Talk:Electroconvulsive therapy/Archive 2

message: Can someone help me fix the citation for David Armstrong? I was able to add the source details under "References" and the footnote number in the article under "Side Effects," but when the corresponding number in "Footnotes" is left blank.
: <ref> is not the easiest template to use. There is more info on  http://meta.wikimedia.org/wiki/Cite/Cite.php but even that isn't easy to follow. Also, it helps to add new subjects to the 'bottom' of talk page - so make for easier archiving at a later date. Oh! and you forgot to sign your name on the this page so I don't know who I'm talking to. --Aspro 20:12, 24 August 2006 (UTC)
thread_title:  Reference to David Armstrong 

message: Who added this sentence:  "Some recent studies suggest the opposite; long term ECT treatment, like antidepressant treatment, seems to protect the brain from the damaging effects of depression." and why?  What studies?  Why the hell is this in here?  I'm taking it out until it's properly sourced.  Francesca Allan of MindFreedomBC 05:25, 15 November 2005 (UTC)
replies: text: Excuse me.  Why do we need a controlled study to confirm that many electroshock survivors are harmed?  Why is psychiatry not held to the same standard?  Electroshock survivors (including myself) report devastating memory problems.  For about one year afterwards, I read the same book over and over because I simply could not retain what I read.  Why this wilful blindness to first-hand knowledge of electroshock?  Have you been electroshocked?  If not, perhaps you should drop the attitude.  Francesca Allan of MindFreedomBC 16:12, 1 December 2005 (UTC)

text: Memory loss is much more involved than just around the treatment.  The effects seem to last months, years, even decades.  Sadly, I do have first hand experience.  Francesca Allan of MindFreedomBC 16:12, 1 December 2005 (UTC)
replies: text:  I am sorry that your experience did not work out well for you but it really is not terribly relevant.  The fact remains that research has shown that for the vast majority of people the memory loss is not experienced as you describe it. djheart 06:24, 2 December 2005 (UTC)

text: No, you were right the first time.  You're a wiki-bully and you want to force your POV even if it destroys the article.  Francesca Allan of MindFreedomBC 04:19, 2 December 2005 (UTC)

text: Your faith in "controlled" neurobiological research is quaint.  Let's not forget the horrors that peer-reviewed studies have brought us in the past.  Francesca Allan of MindFreedomBC 16:12, 1 December 2005 (UTC)

text: The scientific community is notorious for being blind to the obvious.  The fact that psychiatrists don't care enough about their patients to investigate these claims is a reflection on the arrogance of psychiatry, and has nothing whatsoever to do with the validity of the patients' claims.  Electroshock is brutal and should be abolished.  Francesca Allan of MindFreedomBC 04:14, 2 December 2005 (UTC)
replies: text:  I revised risks section so that it no longer reads that ECT causes brain damage.  Wikipedia has an anti-pseudoscience policy and as I already discussed at length on the psychiatry talk page there is no credible scientific evidence that ECT causes brain damage (and please don't use a Breggin quote again as defense, it's getting tiring).  I will delete any references to brain damage that don't qualify the statement by stating that the idea of brain damage is only supported by one a small minority of researchers (which I think is a generous thing to say since so far you have only fished out one guy). djheart 06:17, 2 December 2005 (UTC)

text: I never said you can't use Breggin as I source, I'm just saying that it seems to be your only source (well Breggin and your own personal experience) and the only crutch you are standing on to support your ideas.  On a side-note I won't continue this discussion if you continue with ad homenum (sp?) attacks.  djheart 01:42, 5 December 2005 (UTC)
thread_title:  Question 

message: Allowing for the mixed system of Harvard references with the citation details in the 'References' section and also use of the cite.php system, there were inconsistancies in how these were used and some duplication of full details in both sections. I have also had a go at some wikistyle issues, using the citation templates wherever possible:
* Where cite.php reference used in the text, then converted to standard citation formating using citation templates - thus matching how the list under the 'References' section is marked up.
* Cite.php link listing multiple sources:
** No need to give a full citation template if item already exists in the 'Reference' section.
** Likewise move any individual citation template across to the 'Reference' section
** Some multiple item references just give main author and year, some also the PubMed abstract number. As all the details are then given in the 'References' section, this is unnecessary duplication and PMID number removed.
** Some citations as 'name <comma> year', others in Harvard stye of 'name (year)' - switched to consistant Harvard style used for other citation links
* Convert any book references to also use relevant 'template:cite book' 
* If a full citation is given both as a cite.php reference and in the 'reference' section, and is not mentioned elsewhere, then removed from 'Reference section'
* Move citation links after punctuation.
* Convert html italics  to wikimarkup  
* Where same reference used twice, use duplicate format of cite.php 
* In cite:journal template, the PubMed link need only be given as id=PMID number. there is no need enclose in curley brackets.
David Ruben  Talk  03:39, 7 June 2006 (UTC)
thread_title: References tidy up

message: I'm not sure of the process for doing this, but I think the "Controversy" section is now reasonably neutral and pretty cast-iron factually accurate. Can anyone interested please say whether they would support removing the tag from the section?
Please sign your name using four tildes (~~~~) under the position you support, with a brief comment if you wish. It would be helpful if longer comments / discussion could get their own section (click the "+" above!)
Remove the tag - the article is now neutral and factually accurate
Nmg20 15:13, 25 June 2006 (UTC)
thread_title:  Removing dispute tag: poll 

message: I have replaced
In England and Wales the Mental Health Act 1983 allows the use of two ECTs in a life-threatening situation, at the discretion of the treating psychiatrist. This is most commonly invoked in the case of a patient who has stopped drinking fluids whilst suffering from a severe depressive illness. Further ECT, or involuntary ECT in less urgent circumstances, must be authorised by an independent psychiatrist, who, if in agreement, will usually give consent for a total of twelve ECT.
because the law doesn't actually specify 2 treatments or a life-threatening situation. Mental Health Act Commission Guidance for Commissioners
Regarding the bits about twelve treatments or stopped drinking fluids - if anyone wants them back in, could they say where the info comes from? 
Actually I have found a reference to 12 treatments. In that same guidance it says that a maximum number of treatments must be authorised and the usual number is 12 although the number of treatments authorised may be more or less. As it is not a fixed number I wouldn't have thought it wasn't necessary to put it in, but if anyone disagrees....
This is the first time I have edited and if I haven't quite got the hang of it, apologies. In history the edit has come up as anonymous and 17 instead of see talk. I have worked out what went wrong. But could someone tell me how to get a link into a footnote?
Staug73 16:04, 2 July 2006 (UTC)
thread_title: Involuntary ECT in England and Wales

message: Hello: My name is Wolfdeck (clearly a newbie) and I am a little upset with the state of this page. I didn't find a single reference to Leonard Roy Frank nor a link, although I added one at the end. I think that the most important and influential authority on the subject really ought to be visible at a glance. The intro takes a hitch ~3rd sentence, 2nd paragraph (like someone went into it and wrote graffiti. The side-effects section (scanned) appears to be well-stated. As Leonard is a walking encyclopedia himself, I don't understand why he isn't being better used to enhance Wikipedia in support of the inquiring masses. More importantly I feel this page is a dishonour to Leonard, although clearly some people have had to fight to maintain it to this level, which is commendable. For example: ABOUT LEONARD ROY FRANK
In the 1990s update to his terrific book, Electroshock: The Case Against, which offers summaries of activist resistance to electroshock over the last four decades of the 20th century, Robert Morgan offered the following acknowledgment of Leonard Frank.
	His written work on ECT and advocacy against it have straddled the decades covered in this book. Initially disabled by ECT, Leonard devised some particularly ingenious organizational and memory techniques to overcome his resultant learning disabilities. He has devoted his life to addressing and correcting abuses of the psychiatric system, particularly ECT. Although he has been a strong and effective figure in this history over the decades, it is particularly now that he has emerged as a key figure. A tough, gentle, articulate and consummately effective organizer, he has probably done more to advance survivors' rights than anyone else. A former editor of the Madness Network News (survivors journal) and current primary leader of the opposition, both scientist/professional and survivor, he has been the role model and integrity for a very diverse coalition of independent individuals. Thanks to Leonard, a very well financed and credentialed initiative was defeated, at least in San Francisco, at least for now. 
Leonard  Frank has been strong, effective, gentle and tough with me over the last decade as he became a primary mentor and very close friend. He is best described, however, by the dynamics of love and truth. More than anyone, he has helped me to become more clear about language and the patterns of psychiatric oppression. When the idea to form the Coalition for the Abolition of Electroshock in Texas came into my head last summer, Leonard nurtured the idea with enthusiastic support, and helped us be clear about our Gandhian approach of active, transparent, nonviolent resistance. As we organized ourselves into existence this past fall, Leonard stepped up and has been an integral voice of wisdom, guidance and encouragement. I am grateful to be working shoulder to shoulder with this awesome man, in his fifth decade of activism against psychiatric oppression in general, and electroshock in particular. 
The Electroshock Quotationary is the single best document available to learn about the reality of this horrific practice. 
							         --John Breeding, PhD
								   4-28-06 (Wolfdeck 06:38, 24 July 2006 (UTC)
thread_title: Electroshock Quotationary

message: I'm archiving the talk page, which is over 216 kilobytes long.  This is my first time, so if I mess-up, please feel free to fix anything!  =D  Jumping cheese Contact 04:27, 21 August 2006 (UTC)
replies: text: Looks good, but I moved the "Question" section back since there was a new posting just yesterday.  --zenohockey 16:14, 21 August 2006 (UTC)
thread_title:  Archive 

message: That phrase sort of bothers me; it implies that ect never provides long-term relief. Someone needs to provide documentation of this, or else remove that descriptor altogether.  Asarkees 15:29, 12 September 2006 (UTC)
replies: text: Medically, I think ECT is seen as a medium-term solution to the problem - but the frequency of repeat treatments suggests it isn't in and of itself a long-term one. That's not to say the relief it offers from debilitating psychiatric symptoms can't help effect changes in the interim - but I think that "short-term" is justified here, although "medium-term" might be fairer, or at least a suggestion of how long it works for. Referencing that would be excellent. Nmg20 23:58, 16 September 2006 (UTC)
thread_title:  "Short term improvement?" 

message: The opening of the article has been a point of contention recently, with User:Aspro making five changes I have reverted for the following reasons:
# "a vocal minority of psychiatrists" became "a growing number". The evidence in the article as it stands, coupled with the continued use of ECT by psychiatrists around the globe, supports that a minority of psychiatrists oppose its use. There was no evidence added to the article to support the claim that the numbers of psychiatrists opposed to the practice is growing, and so I don't believe we should allow a co-opting of the majority as has been attempted here.
# "and scientists" was added to the list of those opposed (and also qualified by that weaselly "a growing number"): I don't see any new journal articles, books, newspaper items, or anything else from scientists referenced in the article, and this is another attempt to lend an air of scientific credibility to the anti-ECT arguments.
# the procedure's "efficacy" has apparently come under fire. Again, no evidence was offered to back this up.
# what's more, apparently those untrustworthy sorts who first suggested it overplayed how well it worked!
# "and others" became "Still others", making it sound as if there are whole hosts of anti-ECT campaigners clamouring to be heard in the opening ten lines of the article.
In short, I felt the changes were without exception worsening the state of the article with regards to Weasel Words. Nmg20 01:54, 15 October 2006 (UTC)
replies: text: Could someone tell me why it says "neurologically based disorders affecting mood" rather than "mood disorders" or "depression"?Staug73 16:04, 29 November 2006 (UTC)
thread_title:  Intro edits 

message: Hello, my father (Dr. Nunez, MD PA Geriatric Psychiatrist) is very experienced with ECT, having performed many procedures at Winter Park Hospital, Orlando FL.
He'd like to contribute somehow to this article, but being new to Wikipedia he isn't sure how best to be more helpful than hurtful in regards to NPOV.
Also, it might be beneficial for the article to note that ECT nowadays uses a bidirectional square wave (brief pole stimulus or "spiked" wave) as opposed to the sinusoidal AC with a constant current used back when ECT first started. This has done much reduce the a lot of the disorientation/confusion typically associated with the more antiquated version of ECT. The source of this information originates from the MECTA (Multiple Electro Convulsive Therapy Apparatus) Manual; (pg. 56 Figure B.1)
Any thoughts/contrary opinions? I am typing this on his behalf, so please bear with me :-).
Thanks :-) absolutecaliber
:Welcome to Wikipedia! Technical info like that would be great to see in the article, particularly if referenced - I guess it would fit best under the "Types of ECT" section? Nmg20 08:02, 20 October 2006 (UTC)
replies: text: I have added some technical stuff complete with references. I have called it Techniques and Equipment and replaced the Types of ECT section as it seemed to overlap with the previous section and I think the Sackeim article may be misquoted. In any case most was a quote from the Surgeon General's report (and so should, according to Wiki guidelines have been in quotation marks and accredited) leaving a few lines:"There are two basic forms of ECT: bilateral and unilateral, and bilateral ECT can be subdivided into bitemporal and bifrontal ECT. In bitemporal ECT, current is passed across the temporal lobes, between electrodes placed on either side of the head. With unilateral, the electrodes are only on the right side, and pass current mainly through the right temporal lobe." and "Bifrontal ECT is a modified form of bitemporal ECT in which electrodes are placed 2 inches above the lateral angle of each orbit. It has fewer adverse effects on memory than bitemporal ECT, and it increases the blood flow to the prefrontal cortex.Blumenfeld et al. (2003)" which I think have been covered elsewhere, although perhaps not bifrontal which isn't used much. Perhaps it ought to get a mention. Staug73 13:36, 24 October 2006 (UTC)
thread_title:  Best Way to Contribute? 

message: I have never read a more sanitised POV oriented article in my life.  The controversy section is inadequate, two paragraphs (I added a third touching on the fact it's a lobotomy via electrocution in as neutral a way as it could be put) is not adequate representation of a treatment that, admittedly by laymen, is considered barbaric, anachronistic and having no worthwhile effect.
It's effectiveness and the manner in which it addressed is clinical.  Yes, it can fix a lot of things, but it does so by fragging your brain.  Good trade-off?  Many would disagree.  The whole controversy in Western Australia that led to a film about the horrors of the treatment in psyche wards was based on the fact that the medical world didn't warn people before hand that they will -never- be the same again after treatment, that they will lose memory, that they will lose emotions, feelings, concepts of reality, and as many sufferers of the treatment would say, they lose themselves or their souls.
I'm flagging this as NPOV until we can get some ethical approach to reformatting this horrid article; I recommend that ethics be a primary focus, not a clinical numeric patient system of addressing 'this does x, y and x, it may have some side effects.' only.  211.30.71.59 07:00, 18 November 2006 (UTC)
replies: text: Your post is very light on evidence; by all means add details of that Western Australian film to the article - there's a section on ECT in popular culture - but you'll need to provide actual evidence to support your opinion that ECT is "barbaric, anachronistic and [has] no worthwhile effect". Nmg20 19:03, 19 November 2006 (UTC)
replies: text:  I agree that the section on controversy is weak. I have been looking at the wiki guidelines on dealing with controversy and might do some work on it. It seems that the idea is to make it clear who says what, rather than censoring minority views or facts you don't like.Staug73 15:48, 20 November 2006 (UTC)
thread_title: NPOV

message: I have added references to this section and removed the tag.
The paragraph on UK already had refs.
I have put in refs for WHO quote and MDRI quote.
The bit on the USA was  a quote from the Surgeon General's report. I have put in quotation marks and a ref. I took out "nearly all states" because it wasn't in original quote and replaced with "there are exceptions", leaving a tag because I have only heard about Oregon in an article by Elizabeth Newell which I don't think is published anywhere. Anyone?
I have left the tag for Australia as I don't know where this comes from.Staug73 18:06, 4 December 2006 (UTC)
thread_title:  Involuntary ECT 

message: The sentence "ECT also decreases the functioning of norepinephrine and dopamine ... causing more of each to be released." makes no sense. Does ECT decrease the action of these neurotransmitters, or does it cause more of each to be released, therefore enhancing their action? 
This should be rectified..
58.160.150.148 18:31, 9 December 2006 (UTC)
replies: text: Not an expert here, but actually the two statements are not contradictory. A simple way to express it is that the receptors for those two chemicals are reduced in sensitivity, and so the body responds by making more to compensate. Kazuaki Shimazaki 02:57, 10 December 2006 (UTC)
replies: text:  I think this was too detailed for overview so I started new section and rewrote overview to keep it simple introduction for people who won't read any further, and because there were a number of errors and some cut and pasted stuff. Staug73 18:07, 13 December 2006 (UTC)
thread_title:  Mechanism of Action 

message: I have changed the sentence: 
"They say that anesthesia and muscle-paralyzing drugs increase the risks of the procedure and thus its mortality rate"
because the authors of the articles in ref 24 were definitely not critics of ECT. They were all, on the contrary, prominent supporters of ECT. Baker for example appeared as a witness for the defence in the Bolam case, which revolved in part around the safety or otherwise or muscle relaxants and anaesthesia. The defendants argued successfully that the remote risk of mortality with anaesthesia and muscle relaxants outweighed the remote risk of fractures without.
Alternatively if you want to say "Critics say that anaesthesia...." then you could find a reference of a critic saying that, and remove the references to supporters of ECT. But the sentence and references need to match.Staug73 14:13, 2 January 2007 (UTC)
replies: text: Ah, I see.  The sentence before that was "However, critics argue that the differences might make the procedure more damaging, not less," so I thought this one referred to the critics' view as well.  Thanks for catching that.  --zenohockey 22:51, 2 January 2007 (UTC)
thread_title:  Anaesthesia and muscle relaxants 

message: I have gone through the article removing unattributed quotes from the Surgeon General's report, that is passages that were cut-and-pasted from the report without quotation marks or a reference saying where they came from. They were in the following sections:
*Effectiveness - this was almost entirely from the Surgeon General's report. I have paraphrased it and put in a footnote. There was one sentence about maintenance ECT that someone had written which I will put in another section.
*Continuation phase therapy - this was entirely from the Surgeon General's Report. I have removed it because it wasn't specifically about ECT.
*Historical usage - there were two paragraphs from the Surgeon General's report. One, about ECT being largely replaced with drugs, is covered in overview so I have removed it. The other about techniques is covered in Techniques and equipment section so I removed it.
*Informed consent - this was copied from the report. I have paraphrased it and put in a footnote.
I have removed the source note as it is no longer necessary. People can now see which bits come from the Surgeon General's report. There are probably still a couple of bits in the Side-effects section - I haven't dared look.
Taking out or unattributed quotes has also removed some of the footnotes which I think improves the article. According to the guidelines we are not meant to have second-hand references.Staug73 15:57, 11 January 2007 (UTC)
thread_title:  The Surgeon General's Report 

message: I have expanded this section. I took out a couple of sentences which I have covered in more detail, for example the sentence about most psychiatrists I have replaced with an example from a survey. Anyone know of a recent survey from the US? The bit about consent and consent forms I have moved to the section on consent.Staug73 18:11, 15 January 2007 (UTC)
thread_title:  Controversy [1] 

message: Someone had added "maximum" to the sentence about typical current strengths. I have removed it because 300 amps wasn't a maximum value. It was a typical value for someone with a head with average impedance. The whole point about the early machines was that they were constant voltage. The operater could set the voltage (and the duration) but the current would vary automatically with the patient's impedance. So if the impedance was low the current could be much higher - I have seen examples quoted of an amp or more. But that wasn't typical. If the person who put maximum in could explain what they meant, there might be a better way of putting it.Staug73 12:22, 20 January 2007 (UTC)
thread_title:  Techniques and equipment 

message: Someone had added norepinephrine, and I have changed this to noradrenergic system. Epinephrine and norephinephrine are the US terms for what in Europe are called adrenaline and noradrenaline. But the US uses adrenergic/noradrenergic (rather than epinephrinergic/norepinephrinergic).Staug73 10:20, 30 January 2007 (UTC)
thread_title:  Overview 

message: I changed the week/meek patients into just more manageable ones to avoid an argument, but then I noticed that the whole sentence had been cut-and-pasted from another website http://www.zipworld.com.au/~aamca/cvag/cect.htm so I took it out. I am not even sure that it is true - that Cerletti was concerned with meekening/managing his patients. Meek was definitely the word though.Staug73 16:46, 30 January 2007 (UTC)
thread_title:  Historical usage 

message: I have replaced a brief mention of two primary sources (neither of which seemed particulary seminal) with a summary of a review of the research from a secondary source.Staug73 14:33, 16 February 2007 (UTC)
thread_title:  Mechanism of action 

message: I have done some drastic editing on the introduction. I think the last addition, about how ECT was controversial in the past but not now was probably vandalism - unless someone can give me a date for when it stopped being controversial.
I have changed it to being a psychiatric, rather than a medical treatment, as its use outside psychiatry has been very unusual (although there have been a few doctors who have used it for non-pyschiatric disorders). I haven't put in a link to psychiatric treatment as it gets redirected to psychotherapy.
I have taken out the bits about modified/unmodified, as they are all covered in the overview and section on anesthesia, and replaced them with a reference to an anaesthetised patient - rather reluctantly as in many parts of the world some patients still aren't anaesthetised (but that is explained in overview).
I have also taken out the bits about vocal minorities, abuse etc as I think they really belong in the controvery section, although perhaps a brief mention needs to go back in. I think it is very important to keep arguments out of the introduction and to keep it simple. After all, its supposed to tell people who don't want to read any further all they need to know (it's a psychiatric treatment, its still used) and not put off too much those who might want to know more.Staug73 16:26, 16 February 2007 (UTC)
thread_title:  Introduction 

message: ECT is administered to Denzel Washington's character in the remake of "The Manchurian Candidate." —The preceding unsigned comment was added by 206.66.168.45 (talk) 21:16, 19 February 2007 (UTC)
thread_title:  Fictional Depictions