A version of lobotomy still performed today

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The only "measurable" changes are negative ones. A positive measurable change would be IQ going up. That doesn't happen does it. The fact that they appear "more normal" is not measurable; it is subjective judgement of NT society. And yes, the memory loss and lack of connectivity IS important. And by the way "lack of connectivity" is quite broad with far reaching consequences so you can't dismiss it.

The main result of ECT is a measurable decrease in depressive symptoms. It has nothing to do with "normal," it has to do with making a miserable life tolerable.

When a person's feedback system is broken, and they develop pathological neural pathways, destroying those pathways is not "negative." And some of us would be happy to get rid of all of our memories - memories aren't always worth having, ask anybody with PTSD.

Having depressive symptoms is subjective it can't be measured. Besides, once you have a depression you can always be cured of it later, but if you ruin the brain that is it, you can't get your IQ back. The only "irreversible" consequence of depression is suicide. The solution would be physical restraint that would prevent the person from killing themselves. Physical restraint can be "undone", shock therapy can not be.

And you can't selectively destroy "only" depressive pathways, ECT is not "smart" to do that. You have to destroy "all" pathways and depressive pathways will be destroyed proportionally. Thus, ECT is mini-suicide so to speak. In fact the logic between ECT and suicide is the same. ECT destroys "all" pathways in order to destroy the depressive ones, while suicide destroys "all" parts of your life in order to destroy negative ones. If you agree suicide is a bad idea, you should also agree that ECT is a bad idea too.

OK, let go of your anti-psychiatry agenda. They aren't always right, but psychiatrists are trying to help. The vast majority do not knowingly cause harm to patients. Science marches on and all that.

Currently, the most common condition treated by neurosurgery is epilepsy, so I'll talk about a typical patient who undergoes anti-epilepsy neurosurgery.

They have seizures several times a day. These seizures very often are life-threatening, even if they're not, they render the person unable to function because most of their time is spent either seizing or recovering from a seizure. (In contrast, most epileptic people, if untreated, would have one seizure every few months.)

There are many anti-seizure medications, they try them all, none of them work on this patient. (If they did, the process would stop there.) Even if they reduce seizure rates a little, the rate is still extremely high. Plus, seizure meds can have unpleasant side effects like sedation, especially when taken in high doses - which they will be by this patient, because low doses aren't working.

They even start trying some of the rarer, more dangerous or difficult treatments, such as ketogenic diet (a diet extremely low in protein, which induces a metabolic state similar to untreated diabetes, and sometimes reduces seizures but is dangerous for their health). These don't work either.

Meanwhile, neurological tests indicate that the seizures come from a very specific part of the brain, which is damaged and has scarring that acts like an electrical short.

So finally they decide on neurosurgery. They use local anesthetic, so the person is still conscious, and probe the surrounding area with electrodes while the person does cognitive tasks (which tasks depend on what that brain region typically does). This enables them to map out which parts of that region are still doing valuable functions. They remove only the damaged, nonfunctional part, careful to cut in such a way that scarring does not occur.

Occasionally, they get it wrong, and the person loses a specific cognitive skill. But in most cases, the surgery successfully stops or greatly reduces the seizures. And even if the person does end up with cognitive impairment, they may still be better off than if they kept seizing.

In the past, they overused neurosurgery. Doesn't mean it isn't warranted in some cases.

In case of epilepsy I agree with you that the treatment is justified. I am only opposing it in case of mental disorders (Schizophrenia, depression, OCD, etc) which are all subjective. On the other hand seizures are objective and one can not stop them no matter how one slices it.

Symptoms are measured indirectly, that doesn't mean they aren't measured. Regardless, there are many signs of depression that are behavioral and can be directly measured.



Treatment-resistant depression generally has a poor prognosis. In especially severe cases, in which a large number of medications have been tried, including antipsychotics, mood stabilizers, tricyclics, and MAOIs in addition to conventional SSRIs/NRIs have little hope of any "cure."

Long-term physical restraint has serious permanent long-term consequences, particularly if it involves isolation. Regardless, the cost is prohibitive and involuntary long-term restraint is generally considered a serious violation of human rights.

Chronic suicidal ideation is one of the most dangerous conditions known in terms of patient survival. The National Safety Council ranks suicide as the sixth leading cause of death in the US, and it may be the most common cause of trauma-related death. Patients with severe chronic depression and marked suicidal ideation are at an extremely high risk of death (on the same order of magnitude as most cancers).

I don't think survival is the most important thing at all, but as you've seemed generally insensitive to patient suffering so far that path may not be worth pursuing. However, depression causes serious functional changes in the brain that persist even in patients who remit (ie these are permanent and there is no way to "cure" them). This is well-documented, here and here are some quick search results, but there are many pages of relevant research on both Google and Google Scholar. Depression is a disease with serious, measurable, and permanent consequences.



ECT primarily affects the hippocampus, it doesn't affect the whole brain equally. Any significant cortical effects appear to be largely mitigated by the use of unilateral brief pulse ECT, the primary form now practiced. The only known permanent side effect of this form of treatment is memory loss.



This is false. Also, I don't agree that suicide is a bad idea. Regardless, the analogy is not valid. If this were an accurate description of ECT, that would make ECT similar to chemotherapy, not suicide. If you are opposed to chemotherapy then our disagreement may be more fundamental.

Schizophrenia, depression, and OCD can all be detected by brain scans and by behavioral observation. Diagnosis by symptoms is most common because it's much easier and less expensive, and because the diagnostic literature is restricted (some efforts are being made to change this in the DSM-V, though I'm not hopeful) - but all of these conditions are objective and can be measured directly (for example with fMRI).

Furthermore, psychiatric disorders can be just as hard to treat as epilepsy (for some disorders the likelihood of treatment resistant cases is higher than in epilepsy).

Lets put it this way: mood and behavior can change, intellingence can not. What would happen if Einstein felt depressed and they decided to give him shock therapy? As a result of ECT he would have never been able to come up with his theories. Now if they were to avoid ETC perhaps he wont come up with them either since he would be too depressed to think. But still if he had enough will power he would force himself to think and write down his theory despite depression. But if he has ECT he won't be able to do it with or without will power.

By the way it is a real pity that John Nash had ECT. Yes, he got Noble Prize, but who is to say how much more he would have done if he didn't have ECT?



Well then do the physical restraint without isolation. Or even dont restraint but put them in the room with someone to watch over them without any sharp objects there. One can be creative about this. But there is no creative way of undoing ECT.




And what is cost? Money is just a bunch of pieces of papers that humans attached some sort of importance to. People can change their policies and economy etc. But if you damage a brain with ECT you can never "undo" that damage.



If they make exception and say forced ECT is okay, they can instead make another exception and say physical restraint is okay.



The difference though is that in case of depression you can find creative ways of stoping them from killing themselves, while in case of cancer you can't stop its progression.



Why would they persist after remission? I mean the functional changes are due to lack of motivation. Once the person remits they will be motivated again so they will perform well again.



If I take your first link, it just says they react to criticism differently. I think it is a lot less important than IQ so ruining IQ with ECT in order to "solve" that personality aspect is not worth it. As far as your second link is concerned which talks about less neurons, that seems more important. But still, if you compare the decrease in neurons due to depression vs due to ECT, the latter would be more serious. After all the evidence that ppl after ECT have memory loss is "in contrast" to the memory loss due to depression. So clearly the ECT effects have to be larger in order to be visible.



Hippocampus still has some role otherwise it wont be there.



I think most people agree suicide is a bad idea. If you don't think its bad, why do you want to cure depression to begin with?



I support chemotherapy. My former physics professor back in community college had one, and he was bold for half a year but then a year later he had all his hair back. So chemotherapy is reversible. The same is not true for ECT. Besides, chemotherapy targets only cancer cells while shock therapy targets "all" functions of hypocampus, both good and bad.

Roman, you obviously have little to no understanding of severe mental illness.

Aspergers and severe mental illnesses such as schizophrenia, chronic major depression, bipolar, and severe epilepsy are completely different things. Aspergers is a developmental disorder or neurological difference depending on how you see it, but not a mental illness.

Many of your comments could be construed as being offensive to someone suffering a severe mental illness, especially comments regarding motivation, behaviour being subjective and non-permanent, and so forth.

Severe mental illness is not something you can just "put up with" or "motivate yourself out of" or a subjective label (even the thought of calling mental illnesses such as these "subjective" is laughable, you may as well call, for example, cerebral palsy subjective and say that it's stupid to give sufferers crutches to help them walk or wheelchairs, or physiotherapy, because it's only subjective anyway and they should just motivate themselves not to be disabled).

When you are suffering from mental illness severe enough (and having tried all other medications) to consider procedures such as these you have no quality of life and your situation is not going to change. In that position, it is completely correct to undergo procedures that have been scientifically proven to improve quality of life even if there are side effects (which are still relatively minor in comparison to the benefits).

And I thank the heavens for psychiatry every day as it effectively saved my life, without psychiatry I would have no quality of life.

Late to this thread, but whatever. I greatly disagree with the statements and views that have been posted so far by the original poster, and so I'll share.

OP/Roman, would you object to a procedure to remove a tumor, since they were destroying the tumor? Both are OF the patients' body, but both [tumor and the part of the brain that is removed] utterly destroy quality of life. Just because something is destroyed, doesn't mean that the procedure is morally objectionable. As long as the patients' rights are respected, and it improves their quality of life, then this procedure is not much like a lobotomy at all save for the damage to the brain.

Lobotomies destroyed people's lives. Have you ever heard of the sister of Kennedy, the one who underwent a lobotomy and spent the rest of her life disabled? I agree that lobotomies are morally objectionable, especially in the way that they were carried out. But you should not carry an opinion on one admittedly very horrible thing over to something else that can potentially help people as a last resort.

You object, saying that since it's part of the brain being destroyed then it's like hitting a computer with a hammer. I agree that sometimes, removing something so that it cannot send such a signal is wrong. But this would be one of the times that it is right. Sometimes things have to be destroyed to make things better. I could go on to talk about this in a empathetic way but I believe it would be lost on the audience - I usually use that tactic to talk with neurotypicals.

As for whether or not adverse effects are visible or not, what does it matter if the patients are not suffering for it? I do not understand your reasoning here - do you think that just because there IS an adverse effect that it's morally objectionable? I'm sorry to say, and I don't mean this to be offensive in the least, but the world doesn't work that way. The good ALWAYS comes with the bad. It's minimizing the bad that counts, and if the bad is not visible and cannot be felt then the point is lost.

As to depression being reversible; yes, you can, later down the road, not be depressed. But the effects the depression have on your life are permanent. I have been challenging my grade 12 diploma for three years. I have a decent IQ, and I'm considered very smart. This "stall" in my life has been caused by my depression and I can't get that time back. You can also get depressed again further down the road, and cause more damage.

All in all I think that you are focusing too much on the method and not enough on the outcome. If the patient has a better quality of life, then it is successful, right?


Ugh, it was hard to type all that and keep anti-psychiatry out of this. Because, really, you sound like you have a vendetta of some sort, OP. Perhaps if you explained why, then the understanding of your audience would be better. What is it that causes you to have negative feelings about this, even though this treatment helps improve quality of life. You have mentioned the impact over and over, do you believe that if there is negative, then it doesn't matter if there is positive?

Writing this on little sleep so let's hope this comes out with few if any typos

Essentially I think that surgery is justified if you can clearly separate healthy tissue from sick tissue and only destroy the sick. So, for example, if you remove the tumor or drill the tooth cavity, both are well justified. But in case of the brain, it is technically a healthy tissue in a sense that it is still functioning. So you don't just destroy something "bad" like a tumor, you destroy the "whole package".

Speaking of tooth cavity, about a year ago the dentist decided to put a crown on my tooth. But I didn't realize that when they said they would "polish" the tooth after drilling the cavity what they meant was that they get rid of a huge portion of healthy tooth. Now that I finally realized what they did I regret the operation. I believe that it is fine to remove cavities or tumors, but nothing else.

I am likewise against the idea of removing of wisdom teeth for no reason. So my wisdom teeth had cavities but doctors were refusing to drill them because they should be removed. I was going from one doctor to another to drill the cavity until finally someone agreed to do it. Unfortunately I was not as lucky with the other tooth since I had to get it done before I was flying to India. So I had that wisdom tooth removed, but I regret having done that. I mean I was insisting that doctor drills it but he kept refusing it and insisted that either he removes it or he doesn't do anything at all.

To illustrate my point even clearer, lets say that in the process of removing the tumor you damage surrounding tissues on your way. In this case operation is still justified. After all, the magnitude of the former is by far greater than the latter. But if you are actually "trying" to destroy healthy tissues then that is no longer justified.

Also I have some personal experiences that motivate me to have an opinion that I do

1. I want to be a physicist and it was my life time goal since I was 9. Now I realize that not everyone has that goal. But still I feel "what if a person X changes his mind later on and decides they wanted to be a physicist, after all". Well I don't want ECT to stay on a way. Also when I hear "your mood is more important than performance" as a justification for ECT against depression, its like saying "you don't have to work hard just try to be happy".

2. A few years ago I was in a relationship with Jennifer. She didn't have depression at first, but when things didn't work out at school she became suicidal. Meanwhile I was visiting my thesis advisor for 2 weeks. I should have just cut the visit short and fly to be there for her emotionally. But I didn't do it, and I feel guilty that I didn't. Then, later on, she was put on antidepressants. Now the way she described her experience is that she still felt miserable, and the only thing antidepressants did to her is "put a wall" so that she couldn't cry even though she wanted to. So I felt bad for her, I wish she was off of them so she could cry. I feel like I "betrayed" her by not coming to help her and as a result of my betrayal she had to "put that wall" instead. Now, as of now, she is happy person and all. But I feel like its the other part of her that is happy, while the part of her that was depressed is even worse off: its destroyed.

Thanks for the above post, Roman. While I still do not 100% agree with your opinion, I now understand it better.

Roman: I don't think you have your facts straight on mental illness, mood, intelligence, suicide, economics and resources, hospital administration, or chemotherapy. Our premises are too divergent to allow further meaningful discussion.

Prove it.

Prove that IQ is affected by ICT. Show me the research. Show me the peer-reviewed journal articles stating this.

There are peer-reviewed journal articles substatiating that depression has a neurophysiological basis. Here are some:

http://journals.psychiatryonline.org/article.aspx?Volume=163&page=735&journalID=13

http://homepages.gac.edu/~jwotton2/PSY385/psy4.pdf

http://www.imhr.ca/research/northofflab/documents/grimm_et_al_biol_psych_2007_arti_in_press.pdf

http://www.psychmed.org.uk/Download/2003%20Mitterschiffthaler%20et%20al.Neuroreport.Anhedonia.pdf

http://ajp.psychiatryonline.org/article.aspx?articleid=176635

If you can provide similar kinds of articles documenting IQ score decrease with ICT, I'll grant you that point.

I don't know such articles but that doesn't mean they don't exist. I just haven't spent time researching it. But one book that is worth reading is "Toxic psychiatry" it discusses in detail all of the adverse effects of ECT.



I agree that depression has neurological basis. But ECT does not "reverse" the bad neurology. It simply "adds" something "unrelated" to it hoping that two wrongs would make up for right. Same with prozac: its not like people with depression don't have enough prozac in their blood; no one has prozac in their blood!

A productive way to treat depression is to reverse the cause. Find the chemicals that are imbalanced and then take supplements that would compensate for the exact imbalance you have found.