![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by utopizen on October 22, 2008, at 19:17:52
The quotes from this article by clinicians are the most poetic I have yet to ever read. Enjoy. =)
---------------------------
Note: article posted here because it discusses meds, ECT. Of interest to anyone interested in pathology of disorder as well.--------------------------
TIME Magazine Monday, Aug. 07, 1972
http://www.time.com/time/magazine/article/0,9171,879142,00.html
DEPRESSION is such a commonly used term and such a frequently experienced mood that there probably would have been no great national concern if it had been learned that Thomas Eagleton had merely sought medical help to shake such a state of mind. But the revelation that his condition had been considered by some doctors clinically serious enough to require electric-shock treatments twice sounded alarming. To many people, that smacks of a radical, frightening assault on the brain that would only be used in desperate circumstances. In fact, both the illness and the remedy are surprisingly commonplace. A panel of experts convened by the American Psychiatric Association to help handle press queries after Eagleton's medical history was revealed calls depression "the most common form of mental disorder." Every year doctors treat some 4,000,000 to 8,000,000 Americans for it; about 250,000 of the cases require hospitalization. No one knows how many undergo shock therapy, which, like the illness, remains in some ways mysterious. Explains Dr. Lothar Kalinowsky, a New York City psychiatrist who was one of the pioneers of electroconvulsive therapy in the U.S.: "We must admit that we are very successfully treating conditions of an unknown cause with treatments of an equally unknown mode of action."There is no clear-cut medical definition of depression (which used to be known as melancholia). No consensus exists on whether it is merely an aggravated degree of the sadness or "blues" that everyone feels at times, whether it stems from some deeply rooted inner psychological condition, or whether it has a biochemical origin in the body. Pragmatically, it tends to be defined by its symptoms: feelings of worthlessness, guilt and anxiety; an inability to find pleasure in normal activities; early-morning sleeplessness; fatigue and change of weight; and occasionally, serious consideration of suicide. When a person's feelings do not seem to be justified by his actual circumstances, and when they interfere with his functioning, he is considered ill.
Shock treatment is not a new technique in treating depression. Modern electroconvulsive therapy was developed by Italian psychiatrists in the late 1930s. They acted on others' observations that patients who developed spontaneous convulsions, as in high fevers, seemed to become less melancholic. Shock therapy in effect artificially throws the body into a brief convulsion.
As practiced today, shock treatments are administered through electrodes attached to the patient's temples. A device the size of a file-card box is used to send an alternating current of about 400 milliamperes through the brain at roughly 100 volts for seven seconds (electric chairs employ a seven-ampere current at 50,000 volts). The resulting convulsion lasts less than a minute. The patient is protected by both muscle-relaxant drugs and anesthesia against one of shock treatment's early hazards: the possibility of arm or leg fractures. The patient experiences loss of recent memory when he regains consciousness, but memory returns quickly to all but elderly patients.
No one knows why the treatment helps, but it usually does. Boston Psychiatrist Robert Arnot theorizes that "when an intense, hard-driving person overdrives himself, the nervous system just won't turn off; shock turns off the mind and stops the patient from thinking about whatever it is that he is preoccupied with." Other experts suggest that the shock somehow shakes up the brain so that "things fall back into their normal places." It is largely because of the lack of scientific understanding about its workings that many psychiatrists distrust the treatment.
There has been a general decline in the use of shock therapy since the 1950s, when various antidepressant drugs such as Marplan and Thorazine came into wide use. Although their effect generally takes place more slowly, they do not present the doctor with the problem of first having to combat his patient's fear of the treatment, as in the case of shock. In treating depression, psychotherapy is always used by psychiatrists, sometimes in combination with shock or drugs. Prevailing medical sentiment seems to have shifted to the idea that shock therapy ought to be only an emergency measure or one of last resort, on the theory that psychotherapy alone can get at the underlying causes of the depression, however elusive they may be. This was not as much the case in 1960, however, when Eagleton first underwent treatment, and it has still not persuaded many doctors and hospitals.
Fast. In medical circles, both St. Louis' Barnes Hospital and Minnesota's Mayo Clinic have a reputation for liberal use of shock therapy; thus the fact that Eagleton was treated by shock at those institutions does not necessarily indicate that his depression was severe. Shock is often preferred by politicians and others in the public eye because it is faster than psychiatric counseling (also cheaper: about $55 a treatment). The American Psychiatric Association claims that electroconvulsive therapy is effective in at least 90% of the depression cases in which it is carefully used, "sometimes in a matter of days and virtually always within a month."
While no psychiatrist can comment intelligently on Eagleton's case without knowing him and without the full disclosure of his records, some say he might well fit a fairly common depression syndrome: the ambitious, energetic and successful person who at moments of achievement envisions even higher goals that seem depressingly out of reach. It is, oddly, an illness of the ablest. Says Washington Psychiatrist Zigmond Lebensohn of Eagleton: "The very fact that he reached out for help is healthy." While recurrence of depression cannot be ruled out, the fact that Eagleton has gone six years without treatment and has performed effectively in office makes it less likely. Lebensohn says he treated high political figures as long as 20 years ago without noting any later ineffectiveness among them. Some psychiatrists even say that Eagleton may be less likely to break under pressure than those who have never undergone such therapy. A period of depression, the A.P.A. panel insists, does not permanently impair a person's judgment.
Posted by Phillipa on October 22, 2008, at 23:28:04
In reply to TIME: Depression: 'the disorder of the ablest', posted by utopizen on October 22, 2008, at 19:17:52
Thanks for the complete article. Love Phillipa
Posted by Trotter on October 23, 2008, at 5:42:32
In reply to TIME: Depression: 'the disorder of the ablest', posted by utopizen on October 22, 2008, at 19:17:52
I have long considered the need for constant success and achievement as one of the causes of depression. The chronic stress caused by striving to achieve. The constant tension created when comparing where one is now with where one desires to be. It's energizing, but stressful.
The opposite of the need to achieve is contentment, the acceptance of oneself and one's world as okay just the way it is. Not a popular concept in the West these days. We are taught to value success and power above all.
Not that there is anything wrong with a little desire, purpose or ambition, if it is balanced with an equal mix of love and acceptance.
Posted by utopizen on October 23, 2008, at 21:50:50
In reply to Re: TIME: Depression: 'the disorder of the ablest' » utopizen, posted by Trotter on October 23, 2008, at 5:42:32
http://www.baeblemusic.com/MusicVideos/PeterVonPoehel/TheStoryoftheImpossible
enjoy. =)
Posted by Questionmark on October 30, 2008, at 15:42:59
In reply to TIME: Depression: 'the disorder of the ablest', posted by utopizen on October 22, 2008, at 19:17:52
"... since the 1950s, when various antidepressant drugs such as Marplan and Thorazine came into wide use."
Thorazine is not an antidepressant it is an antipsychotic. I'm a little annoyed he got that wrong. This is one of the reasons i get so irritated with pop psychology and pop psychiatry. So many inaccuracies and oversimplifications.
The article as a whole may have been good though, i can't really tell. I just don't have much interest in ECT.
Posted by stargazer2 on October 31, 2008, at 22:09:32
In reply to Re: TIME: Depression: 'the disorder of the ablest', posted by Questionmark on October 30, 2008, at 15:42:59
I don't know where the author got that figure for the cost of ECT but where I worked, a few years ago, it cost around $1500/per treatment. You have to include anesthesia, medication, 2 MD's (shrink, anesthesiologist)2 RN's, and other misc. costs.
Why do you think the shrink was always looking for more patients to treat. The most common question I was asked is how much does he get paid to "push the button". Amazing. No one ever asked aboout the effectiveness of the treatment.
He definately tried to drum up business, seeking out patients who would stop their treatments and trying to convince them to come back. Those without insurance were obviously not sought out. I never felt that doing ECT on the elderly was humane either.
If it worked well that might be different. But to do this to a 85 year old in a nursing home who refuses to eat is cruel and unusual punishment.
The way many elderly die is when they stop eating. That can be a very normal physiological event and forcing someone to eat is not normal.
It is just the inability of many to allow someone to die with dignity.
I have to make sure that my living will is clear and will not allow something like that to be done to me.I bet they don't do that in Europe or where medical care is valued and not used indiscriminately.
On a side note...Perhaps $55 is just the cost of the juice or wattage.
SG2
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.