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Friday, 11 May 2012

Dr David Healy defends Electroconvulsive Therapy ....where is his evidence FIDDAMAN ?

Shocking the Homeland

May 10, 2012 1 Comment

The thriller Homeland reached its denouement in the UK at the weekend – in an Electroconvulsive Therapy (ECT) scene. Claire Danes, a Homeland security agent supposedly taking Clozapine to contain her paranoia has to distinguish reality from psychosis to save the United States (see Homeland Security). Quite obviously to anyone who knows anything about Clozapine, she was not taking it. She is having ECT, which you are expected to think will wipe her memory, when she solves the plot. Quite obviously to anyone who knows anything about ECT, this is not a reliable way to wipe her memory – giving a benzodiazepine at the key moments would have been much more reliable.

A true story?

Homeland adds to a growing list of psychiatric treatments featured as characters in plots. While inaccurate it does not portray ECT as horrifically as Clint Eastwood’s The Changeling, which starts with a clip saying it is a true story – not just based on a true story. The Changeling portrays the horrors of psychiatry as they have been since One Flew over the Cuckoo’s Nest – through involuntary ECT – even though the heroine’s incarceration happened 10 years before ECT was invented.

The only explanation for getting the history so wrong in a “true” story is that ECT inflicted in this way clearly epitomizes fears about psychiatry. But forced treatment with ECT is vanishingly rare. In practice insiders, staff and patients, are more likely to fear forcible and indefinite medication with long-acting antipsychotic injections – a treatment that is more clearly brain damaging, memory disturbing and likely to turn a person into a zombie than ECT.

Pharmacological Abuse

In terms of the greatest amount of damage done to the greatest number of people, the real abuses, the real dramas, lie in primary care treatment with prescription only drugs like the antidepressants, statins, asthma inhalers and other drugs. Where ECT given punitively, as has happened in the past, might be compared to rape, something closer to sexual abuse or sexual harassment happens with prescription drugs (see Pharmacological Abuse).

The psychiatric detention or treatment papers aren’t in evidence when we are prescribed a prescription drug. We are free to walk out the door after a consultation, and we think as a consequence that there is nothing to worry about.

But prescription links us inescapably to a prescriber. For most of us, going to the doctor is like going to the bank manager or the head teacher – we feel a few inches tall, absurdly grateful for the smallest signs of favor, and often completely forget what we had meant to say. If things begin to go wrong after treatment starts, the doctor may quickly seem like our only way out. We become ever more dependent on him, and grateful.

Stockholm syndrome

We head into a medical version of Stockholm syndrome – the puzzling state where hostages are often close to being in love with those who have taken them hostage. If the difficulties we develop are caused by the treatment and the doctor doesn’t recognise that what he is doing is wrong for us, we become hostages to fate.

It can be extraordinarily difficult to distinguish between the anxieties, insomnias, and morbid thoughts that treatments can cause even in healthy volunteers and the anxieties, insomnias and morbid thoughts stemming from the problem we took to the doctor in the first instance. It is effortless for the doctor to blame any worsening on our original problem, rather than his treatment. With much less going for them, surgeons blamed the victim faced with the evidence of memory problems after cardiac surgery, and psychiatrists routinely blame patients hooked on antidepressants or tranquilizers or who get diabetes from antipsychotics.

From stigma to reprisal

We can become isolated astonishingly quickly. If we approach someone for help in the case of an antidepressant, we have to risk the stigma of being seen to have a mental problem and then also risk being stigmatised as a loser. We risk incomprehension – even if we approach mental health professionals, none of whom are likely to side with us rather than the doctor. We risk having our next prescription increased to treat our illogical thinking. No one will call this a reprisal. If for some reason, we are listened to and treatment stops and we get worse, no-one is likely to counsel patience to help see us through what might well be a withdrawal syndrome.

Our questions will be put in the weighing scales .. and found wanting.

Our questions will be put in the weighing scales against the scientific answers and found wanting. There is no-one on our side who is likely to point out that the so-called scientific evidence has been carefully constructed by companies, who suppress trials that don’t suit their interests, and who selectively publish data from trials so that even a trial that has shown a drug fails to work and can trigger suicide can be transformed into a trial that shows unparalleled evidence of efficacy. No one to point out that pretty well all the trials published in even the best journals are likely to be ghostwritten. No-one to point out that lawyers and others looking after the interests of pharmaceutical companies regularly take advantage of medical innumeracy to hide even more dead bodies by constructing trials so the results will not be statistically significant.

As in other areas of abuse, if we wait for the abusers to recognise the problem we are likely to wait for ever. As in so many other areas from Enron to sexual abuse, it is likely to be women who will blow the whistle.

Dying for a Cure

Rebekah Beddoe’s 2007 book Dying for a Cure does this. Following a post-partum depression, Beddoe outlines a drama of seduction, increasing personal confusion, family bewilderment and finally survival against the odds.

Dying for a Cure calls out for a movie to be made of it – but we are likely to be waiting a long time for Clint Eastwood or a future episode of Homeland to take on this challenge. What stops them? In contrast to The Changeling, the problems found in Dying for a Cure are ones in which we are all complicit.

If directors are not prepared to take on the challenge, as a matter of honor they should desist from making movies like The Changeling, which by picking out the wrong villain play a part in perpetuating the kinds of abuse that makes medicine induced death possibly the leading cause of death in the Western world today.

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