which aren't so much for drugs. I don't think we can use it as-is, but it's a decent thing to work from. Nmg20 23:25, 7 June 2007 (UTC)

Can you make the structure edits, they were positively received. --scuro 01:00, 8 June 2007 (UTC)

Done. A few cuts of info that was repeated (e.g. the Turkey info was already in the intro) and one correction - it's a brazen and actually pretty hilarious lie that the concept of informed consent isn't part of British law, so I've corrected that with links to the relevant articles on here!

I think the article is now easier to navigate, at least, but I have doubts about some sections, e.g. is it appropriate to do a blow-by-blow, country-by-country account of ECT practice? It may be given the controversy over how it's administered, but those sections which start "In the UK..." and "In the USA..." do jar a little IMHO. Would appreciate any and all comments on whether it makes sense as it now reads, and whether and where we can trim some of the fat. Nmg20 17:34, 9 June 2007 (UTC)

Nice job. I agree with you but I'll go one step further and see your "jars" and raise it to "much the article reads like a dictionary". eg there are far too many bold sub-subheading followed by a short definition. This article should be more encyclopedic and a number of the sub-subheadings should actually be paragraphs instead. There is little flow right now. Comments?--scuro 22:35, 9 June 2007 (UTC)

Yep - that's partly a function of the way people have bolted things on over time, and largely a function of the fact I've juggled the sections with only a little bit of smoothing over the transitions. Which subheadings do you think we can axe? Nmg20 22:11, 10 June 2007 (UTC)

Smooth over the transistions. The whole treatment section sub-subheadings could be axed and the info can be merged. Also where would effectiveness go in your scheme of things?--scuro 23:19, 10 June 2007 (UTC)

The "effectiveness" section is third in the list at the moment, but might make more sense after mechanism and adverse effects sections? Nmg20 23:30, 10 June 2007 (UTC)

It simply wasn't mentioned in your list above and I wondered if it was going to be merged. It's current placement is good.--scuro 02:27, 11 June 2007 (UTC)

On the whole I like the new structure, but just one thing I am not sure about - the by country section. Why procedure? The sections on different countries cover more than procedures. They cover rates of use, guidelines etc. So wouldn't "Use by country" be better. And in a separate section? Then individual countries could have their own subsection, or be grouped together into North America, Europe, Asia etc.Staug73 17:32, 18 June 2007 (UTC)

That's a good point, Staug73 - I wonder if we should move this down to where "Legal status" is currently and make legal status a subsection of a "Use by country" section, given that legal status varies from country to country?

On a semi-related note, I'm not convinced the "Dose titration" section belongs under "Treatment procedure" - it's all about mechanism and not really about the procedure itself, to my mind. Thoughts? Nmg20 18:07, 18 June 2007 (UTC)

Use by country could include something about 1)rates of use 2)legal status 3) techniques, eg whether sine-wave or brief-pulse is used 4)whether there are guidelines etc 5) anything else of particular interest for example any particularly interesting research.

Dose titration is definitely procedure not mechanism. The idea is that adverse effects depend not so much on size of shock, but on size of shock above an individual's seizure threshold. So if you gave two people the same size shock, say 800 milliamps for 3 seconds, a person with a high seizure threshold would have fewer cognitive effects than a person with a low seizure threshold. Dose titration, like Unilateral electrode placement or brief-pulse current is about minimizing cognitive effects.Staug73 15:27, 19 June 2007 (UTC)

I'd like to suggest that we merge the following into TREATMENT PROCEDURE: 1) electrode placement, stumulus parameters, and dose tiration.

I'm also wondering about the procedure by country..is that necessary? The real variation with the procedure happens more in regions.--scuro 16:18, 22 June 2007 (UTC)

Medical ethics

Okay, if nobody wants to do the "Ethical Issues" section I proposed, how about adding an internal link to the Wikipedia article "Medical ethics"? This probably should go in the controversy section and, since that section is presently in another article, that linked article would be an appropriate place for an internal link to the article on medical ethics. (I didn't put this note on the controversy article's talk page because that article looks unstable.) The only other appropriate place I presently see would be the "See Also" section, but that section links to the controversy article anyway. The reason for a link to the "Medical ethics" article would be to give the article at least a small mention of ethical conditions, instead of effects alone.

Chris Dubey 00:46, 6 June 2007 (UTC)

I think an "ethical issues" section's a great idea - I don't have time myself to research it and put it in the article, but (if people like my proposed structure above), it would probably fit best in section 8 (role in culture)? Nmg20 14:32, 6 June 2007 (UTC)

An ethical issues section should include "informed consent" and the "involuntary ECT" subsections that are already in the article. Those sections should be merged into such a section (see article structure discussion). If it gets deep such as philosophical issues, brief mention could be made in the article and then it should link to another article for further info. --scuro 16:31, 6 June 2007 (UTC)

The proposed structure seems fine to me. And I agree that ethical issues would fit well in a section on role in culture. So, I approve. Thanks for the comment. (Chris Dubey 16:50, 6 June 2007 (UTC)).

Famous people who have undergone ECT

None of the people cited in this section have citations which support that they have had ECT. When clicking the internal links a number of the articles don't mention ECT. Should these names not have citations to support the claims?--scuro 22:26, 9 June 2007 (UTC)

Agreed. Bizfixer 23:44, 9 June 2007 (UTC)Bizfixer

Finding the citations would be a nice way for an editor who wants to step into this article yet is looking for a place to contribute.--scuro 20:23, 10 June 2007 (UTC)

Unless someone is actively adding citations to this list, there is nothing wrong with adding citation requests for each person. Some of these people are living and it would also be good to be able to check on these facts and read further with a good citation. I'm adding the citations back in and they should stay there unless someone gives a compelling reason for their removal.--scuro 11:14, 12 June 2007 (UTC)

adverse effects

As I read more about side effects there are four possible treatment scenarios using sine vrs. brief and bilateral vrs. unilateral. It seems that the four possible treatment methods are all treated equally or lumped together when in fact sine wave has been discouraged by the APA since 2001 because of the notable difference in long term effects/permanent effects. I believe the conclusions drawn in the article should be "weeded out" more and blanket observations discouraged. Sackheim's recent study has a lot of information on this topic.--scuro 20:48, 11 June 2007 (UTC)

That sounds good - I think we're getting to the stage where you could make the changes to the article and then discuss them on here if needed? Nmg20 21:58, 11 June 2007 (UTC)

Will do so unless I hear objections. I'll be adding info not already mentioned and eliminating older off base conclusions drawn from single studies. I'll be relying more on reviews, textbooks, and Sackheim for this section. Sackheim's recent study adds new knowledge. By the way, I can't access the one reference to the rare side effect of delerium. Anyone know more about this or can point me in the right direction?--scuro 23:11, 11 June 2007 (UTC)

Archiving recent POV discussion

I'd like to archive some of the talk page discussion to a "POV dispute" archive where we can store all future similar discussions. Would anyone like me to leave the recent discussions up here a little longer, or can I go ahead and do this? Nmg20 10:48, 12 June 2007 (UTC)

Not a problem. --scuro 11:10, 12 June 2007 (UTC)

The absence of a "controversy" section

For what is arguably one of THE MOST controversial practices in modern medicine and psychiatry, the absence of a section directly addressing this controversy is GLARING and ultimately POV. I know enough about the subject to know this, but not enough to write the section, at present. I will find out more and write it myself if nobody else takes on the task. —PopeFauveXXIII 19:35, 14 June 2007 (UTC)

There was a very large controversy section in the article which was moved to this page http://en.wikipedia.org/wiki/Controversy_of_ECT. There is also a link for this page at the bottom of the article. The controversy subheading was initially not deleted and there were a few sentences included. All controversy sections should be brief. I believe a disgruntled editor removed the title. Controversy means neither majority or minority opinion. Controversy is typically fringe opinion like Scientology's viewpoint on ECT. If you believe there are controversial ideas which can be supported by majority or minority citations then add these ideas into the main article.

I have removed your sentence in the lead but inserted the word controversial into the first sentence. It was suggested several times that the word be put into the first sentence. You can expand on why it is controversial, with citations, in the subsections following the intro. --scuro 20:19, 14 June 2007 (UTC)

Actually, I think it's far more POV to lump all the controversy into a single section, chiefly because it means that 'legitimate' causes for concern (like the query over the nature of the memory loss caused by ECT) then have to sit alongside the more lunatic fringe ideas (e.g. the soul is a small lemur called Eric who lives under people's left armpit, and he doesn't like ECT at all).

The proper place for controversy is not in its own section, but in the relevant part of the article, to my mind - that way to more fringe criticisms are put in the more fringe sections, and those folk who care more about whether it works and what the downsides are can get that info without trawling through all the other reasons people think it's controversial.

For my money that sub-article should be deleted and the relevant info re-assimilated here - having a separate article means (a) legitimate controversy is one step away from where it should be and (b) 'illegitimate' controversy needs policed there too.

Fully support having "controversial" in the intro, BTW - my mistake not to have included it at the beginning. Nmg20 21:52, 14 June 2007 (UTC)

Wikipedia states that you don't have to include fringe stuff into articles. For instance someone like John Breeding doesn't belong on this article. He believes all ECT causes brain damage. No citable source will support this viewpoint. The only support for such a contention is other fringe groups or authors. When you read the definition of controversy the dictionary use words like strife and dispute. That is accurate of Breeding. He has a belief system and it will never be changed no matter what scientific evidence is brought forward. Take a look at Peter Breggin's stance on ADHD. It has not changed one iota in 30 years. Controversial authors want to debate and have an antagonistic message from the mainstream viewpoint. They do this to create distance from majority views and attention for their views so that they garner support for their belief system. e.g. There is nothing wrong with your child, his behaviour is caused by bad teaching.

Minority opinion is different. A citable minority opinion is not based on a belief system. The opinion changes as more is known on the topic. The minority opinion often agrees with the majority opinion on many issues and is open to criticism because there opinion is based on a body of evidence. They don't cherry pick information to draw conclusions. While there are differing opinions on memory loss, the opinions merge as more evidence comes to light. That doesn't happen with fringe opinions. Minority opinion and majority opinion usually also agree on more things then they disagree about.

The last thing this article needs is the word controversy peppered through out the article. New fringe controversial subsections don't belong in this article. If there are good supportable contentions with sources, include it in the main article as either minority or majority viewpoint. Otherwise it deserves scant mention in a controversy subsection or if you like, to appease fringe voices, it's own article with a link from the controversy subsection. --scuro 22:37, 14 June 2007 (UTC)

I have added a reference to the shock therapy article to the intro paragraph, for the third time. not sure why this keeps disappearing, but i think its important to disambiguate the terms and give people a good idea of the scientifically questionable origins of this practice. it is an interesting and relevant statement of bare fact, and if that stays, ill be happy. --PopeFauveXXIII 02:07, 15 June 2007 (UTC)

While the shock therapy tidbit is interesting, there are thousands and thousands of facts that are interesting. Do they all go into the intro? Make the case why this particular tidbit belongs in the intro and not in the history section. Personal happiness is not a reason! :)

--scuro 16:30, 15 June 2007 (UTC)

The sentence was removed after no further input was given.--scuro 23:32, 18 June 2007 (UTC)

alright, so you have some rationale regarding the subjective nature of what is interesting. would you care to address the fact that "shock therapy" and "ECT" need to be disambiguated? im replacing the line. --PopeFauveXXIII 03:19, 24 June 2007 (UTC)

The line mentioned above was moved to the history section from the intro. When you add new material the editor must defend why it is added. When that material is added to the intro the editor must also show why that information is important enough to belong in first few sentences of the article. To date, this hasn't been done even though the request has been made. I kindly request that you do this at your earliest convience. Without further input about the reasoning behind the addition, this information will be removed.--scuro 05:01, 24 June 2007 (UTC)

um. ok. i feel like im being given the old "i can't hear you" treatment. here's my rationale, in 4 parts.

1. the term "shock therapy" is often confused amongst the lay population as being synonymous with Electroconvulsive therapy, when in actuality it is a parent term, hence my first reason for including the term: disambiguation.
2. As "shock therapy" is family of treatments to which ECT belongs, a direct, prominent link in the ECT article, stating ECT's status among said treatments, is eminently reasonable.
3. The "shock therapy" article is a detailed analysis of the history and variations of shock treatments, and is, as such, tremendously relevant to the ECT article.
4. All 3 of the above effects are accomplished efficiently, in a space of less than 15 words which are in no way disruptive of the flow of the intro paragraph.

—PopeFauveXXIII 05:51, 24 June 2007 (UTC)

Thank you for your reasoned argument. The crux of the matter is wether the addition is worthy of the intro because it has already been placed in the history section. For this reason really only the first point has merit of the four mentioned above, has merit. Do we really need to know in the intro that it is the only form of shock therapy still used? That is my question. --scuro 03:56, 25 June 2007 (UTC)

well, i think you already know my answer to that question, so i have to wonder why you would waste your time asking me. disambiguation is important. shock therapy has a prominent link to ECT, ECT should have a prominent link to shock therapy. you ask why. i ask why not? --PopeFauveXXIII 03:21, 26 June 2007 (UTC)

I think a problem is that a lot of people equate ECT with shock therapy and don't realise that the term includes other therapies (I know it is explained if you follow the link, but people don't always follow links). So I have added a brief explanation. I think a mention of ECT's origins is fine in the introduction.Staug73 08:31, 26 June 2007 (UTC)

I think the new rewrite of the line in question is awkward compared to the previous two versions. Hope it doesn't get removed as a result... especially by the person who reworded it. --PopeFauveXXIII 01:03, 28 June 2007 (UTC)

I was blithely assuming that the "shock" in "shock therapy" referred to electric shock - in fact, that article claims it refers to [[shock (medicine}|medical shock]], which is a state of acute tissue hypoxia, as in anaphylactic shock or hypovolaemic shock.

This has never been presumed to play a role in the mechanism of action of ECT, as the history and mechanism sections of the article make clear. I have thus removed it from the article, and would appreciate it being discussed here before it gets re-inserted - as it's fundamentally wrong both historically and physiologically to suggest that a seizure causes brain hypoxia - it doesn't and indeed there's no real way it could - the brain's ability to autoregulate cerebral perfusion pressure is maintained except in severe haemodynamic compromise, and passing a current through the brain doesn't do anything to a patient's haemodynamic status. I'm going to post something similar on the shock therapy article, because ECT doesn't belong on there if this is the definition of shock therapy. Nmg20 00:03, 30 June 2007 (UTC)

voluntary involuntary consent

If we are to get specific about national practices the focus simply can't be on the US. Lets examine the matter in discussion.--scuro 16:34, 18 June 2007 (UTC)

I am requesting that we don't get into edit waring over this issue. It's fine to make minor changes to the article but if an editor disagrees then consensus should be sought in discussion as was stated very clearly in the mediation cabal. I have no problem changing the wording of that particular sentence but lets do it like civilized adults in discussion this time around. --scuro 23:31, 18 June 2007 (UTC)

I may have been a bit brisk in the way I undid Staug's edits - and if so, I apologise. For reference, I changed:

"Informed consent is a standard of modern electroconvulsive therapy in many countries. Involuntary treatment with ECT is uncommon in many countries and in some countries is only used when the use of ECT is considered potentially life saving." to:

"Informed consent is a standard of modern electroconvulsive therapy; involuntary treatment is uncommon and is typically only used when the use of ECT is considered potentially life saving."

Rationale:

(1) The sentence is discussing "modern" ECT, and informed consent is a standard in every country that practices modern ECT.

(2) Involuntary treatment is uncommon globally because the majority of cases are carried out in developed countries (for financial reasons) where a minority of patients have treatment involuntarily (per the ref I just added the link to - 16).

(3) It is not correct at all to say that informed consent is "not recognised by law". It makes up the whole of part 4 of the Mental Health Act 1983 and the Mental Capacity Act 2005 is pretty much entirely concerned with clearly defining who does and does not have capacity to consent to treatment. In addition, the first of the two references I've removed (the Royal College one) states in it "A potential source of confusion in this context is the term ‘informed consent’. It is commonly used in medical ethics, but also has a defined legal meaning." - i.e. it is very much defined in law. Nmg20 00:19, 19 June 2007 (UTC)

Nothing wrong with the undo Nmg20. The major change in text was making voluntary and involuntary consent specific to the US. If Staug73 wants to change the sentence and editors disagree, it is his Wikipedian responsibility to share his reasoning in discussion as noted in the Mediation Cabal.--scuro 02:42, 19 June 2007 (UTC)

Informed consent does indeed cause confusion. If you had read to the end of the paragraph in Graham Kyle's article you would have seen "The house of Lords....stated that the 'doctrine of informed consent is not recognised in English law'". Everyone talks about "informed consent" but it is not a legal doctrine in England. The MHA 1983 does not use the word "informed". I don't think they define consent either, although I am not sure about that. I think it is in the code of practice rather than the act, but I may be wrong. The difference between "informed" consent and British consent is explained in that same paragraph in the Kyle article. That said there have been a couple of legal cases recently, for example, Chester v Afshar, which show signs of moving towards "informed" consent. So I have compromised and used Jones' "broad terms" in the article.Staug73 15:06, 19 June 2007 (UTC) 15:05, 19 June 2007 (UTC)

Part IV sections 56-64 of the MHA is concerned with serious medical procedures which require informed consent and, in patients without capacity, an independent second medical opinion. That info is taken from a document published by the DoH to which Richard Jones contributed[4]. It's in the Act itself, in the Royal College of Psychiatry's guidelines from 2000, and in GMC guidelines to all doctors (emphasis mine):

"1. Successful relationships between doctors and patients depend on trust. To establish that trust you must respect patients' autonomy - their right to decide whether or not to undergo any medical intervention even where a refusal may result in harm to themselves or in their own death1. Patients must be given sufficient information, in a way that they can understand, to enable them to exercise their right to make informed decisions about their care.

2. This right is protected in law, and you are expected to be aware of the legal principles set by relevant case law in this area2. Existing case law gives a guide to what can be considered minimum requirements of good practice in seeking informed consent from patients." [5] There's a good review here.

The only question in law, as Kyle's article points out, is whether "informed" means exhaustively informed of every possible eventuality, or whether such an approach (of over-informing a patient) can in fact be damaging to their health. It may be that the Lords were referring to case law rather than common law, but I'm not a lawyer and it makes no practical difference. Nmg20 15:53, 19 June 2007 (UTC)

Interestingly, the memorandum only uses the word "informed" in relation to consent to psychosurgery and not in relation to consent to drugs/ECT. I wonder if this was intentional. By the way, Part IV applies to patients both with and without capacity. In England and Wales you don't have to lack capacity to be given ECT without consent.Staug73 16:42, 19 June 2007 (UTC)

That's not my understanding. ECT is covered by part 4 section 58 of the MHA, which states:

Subject to section 62 below, a patient shall not be given any form of treatment to which this section applies unless—

(a) he has consented to that treatment and either the responsible medical officer or a registered medical practitioner appointed for the purposes of this Part of this Act by the Secretary of State has certified in writing that the patient is capable of understanding its nature, purpose and likely effects and has consented to it; or

(b) a registered medical practitioner appointed as aforesaid (not being the responsible medical officer) has certified in writing that the patient is not capable of understanding the nature, purpose and likely effects of that treatment or has not consented to it but that, having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given.

The exceptions mentioned in section 62 are:

62.—(1) Sections 57 and 58 above shall not apply to any treatment—

(a) which is immediately necessary to save the patient’s life; or

(b) which (not being irreversible) is immediately necessary to prevent a serious deterioration of his condition; or

(c) which (not being irreversible or hazardous) is immediately necessary to alleviate serious suffering by the patient; or

(d) which (not being irreversible or hazardous) is immediately necessary and represents the minimum interference necessary to prevent the patient from behaving violently or being a danger to himself or to others.

That reads pretty clearly to me: you either consent or lack capacity for consent - it is not correct to say that it can be given without consent if the patient has capacity, in other words. Nmg20 17:45, 19 June 2007 (UTC)

Read the first b) carefully: a registered medical practitioner appointed as aforesaid (not being the responsible medical officer) has certified in writing that the patient is not capable of understanding the nature, purpose and likely effects of that treatment OR HAS NOT CONSENTED TO IT but that, having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given.

The OR is very important. The Mental Health Act Commission collects statistics on the use of section 58, and how many patients are lacking capacity v how many are "capable but refusing". In eleventh biennial report for example 36 per cent were refusing and 74 per cent were incapable.Staug73 14:17, 21 June 2007 (UTC)

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