Re: Are We Really OK With Electroshocking Toddlers?

[xEnderx]

I suggest that you familiarize yourself with the difference between medically administered MODERN ECT and what is generally conceived of when someone says "electroshock therapy". They aren't the same.

I usually see at least 1 client per month undergoing ECT at one of the Kaiser facilities here in the Bay Area and frankly, it seems helpful much of the time.


A very breif education for those unfamiliar with the procedure.

Under intense medical supervision the patient is sedated into a coma-like state, and while under this effect electrodes are placed on either temple. A jolt is then applied that "reboots" the brain, and this process releases chemicals that have proven to be effective in treating extreme depression that does not respond to medication or traditional therapy. I've also seen it used to assist in treatment of suicidal ideation, self mutilation, and other obsessive disorders. Generally this procedure is administered during a stay in a Crisis Residential facility so that the patient can be monitored for their own safety. It can cause some short term memory issues (12 hour timeframe) and some disorientation for a few hours.

As for it being applied to children, from what I have seen it would need to be an EXTREME case and honestly I don't think it would really be ethically sound due to developmental concerns.

Personally I don't have one problem with ECT in an adult patient population.

[try another castle]

I usually see at least 1 client per month undergoing ECT at one of the Kaiser facilities here in the Bay Area and frankly, it seems helpful much of the time.

Wait a minute. Kaiser was helpful? You're shitting me.

Everyone I know who has kaiser says it sucks big fat balls of shit.

[xEnderx]

I usually see at least 1 client per month undergoing ECT at one of the Kaiser facilities here in the Bay Area and frankly, it seems helpful much of the time.

Wait a minute. Kaiser was helpful? You're shitting me.

Everyone I know who has kaiser says it sucks big fat balls of shit.

When I say "helpful" I mean that after the ECT has reached what is called the "maintenance stage" the clients verbalize lowered primary behavioral symptoms (depression, anxiety, suicidal ideation, etc) in comparison to their state prior to beginning the treatments. In my experience ECT is administered in conjunction with high intensity psychotherapy and (in every case I've seen) psychiatric medications.


I've heard complaints, and I've heard many success stories. With an HMO as large as Kaiser you'll get plenty of both. Per normal though, the negative publicity is that which you see most intensely. There are vast numbers of Kaiser patients that receive satisfactory health care. The ones that don't scream bloody murder.

Think about it like this....McDonalds serves millions of happy customers every day, but EVERYONE knows the story of the lady that sued because her coffee was hot. Not a 100% accurate comparison, but I hope you see what I'm trying to get at.


I also work in a facility that has most beds contracted out to Kaiser referral so I see probably 100-120 clients in a 2 month period that are referred from a Kaiser psych department. Most of them feel they get satisfactory health care...some do not. <shrug>

Hope that clarifies things a bit.

[Inculcated]

ECT, advising a cure in traumatic brain injury? The suffering of cognitive problems, including significant memory loss and learning impairment seems of little consequence to those who consider that they are applying this as a life saving measure to the severely depressed.

My problem with this (a treatment I had at one point considered) is that this ”treatment” is administered with the logic that a trauma team might aptly use to justify extreme life saving measures in physical injuries. The flaws are that all too often the patients who receive ECT are not in an immediate endangered condition that requires an intervention of “last resort” rather they are despondent persons who are desperate to not feel the way they do at that time. Doctors who advocate this treatment are all too willing to accommodate their patient’s need for relief without considering or advising what of their patient will be lost to the treatment. Patients in severely depressed states may not consider the fact that follow up shocks are required to maintain the short term relief (This also perpetuates the side effects).

This quick fix is also strikingly similar to the philosophies of programming that are myopically fixated on the short term appearance of change without regard to the damage incurred by the individual.

[try another castle]

I've heard complaints, and I've heard many success stories. With an HMO as large as Kaiser you'll get plenty of both. Per normal though, the negative publicity is that which you see most intensely. There are vast numbers of Kaiser patients that receive satisfactory health care. The ones that don't scream bloody murder.

ja, I know. A good lot of tongue-in-cheek in most everything I say on these forums. Best way to avoid responsibility.


But true. I know someone who works for them, and he says even though it can be a real pain in the ass, overall its pretty good.

[xEnderx]

They do have pretty draconian bureaucracy, but if you know how to navigate things it makes sense. If you are "on the outside looking in" it can seem to be a pretty terrible system though. I think that is where most complaints I've heard originate from.

[xEnderx]

My problem with this (a treatment I had at one point considered) is that this ”treatment” is administered with the logic that a trauma team might aptly use to justify extreme life saving measures in physical injuries. The flaws are that all too often the patients who receive ECT are not in an immediate endangered condition that requires an intervention of “last resort” rather they are despondent persons who are desperate to not feel the way they do at that time. Doctors who advocate this treatment are all too willing to accommodate their patient’s need for relief without considering or advising what of their patient will be lost to the treatment. Patients in severely depressed states may not consider the fact that follow up shocks are required to maintain the short term relief (This also perpetuates the side effects).

I do not disagree with any part of  your post, but I feel the issues you brought up have more to do with the doctors or treatment teams than they do with the efficacy (or lack there of) of the procedure.

[Inculcated]

My problem with this (a treatment I had at one point considered) is that this ”treatment” is administered with the logic that a trauma team might aptly use to justify extreme life saving measures in physical injuries. The flaws are that all too often the patients who receive ECT are not in an immediate endangered condition that requires an intervention of “last resort” rather they are despondent persons who are desperate to not feel the way they do at that time. Doctors who advocate this treatment are all too willing to accommodate their patient’s need for relief without considering or advising what of their patient will be lost to the treatment. Patients in severely depressed states may not consider the fact that follow up shocks are required to maintain the short term relief (This also perpetuates the side effects).

I do not disagree with any part of  your post, but I feel the issues you brought up have more to do with the doctors or treatment teams than they do with the efficacy (or lack there of) of the procedure.

Well, the quoted mid section of my post certainly does focus on the overuse and under inform aspect of the issues I have with ECT.
The rest …

ECT, advising a cure in traumatic brain injury? The suffering of cognitive problems, including significant memory loss and learning impairment seems of little consequence to those who consider that they are applying this as a life saving measure to the severely depressed.

This quick fix is also strikingly similar to the philosophies of programming that are myopically fixated on the short term appearance of change without regard to the damage incurred by the individual

Less radical interventions are available, but as the use of ECT increases these options are being forgone.
I suspect the reasons for this have quite a bit to do with the treat and street pressures being applied to care providers.

 Maybe you could provide some insights into these conflicts, and how they've impacted mental health care.

If it came up in another thread’s discussion, I missed it. What kind of facility do you work in, and in what capacity?

[xEnderx]

In my experience (which is a bit limited), ECT is very much a "last resort" treatment. I've only seen it used in adult patients that have been completely unresponsive (therapeutically) to less extreme measures. As previously mentioned, the vast majority of cases I've dealt with have been Major Depressive Disorder. From what I've seen, the treatments have been reasonably effective in helping to alleviate the most intense symptoms of the patients. The impact on memory and cognition have been entirely limited to a 5-6 hour window after the procedure. Most times the procedures take place between 7 and 8 AM, and then the patients return to our facility and spend the rest of the morning and early afternoon sleeping. By the time evening group starts at 8ish PM, they are back to "normal" in regards to memory and cognition. I've seen a lot more negative side effects from adjusting to psychiatric meds than I have from ECT.


"Treat and Street", or "Bed Flipping" as it is commonly referred to, happens constantly. Its not limited to any particular procedure. It is however, an inevitable result of managed care. I mean when health care is run as a corporation, do you really expect that corporation to use less monetarily efficient means to treat a disease or disorder? Not saying that its good, right, or that I support it, simply pointing out that managed care has changed health care into a system where patients literally are a medical record number. Some docs are less ethical than others, and the same is true for any profession.

Basically I'm just saying (in a long winded way) that in certain patients, ECT has quite a bit of therapeutic value. I also try to educate people that ECT and "Shock Treatment" are most assuredly NOT the same thing.

[Inculcated]

In my experience (which is a bit limited), ECT is very much a "last resort" treatment. I've only seen it used in adult patients that have been completely unresponsive (therapeutically) to less extreme measures. As previously mentioned, the vast majority of cases I've dealt with have been Major Depressive Disorder. From what I've seen, the treatments have been reasonably effective in helping to alleviate the most intense symptoms of the patients. The impact on memory and cognition have been entirely limited to a 5-6 hour window after the procedure. Most times the procedures take place between 7 and 8 AM, and then the patients return to our facility and spend the rest of the morning and early afternoon sleeping. By the time evening group starts at 8ish PM, they are back to "normal" in regards to memory and cognition. I've seen a lot more negative side effects from adjusting to psychiatric meds than I have from ECT.

That’s an astonishing recovery. What assessments do you use to get a baseline and to then evaluate the patient’s experience of the effects and their individual ability to tolerate these?

"Treat and Street", or "Bed Flipping" as it is commonly referred to, happens constantly. Its not limited to any particular procedure. It is however, an inevitable result of managed care. I mean when health care is run as a corporation, do you really expect that corporation to use less monetarily efficient means to treat a disease or disorder?

No, and you have no reason to assume I have such an expectation

Not saying that its good, right, or that I support it, simply pointing out that managed care has changed health care into a system where patients literally are a medical record number. Some docs are less ethical than others, and the same is true for any profession.

Agreed.

Basically I'm just saying (in a long winded way) that in certain patients, ECT has quite a bit of therapeutic value.

Please elaborate on this

I also try to educate people that ECT and "Shock Treatment" are most assuredly NOT the same thing.

Please expand on this last part for me, specifically these differences. (I’m sure that it’s not like Ken Kesey’s representation of the procedure.)

Again:
If it came up in another thread’s discussion, I missed it. What kind of facility do you work in, and in what capacity?

[xEnderx]

That’s an astonishing recovery. What assessments do you use to get a baseline and to then evaluate the patient’s experience of the effects and their individual ability to tolerate these?[/quote]

I'm not saying the symptoms of their primary presenting behavioral health concern are alleviated in that time frame, simply stating that the most pronounced negative aspects of the ECT are gone within 5-6 hours in every case I've seen.

Most of this type of thing is handled by the ECT personnel at a hospital. As for what we do to gauge a client's negative symptoms when they return to our facility, we do 1:1 interviews 3 times per day with each client, more if they approach us with a desire to talk. We document any negative symptom, and compare it each time when they return to ECT. A fairly simple explanation would be that we compare behavior (in regards to orientation) and interaction with staff to their established pattern of interaction. We also gauge it by the amount of time spent sleeping post-ECT.

Basically I'm just saying (in a long winded way) that in certain patients, ECT has quite a bit of therapeutic value.

Please elaborate on this

In clients that I have observed, after between 12 and 15 treatments clients report a decrease in anxiety and depression for a sustained period of time. Affects generally improve as well....IE a client presenting as depressed and tearful generally shows more incidence of smiling, joking, higher levels of self motivation, etc. Again, keep in mind that 100% of clients I've seen are doing ECT in conjunction with psych meds, and receive individual treatment from the ECT team from both a procedural standpoint and an aftercare standpoint.

Please expand on this last part for me, specifically these differences. (I’m sure that it’s not like Ken Kesey’s representation of the procedure.)

Shock Therapy was an "aversion treatment" designed to train the human brain to associate negative stimuli with a behavior or outside stimuli. IE patients were "zapped" when a stimulus was applied, or when they failed to apply a behavior or stimuli in response to something.

ECT is an electrically induced seizure performed while the patient is under clinical anesthesia. First the client is given a short acting drug to "put them under", and once they reach a certian point electrodes are placed on their head, and the seizure is induced. This seizure causes the release of certian neurotransmitters and other chemicals in the brain. The latter is where the therapeutic value of the procedure comes from.

Also, please let me be clear that I am NOT the one performing this procedure. The information I provide is based on what I have gathered from the clients regarding their treatments.

Again:
If it came up in another thread’s discussion, I missed it. What kind of facility do you work in, and in what capacity?

The easiest way to explain it would be "line staff" at a Crisis Residential facility. I am a CAADAC intern (addiction medicine), and currently working on my second year towards a degree in social work. I also have employment pending (DOJ background check, fingerprinting, etc) in a lockdown facility for adults.

[Inculcated]

^Thx, for the informative discussion,xEnderx.

 When I initially researched electroconvulsive therapy as an option, I found a lot of representation for either position. It’s not a debate that will end anytime soon. Much of what was stated regarding the efficacy and benefits is out there, also the very many counter arguments . I found the anecdotal reports of those xEnderx worked with in the residential setting interesting. Of the testimonials to be culled from a net search, few that I had found are glowing reviews. If I can excavate some of the medline articles etc. a friend sent to me on the topic at that time, I’ll post paste.

It’s been interesting reading posts on this topic. I can’t say that they have dissuaded me from my opinion that the increased usage of electroconvulsive therapy does not serve the best interests of most those who will receive it.

The resulting consequences of cognitive problems, including significant memory loss and learning impairment are not insubstantial and not as transitory as the more immediate after effects of ECT present.

 And again, (imo):
This quick fix is also strikingly similar to the philosophies of programming that are myopically fixated on the short term appearance of change without regard for the damage incurred by the individual.

[xEnderx]

Gotcha.

I don't disagree with your standpoint, nor with your hesitation to undergo the treatment. It is pretty intense for a non-surgical outpatient procedure. Its important to understand that ECT and Electroshock Therapy are not the same thing. Thats my primary goal in posting on this thread.

This quick fix is also strikingly similar to the philosophies of programming that are myopically fixated on the short term appearance of change without regard for the damage incurred by the individual.

I'll present the counter point to this comment that alleviation of acute symptoms is sometimes needed before you can address the root causes. If you are actively suicidal then you need to "fix" that before you can look at family of origin concerns. (just as a very generalized example)

I would never say that ECT is a miracle cure, only that in my experience I have seen some clients that appear to derive some therapeutic value from it. Being an informed patient that looks at the research and anecdotal evidence regarding a procedure is a very important and valuable quality.



Interestingly enough we had a long discussion about this very topic during class this morning.



















P.S. I don't support electroshocking toddlers.  :timeout:

[Che Gookin]

So what is Ray, the energizer bunny or some shit?

 :suicide:

[xEnderx]

http://http://www.thepetitionsite.com/1/stop-shocking-ray

Ray is a 55-year-old Minnesota resident who is regularly  receiving "Involuntary Outpatient Maintenance Electroshock."
Involuntary outpatient electroshock (IOE) is part of a trend to bring the power of forced psychiatric procedures out into the community.

Your home is no longer your castle... it can become your ward. For example, most USA states have quietly passed laws allowing individuals living at home to be court ordered to take powerful psychiatric drugs against their will. It was only a matter of time until such outpatient coercion included electroshock.

Electroshock itself has made a comeback throughout the USA, and internationally, without adequate human rights protection.

Ray is receiving so-called "maintenance" ongoing weekly electroshock over his expressed wishes while living at home. Falsely believing "new improved" electroshock is safe, the mental health system is at times administering more than 100 "maintenance" electroshocks to a single individual over months and years.

This could happen to Ray. Even his mother, who is a retired nurse who used to administer involuntary electroshocks back in the 1950's, is concerned by the sheer number of forced shocks he has received.

This could happen to anyone.

This could happen to you or a loved one.

The mental health system today has a lot of "buzz words" like empowerment, self-determination, advocacy, recovery, peer support, transformation, consumer-run, trauma-informed care.

How real are buzz words, when Ray Sandford gets forced outpatient electroshock each week :suicide:
http://http://www.mindfreedom.org/ray

No offense, but those article's are pretty blatantly biased.