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Electroshock therapy has long suffered from a controversial and bizarre public image, effectively removing it as a treatment option for many patients. In Electroshock, Max Fink, M.D., draws on 45 years of clinical and research experience to argue that ECT is now a safe, painless, and sometimes life-saving treatment for emotional and mental disorders.
Dr. Fink traces the development of ECT from its discovery in 1934 followed by widespread use for two decades, to the 1950s when it was largely replaced by the introduction of psychotropic drugs, to its revival in the past twenty years as a viable treatment. He provides actual case studies of patients who have been treated with ECT and illustrates that many disorders--such as depression, mania, catatonia, and schizophrenia--respond well to it. As he explains the whole procedure from preparation to recovery, we see what the patient experiences. Fink also shows how anesthesia and muscle relaxation have refined ECT, minimizing discomfort and reducing risks to a level far lower than those experienced by patients using psychotropic drugs routinely prescribed for the same problems.
Clarifying the many misconceptions surrounding ECT, Electroshock is an excellent sourcebook for patients, their families, and mental health professionals.
- Sales Rank: #2510671 in Books
- Published on: 2002-12-19
- Original language: English
- Number of items: 1
- Dimensions: 5.20" h x .50" w x 7.80" l, .32 pounds
- Binding: Paperback
- 176 pages
From The New England Journal of Medicine
In this book, Dr. Max Fink has made another important contribution to patients and physicians by filling the gap between standard patient-education materials on electroconvulsive treatment, most of which are dated as compared with information available at www.electroshock.org or other Web sites, and the specialized literature. Electroshock is written in language that will be easily understood by laypersons, and the supplemental notes and references will be very informative for primary care physicians who treat most of the depressed patients who should be referred for electroconvulsive treatment when standard medication is ineffective.
Psychiatrists unfamiliar with electroconvulsive treatment may be embarrassed to discover that concern about its risk is greatly exaggerated and that relapse after electroconvulsive treatment indicates a need for maintenance treatment, not a lack of efficacy. Even authorities on drug treatment are puzzled by the broad spectrum of efficacy of electroconvulsive treatment. For example, all antidepressants can cause mania, but only electroconvulsive treatment can treat it, and no antidepressant drug has been shown to be as effective as electroconvulsive treatment for treating schizophrenia. In bipolar disorder, electroconvulsive treatment is often effective when mood stabilizers fail. In treating catatonic states for which benzodiazepines are the best drug treatment, electroconvulsive treatment succeeds when these drugs fail. These findings do not fit with any data from the neurosciences on receptor mechanisms or second and third messengers.
After briefly defining electroconvulsive treatment and outlining its uses, Fink discusses the patient's experience. He then describes the risks and technical features of the treatment and the contraindications to it. There are chapters on each of the principal indications for electroconvulsive treatment: depression, mania, thought disorders, and movement disorders, which include catatonic states and parkinsonian rigidity. There is some speculation about the mechanism of action (which is unknown), a brief account of the fascinating origins of electroconvulsive treatment, and considerable discussion of how electroconvulsive treatment became controversial. Each of the clinical chapters contains detailed case reports, and some chapters also contain autobiographical accounts from the popular literature. These profiles reiterate the benefits of the treatment, the often tragic consequences of withholding it or using it inappropriately without consideration of the need for maintenance treatment, and the minimal medical risks and cognitive side effects with current practice. The discussion of informed consent for use in minors and incompetent patients is exemplary.
The negative feelings about electroconvulsive treatment evoked by the movie One Flew over the Cuckoo's Nest, based on the novel by Ken Kesey (New York, Viking Press, 1962), are still widespread, but most people, when faced with drug-refractory mental illness in a family member or themselves, realize that the movie does not reflect reality. A more important contribution to the decline in the availability of electroconvulsive treatment in this country was an influential report by the Group for the Advancement of Psychiatry, published in 1947, that stressed its overuse. This accusation was based on the now absurd idea that because all mental illness could be treated effectively only by psychotherapy, any other intervention might interfere with the patient's working through the underlying psychological issues. The frequent two-to-three-week period of confusion associated with electroconvulsive treatment at this time supported this idea. Further criticism came from the now discredited works of Thomas Szasz and other "antipsychiatrists."
Despite the advent of effective pharmacologic agents, psychogenic theories of mental illness remained prominent until the mid-1970s, and the use of electroconvulsive treatment was considered to be an indication of inadequate psychotherapy. The more economically pragmatic Church of Scientology viewed electroconvulsive treatment as a threat, regularly demonstrated against its use, and spearheaded severe legislative restrictions in California. The legislatures of Colorado, Tennessee, and Texas have banned electroconvulsive treatment for suicidal adolescents. Similar bills are pending in Arizona and Vermont. Uninformed criticism was also recently evoked by the leaking of a draft of the surgeon general's favorable report on electroconvulsive treatment.
Despite intensive pharmaceutical research, it now appears that the benefits of the new drugs for depression and schizophrenia are mostly decreased side effects and improved compliance; there is little increased efficacy in refractory conditions, which underscores the need for a trial of electroconvulsive treatment. Although new agents for bipolar disorder are more promising, the need for electroconvulsive treatment to treat refractory conditions remains.
My only concern about Electroshock is that the author is rather unfocused in his critique of psychopharmacologic treatment. The kernel of truth is that such treatment often harms patients by repeated switching or adding of drugs during refractory states owing to the unavailability of or ignorance about electroconvulsive treatment. Nevertheless, it would be unfortunate if some inaccurate or controversial details in the book were misused to justify failing to use electroconvulsive treatment when indicated. On the positive side, by increasing general awareness, the book should facilitate the restoration of electroconvulsive treatment to its appropriate place in contemporary psychiatric treatment.
Reviewed by Chester Pearlman, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
"Dr. Fink...writes about the use of electroshock in the treatment of depression, mania and schizophrenia, among other disorders. He cites numerous studies that he says demonstrate its effectiveness, its record in reducing the cost and length of inpatient treatment, and its ability to bring on antidepressant effects earlier 'and more robust than those of antidepressant drugs.' Dr. Fink's assessment is generally confirmed by the National Institute of Mental Health, which characterizes electroshock therapy as 'one of the most effective yet most stigmatized treatments for depression.'"--The New York Times
"In an America long besotted with psychotherapy, Max Fink carried an often lonely torch for the physical treatment of psychiatric disorders . . . . Electroshock is a slim volume, packing a punch of controversy."--Nature
"This book, clearly written, concise, and assertive, should help balance the picture, educating mental health professionals and the general public alike"--Forward Magazine
"Dr. Fink...writes about the use of electroshock in the treatment of depression, mania and schizophrenia, among other disorders. He cites numerous studies that he says demonstrate its effectiveness, its record in reducing the cost and length of inpatient treatment, and its ability to bring on antidepressant effects earlier 'and more robust than those of antidepressant drugs.' Dr. Fink's assessment is generally confirmed by the National Institute of Mental Health, which characterizes electroshock therapy as 'one of the most effective yet most stigmatized treatments for depression.'"--The New York Times
"In an America long besotted with psychotherapy, Max Fink carried an often lonely torch for the physical treatment of psychiatric disorders . . . . Electroshock is a slim volume, packing a punch of controversy."--Nature
"This book, clearly written, concise, and assertive, should help balance the picture, educating mental health professionals and the general public alike"--Forward Magazine
"Among many ECT books that cover similar content, this volume really stands out. It not only reviews evidence-based literature but also reflects the author's enormous amount of personal experience in taking care of severely ill and often treatment-resistant patients....This book is clearly written by a strong ECT advocate, but it presents a balanced view of concomitant treatment options and alternatives."--Ethiopian Reivew, part of DC's Health News Forum
About the Author
Max Fink, M.D., is Professor of Psychiatry and Neurology Emeritus at the State University of New York at Stony Brook and Attending Psychiatrist at the Long Island Jewish-Hillside Hospital Medical Center. He is the author of Convulsive Therapy: Theory and Practice, Psychobiology of Convulsive Therapy, and other books. He lives in Nissequogue, New York.
Most helpful customer reviews
22 of 27 people found the following review helpful.
Cautious, Not Unconvinced
By Lynroshel
I have some hesitation recommending a book on Electro-shock which is so clearly pro-ECT and does not review this very controversial subject with an objective eye, however, having said that, I believe it is a worthwhile book as long as it is read in conjunction with a book that seriously questions the value of ECT and studies the mechanism by which it is assumed to work. Dr. Fink gives some very clear and logical sounding reasons for choosing ECT, but he does not counterbalance these
with serious looks at the downsides of ECT. I am not an anti-ECT protester, nor an I a pro-ECT advocate. ECT does offer some valuable help to some patients, but, having had ECT myself, I also know that in the case of ECT, the cure can sometimes be worse than the illness. Memory problems are not the only side effect of ECT and Max Fink is remiss in not presenting patient accounts that tell the whole story. Would I choose ECT again? I don't know, (my recovery from ECT has been slow - 2+ years now), but I do know that I wish I had read both a book like Max Fink's ALONG WITH one that talked about the flip side of the coin. One more word of caution - Max Fink makes his living by pushing the ECT button many times a day. It pays better than "talk therapy" and takes less time to provide, so be cautious in viewing Fink's book as an objective or "outside" endorsement of ECT. And remember, that what works for one, may not work for another.
5 of 5 people found the following review helpful.
Memory loss IS a concern!
By John D, RN
Having suffered from treatment resistant major depressive dissorder for 20 years I am very gratefull that ECT is still used to treat depression. It has been very effective at ameliorating the symptoms, though it has not been a cure. Ironically, the tratment has caused other stresses in my life that have been as incapasitating, if not more so, than the depression itself (though far less painfull). The main side effect being memory loss. I was on dissability for 6 months and received a total of 52 treatments. Upon returning to work there were many of my co-workers that I was convinced I had never met before, depite having working with them for years. Now almost a year later, someone will come up to me and say hi, when they leave I think "who on earth was that". Luckily my memory for my job has remained relitivly intact as far as clinical skills, the computer is a whole different issue. I have lived in my home city since 1992, used to know it like the back of my hand. Now, if it were not for my GPS I would not get anywhere. Another problem has been time perception, I am allways late, no matter how hard I try. I am very gratefull that my ability to relearn lost knowledge has not been greately effected, it does take repition though. I returned to work March 31, 2011, having had my last treatment on the monday of that week. It is now December 25th. Durring that time I have been asked to take time off or go back on dissability four times. This has been a huge source of humiliation and frustration, it also goes to show that the side effects are not in my head, they are clear to everyone else. This has been the hardest year of my life.
Having said that, I have been told that my case is very unusual, and lately I can honestly say I have noticed significant improvements, noted by others as well. It is ironic, had I not had the ECT, I do not think I would have had the strength to have coped with its ramifications.
In no way do I regret havining the ECT, there were no other options and I was just about done. It saved my life. I only bring this up to point out that in my case at least, it was not a benign treatment. I hope I will never have to go through this again, but if I had to I would. I cannot bear the thought of suffering the way I did for so long.
Do not discount the very real and dramatic effects that ECT has to offer, but be aware that, for some people at least, memory problems are a possibility and it can be a real chalange to get your life back in order. However if you are at a point were there is no light at the end of the tunnel...what do you have to lose.
John.
31 of 42 people found the following review helpful.
A must-read book for families of new patients
By erichisaac@worldnet.att.net
This book fulfills a very important function: written by a foremost medical expert on ECT, it provides the lay reader with a brief, clear, up-to-date summary of this much maligned yet highly effective treatment. To this reader, the most valuable (and original) contribution of this book is its emphasis on continuation ECT. Fink gives repeated examples of individuals given ECT who responded, as the families put it "miraculously." But then, when the symptoms returned months or even years later, ECT was not used again. It was assumed to have "failed" because its effects were not permanent. But no one assumes that drugs have failed if they are taken and symptoms return when the patient stops taking them. Patients who have responded well to ECT have an excellent chance of responding again: many patients will do best if they are given ECT on a continuation basis but spaced far more broadly than at the initial crisis. There are two other particularly important contributions of this book. One is the discussion of the large variety of mental illnesses (not just depression) that respond well to ECT. The other is the encouragement it gives families to use ECT early in schizophrenia (where it is not rarely used at all, early or late). ECT used early in acute onset schizophrenia can not infrequently cut off the disease at the start, saving patients and their families a lifetime of torment.
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