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Matthews G, Ho M. Mental health treatments and the influence of culture: portrayals of hypnotherapy and electroconvulsive therapy in Singaporean television dramas. MEDICAL HUMANITIES 2024:medhum-2023-012854. [PMID: 38991757 DOI: 10.1136/medhum-2023-012854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/13/2024]
Abstract
Stigma is one of the chief reasons for treatment-avoidant behaviour among people with mental health conditions. Stigmatising attitudes are spread through multiple determinants, including but not limited to: (i) individual beliefs; (ii) interpersonal influences; (iii) local cultural values and (iv) shared culture such as depictions in television shows. Our research indicates that popular television shows are currently understudied vectors for narratives that alternately reify or debunk assumptions and stereotypes about people with mental health conditions. Although such shows are fictional, they influence perception by normalising 'common sense' assumptions over extended periods of time. Consequently, representations of patients, psychiatrists and treatments influence knowledge and understanding of mental health and treatment-seeking behaviour. While storytelling about sickness can inspire possibilities and bestow meaning on traumatic experiences, fictional narratives written without sufficient care can have the inverse effect of curtailing horizons and limiting expectations. Problematic portrayals of patients, mental health professionals and psychological interventions are often reductive and may increase stigma and prevent treatment-seeking behaviour. This article analyses the representation of hypnotherapy and electroconvulsive therapy (ECT) in Singaporean television dramas that attract a wide, mainstream audience. Our diverse team investigated dramas in all four of the official languages of Singapore: English, Mandarin Chinese, Bahasa Melayu and Tamil. We found that depictions of hypnotherapy tend to produce problematic images of mental health professionals as manipulative, able to read minds, engaging in criminal behaviour, lacking in compassion and self-interested. Meanwhile, representations of ECT typically focus on the fear and distress of the patient, and it is primarily depicted as a disciplinary tool rather than a safe and effective medical procedure for patients whose condition is severe and refractory to pharmacotherapy and behavioural interventions. These depictions have the potential to discourage treatment-seeking behaviour-when early intervention has found to be crucial-among vulnerable populations.
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Affiliation(s)
| | - Melissa Ho
- Nanyang Technological University, Singapore
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Schuster H, Walters RW, Mathy J, Ramaswamy S, Alsakaf I. Correlation Between ECT Quality Measures and Likelihood to Transition From Acute to Continuation and Maintenance ECT. J ECT 2024:00124509-990000000-00171. [PMID: 38924479 DOI: 10.1097/yct.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To evaluate the association between 3 ECT quality measures (seizure duration, Postictal Suppression Index [PSI], and heart rate response) and therapeutic compliance as indicated by transitioning from acute to continuation to maintenance phases of ECT. METHODS This was a retrospective chart review of patients who received ECT between July 2016 and July 2019. ECT quality measures were lagged by 1 ECT session to examine the effect of the prior session's quality measure on progressing to a higher ECT phase at the subsequent ECT session. Associations with therapeutic compliance were analyzed using mixed-effects ordinal regression and mixed-effects partial proportional odds models. RESULTS Seizure duration was associated with 8% higher adjusted odds of progressing to out of the acute phase (95% confidence interval [CI]: 2% to 15%, P = 0.007) and 18% higher adjusted odds of progressing to the maintenance phase (95% CI: 10% to 28%, P < 0.001); PSI was associated with 9% higher adjusted odds of progressing out of the acute phase (95% CI: 3% to 16%, P = 0.005), whereas heart rate response was not statistically associated with therapeutic compliance. Greater therapeutic compliance was also associated with bilateral electrode placement and older age. CONCLUSIONS Longer seizure duration was associated with greater therapeutic compliance across all ECT phases, PSI was associated with progressing out of the acute phase, and heart rate response was not associated with therapeutic compliance. Our findings assist ECT psychiatrists in optimizing ECT quality measures to promote better compliance with ECT.
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Affiliation(s)
| | - Ryan W Walters
- Clinical Research and Public Health, School of Medicine, Creighton University, Omaha, NE; and
| | - Jacob Mathy
- University of South Dakota School of Medicine, Sioux Falls, SD
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Quiles C, Sy H, Verdoux H. Stigmatization towards electro convulsive therapy: Impact of practical teaching on medical and nursing students. L'ENCEPHALE 2024; 50:125-129. [PMID: 37121808 DOI: 10.1016/j.encep.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND This study explored the impact of theoretical and practical teaching on electro convulsive therapy (ECT) on medical and nursing students' stigmatizing attitudes towards ECT and representations of it. METHOD Fourth-year medical students and nursing students answered questions from the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) and from the Mental Illness: Clinicians' Attitudes version 2 (MICA v2) scale. The questionnaires were completed before and after observing a 3-hour practical training session in the ECT unit. The endpoint was the impact of practical training as assessed by MICA and QuAKE scores. Multivariate analyses were used to explore the impact of practical training on MICA and QuAKE total scores. RESULTS Stigmatizing attitudes and representations of both medical and nursing students towards ECT were reduced after practical training (β=-4.43 [95% CI -6.15; -2.70] p=0.0001). The impact was greater in medical students (β=-8.03; 95% CI [-10.71; -5.43], P=0.0001) than in nursing students (β=-2.77; 95% CI [-4.98; to 0.44], P=0.02). Gender, psychiatric history in close persons, and having already followed a psychiatric/ECT course had no independent impact on stigmatizing attitudes towards ECT and representations of it. CONCLUSION Practical training in ECT should be given to all health professionals to improve access to it.
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Affiliation(s)
- Clélia Quiles
- Centre Hospitalier Charles Perrens, 121, rue de la Béchade, CS81285, 33076 Bordeaux Cedex, France; Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, 33000 Bordeaux, France.
| | - Héloïse Sy
- Centre Hospitalier Charles Perrens, 121, rue de la Béchade, CS81285, 33076 Bordeaux Cedex, France
| | - Hélène Verdoux
- Centre Hospitalier Charles Perrens, 121, rue de la Béchade, CS81285, 33076 Bordeaux Cedex, France; Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, 33000 Bordeaux, France
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Cabrera LY, Gilbert MMC, McCright AM, Achtyes ED, Bluhm R. Beyond the Cuckoo's Nest: Patient and Public Attitudes about Psychiatric Electroceutical Interventions. Psychiatr Q 2021; 92:1425-1438. [PMID: 33864542 PMCID: PMC8531080 DOI: 10.1007/s11126-021-09916-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 12/28/2022]
Abstract
Recent research emphasizes the role of psychiatric electroceutical interventions (PEIs), bioelectronic treatments that employ electrical stimulation to affect and modify brain function, to effectively treat psychiatric disorders. We sought to examine attitudes about three PEIs-electroconvulsive therapy, transcranial magnetic stimulation, and deep brain stimulation-among patients with depression and members of the general public. As part of a larger study to assess different stakeholders' attitudes about PEIs, we conducted semi-structured key informant interviews with 16 individuals living with depression and 16 non-depressive members of the general public. We used a purposive sampling approach to recruit potential participants based on eligibility criteria. We performed qualitative content analysis of interview transcripts. Participants from both groups expressed an overall cautionary attitude towards PEIs, yet there were mixed attitudes in both groups. Patients commonly described electroconvulsive therapy as scary, traumatic, or intense, while members of the general public often referenced the treatment's negative portrayal in One Flew over the Cuckoo's Nest. Patients and the general public saw transcranial magnetic stimulation as a potentially viable option, but in most cases only if medication was not effective. Deep brain stimulation attitudes were predominantly negative among patients and cautionary among public. The overall cautionary attitudes towards PEIs, together with the technological features and social aspects underlying those attitudes, highlight the need for unbiased education to fill the gaps in knowledge and inform perceptions of those who may benefit from these treatments.
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Affiliation(s)
- Laura Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Penn State University, University Park, W-319 Millennium Science Complex, State College, PA, 16802, USA. .,Rock Ethics Institute, Penn State University, University Park, State College, PA, USA.
| | | | - Aaron M McCright
- Department of Sociology, College of Social Science, Michigan State University, East Lansing, MI, USA
| | - Eric D Achtyes
- Division of Psychiatry & Behavioral Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.,Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Robyn Bluhm
- Department of Philosophy, College of Arts and Letters, Michigan State University, East Lansing, MI, USA.,Lyman Briggs College, Michigan State University, East Lansing, MI, USA
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Sirgiovanni E, Aruta A. The electroshock triangle: disputes about the ECT apparatus prototype and its display in the 1960s. HISTORY OF PSYCHIATRY 2020; 31:311-324. [PMID: 32308035 DOI: 10.1177/0957154x20916147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the early 1960s, a climate of public condemnation of electroconvulsive therapy was emerging in the USA and Europe. In spite of this, the electroshock apparatus prototype, introduced in Rome in 1938, was becoming hotly contended. This article explores the disputes around the display of the electroshock apparatus prototype in the summer of 1964 and sheds new light on the triangle of personalities that shaped its future: Karl and William Menninger, two key figures of American psychiatry in Topeka; their competitor, Adalberto Pazzini, the founder of the Sapienza Museum of the History of Medicine in Rome; and, between them, Lucio Bini, one of the original inventors of ECT, who died unexpectedly that summer.
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Tsai J, Huang M, Rosenheck RA, Wilkinson S. A Randomized Controlled Trial of Video Psychoeducation for Electroconvulsive Therapy in the United States. Psychiatr Serv 2020; 71:562-569. [PMID: 32151214 DOI: 10.1176/appi.ps.201900448] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment that remains largely underutilized. Patient psychoeducation about ECT may improve uptake of this treatment. METHODS This randomized controlled trial compared two forms of psychoeducation about ECT: video psychoeducation and an informational brochure. In 2019, a national sample of 556 U.S. adults who screened positive for depression were recruited and randomly assigned to receive one of these educational interventions online. Participant perceptions, knowledge, and willingness to receive ECT were assessed before and after psychoeducation. RESULTS Both the video psychoeducation and brochure groups showed significantly more positive perceptions and knowledge about ECT following the intervention, with no significant differences between groups. The proportion of participants who reported being willing to receive ECT increased significantly after receipt of psychoeducation (from 31% to 63% in the video psychoeducation group and from 29% to 56% in the brochure group). Female gender, severity of depression, and comorbid mental and substance use disorders were associated with positive changes in ECT perceptions and increased willingness to receive ECT. CONCLUSIONS These findings suggest brief psychoeducation for ECT is needed and may improve acceptance of this robust treatment.
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Affiliation(s)
- Jack Tsai
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang)
| | - Minda Huang
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang)
| | - Robert A Rosenheck
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang)
| | - Samuel Wilkinson
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang)
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Kring IS, Bergholt MD, Midtgaard J. The perspectives of former recipients and experts on stigmatization related to electroconvulsive therapy in Denmark: A focus group study. J Psychiatr Ment Health Nurs 2018; 25:358-367. [PMID: 29758121 DOI: 10.1111/jpm.12470] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/04/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Electroconvulsive therapy (ECT) has existed worldwide for nearly 80 years. ECT is a fast-working and potentially life-saving treatment, but it is considered controversial. Although frequently mentioned, stigmatization in relation to ECT has not been systematically explored so far. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides new insight into both recipient and expert perspectives on ECT. It identifies several issues of stigmatization related to ECT and suggests that full recovery following ECT might be jeopardized due to both stigmatization and self-stigmatization. The study suggests that most of the stigmatizing behaviors can be ascribed to (a lack of) available knowledge of and experience with ECT. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Being aware of and listening to the needs of former ECT-recipients seems essential to increase their treatment options and support care as well as a will to prioritize this patient group. For example, by addressing the potential stigma issues in follow-up groups and helping to distribute sober, factual information about ECT in society. Providing written information and psychoeducation for patients and relatives before, during, and after ECT, in addition to supporting active use of diaries, might be valuable remedies for helping patients feel adequately informed and able to accept the pros and cons of ECT during and after treatment period. ABSTRACT: Introduction Electroconvulsive therapy (ECT) has existed worldwide for nearly 80 years. Although fast-working and potentially life-saving treatment, ECT is regarded as a strongly controversial treatment and stigmatization is frequently mentioned in relation to it. However, no systematic research in this area has taken place so far. Aim The aim of this qualitative study was to explore the experiences and attitudes of former recipients of ECT and of experts professionally involved with ECT to identify potential stigmatization. Method Two focus groups, one comprising four recipients of ECT and the other seven professional experts, were conducted. Data from each focus group were analyzed separately using a framework-analysis. Results The analysis yielded three major themes for the first focus group interview: ambivalent attitudes, discrediting and exclusion, and survival strategies and three major themes for the second focus group interview: dramatic depictions of ECT, an overlooked and rare treatment, and anti-stigmatization strategies. Discussion and implications for practice Stigmatizing attitudes and behaviors in relation to ECT are closely related to one's personal and factual knowledge, and there is a great need for multi-facetted approaches if social acceptance and recognition are to be achieved. This study provides new knowledge on a scarcely examined area while also introducing suitable methods for anti-stigmatization and empowerment.
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Affiliation(s)
| | | | - Julie Midtgaard
- Department of Public Health, University Hospitals' Center of Health Research (UCSF) and Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Tripathi A, Winek NC, Goel K, D'Agati D, Gallegos J, Jayaram G, Nguyen T, Vaidya P, Zandi P, Trivedi JK, Reti IM. Electroconvulsive therapy pre-treatment with low dose propofol: comparison with unmodified treatment. J Psychiatr Res 2014; 53:173-9. [PMID: 24602447 DOI: 10.1016/j.jpsychires.2014.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/08/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Whilst electroconvulsive therapy (ECT) is routinely administered under anesthesia in developed nations, in many developing countries, ECT is still administered unmodified. This practice has attracted considerable scrutiny with calls to ban unmodified ECT. However, there are no affordable alternatives for many poor, acutely ill psychiatric patients. We evaluated whether administration of intravenous propofol 0.5 mg/kg for sedation by the ECT psychiatrist just prior to otherwise unmodified treatment improved acceptance of and reduced anxiety surrounding the treatment. METHOD We conducted an open label trial at The King George's Medical University in Lucknow, India. Forty-nine patients received propofol pre-treatment and 50 patients received unmodified treatment as usual. RESULTS Socio-demographic profiles, diagnoses and clinical responses were comparable. Patients who received propofol experienced less anxiety monitored by the State-Trait Anxiety Inventory just prior to ECT (p < 0.001), and had a more favorable attitude towards treatment assessed by an established questionnaire (Freeman and Kendell, 1980). Propofol patients were less likely to experience post-ictal delirium monitored by the CAM-ICU (p = 0.015) and had fewer cognitive side-effects on the MMSE (p = 0.004). There were no adverse events associated with propofol administration. CONCLUSION Whilst unmodified ECT should never be used when modified ECT under anesthesia is available, we have found low dose propofol can be safely administered by the ECT psychiatrist to sedate patients pre-treatment who would otherwise receive completely unmodified treatment. The intervention was associated with reduced anxiety and a more positive attitude towards ECT, without compromising efficacy. A randomized double blind controlled study is necessary to confirm these benefits.
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Affiliation(s)
- Adarsh Tripathi
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Nathan C Winek
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kapil Goel
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Douglas D'Agati
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jesus Gallegos
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetha Jayaram
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thai Nguyen
- Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Punit Vaidya
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Zandi
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jitendra K Trivedi
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Irving M Reti
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hirshbein L. Historical essay: electroconvulsive therapy, memory, and self in America. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2012; 21:147-169. [PMID: 22428737 DOI: 10.1080/0964704x.2011.577393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Electroconvulsive Therapy (ECT) practitioners and anti-ECT activists have divergent interpretations of both the treatment and its history. Despite claims by ECT opponents that practitioners do not acknowledge memory side effects, the published literature on the procedure demonstrates psychiatrists' awareness of this issue. And though current ECT practitioners claim that memory side effects were mostly the result of outmoded methods, investigators continue to publish studies that indicate ongoing memory problems. This article explores the conflict between pro- and anti-ECT groups around the issue of memory side effects in the broader context of changes in American psychiatry and society.
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Affiliation(s)
- Laura Hirshbein
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA.
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Hirshbein L. The American Psychiatric Association and the history of psychiatry. HISTORY OF PSYCHIATRY 2011; 22:302-314. [PMID: 22043663 DOI: 10.1177/0957154x10389744] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The history committee within the American Psychiatric Association was actively involved in the history of psychiatry in the early decades of the twentieth century, as well as from 1942 to 2009.This paper explores the role of this committee in the context of changes in the psychiatric profession over the twentieth century.
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Affiliation(s)
- Laura Hirshbein
- University of Michigan, Department of Psychiatry, 1500 E. Medical Center Dr.- SPC 5020, Ann Arbor, MI 48109-5020, USA.
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Pickersgill M. From psyche to soma? Changing accounts of antisocial personality disorders in the American Journal of Psychiatry. HISTORY OF PSYCHIATRY 2010; 21:294-311. [PMID: 21879688 DOI: 10.1177/0957154x09102800] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The history of psychiatry is often portrayed through the metaphor of a pendulum, the profession swinging back and forth between a concern with psyche and soma. Recent work critiquing the pendulum metaphor, however, suggests that it does not account for the complexity of psychiatry. This article explores the metaphor through an analysis of the changing aetiological accounts of personality disorders associated with antisocial behaviour advanced in the American Journal of Psychiatry from 1950 onwards. It is argued that the social, scientific and economic factors which help shape overarching professional trends in psychiatry only partly structure personality disorder discourse. If the pendulum swings, therefore, not all psychiatrists move with it.
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Affiliation(s)
- Martyn Pickersgill
- Public Health Sciences Section, Division of Community Health Sciences, The University of Edinburgh Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
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Abstract
In recent years, the history of electroconvulsive therapy (ECT) has received renewed attention from historical researchers, who have published thorough monographs and articles on the subject of ECT. In these studies, however, one of the important events in the history of ECT has been overlooked: the lectures by Cerletti and Bini at the Third International Neurological Congress in Copenhagen. The lectures at the congress were the first presentation of ECT before a large international audience and became the impetus to the first Danish ECT trials. The first part of this article outlines the events of the neurological congress in 1939 and provides a translation of the paper presented by Bini at the congress. In the last part of the article, the history of ECT in Denmark is summarized.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight recent English-language literature in the history of psychiatry, with a special emphasis on the history of forensic psychiatry. It considers publications from 2008 and early 2009, as well as a few important older works that have not yet been reviewed in these pages. RECENT FINDINGS The history of forensic psychiatry is a mixtum compositum that challenges historians to reassess their stock narratives in many different ways. Recent studies have demonstrated that the traditional research paradigms of modernization, medicalization, and professionalization fail adequately to capture the historical complexity and contingency of forensic practices and experiences. These deficits have prompted historians to set out in search of new, more hybrid historiographic strategies. Accordingly, their research is turning increasingly to the thresholds of forensic psychiatry where they are exploring how a heterogeneous array of concepts, images, and materials are exchanged and circulated in ways that shape the historical disposition of forensic psychiatry. SUMMARY This review assesses three historiographic domains in which historians have traditionally situated forensic psychiatry. It argues that we need to be cognizant of these different domains and to recognize that enhancing our historical understanding will require us to reflect more carefully on the relationship between them.
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Abstract
The concept of inducing convulsions, mainly through chemical means, to promote mental wellness has existed since the 16th century. In 1938, Italian scientists first applied electrically induced therapeutic seizures. Although electroconvulsive therapy (ECT) is employed in the treatment of several psychiatric disorders, it is most frequently used today to treat severe depressive episodes and remains the most effective treatment available for those disorders. Despite this, ECT continues to be the most stigmatized treatment available in psychiatry, resulting in restrictions on and reduced accessibility to a helpful and potentially life-saving treatment. The psychiatric and psychosocial ramifications of this stigmatization may include the exacerbation of the increasingly serious, global health problem of major depressive disorders as well as serious consequences for individual patients who may not be offered, or may refuse, a potentially beneficial treatment. The goal of this first article in this two-part series is to provide an overview of ECT's historical development and discuss the current state of knowledge about ECT, including technical aspects of delivery, patient selection, its side-effect profile, and factors that may contribute to underuse of ECT.
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Affiliation(s)
- Nancy A Payne
- Silver School of Social Work, New York University (NYU), USA.
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Abstract
The myths surrounding electroconvulsive therapy (ECT) and the misconceptions held by the general public, clinicians, and patients have interfered with acceptance of this treatment throughout its history. Misunderstandings surrounding ECT, and its consequent stigmatization, are reviewed, including negative depictions of ECT in film, print media, and on the Internet. Clinicians involved in the delivery of ECT benefit from gaining an understanding of how ECT may be perceived by patients and other mental health professionals; they can play a vital role in educating patients and helping ensure the delivery of a successful course of ECT. Guidance is provided for clinicians on how to support patients and families through the ECT process using a model team approach. Anxiety reduction, meeting individual needs, patient and family psychoeducation, assessment of psychosocial supports, and discharge planning are discussed.
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Affiliation(s)
- Nancy A Payne
- New York University (NYU), Silver School of Social Work , USA.
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