The American Psychiatric Association Annual Conference 2015 and Silly Season

newer meBy Marvin Ross with an Addendum by Dr David Laing Dawson

This year, the American Psychiatric Association (APA) is having its annual conference in Toronto starting May 16 and, again, they are being picketed. While most Canadians are enjoying the first long weekend of summer opening cottages, having picnics, planting their gardens and enjoying the fireworks –a hold over from our colonial heritage celebrating the birthday of Queen Victoria – anti-psychiatrists are marching.

Strangely, this is not an unusual event. The APA is the only medical organization that is regularly picketed and this year, opponents of electroconvulsive shock therapy (ECT), are gathering at Toronto’s City Hall Square to march across the street to the Sheraton Hotel. This is a rather curious locale since the conference is at the Metro Convention Centre about a mile from the hotel.

According to the facebook manifesto “this psychiatric organization constantly deceives, minimizes and generally lies about the devastating trauma, permanent memory loss and brain damage caused by electroshock. It actively promotes ECT and holds continuing education courses, funded by Big Pharma, at all its annual meetings.”

It goes on to say that “In its 2007 official policy position statement, the APA claims, “Electroconvulsive therapy is a safe and effective evidence-based medical treatment. ECT is endorsed by the APA when administered by properly qualified psychiatrists for appropriately selected patients.”

The APA and The National Institute for Health and Care Excellence (NICE) in the UK do not endorse the use of ECT based on a whim or without proper evidence and they do not recommend it for everyone. ECT is used for rapid improvement, in the short term, of these symptoms

  • Severe depressive illness or refractory depression.
  • Catatonia.
  • A prolonged or severe episode of mania.

It should only be used if other treatment options have failed or the condition is potentially life-threatening (eg, personal distress, social impairment or high suicide risk).

A metaanalysis published in 2014 that compared ECT with the newer transcranial magnetic stimulation concluded that ECT is the leading therapeutic modality for patients with treatment resistant depression.

ECT can be helpful! Now I would join the protesters if psychiatrists dragged unsuspecting patients out of their hospital beds, hustled them down the hall to a room where they attached electrodes to their heads and zapped them with electricity.

But this does not happen!

There is this thing know as informed consent and every patient, or their substitute decision maker if they are not competent, signs one. Before a doctor can treat – be it ECT or pumping toxic chemicals into the body to rid it of cancer – the patient must understand the potential risks and benefits of the treatment before consenting to it. With ECT, the patient is in extreme distress, nothing else has helped and they are desperate for relief.

For some stranger like those marching at the Sheraton Hotel in Toronto to think they can decide what is good or not good for a patient takes an enormous amount of chutzpah.

A Personal View of ECT from Dr David Laing Dawson

The year was 1969. I was a psychiatric resident in a new open-door nicely appointed psychiatric ward and I didn’t think much of ECT. It had been overused in the past, but all specialties of medicine have a history of finding a treatment that works (finally!) and then over-using it, from antibiotics to every kind of surgery. Still, it just felt wrong to induce a seizure, a convulsion, to fix a mental disorder, especially when we had no clue why it actually worked.

So I avoided using ECT, and had managed without it for about a year and a half.

And then a man in his twenties was admitted to my care. He was thin, almost emaciated, and not talking. He had been living in a small room in the back of his parents’ downtown apartment and had gradually ceased to look after himself or get out of bed. Now he lay on his back in a hospital bed. He did not speak. He made no eye contact.

I sat beside him and talked. Nothing. Over time I gave him several medications and then withdrew them. Nothing. I hauled him out of bed each day for a week, and, holding his arm, walked him around the hospital ward. Nothing. We could keep him hydrated with some nutrients but he was still not eating.

So it came down to ECT. Six treatments. His mood brightened. He made eye contact. He ate. He talked to me. He remained my patient for a few months, moving to the day hospital and then outpatients. Because he now talked with me I could figure out what medications might keep him well.

And for five years after that, every year, I received a Christmas card from him thanking me.

And today, perhaps with thanks to Jack Nicholson, of all the treatments and procedures administered by modern medicine for serious illness, ECT is one of the safest, most effective, and very carefully restricted and monitored.

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9 thoughts on “The American Psychiatric Association Annual Conference 2015 and Silly Season

  1. The anti-psychiatry crowd could use some of the scientific reading material available in community libraries. Without this ‘book learning’ they lean on the bent reeds of suppositions.

    Get thee to the science section.

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    1. Absolutely agree..sooo tired of people spouting off about something they know not of…I have seen ECT in my career as a nurse and have seen positive results in severely depressed patients. I hope that someday the complexities of severe mental illnesses can be portrayed in a serious movie to the public so they can truly understand the huge struggles these people live with day in and day out….not to mention what family members must go through…the public needs education.

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  2. I saw Jack Nicholson in One Flew Over the Cuckoos’ Nest again just recently. I was surprised about how clear the message of the film was about the consequences to those who rock the boat. It really is a statement about the abuse of power. I think they should re-circulate it, it’s that good.

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    1. It is one thing to rock the boat responsibly. I am all for that, But to do it in the way the leading protagonist in the film did, that is dangerous. This was all part of the anti-psychiatry movement. Nurse Rached may have been a horror but she does not represent any nurses that I knew.

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  3. Just remembered the most memorable quote, for me, in One Flew Over the Cuckoo’s was when Jack Nicholson complained about Nurse Ratched to the Psychiatrist in Charge.

    The Psychiatrist’s response was “Why Nurse Ratched is one of our finest nurses.” How many times have we hit a “wall” or been given the “run around” when we have tried to communicate something that is a valid concern? Loved that movie!

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  4. I did not know that One Flew Over the Cuckoos Nest was about psychiatry. That’s news to me Patricia. What happened to Jack Nicholson could happen to a number of people in different settings. He just spoke up and the response was “over the top” in a horrible way.

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    1. As the setting was a mental institution I think it is fair to say it was about psychiatry and mental disorder!

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  5. ECT has worried me for years given our lack of cause and effect knowledge. However your measured arguments gentlemen are, as always, sensible and rationally argued (as in issue lol)

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