Thursday, December 11, 2014


I had a really interesting day yesterday.  I went to Richmond to learn about electroconvulsive therapy, or ECT.  Yes, shock treatments.  Now we have ECT in Baltimore, and all residents see patients on the inpatient unit who have ECT, and all residents do ECT.  I wanted to see it again because it's been a long time since I was a resident in an ECT suite, and thought perhaps something might have changed.  Nothing changed, except that now the psychiatry resident spends a lot of time looking at a computer. 

Why did I go to Richmond?  I'm doing research for our book on involuntary treatments, and in Maryland ECT is only used for people on a voluntary basis.  The only way around this for someone who is so sick that they are in danger of dying if their condition doesn't get treated, is to have a guardianship appointed, and this is quite rare and for quite extreme cases.  In Virginia, ECT is treated like any other involuntary treatment, a magistrate comes to the hospital to hear civil commitment cases, have medication review panels (I'm not sure what they call it there, that's the Maryland lingo) and involuntary ECT is considered another treatment.  Obviously, it's reserved for the very sick, who have not responded to other treatments, or where a quick response is imperative.  I heard about one patient who had been catatonic with a feeding tube and unresponsive to any treatments - a man in his early 50's -- the treating facility's plan had been to transfer him to hospice to die, and instead he was transferred for ECT treatments and he recovered.  

The doctors who do ECT regularly see it as a highly effective treatment, often life-saving, when all else has failed.  Clearly, this is the most controversial treatment we have in psychiatry, some might even say it's barbaric.  

I've hesitated to blog about the research I've been doing as I work on the book -- not because there's anything secretive about it, and it's been a fascinating project for me -- but because I'm not sure how are readers will respond.  Obviously, involuntary treatments make for a controversial and heated discussion.

And if you're interested in the latest on what Maryland's Department of Health and Mental Hygiene is planning to recommend to out state legislature on involuntary outpatient commitment, Here is an article in the Baltimore Sun to check out. 


Moody Mommy said...

My ex-husband received voluntary, outpatient ECT treatments when we were married. He actually underwent two full courses and another smaller maintenance course during our marriage. He now says he would never do it again. But at the time, even though the treatments were difficult for him to endure, he admitted they saved his life and did not regret agreeing to ECT.

It was a very stressful process not just for him but for me as well...supporting and caring for him as his abilities declined, making decisions and consenting to treatment when his side effects no longer left him that ability, watching him decline before the treatment started to work and improve things. Obviously the ECT was more difficult for him but it is a stressful process for everyone involved. Yet I do find it frustrating when I encounter people who automatically dismiss it as a barbaric procedure that should not be used at all. It is a difficult and last resort decisions, but life saving for many.

Dinah said...

Moody Mommy,
Thank you so much for the first-person (or ex-wife of first person) account. The doc I spoke with was very vocal about how this is not a pleasant procedure or easy time. Nor is being horribly depressed. I find the involuntary concept very distressing, but when you put in the perspective of leaving someone in a horrible state when nothing else has worked, it's worth at least thinking about.

Anonymous said...

About 12 years ago I was told that I needed ECT and that there was nothing left to try other than ECT. The problem is the physician was wrong. I think this physician was more likely to look to ECT as an option simply because the hospital where he had privileges offered it. I never could get that psychiatrist to discuss the risks, he just ranted on and on about scientologists if I asked about concerns like memory loss. Not helpful.

One of the things that was very important to me when I finally agreed to see the psychiatrist I see now is that a.) he did not do ECT and b.) that he did not have privileges at a hospital that did. Thankfully, none of the hospitals anywhere near where he practices does ECT, and that makes me feel safer.

I would not want ECT under any circumstances, and I've made that clear to my psychiatrist. I support those who agree to it voluntarily as long as it is truly voluntary, and the patients are given real informed consent.


R said...

Dinah, perhaps you should elaborate on the anesthesia that you typically see administered in conjunction with ECT. I suspect that many folks envision some scene from an old move rather than what is typical of a modern ECT treatment.

Anonymous said...

I would really caution against assuming patients get their concerns about ECT from movies. My previous psychiatrist also made the comment that "it's not like One Flew Over a Cuckoo's Nest." I was born in 1973, and I had never seen that movie. So, that kind of assumption can be a little insulting to patients.

My concerns came from what I had read. What I had read was that in my state psychiatrists were required to report side effects, like memory loss, to the state. I had also read that in my state (Texas) there was very specific requirements about the informed consent for ECT, and that it was very long. I knew that psychiatrists who did ECT paid more in malpractice insurance than other psychiatrists. I couldn't help but wonder why the higher malpractice and why the required reporting to the state and why the more stringent requirements about what is to be included in the informed consent if it was such a benign procedure.

I don't have any problem with ECT being offered to patients provided psychiatrists discuss the risks and alternatives, along with discussing the benefits. If they don't discuss the risks, then patients won't trust them. I think my previous psychiatrist's failure to discuss risks made me that much more skeptical about trying ECT.


Borderline said...

@PK: lol at the pdoc accusing you of having been brainwashed by scientologists. That has been my experience as well with some pdocs. I ask questions about possible treatment risks or even just more info about my condition and it somehow deteriorates into the corruption of scientology...even though I'm not a scientologist and I barely know anything about them.

Anonymous said...

I don't support involuntary ECT, because I think it's such a personal decision. Some who have had it are glad they did it, and others are not. I also don't think there's very wide public support for forced ECT as evidenced by the public outcry against it when patients have come forward in the media begging for ECT to be stopped. In the cases I can think of where patients have made it public, there was such a public outcry against it that the ECT was stopped, and the patient was transferred to another psychiatrist. Even the family members in these cases were asking for it to be stopped, and the psychiatrist didn't listen. Not sure why.

I wish the psychiatrist who tried to get me to do ECT had talked to me about the risks. Because he didn't I was left to learn about it on the internet. I learned from the internet that I would have to wear a diaper, because it might cause me to lose control of my bodily functions. Why didn't my doctor tell me that? I learned that there was more of a risk of memory loss with bilateral ECT as opposed to unilateral ECT. Why didn't my psychiatrist discuss that? I still have no idea if the ECT he was recommending was unilateral or bilateral. I don't know much of anything about the procedure, because he wouldn't talk about it.

If you have a psychiatrist who will not discuss risks, then try and find another one. Any time the psychiatrist I have now starts a new medication he immediately says, "Let's talk about side effects." I have never had to even ask him about the risks, he just tells me. If I have mentioned a concern, he has never once brought up scientologists or blamed my feelings on an old movie I haven't seen. I think every patient deserves to have their concerns taken seriously, and they deserve to be told the risks of treatment. That's the respectful thing to do.


Anonymous said...


Sadly your psychiatrist's routine approach in discussing risks of meds is rare with most doctors and not just in psychiatry.

When my PCP prescribed a med which turned out not to necessary since I was not diagnosed correctly, when I expressed concern that it caused insomnia, she gave me that discounting look. I didn't get this side effect off of an obscure site as it was a common one with this type of medication. And since sleep has been a major issue for me due to pap therapy intolerance issues, I had every reason to be concerned about taking that med, especially when there were plenty of other options if that diagnosis had been correct.

However, I am not going to let psychiatry off of the hook as I think the problem is worse due to people with "MI" labels not being taken seriously. So of course, if you express concern about ECT side effects, it is due to being a nut case.

By the way, I know someone who ended up involuntarily committed against her will when she asked her psychiatrist to switch her to another med from the one she was taking. She became admittedly belligerent when he attributed her complaint to her mental illness. I thought this was a rare incident but I have read many anecdotal reports that it isn't.

Anyway, maybe if psychiatry would take a page out your psychiatrist's book and treat patients like human beings who deserve respect, psychiatry wouldn't be hated so much. Instead, most of them take the tactic as that other psychiatrist you described when he blamed concerns about memory loss on Scientology zealots. Not exactly a great way of moving a dialogue forward.

Borderline said...

I think sometimes a good therapist can keep a pdoc in check. I mean to say that if the pdoc starts getting a God complex, the therapist can disagree. I've seen some therapists who seemed afraid to challenge a pdoc, and it has seemed to me that psychiatrists like to use therapists almost like they are a support staff that is solely there to back them up.

I'm happy to say that my therapist has a pair of balls. I think if my pdoc ever went nuts and tried to commit me for disagreeing with her choice of treament, my therapist would step in and call her a loon. He has shown in the past that he has no problems with disagreeing with doctors.