![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Squiggles on December 1, 2005, at 10:47:55
I just finished reading a scholarly
article on depression and ECT from a
Yale person. The article is still not
copyrighted so I am not allowed to
quote from it. In any event, it is
"for" ECT. I would have many comments
to make on some of the assertions but not
here and now.Nor will I say much about it, in case people
here who have had ECT, are offened by my
comments.I will say though, that there was an occasion
I wrote about some time ago (this summer) when
the pharmacy gave me corrupted drugs and
I sank into mixed states. It was a very tough
experience and close to suicide. I pulled myself
up through my own bootstraps and had to
experiment with li dosages after calling my dr.
to ask for the "good" batch from another pharmacy.The point of this is, that under the conditions
of that paper, which I assume is very mainstream, I would have received ECT as emergency
treatment had I gone to the hospital
for help. Instead, I juggled the dose myself
and recovered over a month. But the first days
of the fall into the abyss were "critical",
requiring immediate treatment. I'm sure that
is what they would have given me if presented
at Emergency.Had I gone to the hospital and actually
asked, I would have preferred brain surgery --
which may not be commonly done for depression
or manic-depression, if the only other option
were ECT.
Squiggles
Posted by Racer on December 1, 2005, at 12:24:03
In reply to Last resorts, posted by Squiggles on December 1, 2005, at 10:47:55
I won't say anything about ECT, because I've heard good and bad and never had it.
What I will say, though, is that you wouldn't necessarily have had ECT had you been hospitalized. More likely, you would have had close observation and drugs to help keep you calmer. Many hospitals do not have the facilities to perform ECT, and those that do would still require some form of permission to do it. It's like any other medical procedure: unless you're in a life-threatening condition, they can't just start on their treatments. If you were considered not to be able to make decisions for yourself, they'd have needed permission from your next of kin.
Just putting that in there. I hate to see people so afraid of hospitalization. It's never pleasant, I don't think, but if it's necessary, well, then better voluntary than in-.
Posted by Squiggles on December 1, 2005, at 12:40:04
In reply to Re: Last resorts, posted by Racer on December 1, 2005, at 12:24:03
The hospitals I *could* have gone to
and would, *do* have ECT paraphernalia.
It was a life-threatening situation -- I
was searching for methods and asking my
husband to check the net for the most
effective. It really was that bad --
I was just lucky to get out of it with
the new batch of lithium, on time.Had I gone, if as you say permission would
be necessary - gratefully my husband has
the same opinions on ECT as I do, and
I think would have said no, though
I don't know about others' in my family.Perhaps they would have given me drugs,
perhaps not. In that state it may not
have been up to me; but if I were asked
do you want ECT or cingularotomy[?] - sorry
I am not sure of the frontal surgeries they
do, I would have preferred the latter.Of course pharmacotherapy would be the best
but that may have depended on the doctor's
belief and assessment.Squiggles
Posted by Bob on December 2, 2005, at 0:32:40
In reply to Re: Last resorts, posted by Squiggles on December 1, 2005, at 12:40:04
I had ECT voluntarily as an outpatient earlier this past spring. I wasn't in an ultra-crisis but was headed down hill and felt that I was at an impasse with meds. Unfortunately, I don't think it came out well. I've heard from plenty of sources that ECT helps many people, but I can say with some certainty that I wasn't one of them. There were some interesting positive things that occurred, but as time went on, I began getting some extreme negatives that eventually brought the treatments to a close. One thing ECT did was give me some energy. Ironically, the time after cessation of the treatments was the worst, which no one saw coming, and I have never really gotten back to a truly safe place since. I'm in bad shape, and I don't think I'd ever go back to those treatments. I do think back sometimss and wish I could have retained the few benefits it proferred. I hate medicines, so it's not like I'm overjoyed to be back on them. My ECT doctor told me that some people are transformed to like new from ECT and I believe him. I don't really see why he'd lie.
Posted by Ilene on December 2, 2005, at 0:50:30
In reply to Re: Last resorts, posted by Squiggles on December 1, 2005, at 12:40:04
I also had ECT, BTW.
I do not think a hospital, these days, would perform ECT on a person who did not give permission. For one thing, it is very expensive.
If you are in a hospital voluntarily you can say "no" to anything. When I was in a psych ward last month I told them I didn't want to take a certain med (they tried to give me something wrong). They just said okay and wrote down that I had refused medication.
If you are there involuntarily they can only keep you for a limited period of time. In this state it's 72 hours. After that, if they still think you are still a danger to yourself or others, I believe they have to go before a judge and you probably have a right to a lawyer.
I.
Posted by med_empowered on December 2, 2005, at 1:56:59
In reply to Re: Last resorts, posted by Ilene on December 2, 2005, at 0:50:30
The involuntary-treatment situation varies apparently from state-to-state. I was involuntarily hospitalized, but I still refused meds, and it wasn't a big deal. The nurses would tell patients who were having problems that "if you'd like, you can just refuse it". They were being kind of callous about it--kind of like well, you don't like it (b/c you're whiney and crazy) ? Then dont take it. But still...it was nice to have that option.
I think involuntary ECT happens occasionally, but it isn't common like it used to be. Its expensive, patients hate it, it has a bad reputation, etc. I'm not impressed by ECT; it just doesn't strike me as being nearly as effective or harmless as so many "experts" would have us believe. Also, its important to realize that ECT can be a BIG money maker; a full course can run the insurance company thousands of dollars, with minmal overhead...that means big $$$ for the hospitals and doctors that do ECT. I also read a survey where about 41% of psychiatrists said they thought it was "likely that ECT causes brain damage". That's almost half who will admit it in a *survey*. I'm also disturbed by this move in psychiatry towards more involuntary treatment--out-patient commitment, making it easier to hospitalize people, that sort of thing. Have you read about the new Haldol implants? Apparently, this "advance" in schizophrenia treatment will allow for an implant to release haloperidol over a 1year period. I think this "advance" is one of the scariest things I've ever heard of.
Posted by Squiggles on December 2, 2005, at 7:59:25
In reply to Re: Last resorts, posted by Ilene on December 2, 2005, at 0:50:30
> I also had ECT, BTW.
>
> I do not think a hospital, these days, would perform ECT on a person who did not give permission. For one thing, it is very expensive.Heh, that's cynical :-)
The giving of permission requires a person
to be in a relatively aware if not sane state-
that is what would disturb me.>
> If you are in a hospital voluntarily you can say "no" to anything. When I was in a psych ward last month I told them I didn't want to take a certain med (they tried to give me something wrong). They just said okay and wrote down that I had refused medication.
>
> If you are there involuntarily they can only keep you for a limited period of time. In this state it's 72 hours. After that, if they still think you are still a danger to yourself or others, I believe they have to go before a judge and you probably have a right to a lawyer.
>
> I.That's sounds reasonable to me. I am not sure
of the laws here and now. The state a person
is in when hauled into ER is what would concern
me; it may be the prime minister or it may be
a bum on the street - but either way they would
have to make a decision if he is legally insane
at that moment. If that is interpreted as
"danger to himself or others", then I suppose
they have to do something-- drugs? What kind?
If they work, then ECT becomes redundant.Squiggles
Posted by Squiggles on December 2, 2005, at 8:13:18
In reply to Re: Last resorts, posted by med_empowered on December 2, 2005, at 1:56:59
I've been doing some reading on the subject.
I think most doctors now agree that the
effects, though temporarily or transiently
effective in depression, or manic-depression,
or schizophrenia (interesting that all these
would occur in the same pre-frontal area of
the brain), may not last, or if they do, may
result in some memory loss.I would have thought that the transient aspect
of the treatment would make it *cost-inefficient*,
as the patient would have to be under care
for the effects of that, and still take meds.The implant things are being developed not just
for psychiatric drugs but estrogen replacement
(i think) and other conditions. It's a trend.I do wish they would put some technical imagination into making a portable lithium
meter for people taking lithium. I wrote to a
few med instrument and drug companies, and one told me that it just wasn't economically
feasible enough -- not enough people taking it,
but technically it could be done.Squiggles
Posted by Squiggles on December 2, 2005, at 8:22:47
In reply to Re: Last resorts » Squiggles, posted by Bob on December 2, 2005, at 0:32:40
> I had ECT voluntarily as an outpatient earlier this past spring. I wasn't in an ultra-crisis but was headed down hill and felt that I was at an impasse with meds. Unfortunately, I don't think it came out well.
I'm sorry to read this.
I've heard from plenty of sources that ECT helps many people, but I can say with some certainty that I wasn't one of them. There were some interesting positive things that occurred, but as time went on, I began getting some extreme negatives that eventually brought the treatments to a close.
I think having that option is good, be it with
meds or ECT, but especially with something
like this controversial treatment. In my reading
about the negative effects, I came across some
reports that say eventually, the negative as
well as the postive effects may fade.
One thing ECT did was give me some energy. Ironically, the time after cessation of the treatments was the worst, which no one saw coming, and I have never really gotten back to a truly safe place since. I'm in bad shape, and I don't think I'd ever go back to those treatments.My sympathies. I hope you find a doctor who
can give you the right medications and special
care to recover slowly.
I do think back sometimss and wish I could have retained the few benefits it proferred. I hate medicines, so it's not like I'm overjoyed to be back on them. My ECT doctor told me that some people are transformed to like new from ECT and I believe him. I don't really see why he'd lie.I don't think it's a lie, but in my own
unprofessional imagination, it seems that
it is not a precise treatment -- I'm not
even sure its trajectory in the brain is predictable -- so like any seizure it can leave
you with variable effects. On the other hand,
like any seizure, you can recover in time.Best of luck to you.
Squiggles
Posted by Squiggles on December 2, 2005, at 9:26:44
In reply to Last resorts, posted by Squiggles on December 1, 2005, at 10:47:55
OK - I found the blurb on the Canadian site:
MENTAL HEALTH INTERNET -
"Informed Consent
When the physician has determined that clinical indications justify the administration of ECT, the law requires, and medical ethics demand, that the patient's freedom to accept or refuse the treatment be fully honored. An ongoing consultative process should take place. In this process, the physician must make clear to the patient the nature of the options available and the fact that the patient is entitled to choose among those options.
No uniform "shopping list" can be drawn up regarding the matters that should be discussed by patient and physician to assure a fully informed consent. They should discuss the character of the procedure, its possible risks and benefits (including full acknowledgement of posttreatment confusion, memory dysfunction, and other attendant uncertainties), and the alternative treatment options (including the option of no treatment at all). Special individual needs may also be relevant to some patients, for example, a personal situation that requires rapid remission to facilitate return to work and to reduce family disruption. In all matters, the patient should not be inundated with technical detail; the technical issues should be translated into terms meaningful and accessible to the patient.
It is not easy to achieve this ideal of "informed consent" in any aspect of medical practice; and there are special difficulties that arise regarding the administration of ECT. In particular, the patients for whom this procedure is medically appropriate may be suffering from a severe psychiatric illness that, although not impairing their legal competency to consent, may nonetheless cloud judgment in fully weighing all of the available options. Such judgmental distortion does not justify disregarding the patient's choices; rather it makes it all the more important that the physician strive to identify and clarify the options that the patient alone is entitled to exercise.
The consent given by the patient at the outset of treatment should not be the final exchange on this issue but should be reexamined with the patient repeatedly throughout the course of the treatment. These periodic reviews should be initiated by the physician and not depend on patient initiative to "rescind" consent.
There are several reasons for this repeated consenting procedure: because of the relatively rapid therapeutic effect of the procedure itself, the patient after initial treatments is likely to have enhanced judgmental capacities; the risks of adverse effects increase with repeated treatments, so that the question of continued treatment presents a possibly changed risk/benefit assessment for the patient; and because of the short-term memory deficits that accompany each administration of ECT, the patient's recollection of the prior consenting transaction might itself be impaired, so that repeated consultations reiterating the patient's treatment options are important to protect the patient's sense of autonomy throughout the treatment process. Moreover, if the patient agrees, the family should be involved in each step of this consultative process.
N.B.*********************[This statement seems legally vague to me
but I think it says, they will go ahead in
cases of incapacity for consent in Canada]:In a small minority of cases, a patient will lack adequate legal capacity to consent to the proposed procedure. In such cases, timely court proceedings are necessary if treatment is to be provided. Legislation in a few states dictates that ECT may in no circumstance be provided to an involuntarily committed patient. The panel believes that such absolute bans are unduly restrictive and make treatment impossible for patients who might obtain more benefit, at acceptable levels of risk, from ECT than from alternative treatments.
***************************
It may be desirable for physicians with patients for whom the prospect of ECT is a foreseeable but not immediate possibility to discuss this in advance with the patient when his or her judgment appears least compromised by the underlying disease process. Such advance discussion would serve as a nonbinding guide both to the patient and physician and would be another means to enhance the patient's autonomous choice in weighing the risks and benefits of this procedure and its alternatives."
/Squiggles
Posted by med_empowered on December 2, 2005, at 11:34:28
In reply to Re: Last resorts » Bob, posted by Squiggles on December 2, 2005, at 8:22:47
Hi! the implants bother me b/c of power and consent issues. Psychiatry has a history of screwing over the mentally ill in the name of "treatment," and things are looking kind of scary right now (Mental Health Screening Project, easier commitment statutes, etc.). I kind of feel like we could be entering a secong age of Mental Hygiene. (shudder)
ECT doesn't strike me as treatment so much as mild brain damage/head injury that sometimes proves helpful. If you'll notice, depression, bipolar, and schizophrenia were also often treated by lobotomy with "success," according to some docs. Just like lobtomy, ECT functions to impair or disable certain bran functions, which could I suppose have a "therapeutic" effect, at least in the eyes of the shrink observing the patient (I imagine many ECT survivors would have a different outlook on the subject). The canadian ect position paper you posted was interesting...it seemed like they were trying to speak the language of patient-empowerment, while keeping everything vague enough so they could still push ect as deemed appropriate.
I can't imagine how I'd handle a doc talking to me about ECT. I've read that some shrinks avoid discussing it, since it can "break the therapeutic alliance". This is true, with me at least. I'm kind of concerned that shrinks can offer brain damage as treatment, and call it "highly effective" and "aggressive treatment" of psychiatric disorders. Its disconcerting, to say the least.
Posted by Squiggles on December 2, 2005, at 11:54:31
In reply to Implants, ECT, posted by med_empowered on December 2, 2005, at 11:34:28
> Hi! the implants bother me b/c of power and consent issues.
Can't they be removed at will?
Psychiatry has a history of screwing over the mentally ill in the name of "treatment," and things are looking kind of scary right now (Mental Health Screening Project, easier commitment statutes, etc.).
Being in the States, I think you are referring
to the Bush initiative to check people for
mental health? I am not pro-Bush but I don't
see anything wrong with public health checks
on a *voluntary* basis.
I kind of feel like we could be entering a secong age of Mental Hygiene. (shudder)Yeah, I think I know what you mean. I was just
reading the BBC news on Chinese "Work makes you
Virtuous" programs in their prisons.
>
> ECT doesn't strike me as treatment so much as mild brain damage/head injury that sometimes proves helpful. If you'll notice, depression, bipolar, and schizophrenia were also often treated by lobotomy with "success," according to some docs.Strange thing but lobotomy does not scare me
as much as ECT. I may have an erronous assumption
that with brain surgery they more or less know
where the emotive malfunction orginates. Brain
tumours are successfully removed most of the time.Just like lobtomy, ECT functions to impair or disable certain bran functions, which could I suppose have a "therapeutic" effect, at least in the eyes of the shrink observing the patient (I imagine many ECT survivors would have a different outlook on the subject).
There is such a thing as an abnormal brain --
due to any number of conditions, e.g. car accidents, epilepsy, hypoxia at birth, lesions,
etc. The trick is recognizing the source of
the abnormality, and correcting it.
The canadian ect position paper you posted was interesting...it seemed like they were trying to speak the language of patient-empowerment, while keeping everything vague enough so they could still push ect as deemed appropriate.I got the same impression. But I have not
looked at the Canadian Psychiatric Association
policy -- i may do that later today.Tx.
>
> I can't imagine how I'd handle a doc talking to me about ECT. I've read that some shrinks avoid discussing it, since it can "break the therapeutic alliance". This is true, with me at least. I'm kind of concerned that shrinks can offer brain damage as treatment, and call it "highly effective" and "aggressive treatment" of psychiatric disorders. Its disconcerting, to say the least.It's such a hot topic that I doubt a doctor
would bring it up - though the patient might.
It's not the kind of treatment that is
considered in the office but in crisis situations,
and that is why I was looking for the consent
thing - the alternatives. BTW, I was wondering
if anaesthesia has not been tried in these
crisis situations -- if anyone comes out of that
better. At least it would give drs. time to
figure out a better drug and the history of
the patient.Squiggles
Posted by med_empowered on December 2, 2005, at 13:50:18
In reply to Re: Implants, ECT, posted by Squiggles on December 2, 2005, at 11:54:31
as I understand the implants, it takes a minor procedure to implant them, and another minor procedure to remove them. So..they *are* reversible, more so than depot neuroleptics. But...given the costs involved with removal and the hurdles to getting off antipsychotic treatment in general, my guess would be that, in practice, a schizophrenic patient would have a difficult time getting the implants removed. I'm also concerned b/c developments like this don't really benefit patients (I have yet to meet someone begging to be given a long-acting haloperidol implant.) Really they seem to serve to increase the psychiatrist's power in the doctor-patient relationship.
As for lobotomy...it was pretty rough stuff. The idea of a "dysfunctional brain" is enchanting, but has yet to be proven satisfactorily. As it stands now, psychiatric illness is "understood" to be biological, but there still aren't any scans or other tests that can DX an illness based on any sort of physical abnormality. So..basically, the idea that mental illness is physical in origin is pretty much the statement of *consensus* within the psychiatric community rather than the result of any sort of ground-breaking research or anything of that nature. Conveniently enough, the emphsis on physical origins of mental illness became more pronounced in the 1970s, which was about the time the APA and Big Pharma began a "partnership" that continues to this day.
Additionally, its worth noting that although lobotomy did help *some* patients, on the whole it wasn't that great (one study showed no major difference from placebo). The **big** advantage, one which many psychosurgeons openly pursued in performing lobotomy, was making patients more manageable--they could be cared for at home with minimal fuss, or kept in the insitutions with less supervision and care (which helped keep down costs).
The idea of giving patients anaesthesia during a crisis intrigues me. Its interesting how in the past opiates and heavy sedatives were pretty standard treatment for crises, such as "manic depressive psychosis". After years of looking on such treatment with disdain, given today's "sophisticated" treatments, docs are re-visiting a modified version of old-school treatments (ex: Temgesic for depression, other opiates as adjunctive therapy in severe, refractory schizophrenia). Its also interesting that antipsychotics are often used as part of anaethesia cocktails--like DPT, the demerol, promethazine, Thorazine combo used for pediatric anaesthesia.
Posted by Squiggles on December 2, 2005, at 19:55:33
In reply to Re: Last resorts - the Canadian policy on ECT, posted by Squiggles on December 2, 2005, at 9:26:44
I found it.
http://www.psycom.net/depression.central.ect.html
It is very positive with regard to this treatment.
Although, I have seen another paper co-authored
by Cohen and Healy (in Quebec) recommending
vegas nerve stimulation as a substitute.The part on Consent gives me the impression that
the road is clear for possible harm in
certain situations. For example, homeless
men or distraught relatives who go along
with an encouraging doctor. In the case
of a patient's incapacity, the relatives
can be consulted. The green light is in
accordance to the guidelines as specified
by the legal codes of the area (and I am
not sure what that means).Squiggles
Posted by Squiggles on December 2, 2005, at 20:11:34
In reply to Re: Implants, ECT, posted by med_empowered on December 2, 2005, at 13:50:18
...
So..they *are* reversible, more so than depot neuroleptics. But...given the costs involved with removal and the hurdles to getting off antipsychotic treatment in general, my guess would be that, in practice, a schizophrenic patient would have a difficult time getting the implants removed.Do you have to pay extra to have the implant
removed? I don't see the problem. Where
are they implanted?
I'm also concerned b/c developments like this don't really benefit patients (I have yet to meet someone begging to be given a long-acting haloperidol implant.) Really they seem to serve to increase the psychiatrist's power in the doctor-patient relationship.Well, I am not sure about the psychiatric
condition of the doctor. I am giving him
the benefit of the doubt that he does not
have a Napoleonic complex.
>
> As for lobotomy...it was pretty rough stuff. The idea of a "dysfunctional brain" is enchanting, but has yet to be proven satisfactorily. As it stands now, psychiatric illness is "understood" to be biological, but there still aren't any scans or other tests that can DX an illness based on any sort of physical abnormality.Scans can detect stroke remnants, meningal
infections, tumours, lesions, overactivity
in certain areas of the brain, etc. etc.
Actually, this is not something new. But
the attempt to treat the conditions is.So..basically, the idea that mental illness is physical in origin is pretty much the statement of *consensus* within the psychiatric community rather than the result of any sort of ground-breaking research or anything of that nature. Conveniently enough, the emphsis on physical origins of mental illness became more pronounced in the 1970s, which was about the time the APA and Big Pharma began a "partnership" that continues to this day.
If mental illness is not physical, then
I don't have a brain.
>
> Additionally, its worth noting that although lobotomy did help *some* patients, on the whole it wasn't that great (one study showed no major difference from placebo). The **big** advantage, one which many psychosurgeons openly pursued in performing lobotomy, was making patients more manageable--they could be cared for at home with minimal fuss, or kept in the insitutions with less supervision and care (which helped keep down costs).As I said, I think it is more precise,
given a better understanding of the correlation
between brain function and brain physiology.
>
> The idea of giving patients anaesthesia during a crisis intrigues me. Its interesting how in the past opiates and heavy sedatives were pretty standard treatment for crises, such as "manic depressive psychosis". After years of looking on such treatment with disdain, given today's "sophisticated" treatments, docs are re-visiting a modified version of old-school treatments (ex: Temgesic for depression, other opiates as adjunctive therapy in severe, refractory schizophrenia). Its also interesting that antipsychotics are often used as part of anaethesia cocktails--like DPT, the demerol, promethazine, Thorazine combo used for pediatric anaesthesia.
>
What is Temgesic? I did not know about all
this stuff. At any rate, these physical
interventions must be applied to the brain
right, Q.E.D.Squiggles
Posted by med_empowered on December 2, 2005, at 22:11:32
In reply to Re: Implants, ECT, posted by Squiggles on December 2, 2005, at 20:11:34
Undoubtedly, what one feels and thinks emanates from the brain. The question is..when what one feels or thinks or how one behaves is undesirable or deviant, is it in fact an "illness" in the truest sense? And..if there are physical differences in the brain, is it because the brain suddently went crazy, or is it a result of of something else? Its like that study where they found that meditation changes the brain, and playing the violin changes the brain...it isn't as simple as "crazy comes from the brain"...theres a whole lot more involved here. And since bipolar/depression/etc. aren't fatal in and of themselves--no one ever died of advanced dysthmia, for instance--I kind of think the mentall illness thing is more analogy than well-researched, data-backed fact. As for involuntary treatment..that is just plain disturbing.
Its like the "medicalization of deviance" Foucault and others (Goffman, Szasz) talked about.
Posted by Squiggles on December 3, 2005, at 7:15:46
In reply to Re: Implants, ECT, posted by med_empowered on December 2, 2005, at 22:11:32
Why is it that anti-psychiatrists
never have a beef with the subject
of epilepsy? I have never heard them
say, "you can always seize to the music".If you read some of the descriptions
of patients in "advanced" states of
depression, you might sympathize with
the suffering mental illness entails,
and if you can't imagine that, you can
observe some of the serial killings
and other acts of madness in the crime
files on the net.Squiggles
Posted by med_empowered on December 3, 2005, at 18:10:45
In reply to Re: Implants, ECT, posted by Squiggles on December 3, 2005, at 7:15:46
"anti-psychiatry" is a pretty broad term, and its one that seems to be used in a derogatory sense. So...let me make a couple point here.
1) epilepsy can be detected through physical means, and its symptoms are primarily phsyical, not behavioral/emotional (although these sometimes occur with the disorder).
2) serial killers aren't always "insane". They tend, actually, to be a little *too* sane--high IQs, extreme strategic thinking abilities, etc. Mentall illness can contribute to violence, but it appears that even in schizophrenia its more common for the patient to be a *victim* rather than a *perpetrator* of violence/crime. The crime rate for those with mental illness tends to be a bit lower than that of the general populace, except in cases where substance abuse is a big problem.
3) I'm not anti-psychiatry per se; I'm just not comfortable with the way things are currently done. A lot of it strikes me as unhelpful and downright immoral. In my idea world, there'd be more fact-sharing in psychiatry, the patient would have greater ability to start/stop/change treatment and choose drugs/therapies that appealed to them. Also, in my ideal world involuntary hospitalization would be abolished....
...although I can see some of the benefits of involuntary hospitalization, I think it violates the principles of due process. Generally speaking, someone has to be proven guilty of a crime (or plead guilty) before they can be deprived of liberty. You can't imprison someone b/c you think they *might* commit a crime (conspiracy charges are as close as you can get to this, and getting a conviction requires a lot more than showing someon e *might* do something illegal). Why, then, should someone be detained b/c they *might* hurt themselves/others?
Now...as for this long-suffering, severely depressed patient you mentioned. Of course I feel sorry for him/her. That sucks. What I *want* is for the patient to have access to any and all treatments that might help. If the patient wants Dexedrine and electroshock, then go for it. But what I don't want it: involuntary treatment or misinformation or coaxing/cajoling the patient into certain treatments.
So, there you go. And I think you'll find most "antipsychiatry" people are pretty much the same way. The problem lies in treatment that is dehumanizing, degrading, forced, or over-hyped and ineffective. Yes, if you read Foucault and what not there are some qualms about the idea of psychiatry itself, but thats something that is up to the individual to resolve as he/she sees fit.
Posted by Squiggles on December 3, 2005, at 18:30:32
In reply to Re: Implants, ECT, posted by med_empowered on December 3, 2005, at 18:10:45
> "anti-psychiatry" is a pretty broad term, and its one that seems to be used in a derogatory sense. So...let me make a couple point here.
>
> 1) epilepsy can be detected through physical means, and its symptoms are primarily phsyical, not behavioral/emotional (although these sometimes occur with the disorder).I don't know about that. My point was that
it is neurological just as psychiatric
disorders are.
>
> 2) serial killers aren't always "insane". They tend, actually, to be a little *too* sane--high IQs, extreme strategic thinking abilities, etc. Mentall illness can contribute to violence, but it appears that even in schizophrenia its more common for the patient to be a *victim* rather than a *perpetrator* of violence/crime. The crime rate for those with mental illness tends to be a bit lower than that of the general populace, except in cases where substance abuse is a big problem.The relation between psychopathology and
crime is strong, be it through biology or
related screw-ups; seehttp://64.202.182.52/crimetimes/96c/w96cp2.htm
>
> 3) I'm not anti-psychiatry per se; I'm just not comfortable with the way things are currently done. A lot of it strikes me as unhelpful and downright immoral. In my idea world, there'd be more fact-sharing in psychiatry, the patient would have greater ability to start/stop/change treatment and choose drugs/therapies that appealed to them. Also, in my ideal world involuntary hospitalization would be abolished....Frankly, I do not really know how things are now.
I do not know what psychiatric hospitals are
like now, nor do I know what a psychiatrist is
like (with the exception of a silly man I saw
for 5 minutes and seemed more interested in
modelling than psychiatry -- it was a private
office); I only have experience with a doctor
and a consulting clinical psychiatrist at a time
in medicine before the "Golden Era" in Canadian
health care ended - just. I am so ******* lucky.:-)
>
> ...although I can see some of the benefits of involuntary hospitalization, I think it violates the principles of due process. Generally speaking, someone has to be proven guilty of a crime (or plead guilty) before they can be deprived of liberty. You can't imprison someone b/c you think they *might* commit a crime (conspiracy charges are as close as you can get to this, and getting a conviction requires a lot more than showing someon e *might* do something illegal). Why, then, should someone be detained b/c they *might* hurt themselves/others?
>Tricky question -- in some cases I think
that temporary suspension of liberties might
be a good idea -- e.g. sex crimes, domestic
violence, child killings, cult crimes. I am
not sure of the law and how extensive the
liberties are.> Now...as for this long-suffering, severely depressed patient you mentioned. Of course I feel sorry for him/her. That sucks. What I *want* is for the patient to have access to any and all treatments that might help. If the patient wants Dexedrine and electroshock, then go for it. But what I don't want it: involuntary treatment or misinformation or coaxing/cajoling the patient into certain treatments.
I think I would go along with that. Depression
unlike manic-depression and schizophrenia is
more associated with self-harm rather than a danger to others. A balanced and sympathetic
perspective is always necessary.> So, there you go. And I think you'll find most "antipsychiatry" people are pretty much the same way. The problem lies in treatment that is dehumanizing, degrading, forced, or over-hyped and ineffective. Yes, if you read Foucault and what not there are some qualms about the idea of psychiatry itself, but thats something that is up to the individual to resolve as he/she sees fit.
I agree that kind and effective treatment is
the best. I do not consider myself to belong
to the anti-psychiatry camp precisely because
of writers such as Foucault and Szatz and Laing--
that school proposes a division between mind
and body. My view is that the brain is the
primary source and cause of all things mental,
and that is where mental illness originates --
at least serious mental illness, not neurosis.
Squiggles
Posted by med_empowered on December 4, 2005, at 5:17:00
In reply to Re: Implants, ECT, posted by Squiggles on December 3, 2005, at 18:30:32
hi! OK, this is probably the only point we really, strongly disagree on. Sociologists have long disavowed a strong link between "crime" and "mental illness". First of all, you have to define crime. Crime is usually defined by the ruling class, in a method which protects their own interests. So...robbing a convenience store is armed robbery (in my state in the US, thats 7 years minimum in prison), even though the take is small and the company has adequate insurance to cover losses. Now, a corporation that say, produces asbestos or cigarettes or...Vioxx is usually only subject to *civil*, not *criminal* penalties, even when and if individuals in the chain of command repsonsible for the mis-deeds can be identified. Also notice that white-collar crime tends to be identified less often, prosecuted less vigorously, and results in fewer and shorter prison terms. Thus, the "crime" of the underclass is generally seen as more severe than the "crime" of the upper-classes.
Perhaps most importantly, its worth noting that psychiatric treatment doesn't reduce crime. Neuroleptics, which were designed to tranquilize and calm people, can actually induce both suicidality and interpersonal violence. Antidepressants can as well. Even lobotomies, which were the ultimate "treatment" to create docility, can actually create problems by destroying a sense of proper social behavior and self-restraint.
Again...back to the sociologists. Crime tends to be *functional*, not *dysfunctional*--Durkheim said "even in a society of saints, there would still be sinners". Crime helps define and re-define what is good/bad, acceptable/unacceptable within a certain society. Even schizophrenia isn't associated with a high crime rate; even E. Fuller Torrey points that out in his biopsychiatric orthodox tome, "Surviving Schizophrenia". Just about any mental health handout always informs the readers: crazy does not always equal dangerous.
As for the anti-psychiatry intellectuals..they're pretty interesting. Foucault did a lot of social theory work, much of which is utterly fascinating and (I think) insightful. Szasz has his own libertarian agenda to push which I disagree with, but he does hit on some important points, especially in "The Myth Of Mental Illness" The later stuff is more of a mixed bag.
Laing, interestingly, was never really anti-psychiatry. He RX'd medications and had patients who were both medicated and unmedicated. HIs whole contribution was viewing mental illness as at least partly a coping mechanism (an act of sanity and defiance in an uncaring, essentially insane world). Plus, he analyzed psychosis for content, trying to glean information that could prove helpfulto the patient and to society at large. His work is striking because it is so *inquisitive* and *value-free*; he never really passed judgement on the nature of mental illness or anything else...he was just really curious. Foucault also didn't really care to break down the origins of deviant behavior; his main concern was how the behavior was dealt with in a society, which is where the "medicalization of deviance" model came from.
Now, for the involuntary treament issue...I dont know how the law is in canda, but here in the US..."preventitive detention" for *crimes* is flat out illegal/uncontitutional. If a guy looks shifty-eyes and you think he might climb up on a water tower and open fire, the police can certainly watch him, but they can't arrest/detain him b/c of what he *might* do. Why should one apply a different standard to the mentally ill? Plus, its worth noting that when harm is done in mental illness, it is usually to the self...although you seem to imply that schizophrenics and bipolars are more likely than unipolar depressives to hurt others, the indication is really that suicide is *huge* within schizophrenia (15%) and bipolar (20%), while the interpersonal violent crime rate isn't much different than that found in similarly matched controls (if you control for sex, race, age, socio-economic status, etc.).
Posted by Dr. Bob on December 4, 2005, at 15:51:20
In reply to Crime, mental illness, anti-psychiatry..., posted by med_empowered on December 4, 2005, at 5:17:00
> Sociologists have long disavowed a strong link between "crime" and "mental illness"...
Sorry to interrupt, but I'd like to redirect follow-ups regarding crime and mental illness to Psycho-Babble Politics. Here's a link:
http://www.dr-bob.org/babble/poli/20051121/msgs/585420.html
Thanks,
Bob
This is the end of the thread.
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