Disorders and Treatment
- Mental Illness
- Bipolar Disorder
- Mood Disorders
- Borderline Personality
- Mental Health Diagnosis
- Mental Health Treatments
- Alternative Meds
- Case Studies
Continue from Part Two
In the last years of his life, Ernest Hemingway became increasingly despondent due to chronic pain, alcoholism, health problems, and his failing literary career. By 1960, he underwent a series of ECT sessions to treat his depression and paranoia (of course the FBI had been watching him ever since he left Cuba so there may have been reasons for the paranoia). While the ECT was meant to control his depression, it actually seemed to make things worse. In addition to his other problems, Hemingway began experiencing serious memory loss as well. Talking about his ECT sessions, he said that "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient." Following his first suicide attempt in 1961, Hemingway received further ECT treatments before finally succeeding in killing himself on July 2 that same year. While a clear link between Hemingway's ECT use and his suicide can't be established, his tragic experience has made him a poster child for the anti-ECT movement.
The counterculture movement that took shook psychiatry in the late 1960s and early 1970s was driven by a renewed activism by former psychiatric patients rebelling against the perceived authoritarian culture in psychiatric hospitals. Hemingway, Silvia Plath (who committed suicide in 1963), and other writers writing movingly of their experiences with ECT helped shape the popular perception. Combined with the writings of Thomas Szasz, R.D. Laing, Michel Foucault, and Erving Goffmann, psychiatrists came to be seen as increasingly sinister figures who used ECT and other treatments to modify unwanted behaviours rather than treating disease.
Ken Kesey's 1962 book One Flew Over the Cuckoo's Nest and its 1975 movie version helped shape public awareness of ECT and it was during that same period that a massive revolution in how psychiatric patients were treated got underway. With newer and better medications came a rapid deinstititutionalization of psychiatric patients. Mass closing of psychiatric hospitals and the dumping of patients into communities that were often ill-equipped to handle them made the need for better treatment options all the more acute.
Questions concerning the appr opriateness of ECT use and accusations of involuntary treatment spurred the rise of antipsychiatry groups. Patient's rights organizations also began to challenge psychiatric hospitals in court while neurologists also began questioning the potential role of ECT in causing brain damage in patients. In 1976, John Friedburg published Shock Treatment Is Not Good For Your Brain in which he stated that ECT produced amnesia through selective brain damage.
As former patients such as Mark Vonnegut and Leonard Frank came forward describing their own negative experiences with ECT and the public awareness of its dangers grew, more and more patients came to refuse it altogether. Anti-psychiatry groups such as the Network Against Psychiatric Assault (founded in 1973), the Committee for Truth in Psychiatry (founded in 1984) and the Church of Scientology began to agitate against ECT use (especially on involuntary patients). ECT became increasingly rare, especially since psychiatrists using it found themselves receiving sharp increases in their professional liability insurance premiums as a result.
Since not all cases of depression and bipolar disorder respond to medication, ECT continues to have a role in treatment however. My own graduate mentor, Norman Endler, credited ECT with helping him recover from serious bipolar disorder and even wrote a book on his experiences, Holiday of Darkness. Other former psychiatric patients including Kitty Dukakis, Thomas Eagleson, and Andy Behrman have come forward with their own positive experiences although they tend not to be as well-publicized as the negative accounts.
I won't try to do justice to the hundreds of pro- and anti-ECT research studies that have been carried out over the past four decades. Government and non-government organizations including the National Institute of Mental Health (NIMH) and the American Psychiatric Association have released reports confirming the value of ECT in certain circumstances as well as imposed more stringent guidelines concerning informed consent and training of ECT staff. It was in 1985 when Max Fink, a protege of Lothar Kalinowsky, launched the Journal of ECT which remains the primary publication of its type and helped restore some of ECT's lost credibility.
The political debate over ECT use has become increasingly polarized over time with harsh denunciations on both sides. Even a brief Web search can turn up numerous anti-ECT sites that denounce the treatment and its providers. Attempts at a reasoned debate on ECT use have a tendency to degenerate into anti-psychiatry arguments. And there we stand at present.
Ironically, ECT may well be moving into a new direction altogether. The use of deep brain stimulation procedures to treat depression by implanting electrodes to stimulate the subcalossal cingulate region of the brain has been found to relieve treatment-resistant depression with few of the negative side effects associated with ECT or anti-depressant medication. Whether this new form of electrical stimulation will replace its predecessor, only time will tell.
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