Talk:Electroconvulsive therapy/Archive 1

message: Frank, Leonard R. (June 2006). Electroshock Quotationary. Retrieved July 23, 2006, from The Coalition for the Abolition of Electroshock in Texas Web site: http://www.endofshock.com (Wolfdeck 05:48, 24 July 2006 (UTC)
replies: text: I think it was supposedly used as a punishment for people with Sluggishly progressing schizophrenia in the USSR. This was a disease of political prisoners --MacRusgail 02:41, 11 July 2005 (UTC)

text: Here's a history of the development of Electroshock. History of Electroshock Terryeo 13:15, 6 April 2006 (UTC)
thread_title:  Historical Usage 

message: I have changed the controversy section to say there is for the most part consensus amongst psychiatrists about ECT. This is certainly my experience from Australia but I truly don't know what psychiatrists in the rest of the world think.  The APA position in the US would seem to confirm what I have written but I don't have practical experience of that. I do know that many people who have not had direct contact with the clinical use of ECT see it as barbaric and that includes psychology students and graduates who have not worked in psychiatric hospitals. Please feel free to alter that section but I would ask that you internationalise it with any differences. E.g. "While in some parts of the world there is for the most part consensus amongst psychiatrists about the benefits of ECT, in XXX psychiatrists are in general against its use."
This article has a few references but does not then go on to list them at the bottom.  The reader is left with some names and dates and no idea of how to verify or expand on what is said. If anyone has these citations, could they please put them in. --CloudSurfer 17:15, 22 Sep 2004 (UTC)
thread_title:  Recent changes and future improvements 

message: Do we want to mention Citizens Commission on Human Rights (CCHR) in the "External Links" section? --Riddick 23:33, 29 Sep 2004 (UTC)
replies: text:  CCHR plays an active role in Electroshock Therapy in that it has a report line, lawyers and an organization.  It has initiated court cases and in some cases been responsible for changes in law about Electroconvulsive Therapy and insititutions which have used it. One example was the "Sleep Therapy" practiced at a Psych Institution in Australia, the shrinks were raping the women while they were unconcious from Electroconvulsive Therapy.  Australia's laws changed as a result of that one. Terryeo 13:27, 6 April 2006 (UTC)

text: I hadn't really paid much attention to this section of the article. As it stands at the time of this comment, the external links are headed: Pro-ECT, Anti-ECT, Studies in-progress and Others. There are many more links to the Anti-ECT sites, which the CCHR would include. There are major problems here from a NPOV perspective. The article is largely "pro-ECT" and this reflects the scientific consensus which is expressed in the NIMH consensus statement. Personally I think we should have the NIMH and Surgeon general links at the top with the American Psychiatric Association link  all under a new heading, e.g. "Medical and consensus links", or no heading at all. Then I think we should have the remaining "Anti-ECT" links under the heading "Controversy". The CCHR, the name of which could mislead people into thinking it a government body, should mention that it is a Scientology site and a link given to that encyclopedia entry for perspective. --CloudSurfer 06:16, 30 Sep 2004 (UTC)

text: Since the CCHR was just founded by the Curch of Scientology and since the CCHR is not affiliated with (as far as I have been told) the Church of Scientology we should just write that the CCHR was founded by the Church of Scientology. --Riddick 10:14, 30 Sep 2004 (UTC)

text: A link to the Church of Scientology web site could be appropriate in an alternative treatment section (although I am not sure if there are any real alternatives as soon as the patient shows sufficient symptoms for being treated with ECT; but the Church of Scientology claims, that they can do it even in emergencies). --Riddick 10:14, 30 Sep 2004 (UTC)

text: I would agree with the redesign of this section. --Riddick 10:39, 30 Sep 2004 (UTC)
replies: text: The bottom line from a medical research viewpoint is that ECT is the treatment of choice for very severe depression. Once patients (and they are usually patients by the time compulsory treatment is considered) have reached this stage many, if not most jurisdictions allow compulsory treatment with ECT. One of the problems in eliciting informed consent at that stage is that the patient is usually psychotic and their thinking processes are skewed by depressive thoughts. They also often have psychomotor retardation and are either extremely slow to respond or do not respond to discussions about the issues. It is for this reason that most (and I would have thought the vast majority but I don't know this for a fact) jurusdictions in the world allow for compulsory treatment with ECT. Reading the links here should show that the people complaining about ECT represent a minority view. For instance, one site records that one small region of the former Yugoslavia has been the first place in recent times to ban ECT. The article notes that a small number of patients are moved to a neighbouring region that allows it when they need this treatment. The article does not mention the implicit fact that the rest of the world has not banned ECT. The minority view these sites hold does not mean they are wrong just because they are in the minority, but it does mean that the article should not present an inordinate number of views which might be out of balance with the thrust of the text. Most anti-ECT articles provide further links and can act as an entry in to this literature for those who wish to read more. Well, that's my understanding of NPOV anyway. --CloudSurfer 01:00, 1 Oct 2004 (UTC)

text: *I have heard of psycho-techniques that can cause strange muscle conditions (like: a so called "cataleptic bridge" induced by hypnosis (as shown in some circusses in the U.K some time ago; of course it might be just a trick sometimes...)), so that I am really unhappy with ECT, because: It seems to be possible, to create a certain condition in the patient, so that the M.D is driven to apply ECT with all those possible consequences (brain/memory damage, conditioning, stimulation of bad emotions, etc. pp.), which could be a trick of a certain group of co-citizens (see "rehab pressure" below); it would not be a new feature of humans, as we have seen in mid-age. --Riddick 10:33, 1 Oct 2004 (UTC)
replies: text: *ECT causes muscle contractions and the newer technique of transcranial magnetic stimulation (TMS) probably does too but I really don't know anything about it. It's not the muscle contractions or even the electrical stimulus that are important, it's the fit that seems to work. --CloudSurfer 17:31, 1 Oct 2004 (UTC)

text: *I strongly believe, that all other psychiatric symptoms can be simulated by psycho-techniques, so that at least in those cases where the patient complains or would complain (if he or she could) about a bad impact caused by his social environment, psycho-techniques should be used to reverse the bad impact. But I gave it up to explain that kind of treatment to doctors of medicine (they just become incommunicative and do not move so much). --Riddick 10:33, 1 Oct 2004 (UTC)

text: *As far as I understood Scientology they claim to have found a purely psychological approach. --Riddick 10:33, 1 Oct 2004 (UTC)
replies: text: *For a balanced view of Scientology you should read the controversy pages as well. Scientology has run into many problems in many countries. --CloudSurfer 17:31, 1 Oct 2004 (UTC)
replies: text: * Scientology's approach is spiritual.  Its goal is "the rehabilitation of the human spirit."  To understand what that means and how it applies you would have to dig out of thinking of a human being in the same terms as you would think of a pig, from which electroshock was developed as a control mechanism.  Its a different thinking.  Electroshock interferes with a human's control of their body by overloading the nervous system with electrical energy.  Scientology uses communication.  A person, through communication, develops more awareness of their spiritual aspect, from this awareness, control of their thought, emotion and body follow. Terryeo 13:21, 6 April 2006 (UTC)
thread_title:  External Links 

message: In case of catatonia it should be possible to "force feed" (e. g. by those slimy fatty fluids, glucosis and isotonic (NaCl) water infusions (my father had them after his belly did not heal after some surgery)). Does anybody know, why refusing to eat is considered to be an exculpation for ECT? --Riddick 10:14, 30 Sep 2004 (UTC)
replies: text: In catatonia and in severe depression a refusal or inability to take fluids and food requires a relative level of intensive care for a psychiatric hospital. Intravenous treatment is very difficult in a ward of disturbed people. Anyone receiving intravenous, or nasogastric treatment is liable to have their tubes interfered with unless they are treated specially in an individual room. This is usually possible but does require the facilities and the staff resources. The problem then becomes how to treat the person. Experience has shown that ECT works better than medication in these severe and very uncommon problems. That is why it is used. Your use of the word "exculpation" suggests that you believe that ECT is essentially harmful and that its use could evoke blame. All treatments have risks and complications. ECT, in the consensus opinions which are provided in the links, at times presents an equal risk and at other times presents a lower risk than other treatments. No treatment is perfect but doctors try to pick the least harmful and most effective treatment for a specific condition. A core element of the Hippocratic oath is, "In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing ..." and this part of the the oath has been paraphrased into the Latin phrase "Primum non nocere" (first do no harm) which, despite not being in the oath is still an oft repeated phrase that governs the ethics and actions of doctors worldwide. Over the centuries these treatments change and I have no doubt that one day better treatments than ECT will emerge. At present however, ECT remains the most effective treatment for catatonia and severe depression and that is why it continues to be used seventy years after its invention despite the availability of a raft of antidepressants. By comparison, psychosurgery has all but disappeared to be replaced by effective antipsychotics. --CloudSurfer 01:27, 1 Oct 2004 (UTC)
replies: text: *Since 1991 I wonder why patients, who refuse to move, are not moved into a intensive care unit. But the leading M.D just allowed a short-term transfer for implementing a central veneous access point (afterwards he was quite satisfied with the work of his colleagues; he just complained about missing stitches where the hose entered the body). But I gave it up to ask (them)... --Riddick 10:14, 1 Oct 2004 (UTC)
replies: text: * Catatonia is a very uncommon condition. In my years of working in the field I have seen it once, but then I haven't spent a lot of time working in the psychiatric hospitals where people with this disorder are admitted. Because the patient is largely unresponsive it is usually impossible to obtain informed consent for any procedure. Added to that is the great difficulty in treating this condition. ECT is believed to have a role in catatonia but I wonder if a trial has been done comparing ECT with clozapine (the most effective antipsychotic medication). The problem in doing trials with rare conditions is recruiting enough subjects to obtain statiscally valid results. Such a study would probably have to be multi-centre and even then may take several years to collect the numbers. To make it double blind all the patients would then have to be given tablets and referred off to ECT. Those in the tablet trial would get the active drug and dummy ECT and those in the ECT trial would get a placebo and real ECT. The treating doctors would then rate their progress and switch non responders after a set time to the alternate group. Perhaps this study has been done but I am not aware of it. --CloudSurfer 17:51, 1 Oct 2004 (UTC)

text: *By the way: In F.Rep.Germ the Hippocratic oath was substituted by another oath (e. g.: in order to reflect the new pregnancy abortion law), that still says something like "The M.D shall care for the health of the patient first". But there is hear-say about M.D.s who believe that psychiatric treatment should create a "rehabilitation pressure" on the patient, and that this pressure results in a certain suicide rate, that should not be below a certain rate, which sounds quite cruel and like a third justice system (i. e.: 1. criminal, 2. civil, 3. medical) to me... --Riddick 10:14, 1 Oct 2004 (UTC)
replies: text: [N.B.: This is, however, factually wrong. Doctors in Germany are not sworn in under an oath. There is a thing called the "Approbationsordnung für Ärzte" based on another set of laws the "Bundesärzteordnung", which is by no means an oath (would be a pretty long one to recite as well at that ;-)) but rather something like a legal act. And of course we would all be grateful to see a link to a published case or an independent source giving us a more in-depth run-down of an alledged principle in German psychiatry that systematically drives its patients into suicide. This smacks of conspiracy theory IMHO and sure is a great help in an effort to stop stigmata and misconceptions about mental health from propagating. --Ft. Jack Hackett 20:37, 19 November 2005 (UTC)
replies: text: I cannot find the source... :-(( It was hear-say anyway... But I am quite sure, that it said, that the doctors compare their suicide-rates, where a lower rate means, that the rehab-pressure (Rehabilitations-Druck) was not high enough. The same(?) paper said, that a doctor said on a party (in GERM lang) "I wish somebody cripples me, so that I will have my private nurse for the rest of my life." On another paper the author describes the iatric opinion about ECT/lobotomy/euthansia in 1945 in GERM (on  find "Euthanasie"; in that paragraph the author says, that the doctors called ECT "the little leukotomy"). I cannot see any improvement in their concepts (it seems like the psychiatrists mistreat me in order to please my family and social environment). --213.54.75.173 20:11, 1 February 2006 (UTC)

text: * Yes, the Hippocratic oath is an old one and has been changed over the years. The concept of doing no harm remains critical and believed by the vast majority of doctors as being a guiding principle. Psychiatric treatment can put pressure on people but psychiatrists and others working in the field try to prevent that leading to bad consequences. Without some pressure, either internal or external, change will not occur. --CloudSurfer 17:51, 1 Oct 2004 (UTC)
thread_title:  Involuntary ECT 

message: The last sentence in the second last paragraph in the overview reads:
:Studies have shown that each fit must be separated by a day at least.
...or what?  Is the treatment ineffective?  Does it result in some sort of damage?  Does the sky fall?  What happens if fits are not separated by at least a day?  The reader is left expecting more, but unfortunately the sentence unexpectedly ends.
--PJF (talk) 08:31, 19 Feb 2005 (UTC)
thread_title:  Clarification required on the separation of treatment. 

message: I removed this sentence from the article:
:Even though ECT is "safe", passing the current through the 'non-dominant' hemisphere is "safer" — unless of course, one happens to be an artist, musician, or other professional who depends upon the right hemisphere for creativity. 
This appears to be highly POV, unless evidence can be supplied to back it up. Cites, please? -- The Anome 08:45, May 20, 2005 (UTC)
-----
WHO DELETED MY LINK TO AN EXCELLENT REFERENCE,DR. PETER BREGGIN'S PAPER ON ELECTROSHOCK? AND WHY? -- EFS
EFS, I don't think shouting will get you anywhere  and the rationale has been explained  (withdrawn, see above Ft. Jack Hackett 14:43, 19 November 2005 (UTC)
replies: text: So what you're saying is that the Breggin article can't stay because you don't like it.  The Breggin article specifically deals with the brain damaging effects of electroshock so what's the problem?  Francesca Allan of MindFreedomBC 03:39, 2 December 2005 (UTC)

text: Who are you to decide whether or not a reference can stay in?  It's a great article.  It's very informative and raises troubling questions about electroshock and this wikipedia article is about electroshock.  Please clarify your position or back down.  Francesca Allan of MindFreedomBC 03:43, 2 December 2005 (UTC)
thread_title:  Cites needed 

message: HI!
I just thought, that Requiem for a dream does not need to be mentioned, since ETC is not so apparent there (only administered at the very end, and the long-term effects are not visible). When cleaning up the article, I think this example can be taken out. "One flew over the cuckoo's nest" and "The bell jar" are the most prominent examples, and they well deserve to be noted. Just an idea - didn't want to edit the article, in case you people object. Please write "oppose" or "in favor" below. --Msoos 10:40, 12 October 2005 (UTC)
thread_title:  Requiem for a dream 

message: I removed the following, not necessarily because it is wrong but because it is speculative enough to warrant scrupulous sourcing:
Relationship of ECT to Religious Practices for Inducing Ecstatic Seizures
   
The efficacy of ECT for treatment of severe depression have led some to speculate that the seizures observed in some forms of ecstatic religious practice, e.g. among the Holy Ghost, Slain in the Spirit, Shakers, Pentecostals, Shamanic, and Kundalini Yoga practitioners, are serving a similar function in relieving symptoms of depression. Those who support this view theorize that the evolution of such seizure-inducing practices, which is widespread among the world's religions, may have been selected for by an accidental process but remain as cultural traditions due to the emotional benefit the practitioners feel they receive. Some feel that candidates for ECT might benefit from participating in such religious practices if they have a prior religious predisposition.
While it sounds interesting and probably factual, it is unsourced and fairly speculative. Comments? JFW | T@lk 10:24, 21 October 2005 (UTC)
thread_title:  A wild paragraph 

message: A lot of the sources quoted in the text are not actually properly referenced. Only the Blumenfeld ref is there (in the external links section), and the Abrams reference does not even have an antecedent in the text. I could do with some help in fixing this. Any ideas on whether we should be using footnotes for this? JFW | T@lk 10:37, 21 October 2005 (UTC)
thread_title:  Sources 

message: withdrawn. etc.org does not allow posting of this here... sorry Ft. Jack Hackett 16:11, 22 November 2005 (UTC)
thread_title:  Patients' views 

message: There is a big problem here. It's called WP:CITE. The article contains numerous Harvard-style pointers at references but.... there are no references at the end of the article. This is serious. We can't expect every reader to go to the PubMed site and dig for hours to find the correct material. I've added the original Cerletti paper (1938) as a starter, but someone really needs to find the Surgeon General's original article and copy whatever references are mentioned into this article. JFW | T@lk 19:40, 5 December 2005 (UTC)
thread_title:  CITE 

message: The problem of psychiatry lacking "informed consent" is self-evident from mental health legislation.  Patients are offered the choice of treatment.  If they refuse, they're deemed incompetent and consent is dispensed with.  In British Columbia, this is called "deemed consent" and what it means in plain English is "no consent."  Similar problems exist across Canada and I'm quite sure it's true in many states of the USA.  Could you please explain why you tolerate such a double wiki-standard?  Anything remotely anti-psychiatry has to be backed up (and even then pro-psychiatrists complain about the validity of the references) but psychiatrists are allowed to blather on about any highly improbable information they care to without fear of contradiction.  I was under the impression that we were getting along quite nicely, JDW, so please don't let me down.  Please endeavour to hold both sides to the same standard.  Anything less is highly POV.  Francesca Allan of MindFreedomBC 02:00, 6 December 2005 (UTC)
replies: text: I'm not letting you down. I'm just mindful of our verifiability policy. The statements on bypassing consent can be reintroduced without rewording if it gets a source. Possibly you could contact Dr Kaloff's secretary and request where it will be published. JFW | T@lk 02:33, 6 December 2005 (UTC)

text: You may actually have better sources than me on this subject. I'm speaking from experience in The Netherlands, where legislation is very much against forced treatment. Are you aware of any comparative studies between the laws of various jurisdictions in regard to involuntary treatment? JFW | T@lk 05:16, 6 December 2005 (UTC)
replies: text:  Francesca, in Ontario and Quebec ECT can only be given if either the patient or a substitute decision maker consents to it since it is not an emergency procedure.  I'm not sure about the legislation in BC but I'd be quite surprised that it would be much different from the legislation here where the only situation where treatment can be given without such consent (again from patient or SDM) is in emergency situations (e.g. sedation of a patient suffering from psychosis who is acting violently) djheart 05:43, 6 December 2005 (UTC)

text: But should Wikipedia turn into a battlefield because of the situation in BC? Honestly, I'm warmly in favour of representing the issue of forced treatment accurately, but not if this leads to problems of balance. I'm unfamiliar with the legal status in the US and Canada, but the Netherlands have fairly strict rules for prolonged involuntary confinement in closed units and involuntary treatment. In the UK, the basic requirements for involuntary treatment appear to be less strict, although I have not worked in psychiatry here. JFW | T@lk 15:42, 6 December 2005 (UTC)

text: I meant strict from the point-of-view of the psychiatrists, i.e. the patient had to satisfy specific criteria and a judge came to the unit to meet with the doctors and the patient. JFW | T@lk 22:50, 7 December 2005 (UTC)
thread_title:  JDWolff, please. 

message: You made the following edit summary:  "Controversy - removed spamlink, CCHR is a front for the Church of Scientology, so it is not NPOV."
I'm curious.  Although I am no fan of the Church of Scientology, I'm wondering about your logic here.  Why is CCHR POV?  NAMI, by way of comparision, is a front for Big Pharma but I'm sure you'll happily allow references to NAMI.  Just wondering about the double standard.  Please explain, if you can.  Francesca Allan of MindFreedomBC 04:04, 13 December 2005 (UTC)
thread_title:  Rsabbatini 

message: What kind of torture is this?  I know a woman who is having this procedure.  She has no idea why she agreed to this, no idea if it is effevtive {she dosn't think so}, no idea how long she will be subjected to this crime.  Her doctors give her very little info as they believe she won't understand. When we first met 2 years ago she was bright, bubbly, and vivacious. Now she's broccoli. This is a sick procedure and so are the people who perform it.  "Faces Off" —Preceding unsigned comment added by 65.147.117.234 (talk • contribs) 
One presumes from your comments that you feel the proceedure is unwarrented, but has the person concerned not got a mental illness ?  Might not the mental health illness in itself be the cause of the changes you observe ?  If ECT is being used, were other treatments tried first (most psychiatrists would prefer the simpler task of writing out a presdription for a drug and letting the patient self-administer their treatment), if so were they not effective ?  For the patient to have "no idea why she agreed to this" she needs disagree that she has a mental illness, no idea if drugs previously used, no idea if she felt better on any previous drugs given. I suspect ECT was not given to a person who was completely well for no reason... David Ruben  Talk  00:09, 21 January 2006 (UTC)
thread_title: Comment

message: Please provide full citations, especially when making controversial assertions. --JohnDO|Speak your mind  22:18, 20 January 2006 (UTC)
thread_title: Citations

message: Hiya, this is Thor from the Counter Vandalism Unit of Wikipedia.  I have reverted yet ANOTHER anonymous edit by an IP user on the section of this page where NPOV is disputed.  The report made is now being listed with my superiors and I will make sure than any anonymous edits to this page which breach NPOV standards, will be reverted without further recourse to the editor.  Please make sure your edits to this page conform to NPOV.  Thanks  Thor Malmjursson 00:44, 21 January 2006 (UTC)
thread_title: Information Re: Based Edits to this page

message: The citations thus far reviewed are a mixed bag. There are some interesting studies that indicate some possible long term anatomical effects. There are anecdotal reports, public testimony, and case reports. The most controversial assertions are not well supported. 
*that the ECT machine industry monopolized funding - citation is court testimony
*every long term study has confirmed permanent memory loss - 3 citations, one unavailable, the second is here, and the third is a name/date. This statement seems to be original research.
*that at least one-third of ECT patients experience permanent memory loss - see text. This does not distinguish between retrograde memory loss which is acknowledged to be a common complication in the original text, and the implication of anterograde memory loss which tests have proven does not get permanently impaired.
*ECT causes permanent neuropsychological deficits - citation is a fda docket
*ECT causes a >30 point IQ loss - citations are 2 public testimonies and a book by an ect patient.
*that Anesthesia and muscle-paralyzing drugs increase the risks of the procedure and thus its mortality rate - of the 3 citations, one is not available, and the other 2 are name/dates.
In essence, the most controversial assertions are very sparsely supported.  
P.S. It is not customary for the other editors to have to vet sources. It is customary to do your own searches and provide links.  --JohnDO|Speak your mind  07:39, 22 January 2006 (UTC)
replies: text: All material that does not satisfy WP:CITE may be removed. If you can't find a source, how are others supposed to? JFW | T@lk 08:27, 22 January 2006 (UTC)
thread_title:  Regarding citations 

message: There is clearly a double standard here. The original text does not meet Wikipedia quality standards; it is copied, word for word, from the Surgeon General's Report, a highly POV souce (I would like to post the criticism of the Report from major national organizations and news media, which would require typing them in since I have no scanner and cannot find links, but this is a very important point.)
Is that allowable, or is it plagiarism?
Which leads to the second problem. There were only THREE citations for the whole article before I came along, which means nearly all references were not cited! Yet no one complained, no one said they needed references, and there are still NO references for any of these cites. 
Does that not violate quality standards? 
I understand why the copier of this article could not provide references, because they were only copying the Report word for word and did not have the references, but that does not mean that they don't have to provide them!
Meanwhile, while I have provided detailed citations, they have all been deleted, with commentary that is extremely inaccurate and biased IN FAVOR OF ECT, for instance, a peer reviewed article is said, without any foundation or evidence, to be "from an anti ECT Group" which is ridiculous! It is not. 
In short, any kind of sloppy article involving possible plagiarism or at least word for word copying without quotes, and without ANY citations, is acceptable----as long as it is favorable to ECT; however, anything thought, without any reason or evidence (and by WHOM?) to be anti-ECT (Whatever that means)
doesn't need to have any citations at all!
No matter what your opinion on ECT (which should not enter into this) you should be able to see that there is a double standard here and an article that does not meet quality standards.
Either EVERY cite must be referenced or else deleted, or it must be permissible to cite without ANY references (which the majority of the article is). 
The commentary on my references follows the same pattern, with articles in peer reviewed journals that have stood the test of time and been cited countless times being dismissed as not "real articles" apparently simply because someone thinks they aren't favorable enough to ECT.
Also, just because a source is not available online does not make it a "worthless" source. Someone called the FDA docket on ECT this. This docket predates the agency's putting its records online, and it is not online, but it is a public access document that anyone can read in hard copy. Please, by what standard are the FDA---every bit as much part of the government as the SG or NIMH---findings worthless? Only, apparently, by the standards that someone here thinks---without bothering to read it---that it's not sufficiently adulatory about ECT.
Again, the same standard must apply to everyone and every article. No edits and no article should be subjected to some kind of de facto sniff test by someone who obviously has an agenda to promote ECT. And why is this person in charge of this page, anyway?
I may not be the most computer literate person but I do know the literature on ECT.
The issue of financial conflict is critical. There are many ways to verify that authors have financial conflicts of interest which is absolutely material to evaluating their work. I have suggested three. Some, but very few, authors disclose their financial conflict (Abrams, cited here without any discussion of his ownership of a shock machine company, is one) but none disclose it within their articles themselves. 
The vast majority of the cites which appear here without references (almost all that I did not put up) are by financially conflicted authors, and there is proof of that. 13 of 17 references in the ECT section of the SG Report (which was simply copied here word for word) are to financially conflicted authors. Why does Rudorfer appear so many times, who is he, some famous researcher? Not at all. He was the editor of this section of the SG report, and cited to himself more than anyone else on earth because he could. I realize you people did not know that. But now that you do, how could anyone call the Report a NPOV document that should be cited here word for word with claims of neutrality?
Does anyone here disagree that financial conflicts of interestare important for readers to know and for the authors of this article to tell them?—The preceding unsigned comment was added by 209.122.225.79 (talk • contribs) .
::As is apparent here, I had already agreed that the article was deficient in citations and that it must be remedied. In fact, it was the last post before your message here and cleanup and citation needed tags had already been placed in the article. Find a good source for the financial conflict and it goes in, but the language has to be NPOV. And you should try to assume good faith, the reasons for the criticism of individual sources were given. And I assume you are speaking of me when you said someone who obviously has an agenda to promote ECT. And why is this person in charge of this page, anyway?. This kind of attitude is counterproductive and may constitute a personal attack which will significantly reduce your credibility here. No one here has any nefarious agenda. I am not a psychiatrist and do not use ECT, nor am I affiliated with any ECT company. I, like the other editors, am only interested in making this article accurate and NPOV. Frankly a number of your sources (video depositions, court testimonies, patient books) are not good citation sources to support medical claims in a scientific article. The documentation that I could find regarding the FDA docket revealed a conclusion that regulations regarding ECT machines would not be changed. This is not a reputable source to support allegations of permanent neurological deficit caused by ECT. And despite your allegations The commentary on my references follows the same pattern, with articles in peer reviewed journals that have stood the test of time and been cited countless times being dismissed as not "real articles" apparently simply because someone thinks they aren't favorable enough to ECT, the majority of your citations were deemed legitimate. Only 3 of your articles in peer reviewed journals    were questioned as "not real articles", and the reasons were given, generally for lack of pubmed citation. And it is the responsibility of every editor including yourself to do a "sniff test" if someone starts doing massive edits of articles and includes information that is controversial and contrary to accepted knowledge. Frankly, the amount of effort that was expended to vette your sources was unusual, something you don't seem to appreciate. That effort should have been done by the editor inserting the sources. Typically articles are reverted until new additions are vetted. However, I do thank you for providing those sources, but I am troubled by your accusatory tone, and your instant reversion of the article despite good faith efforts to incorporate information from your sources.--JohnDO|Speak your mind 03:08, 24 January 2006 (UTC)
replies: text: P.S. please sign your posts, it helps us figure out who is saying what.--JohnDO|Speak your mind 02:14, 24 January 2006 (UTC)

text: You found the discussion tab? Hurrah! :-) Kim Bruning 02:06, 24 January 2006 (UTC)
thread_title:  double standard here 

message: Once again, I am new to all this. So please be patient. I am coming in and seeing so many inaccuries in the article, it was all I could do not to change it all at once! 
Instead I took the one section that had been copied (or plagiarized, because there are no quotes) from the SG report, a very biased (pro-shock) POV document. There lies the problem, for some reason this article starts with a very strong POV, which no one is acknowledging because after all, they didn't write it, just copied it. 
I don't understand how one person "edits" this, I thought we all did. Apparently there is someone who is a doctor who volunteered? Was chosen? to have final say over this article? How does that happen?
I am assuming he wasn't chosen because of expertise in ECT. 
What is meant by "vet"? Is there a rule that this one person, the editor, has to read every reference? And does he get to judge them all by himself (highly problematic, in my opinion?) 
Clearly this person is not the owner of a shock machine company---but I have been involved with ECT long enough to know that even rank and file doctors react very strongly to anything but the APA's party line on ECT. It is as if when you examine ECT closely, you are holding the entire enterprise of psychiatry up to scrutiny, and any "criticism" of ECT will bring it all down. This is not rational, but I've seen it enough to know it's common.
In any case, Dr. Editor, if there is a rule that you have to read every reference, it is not the case that any of mine are inaccessible to you. They are accessible to anyone. You can get them at a medical library; or in the case of the FDA, at the FDA; or in the case of court hearings or legislative testimony, by ordering the transcripts. 
Thanks for clarification and your patience.
Doogs (anon)
:Please take the time to read the talk page and the discussions above. It should be readily apparent that 4 editors (, , , and ) have reverted your edits, and 2 were involved in checking your sources. Your allegation that one person "was chosen? to have final say"  is inaccurate to say the least.  No one is final arbiter of content. We are supposed to reach a consensus as to content according to the policies of verifiability, no original research,and neutral point of view, something that you have not done as of yet. Again, you should try to assume good faith rather than allege conspiracy. And you should refrain from characterizing other editors' actions as irrational. I am not a psychiatrist and have little stake in their legitimacy. We are all editors who are interested in creating a good article. Again, it is my contention that a number of your sources (FDA dockets, court hearings, legislative testimony, a book by a patient) are inappropriate as citations supporting specific side-effects. --JohnDO|Speak your mind 07:02, 24 January 2006 (UTC)
replies: text: Anyone can edit any page as long as they reach consensus with the other people who have decided to edit that page. "Vetting" is the process of determining accuracy of sources according to wikipedia policy:verifiability. --JohnDO|Speak your mind 21:25, 25 January 2006 (UTC)

text: Admins can ban. I am not an admin, I can't speak for the others. You are mistaken in your assumptions.--JohnDO|Speak your mind 05:17, 26 January 2006 (UTC)
thread_title:  Editors,"vets", POV 

message: Perhaps I should take this a little slower, a piece at a time.
Every single "fact" we know or think we know about ECT is influenced by the research or lack of it. In the case of ECT, it is more the latter case. 
There are some very critical aspects of ECT that simply have never been researched, and some that have been very inadequately researched, and this all relates directly to the financial conflicts of a few key men who have a lock on the research money. 
(In my edit I did not say that these financial conflicts cause the lack of research, for instance, the dearth of long term studies; I said, quite accurately, that the time period when there have been no studies correlates with the time period when research money has been in the hands of men who work for the shock machine companies. This is not a POV statement, but a factual one.)
So, what do you tell patients, or the world in this Wikipedia, when formal research data simply isn't there? You tell them the data isn't there, and because these are such important things to know, you use the best available evidence that exists.
Take IQ. It is extremely important for patients and families to know whether ECT can permanently lower IQ. This has not been studied. However, what you can say, and what I did say, was that former patients have reported extreme (30+ points) loss of IQ, and that they did not only just say this, but they backed it up with neuropsychological testing, and that the some of the results of this neuropsychological testing have been submitted to the FDA, where they can be viewed by anyone by going in and reading the docket. 
Is this "too anecdotal"? I cited testimonies given at formal public hearings, transcripts of which are available to anyone. I did not cite someone going on a talk show and saying, Oh, ECT lowered my IQ. In fact, I could have cited to Philpot on this point, because approximately 40% of ECT patients in their study reported that ECT lowered their intelligence; however, those patients did not, as far as we know, have formal IQ testing done, which the others did. 
Until there is a study done, which in my opinion will not be done until (unlikely) someone wrests the available research money away from those who've had it locked up for 20 years, this is the best evidence we have, and it is important to cite to it.
Interestingly, there are two studies which incidently (as part of studying something else) mention IQ and claim to have tested it, but the scores of the patients were never reported, only means of the whole group, which makes it impossible to see whatever individual differences there were.  However, it is possible to tell in one of these that pre ECT there was a patient who scored 127, and afterwards the highest score was around 100. 
I think it is very important to keep the IQ part in, and use the best available cites that exist. 
One is a "patient book", but remember, the APA does highly regard and recommend "patient books" in its ECT guidelines---as long as they are adulatory of ECT! They do not discredit books written by former patients or say they are unreliable sources.
And this one was published by Random House, so one must assume author credibility.
:Anecdotal does not refer to whether the patients were sworn in. Anecdotal refers to lack of bias control and controls. Patient reports do not demonstrate causality. Until there is research done that demonstrates causality between ECT and loss of IQ, that does not belong in a scholarly article. If you want to say that patients have reported IQ loss but this has not been proven by studies, that seems acceptable. Whether the APA recommends "patient books" is immaterial. We are not going to use pro-ECT patient books to support causality regarding  "lack of side-effects" either. Neither use demonstrates causality. Looking at the book's contents, it contains anecdote and some research. The research within can be cited independently and the anecdote does not demonstrate causality. --JohnDO|Speak your mind 07:08, 24 January 2006 (UTC)
replies: text: Read the policy in its entirety especially as regarding science and medicine articles. --JohnDO|Speak your mind 05:14, 26 January 2006 (UTC)
thread_title:  The best available evidence 

message: Sorry i have forgotten my password. will correct this later. I just looked for some pmids, its a lot of work and i think it is not worth doing it. Greetings Andy.we -- 62.180.225.190 16:56, 26 January 2006 (UTC)
thread_title: Anonym edits from Andy.we

message: Wikipedia guidelines are just guidelines. If we're dealing with an editor who doesn't know them, explain them first. Or just skip the guidelines and use common sense. :-P
Ignorance is an absolute defence around here, as long as people edit articles in good faith. 
Yes it does take some extra long breath and so, but well, some good has come of this already. 
So I'm advocating patience. If no progress whatsoever is made in a weeks time from now, drop me a line, and we'll have to block. But it looks like some progress has been made. Or am I just imagining? :-) Kim Bruning 18:59, 26 January 2006 (UTC)
replies: text: When a user edits a page there is a comment under the edit box "Content must not violate any copyright and must be verifiable. You agree to license your contributions under the GFDL." Just as much as content has to be GFDL compliant, it has to be verifiable. Repeated ignorance of policy despite several reminders is not excusable. And WP:CIVIL is common sense. JFW | T@lk 21:05, 26 January 2006 (UTC)
thread_title: Stay cool

message: I recently reverted 2 edits related to Scientology. Dianetics has no specific relevance to ECT. Please see Scientology and psychiatry, which is linked off of Psychiatry already. N6 01:06, 1 February 2006 (UTC)
replies: text: OK. I had only tried to make it more NPOV and placed in the paragraph that started off talking about anti-psychiatry (which seems appropriate for any scientology viewpoint), but deletion of the reference is fine by me. David Ruben  Talk  01:11, 1 February 2006 (UTC)

text: If you have been helped, then good :-) any form of support/therapy/psychology that helps people either manage better or cope with  problem more effectively is to be welcomed, but single anecdotes don't consitute proof of action verses natural resolution over time/good luck/placebo effect. However Dianetics is a minority viewpoint. I would be the 1st to admit psychiatry is far from perfect in its understanding, assessment of patients, application of best treatment or careful monitoring & ongoing support for patients. For the majority of those who have just very mild disorders it probably makes little difference what treatment option is used, as the absolute effects of success or failure in treament are of relatively little importance. However scientology's general complete rejection of psychiatry, however extreme the apparent psychosis, makes the majority of medical opinion see dianetics as potentially dangerous.  This is really a debate over the psychiatric & psychologial (scientology) models and I'm sure is fully debated/edited in the relevant articles. This article though is about ECT, what it is, methodology of application, history, selection of patients - discussion of Dianetics is inappropriate to this article, as would discussion on counselling for mild psychological distress, choice of SSRIs for depression, etc etc. David Ruben  Talk  17:42, 1 February 2006 (UTC)
replies: text: Hmm... OK... I can't say, that Dianetics helped me, because it was inapplicable in my case (according to a GERM Dianetics Centre), because I have been treated intensely psychiatrically (~4 months) and possibly even with ECT... The Dianetics-idea just feels better (I am aware, that I do not always know the truth)... :-) --213.54.75.173 19:38, 1 February 2006 (UTC)

text: Does anyone want to say something about "Who spread ECT in U.S.A?" or "Are we sure, that we really want it?"? --213.54.75.173 19:38, 1 February 2006 (UTC)
thread_title:  Dianetics 

message: The problem with this article is that it started out so POV that it is  now difficult to tidy up in such a way that it flows and reads easily.  It should have started off the other way around, by describing the current situation as it exists - today -  in the real world. Then us old fogies could have added the history to explain how the present situation came about. Then, those young whippersnappers, with minds free and unencumbered by the dogmas of yester year (and who maybe critical of the present methods etc.), can spend their time referring  to sources that point to the future direction that this treatment modality might take.  
    
That, would then be the time to start looking for errors, omissions,  woolly thinking, et cetera, et cetera, et cetera.    --Aspro 18:31, 18 February 2006 (UTC)
thread_title: Phew!

message: I've removed the phrase "(though not always adhered to)" as no citation was ever given.  I've also reorganized the material in the section to make it more readable and (hopefully) less POV.  Lastly, I've removed the section: 
    
In most cases of depression, the benefit-to-risk ratio will favor the use of medication and/or psychotherapy as the preferred course of action (Depression Guideline Panel, 1993). In cases where medication has not succeeded or is fraught with unusual risk, or else where the potential benefits of ECT are great, such as in delusional depression, the balance of potential benefits to risks may tilt in favor of ECT.
for several reasons:
* it doesn't have anything to do with informed consent
* it has been covered elsewhere in the article
* it borders on giving medical advice, which Wikipedia should not be doing. --Scot →Talk 14:40, 4 March 2006 (UTC)
thread_title: Informed Consent

message: I created a new section for this, as it was diluting the "Controversy" section.  I added a note about the ECT depicted in "One Flew Over The Cuckoo's Nest" being unmodified.  I also moved the excellent Hemmingway quote to be after his name in the "Famous People" section.  --Scot →Talk 15:26, 4 March 2006 (UTC)
thread_title:  Cultural Depictions section 

message: This section is a real mess -- I'm going to start digging into it.  My procedure will be thus:
*Based on the excellent vetting work done previously by several contributors, plus any further vetting work I'll need to do myself, remove any references which do not meet standards of acceptability.
*Clean up the references by putting them all in the Cite.php style, which will make the section at least readable.
*Remove any statements which end up unreferenced, or which are inappropropriate for the section for whatever other reason.
*Do a flow and readability edit on the text.
*See what we have left.  
This may take a while.  Scot →Talk 05:14, 21 March 2006 (UTC)
thread_title:  Cleaning up the Side Effects section 

message: I changed the text to say ECT instead of electroshock for the following reasons:
*'electroshock'
**Is Ambiguous on wether it's about using electricity to induce a state of shock or just using an electric shock.
**Does not describe the intents and purposes of the practitioners.
**Is not the mainstream term of use.
-Sinus 12:13, 27 March 2006 (UTC)
thread_title:  'Electroshock' changed to 'ECT' where appropriate 

message: Is there a protocol regarding the latest edit (19:30, 28 April 2006 151.201.158.242 (→External links - Reordered links, annotated CCHR link)?
It seems to me that "reordering the links" involved moving the CCHR to the head of the list and "annotated CCHR link" involved removing the link to scientology - which strikes me as deliberately misleading. The organisation is run by the Scientologists, and it seems to me that link is an important one to make in an article about a hotly disputed area of psychiatric practice given that the CCHR have called psychiatrists "Professional Rapists, Pervert [sic] and Pedophiles" (see CCHR for the reference).
I think this should be reverted.
Nmg20 23:10, 1 May 2006 (UTC)
thread_title:  Reordering, annotations 

message: Kwertii - may I suggest that some of your recent set of edits (the four on 13th May 2006) undo what I, for one, thought was an excellent set of edits by Gleng in terms of making the article more NPOV.
There are two bits which I'd take issue with:
"While many psychiatrists believe that properly administered ECT is a safe and effective treatment for certain conditions, a vocal minority of pyschiatrists, former patients, antipsychiatry activists, and others strongly criticize the procedure as extremely harmful to patients' subsequent mental state."
*Many people besides psychiatrists believe ECT is a safe and effective treatment for certain conditions - specifically, an awful lot of people with mental illness and their carers do. It is wrong to suggest, as this sentence does, that it's only psychiatrists who back it.
*It's certainly true that the vocal minority you mention do criticise it - but that's implicit in the fact that it's controversial, which is stated in the first sentence of the article. Mentioning this vocal minority in the introduction to an article, before the history, nature, and purpose of ECT have been mentioned, is unnecessary - this belongs in the "Controversy" section, IMHO.
"When it was still in common use, the ECT procedure was sometimes abused by unethical mental health professionals as a means of punishing and controlling unruly or uncooperative patients."
*Can this claim be sourced? If not, I suggest Gleng's "and in some cases it is alleged that it was also used for disciplining unruly psychiatric inpatients" is both more accurate and more NPOV.
Thanks,
Nmg20 00:48, 14 May 2006 (UTC)
thread_title:  Edits by Kwertii 

message: Siney2 claims in the description of his recent edit (18th May 2006) that the part removed is untrue, and therefore that the patients depicted in One Flew Over the Cuckoo's Nest receive ECT with muscle relaxants. To anyone who has seen someone having ECT with muscle relaxants, it's clear that the ECT in the film is unmodified, and this is supported by countless websites:
http://www.bipolarworld.net/Treatments/Treatments/tr8.htm
"The old method of performing ECT - without muscle relaxants or drugs to induce sleep - is what is responsible for the unfavorable reputation given to ECT. A great deal of anti-ECT sentiment was generated by its unfavorable depiction in the 1975 movie One Flew Over the Cuckoo's Nest"
http://www.healthyplace.com/communities/depression/treatment/ect/index.asp
"When we think of ECT many of us recall the terrifying image of Jack Nicholson in “One Flew Over the Cuckoo’s Nest”. This is not an accurate portrayal of the present day application of ECT. Certainly, before the development of effective muscle relaxants, it was not unusual for patients to suffer broken bones as a result of these electrically induced seizures."
http://www.tmcrew.org/stopshock/post.htm
"There is little dispute that ECT administered before the late 1960s, commonly referred to as "unmodified," was different from later treatment."
(Ken Kesey wrote his book in 1962 and was in Menlo Park before 1960)
If Siney2 can find a credible source supporting his claim, I'd like to see it. Otherwise I propose to revert his edit in a day or so.
Nmg20 19:28, 18 May 2006 (UTC)
thread_title:  Latest revision by Siney2 

message: I've deleted the section on use with other medications. There are two issues here, first it is unreferenced, second it seems to be offering specific medical advice. I think it's best avoidedGleng 11:14, 20 May 2006 (UTC)
thread_title: "Advice" and boundaries of article

message: I've put in proper references, and cleaned these up as follows:
*Barker & Baker 1959. Corrected the spelling of the first author's name.
*Novello 1974. Removed - this is an article on psychiatric referral, not on ECT, and while I've been unable to trace it online or in the KCL archives, I find it so unlikely that Novello was genuinely making claims about anaesthesia and mortality in ECT in an article which had nothing directly to do with treatment that I've removed it.
*Impastato 1957. Added link to the study referenced.
*Corselis and Meyer, 1954. Removed this. I assume it is meant to be "KOHLER W, MEYER F, BLENDINGER G. [Convulsive therapy and spontaneous epileptic seizures.] Nervenarzt. 1954 Jun 20;25(6):225-32. German." - regardless, there are several Meyers on Pubmed writing about ECT in 1954 (there are no "Corselis"es anywhere), but the reference as it stands is wrong. Were I able to get hold of the article and read German I would decide if it merited correction - but I can't and I'm not quite there, so I'm removing it until someone who's read it can confirm it does what it's meant to here.
*Madow, 1956. The full reference is "MADOW L. Brain changes in electroshock therapy. Am J Psychiatry. 1956 Oct;113(4):337-47." The abstract is available online <url>http://ajp.psychiatryonline.org/cgi/content/abstract/113/4/337</url>, and this series of four postmortem studies of patients who died during ECT found that only one of four died of cerebral causes.
*Maclay 1953. The full reference is "Maclay WS. Death due to treatment. Proc R Soc Med. 1953 Jan;46(1):13-20." I have no way of confirming it's what it says it is, but it remains.
*Matthew and Constan 1964. There are three papers from this year which this could be, titled "PHARMACOGENETICS IN PRE-ECT MEDICATION.", "COMPLICATIONS FOLLOWING ECT OVER A THREE-YEAR PERIOD IN A STATE INSTITUTION.", and "RUPTURE OF ABDOMINAL VISCUS: A SURGICAL COMPLICATION FOLLOWING ELECTROSHOCK THERAPY." Predictably, none are available online, so I have removed the reference for now. I would of course be happy for whoever included it originally to confirm which paper they meant and include the full reference - all three are on pubmed searching for "matthew constan".
*Barker and Barker 1959. Removed. This is another mis-spelling of the first paper in this list, so I have left it in there on the basis that the same paper should probably only appear once in a list, ideally spelt properly.
*Hartelius 1957. The full reference is "CLEMEDSON CJ, HARTELIUS H, HOLMBERG G. The effect of high explosive blast on the cerebral vascular permeability. Acta Pathol Microbiol Scand. 1957;40(2):89-95." The title suggests this is about vascular permeability and not about brain injury - but I've left it in under duress. I would like to remove it at some point unless someone can confirm quoting the article that it finds an association or reports on a patient who suffered brain injury.
*Heilbrun 1946 (and similar). There are both Heilbrun s and Heilbrunn s on Pubmed - neither have anything available from the 1940s. These have stayed in despite being sixty years old.
*Mckegney & Panzetta 1963. The full ref is "MCKEGNEY FP, PANZETTA AF. AN UNUSUAL FATAL OUTCOME OF ELECTRO-CONVULSIVE THERAPY. Am J Psychiatry. 1963 Oct;120:398-400." While it's clear from that that even then death was unusual, it's far from clear that it was a cerebral death.
In short, the quality of citing of these early sources is the issue, not the sources themselves (necessarily). I suspect that someone has looked for "ECT" and "death" and has listed everything, leaving those attempting to defend the procedure to do the actual work of finding the proper references and critically assessing them. I will resist as strongly as possible, therefore, any attempt to list further papers without evidence they have been read and understood, and without proper referencing.
Nmg20 22:03, 22 May 2006 (UTC)
replies: text: It's Corsellis with 2 "l"s. He was a British neuropathologist and did indeed publish an article about ECT in 1954. Staug73 15:46, 26 May 2006 (UTC)

text: The pubmedid is 13175001. But it is already in the bibliography to the article, although with a small spelling mistake in the title (it should be convulsant, not convulsive). The Journal of Mental Science, by the way, is what the British Journal of Psychiatry used to be called.Staug73 21:44, 26 May 2006 (UTC)
thread_title:  References in the controversy section