not responded to other treatments. Seizures are induced to treat
behaviour as a last resort. This can still be done without consent as it
has been done since the first person screamed for the doctor not to
shock them again. When it was first tried they didn't even bother with
anaesthetic.
In a recent high quality review of scientific trials, i.e. ones which
use a true placebo comparison, the placebo was shown to be very
effective. So effective that during treatment real ECT was only
marginally better and just as good after treatment.
I wonder if anyone else is sitting here thinking this is fucking nuts?
When modern mental healthcare is inept it uses treatments of last
resort. These are dangerous, inhumane treatments only made possible
because of the privilege of medicine, i.e. it's because they're trying
to do a a good thing that ECT is allowed to be used without due process
or forethought. It's just the choice of a psychiatrist to electrocute
their patient. It's the same profession that might have considered
waterboarding, the torture which is now outlawed in civilised society,
as a suitable treatment two centuries ago.
Whenever the placebo effect is explored there are many factors found
other than what's true placebo. In trials it's different from clinical
practice because during a trial staff treat patients differently,
patients get more time spent on them and more attention. The patients
may also get hope from this extreme treatment being used. Specifically
it's not sham-ECT which is as good as ECT. It's sham-ECT in a research
trial setting which is as good as real ECT in a research trial setting.
So what that means to me is there are many other things which could done
before the psychiatrists should think about electrocuting their patient
to change their behaviour. They're all the things that happen during a
research trial. They should do their job properly, offer support and
contact to patients and lots of others things which make research trials
different from clinical practice.
Then perhaps they might not have to ECT patients. Then when they fail
and it is time to ECT them they should only use sham-ECT because the
evidence shows the risks of real ECT compared to the benefits means they
don't have a fucking leg to stand on just like when they used insulin
induced shock until an early RCT showed it to be ineffective.
The key point which I'm probably making pretty badly is that there are a
bunch of things that can be done instead of resorting to treatments of
last resort which don't work. They're they things which are part of the
placebo effect of sham ECT. They're the sort of things that should be
done for all patients so perhaps they won't end up having to be
electrocuted until their memory and cognitive functions are so fucked
that they don't remember why they're unhappy, or till they die.
Many have died because of ECT. Many f those lives could have been saved
with sham-ECT instead, even with the risks of the nocebo effect. Many
people could be helped to recover using the non-electric parts of ECT
trials taken to be used in clinical practice. For example the changes in
clinician behaviour. Clearly ECT is considered a hope by the Royal
College of Psychiatry. Not a treatment which can't be done by any
physician who's taken the Hippocratic Oath.
"First, do no harm."
It's funny but not in a good way. The motto of the Royal College of
Psychiatry is "Let wisdom guide." What wisdom is there in using at
treatment which kills yet is only as effective as a sham treatment on
measures which are valuable to the patient?
Let wisdom guide? Let them suck on my chocolate salty balls.
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