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The DSM, From Jabberwocky to Mock Turtle

I found this Opinion Piece, Why we need a manual on mental disorder, in the PostPartisan section of the Washington Post lame, amusing, as well as completely wrong headed.

The Washington Post, unlike the New York Times, has always had a less than independent warm and cozy bed fellow type of relationship with the psychiatric profession and the pharmaceutical industry. This article further reflects that relationship.

First let’s go to where it is right on target.

Critical assessments of DSM’s next edition include that it will serve as a vehicle by which to sell more drugs and that it will make health insurance more difficult to obtain. It is easier to rationalize prescribing a pharmaceutical for someone with a DSM-certified problem (“hypersexual disorder,” for example, is proposed for people who suffer from an unusually high sex drive) than for someone without, just as it is easier to justify denial of coverage to someone who appears to be headed for a lifetime of expensive monthly prescriptions than for someone whose chart is diagnosis-free. Indeed, an edition of DSM chock-full of new disorders (such as “Internet addiction”) runs the risk of “massively pathologizing people,” said Dr. Jerome C. Wakefield, a professor of social work and psychiatry at New York University.

Why do we have a DSM?

1. So that doctors and the drug industry can sell more drugs.
2. I wouldn’t say that the DSM was designed to prevent certain people from receiving health insurance. I would say that much of its existence is for health insurance purposes. Now that we have mental health insurance parity, insurance companies have to cut deals with the government, psychiatrists and drug companies in the interest of financial survival.
3. Somebody has to pay for these drugs, if the ‘patient’ can’t afford it, the doctor and the drug industry have to turn to an insurance policy, private or public, to profit from the matter.

Now let us look at the articles wrong headedness.

But the critics should realize that a definitive and authoritative reference is an essential tool for alleviating the pain and suffering of those who are afflicted. In the debates over the new edition, it’s easy to forget that treatment is the end goal of psychiatry. Sure, a DSM taken to its logical extreme would need to list 6.8 billion disorders, one for each nut on the planet. But going in the opposite direction, having fewer or inadequate guidelines to help professionals identify mental illnesses and the proper treatments for them, could be worse. The APA has a nearly impossible — yet massively important — job on its hands.

Treatment should never be the end goal of psychiatry. Such treatment is a means by which we arrive at the end goal of mental health recovery.

One essential tool for dealing with everything from caffeine and cigarette dependence to bed wetting and rebellion is common sense. When common sense goes by the wayside, you have a field guide to the species that inhabit Wonderland. Some of us feel that the DSM is much more like this field guide to the species that inhabit Wonderland than it is too any truly essential tool.

If the extreme illogic of the DSM would go so far as to lay a disease on every inhabitant of the planet, of course, the gig would be up. The DSM would be found out for exactly what it is. Individuality here is the culprit, so let’s make an illness of it, and stamp it out. By ignoring differences, and focusing on similarities, you can say we are more similar than we are different, and marked differences can be denigrated to the category of disease. Take a more scientific approach, use a magnifying glass, and those differences again resurface on a more ‘universal’ scale.

The mental illness rate has been climbing for over a century. The drugs used in the maintenance of these conditions are debilitating. So when confronted with ordinary human distress, not knowing what to do with it, we get a doctor to prescribe a drug for it, and out of that drug usage comes a further chemical disability. This process does not necessarily recover anybody to full functionality.

When you have 297 disorders listed in your manual of mental disorders, you are going in the wrong direction when you try to stuff more disorders into this manual. Especially when any minor mental disorder listed is little more than an idiosyncrasy, and there is nothing particularly pathological about idiosyncrasies.

Human is human, and there are fewer examples of humanity more human, in so far as their capacity to make errors is concerned, than those members of the psychiatric profession who are involved in the revising of the DSM. Common sense, together with the remedies nature provides, offer a much better cure than these quack pseudo-scientists ever had imagined. Nonsense, uncorrected by sense, is a permanent diversion of time.

The one thing that these doctor editors do teach us is that commonsense doesn’t always prevail.

Love, The Disorder

Today being St Valentine’s Day, I thought I would turn to the theme of the relationship of madness to love. I used wikipedia to come up with the disorders listed below. Having said this, I encourage people to express their own opinions on the subject, and not to leave the final word to wikipedia.

Hypersexuality is the elevated desire to engage in human sexual behavior at a level high enough to be considered problematic and clinically significant.

Love sickness is a non-medical term used to describe mental and physical symptoms associated with falling in love.

Historically, love sickness has been viewed as a short-lived mental illness brought on by the intense changes associated with love. Universally acknowledged polymath Avicenna, a Persian, viewed obsession as the principal symptom and cause of love sickness.

Obsessive love is a form of love where one person is emotionally obsessed with another.

Love addiction is a human behavior in which people become addicted to the feeling of love. Love addicts can take on many different behaviors. Love addiction strikes quite commonly in the modern world, however most love addicts do not realize they are addicted to love at all. Love addiction can be treated with many different recovery techniques and ways, most of which are similar to recovery from other addictions such as sex addiction, and alcoholism, through group meetings and support groups.

I prefer to ignore psychiatry’s attempts to translate behavior into pathology. The sin of most concern to the behavioral order and other psychiatric sects is apparently that of the diagnosable condition. I imagine that if it gives a person pleasure, displeasure, or no pleasure, psychiatry will find a drug to treat it. When the doctors office is right in front of you, my advice for you is to go in any other direction.

There are good things to be said about what some would call pathological love. If only fools fall in love, then such folly must represent a route towards eventual wisdom. There are those, I would hope, who have learned to soar to love after previously having fallen in it. If we learn by trial and error, corrections of errors come out of those trials. Some people, after all, do learn from their mistakes.

If they don’t learn, well, maybe they had a lot of fun making them.

Also To Be Included In the DSM-V, Psychosis Risk Syndrome

The upcoming DSM-V is expected to cover a certain “psychosis risk syndrome”. My worry with this diagnostic category is that the prevention might become part of the epidemic. How, for example, are we going treat people at risk for psychosis? Is this to be the same way we treat people who are overtly psychotic? If so then you’ve just increased the number of people on psychiatric drugs, and suffering from the slew of health complications that arise from doing so. Should a person pegged with this “psychosis risk syndrome” receive the same treatment as other people thought to have full blown psychosis? Answer yes, and you’ve just increased markedly the number of people in treatment for a “mental illness”. Next question: is this treatment all that effective?

How big of a step do you need to take to get from being “at risk” to being stark raving “psychotic”? My guess is that that step would not be very big, and if that is the case, why have any “pre-psychosis” designation what-so-ever? Isn’t this a little like pushing your luck?

There is a body of evidence suggesting that drug maintenance is at a remove from any treatment that would lead to a full recovery, and that such maintenance on neuroleptic drugs may actually impede the recovery process, and that, in some instances, such drug maintenance will prevent any recovery from taking place at all.

When people are being labeled at ridiculously young ages, 2-7 years old in some cases, and when some people I have known personally in the mental health system entered at a very early age, and have not gotten out of that system to this day, I don’t find this development a particularly positive one.

This category will have its field trials, of course, but I imagine the results will be subject to a variety of differing interpretations. Some people think that because you are treating more people, the treatments you are using must be more effective. Let me just say that, no, quantity is not synonymous with quality.

Yesterday, in the comment section to the post on temper dysregulation with dysphoria (TDD), I had referred to the DSM as a Pandora’s Box from which the last plague had not yet escaped. Today I find published an article on the matter using the exact same metaphor. This article, from a prominent well articulated critic of the current revisions taking place to the DSM, Dr. Frances Allen of Duke University, is called Opening Pandora’s Box: The 19 Worst Suggestions For DSM5. Anybody concerned about the future of mental health care in America might consider giving this article a peek. His criticism is unlikely to keep many of these suggestions out of the next edition of the Manual scheduled for release in 2013.

New Childhood Mental Illness In The Upcoming DSM-V

One of the more disturbing aspects of the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), scheduled for publication in 2013, is that it will undoubtedly contain yet a further diagnostic category for permitting the abuse of children by the psychiatric system in collusion with inept parents.

This brand spanking new childhood behavioral disorder the psychiatrists drafting the DSM have come up with is called temper dysregulation with dysphoria, or TDD for short. This label, according to an ABC newstory, Big Changes for DSM-V, the Psychiatrist’s “Bible” , will be applied to those children who display “persistent negative mood with bursts of rage”.

“About 40 percent to 60 percent of the cases [seen by child psychiatrists] will be children who are doing things that other people don’t want them to do,” he said. Many of these are children who are “stubborn and resistant and disobedient and moody.”

There is currently a recognized syndrome known as oppositional defiant disorder, but some children also display severe aggression and negative moods that go beyond mere stubbornness, according to [Dr. David] Shaffer.

Such children are often tagged as having juvenile bipolar disorder, but research has shown that the label is often inappropriate, since they usually do not qualify for a bipolar disorder diagnosis when they reach adulthood, though they remain dysfunctional. More often, these children are diagnosed as depressed when they become adults.

If the idea is to reverse some of the damage done by the reassigning of some children labeled ADHD as early onset bipolar disorder sufferers, the extension is still an extension, and it is apt to mean more children labeled mentally ill and maintained on powerful psycho-active drugs.

Certainly anybody who will be diagnosed depressed as an adult, after having been diagnosed bipolar, ADHD, TDD, or any combination of those mental disorder labels, as a child, could be said to have gotten off on the wrong career path.

UPDATE

The New York Times is running an article on this future edition of the DSM today, Revising Book on Disorders of the Mind.

“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.

“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”

One significant change would be adding a childhood disorder called temper dysregulation disorder with dysphoria, a recommendation that grew out of recent findings that many wildly aggressive, irritable children who have been given a diagnosis of bipolar disorder do not have it.

The misdiagnosis led many children to be given powerful antipsychotic drugs, which have serious side effects, including metabolic changes.

Apparently this new mental disorder is an attempt to lessen the destruction wreaked in large measure by Dr. Joseph Biederman, who was almost single handedly responsible, together with his associates, for a recent 40-fold increase in the incidense of bipolar disorder.

It’s not this disease. It must be that disease. Oh, no! It’s something entirely different. Or is it? Once we have TDD, I guess we will have to fabricate a history for it the way people have fabricated a history for ADHD.

Higher Ratio Of Black People Labeled Mentally Ill In The UK

Black people in the United Kingdom, like black people in the USA, are apparently being treated for mental disorders at a disproportionately higher rate than their white neighbors.

This is what we find in a post from The Colorful Times, Issues in Black Mental Health.

However, according to a report published by the Sainsbury Centre for Mental Health, the relationship between black communities and mental health services is characterized by fear and mistrust, with black people reluctant to seek help from a service they see as punitive and racist. This is all the more alarming when you consider the large body of research literature suggesting that race has a powerful influence on risk of mental illness, with studies consistently reporting a higher incidence of schizophrenia and psychotic illnesses in black than white populations in the UK.

The article goes on to further elaborate about this disproportion.

Dr Kwame McKenzie of London’s Institute of Psychiatry sees racism as aetiologically important in the development of mental illness. Writing in a January 2003 edition of the British Medical Journal, he identified racial discrimination as a major public health issue. Indeed, a 2002 survey of Caribbean, African and Asian people found that those who had experienced a racist attack in the preceding year were nearly 3 times more likely to be suffering from depression and 5 times more likely to be suffering from psychosis.

In the Not Only Department, this treatment of black people seems by and large more punitive and extreme than it is for people of northern European ancestry.

This misperception of the risk of violence posed by black people is thought to underlie the over- representation of African Caribbeans in psychiatric services. Moreover, it seems to underpin the large body of research indicating an experience of mental health services for black people in the UK that is frequently negative, inadequate and overwhelmingly coercive.

I used to do volunteer work with a social justice organization, The Virginia Organizing Project, and one of the campaigns we were engaged in was directed against racial profiling by law enforcement officers. This is how Wikipedia characterizes racial profiling.

Racial profiling is the inclusion of racial or ethnic characteristics in determining whether a person is considered likely to commit a particular type of crime or an illegal act or to behave in a “predictable” manner.

We also learn this from Racial Profiling of African, Hispanic (Latino), and Asian Americans.

The most common example of police racial profiling is “DWB”, otherwise known as “driving while black”. This refers to the practice of police targeting African Americans for traffic stops because they believe that African Americans are more likely to be engaged in criminal activity.

The point I am trying to make here is that apparently it isn’t only officers of the law who engage in racial profiling. Mental health professionals, mental health authorities, are resorting to the same thing. It may not be entirely conscious, but either the people of African ancestry are more prone to mental illnesses genetically, and given the diversity of peoples on the African continent that doesn’t make much sense, or mental health professionals are doing some, perhaps subconscious, racial profiling of their own. When these mental health professionals are often acting as an extension of the long arm of law enforcement anyway, it’s easy to see how some racial profiling might come into play where coercive practices are concerned.

Stigma the word and mental health

stigma – a generally-held poor or distasteful view associated with something – from the Roman practice of branding slaves’ foreheads; a ‘stigma’ was the brand mark, and a ‘stigmatic’ was a branded slave; hence ‘stigmatise’, which has come to mean ‘give something an unlikeable image’. Originally from the Greek word ‘stigma’, a puncture.
http://www.businessballs.com/clichesorigins.htm

1590s, “mark made on skin by burning with a hot iron,” from L. stigma (pl. stigmata), from Gk. stigma (gen. stigmatos) “mark, puncture,” especially one made by a pointed instrument, from root of stizein “to mark, tattoo,” from PIE *st(e)ig- (see stick (v.)). Figurative meaning “a mark of disgrace” is from 1610s, as is stigmatize in this sense. Stigmas “marks resembling the wounds on the body of Christ, appearing supernaturally on the bodies of the devout” is from 1630s; earlier stigmate (late 14c.), from L. stigmata.
http://www.etymonline.com/index.php?search=stigma&searchmode=none

Stigma is a Greek word that in its origins referred to a kind of tattoo mark that was cut or burned into the skin of criminals, slaves, or traitors in order to visibly identify them as blemished or morally polluted persons. These individuals were to be avoided or shunned, particularly in public places (Healthline Network Inc., 2007).
http://en.wikipedia.org/wiki/Stigma_(sociological_theory)

The feeling that there is a stigma attached to serious mental illness is often used to justify the biological medical theory of psychiatry. According to this theory, mental illness is a biological disorder from which there is ordinarily little to no chance of making a full recovery. If a person cannot recover their mental health after having developed a mental illness, then the best you can expect to do is to try and change people’s perceptions of the illness. The fact is that people can and do recover their mental health after having received mental disorder diagnoses. This fact flies in the face of the illusions fostered by the biological medical theory of psychiatry.

If there is a stigma attached to mental illness, there is no stigma attached to mental health. When a person recovers his or her mental well being after losing it, any stigma associated with the disorder must vanish as well. Perhaps it would be better if we hung on to this notion of stigma a little longer lest more and more people get the idea that the way to be is mentally unsound. I don’t think there is a stigma associated with mental health yet, but do we really need one? Advertisements for illness don’t really make me go all soft and gooey inside, and I don’t tend to think they should do so either.

This aversion to recovering that many of people in treatment have is the thing that really needs to be countered. The notion of being ‘in recovery’ permanently comes from the realm of substance abuse services, and although there may be an addictive element to inappropriate behavior (i.e. symptoms of mental illness), I don’t think that any compulsion to display symptoms of mental illness is of the same order as an addiction to heroin would be, for example. When the process of recovery, completes itself, and one can put one’s discomfort in the past tense, saying that one has recovered, then one has managed to get somewhere.

Unfortunately, most mental health treatment facilities are operating under the oppressive shadow of the pessimism of their professionals. The “we think you can’t” mantra transferred to their clientelle becomes the “I think I can’t” mantra. The important lesson everybody learns in nursery school, “I think I can”, in most cases, has been lost. When you teach people not to succeed, you are teaching people to fail. What people are being taught to fail at, in these instances, is recovery. The person who succeeds at recovering, succeeds in passing beyond “recovery”. Guess what, folks? This or that impasse isn’t everything. Life goes on outside the treatment facility doors.

On The Connection of Madness to Genius

Two more articles have just appeared that would link mental illnesses with genius. You will get no long pause from me here over the subject; I’ve got more important matters to get excited about. Mental illnesses have long been linked to individualism and non-conformity, too, but no one pays too much attention to that factor of the phenomenon. The articles I am referring deal with specific mental disorders. One deals with, I’m sure you’ve seen this kind of thing before, bipolar disorder, while the other concerns, not so much the same thing, attention deficit hyperactivity disorder.

I’d like to point out that the neuroleptic drugs often used to treat bipolar disorder would tend to serve as an antidote to this kind of over achievement. These drugs suppress dopamine activity in the brain, and the neurotransmitter dopamine has much to do with human motivation. If a patient appears listless, lethargic, and largely unmotivated, there’s a fair chance that the drugs that the patient is taking may have something to do with this state of affairs. A tendency exists in fact to confuse the effects of these drugs with the symptoms of any disease the person taking them is impugned to have developed. Should an over achiever visit the psychiatrists office, the psychiatrist then has the power, if utilized, to cure this over achiever of his or her over achieving.

First the article on bipolar disorder, High achievers more likely to be bipolar, involves a study of high school students in Sweden.

The national cohort study was carried out by scientists from King’s College London’s Institute of Psychiatry and the Karolinska Institute in Stockholm, Sweden. The team, led by King’s College senior lecturer in psychiatric epidemiology, Dr James MacCabe, studied the final exam results of all 15-16-year-old pupils attending High Schools in Sweden from 1988 to 1997, and compared them to hospital records of bipolar disorder admissions of patients between the ages of 17 and 31.

Grade A students apparently may be neglecting other areas of their lives.

They found those with A-grade results were almost four times more likely to be admitted for the condition than average students, even after the findings were controlled for income and education level of the parents. The link was stronger in males than females. They also found students with low exam grades had a greater risk of developing bipolar disorder than average pupils.

The names of artists Vincent van Gogh, Sylvia Plath, and Virginia Wolf were dropped as possible bipolar disorder sufferers.

Note: this study doesn’t just find high achievers at risk; it’s the low achievers who are at risk, too, according to the study results. If you’re a C student I guess you can breathe a huge sigh of relief. The heading of the article itself is something of a half-truth.

The other article, Attention-deficit hyperactivity disorder link to genius, in the BBC, concerns the beliefs of a certain Professor Michael Fitzgerald who credits ADHD cases with the ability to ‘hyper-focus’.

He starts by dropping the names of Jules Verne and Mark Twain as examples of high achieving ADHD candidates. By the end of the article this club includes the likes of Lord George Byron, Kurt Cobain, Pablo Picasso, Sir Walter Raleigh, Thomas Edison, Oscar Wilde, James Dean, Clark Gable, and Ernesto Che Guevara.

“The same genes that are involved in ADHD can also be associated with risk-taking behaviour.

“While these urges can be problematic or even self-destructive – occasionally leading people into delinquency, addiction, or crime, they can also lead to earth-shattering breakthroughs in the fields of the arts, science, and exploration.”

Wolfgang Amadeus Mozart, George Orwell, and Andy Warhol, this article goes on to say, received mention from a 2004 book by Professor Fitzgerald as possible Autism Spectrum Disorder cases. I’ve always thought something smelled a little fishy about diagnoses being made on the high functioning end of the autism spectrum, and this kind of a crazy leap doesn’t make me feel any more secure about those diagnoses.

I don’t really see any reason here for so much as the raising of a single incredulous eyebrow. I just wonder, in many of these cases, whether the abilities of the people so named would have survived intact had they received a diagnosis and treatment for any such disorder in their own time.

I also thought it more than a little queer, if not downright misogynist, that Professor Fitzgerald wasn’t able to come up with a few female names.

I think some of our Professors are star struck.

Although Professor Fitzgerald’s aim is positive, and involves that of seeing an advantagous angle to ADHD as opposed to the more conventional disadvantagous view, I don’t think this type of thinking would necessarily encourage any high achiever of notoriety to seek some kind of psychiatric help for the brain disease suffered from. On the other hand, maybe a few academics have been working too hard for a few too many hours lately, and are under a great deal of pressure. Perhaps they are approaching the verge of nervous exhaustion and collapse. Maybe a vacation is the order of the day. I would just like to recommend that they lay off the biographies and memoirs of celebrated figures for a spell lest it aggravate their conditions.

Cracking the mad dictionary

Psychiatrist – drug pusher

Mental Health Service Provider – adult baby sitter

Mental Health Consumer – adult baby

Peer Support Specialist – sell out

Mad person – chosen of the Gods and Goddesses

Psychiatric survivor – politically enlightened ex-patient

Non-survivor – cadaver

Ex-patient – one who had lost his or her wits who has regained his or her wits

Recovery – all things to all people but, chiefly, nonsense

Mental illness – a mythological bug

Normal – deluded

Mental patient – political prisoner

Mental health treatment – brainwashing, imprisonment, torture and murder

Seriously mentally ill – lacking a sense of humor

Pennsylvania Hospital Closures

While in some states such as Virginia and Oregon state hospitals are being rebuild, if on a smaller scale than previously, Pennsylvania is actually closing state hospitals. Allentown State Hospital is the latest of its hospitals to get the axe.

According to a PR-CANADA.net article, MENTAL HEALTH ADVOCATES AND COMMUNITY PROVIDERS SUPPORT ALLENTOWN STATE HOSPITAL CLOSING, on the subject:

Up to 125 people from ASH and Wernersville State Hospital (WeSH) will return to communities of their choice, and up to 65 will transfer from ASH to WeSH. Although it would be ideal if every person was discharged to the community, mental health advocates and providers endorse DPW’s decision, as it will enable the reintegration of approximately 125 people into the community and support community-based recovery and the development of recovery services that work.

I don’t think anybody could say it better than a state resident and ex-patient.

“Having been a psychiatric patient myself, both in the community and a state hospital, I have experienced the full spectrum of treatment,” said Pennsylvania resident Dan Craig. “I learned to participate in the community and form relationships by living in the community. Having mental illness symptoms doesn’t limit the possibilities of anyone’s life. Everyone is capable of holding jobs, volunteering, being a member of a church, synagogue, mosque or temple, participating politically, or going back to school. These are all things that build our society, and enhance everyone’s quality of life. Recovery is possible for everyone!”

State hospital care is very costly. It is more cost effective to take care of people in the community.

Advocates point to the recent closings of three state hospitals as examples of the benefits of community integration.

— In December 2008, Mayview State Hospital (MHS) closed, discharging
individuals from Allegheny, Beaver, Lawrence, and Washington Counties
to their communities, where they continue to receive regular,
individualized, tailored supports around behavioral health, housing,
employment, education, social activities, and physical health. A year
later, a majority of those discharged into the community continue to
reside in community-based residences.
— Harrisburg State Hospital (HSH) closed in January 2006, with 187 of
the 289 discharged individuals moving into the community. In a report
issued one year later, the overwhelming majority of these residents
remained in their communities thanks to ongoing, community-based care
and services.
— In 1990 Philadelphia State Hospital (PSH) closed its doors. Five years
later, a study by the Pew Charitable Trusts found that the
overwhelming majority of those released at closure were living
successfully in the community.

Other states in the union need to perk up their ears, and pay attention to what’s going on in states like Pennsylvania where deinstitutionalization is actually becoming a reality. Part and parcel of this deinstitutionalization is community integration, that is, housing and jobs rather than jails and tent cities.

Involuntary Shock Treatments In Ireland

A debate of the kind I’d like to see in a US newspaper is unfolding in the Irish Times. This debate revolves around the issue electro-convulsive shock therapy, and in particular shock treatments given involuntarily or without patient consent.

Three articles have appeared on the subject in that newspaper in fact. The first is called A shock to the system of care, and it deals with the issue in some detail.

Rightly or wrongly, no other treatment arouses as much fear as electroconvulsive therapy (ECT). Depending on who you talk to, ECT is an effective and fast-acting treatment for severe depressive disorders, or it is a potentially dangerous procedure unsupported by research and whose side effects include long-term memory loss.

The debate in Ireland focuses on a section of the Mental Health Act that allows for involuntary shock, activists and advocates in that country want to see this section removed from the law.

John McCarthy, a mental health campaigner and founder of the Mad Pride Ireland group, is among those leading the charge for change.

Along with other mental health campaigners he has set up a website (www.delete59b.com) to remove section 59(b) from the Mental Health Act. This allows for the use of the procedure where patients are “unable or unwilling to give such consent”.

Two others articles on the subject follow this one. One contains a doctor’s view on the subject of shock treatment, Dr. Tony Bates, and the other holds a victim of involuntary shock’s view.

I am thinking of a lady, aged 72 years, who had lost her husband and two years later was still lost in her grief. Her will to live had completely disappeared and every day she woke feeling that she was utterly unworthy of her life, that she did not deserve to be fed or cared for, and that she should be simply allowed to die.

A bereavement counselor had worked with this woman for the better part of a year before this electroshock procedure was tried.

But when I saw her literally “awaken” after the six ECT procedures and regain her natural exuberance, I had to acknowledge the benefit of this intervention to her. She graduated from our service and remained well.

At 72 years, this lady might not have had that much time left either, or so my thinking ran. Could this doctor possibly have come up with a better example?

The patient, Colette Ni Dhuinneacha, was a different matter.

I was 19 the first time I was detained in a psychiatric hospital. I escaped after six months. I literally hopped over the wall and got on a bus. I was detained involuntarily. It’s a terrible thing to happen. All your rights are taken away.

Emphasis added.

Then she talks about her experience with ECT.

I wish I could tell you in detail about the first time I had ECT, but I have no memory of it. To be honest, I remember very little about my childhood. I have only a couple of memories. I feel that I have been robbed of so much of the richness of life. I hear my sister recalling things that happened, but I can’t remember any of it.

Memory loss speaks for itself, it can be one of the lasting effects of shock treatment, and it is caused by brain damage. Further she states.

I feel very strongly that forced ECT should be outlawed. I would like to see it outlawed in all circumstances – it has no place in a civilised world. I don’t agree with this argument that people who are ill have not the capacity to decide what is best for themselves.

I remember speaking with a university student in Virginia who seemed to think electro-convulsive shock therapy had gone the way of the dodo bird. I had to explain to her that people are still being harmed by electro-shock treatments.

With a debate like this one raging in a major US newspaper, maybe we could get a few more concerned citizens to come forward and help us end this barbaric and devastating practice, especially in so far as involuntary shock is concerned.