Simon Wessely: ‘ECT is in my own advance directive’

[ladycatlover]

I thought this was interesting as it shows Wessely not really answering questions from Mental Health Today about the Mental Health Act review.

https://www.mentalhealthtoday.co.uk...on-wessely-ect-is-in-my-own-advance-directive

Should advance refusals of ECT become binding under the new Mental Health Act?

Wessely believes there remains a role for ECT in mental health care.

“In my advance directive, I’ve said if I get old and get very severe melancholic depression, I would like ECT,” the psychiatrist told MHT, speaking after a recent London workshop for the new Act.

Earlier in the day, review vice-chair and suicide survivor Steve Gilbert referenced the “life-saving” qualities of ECT during a group discussion on advance statements.

Mental Health Today asked Wessely to describe how ECT, which comprises induced brain seizures, contribute to improved mental health.

ECT has its backers. But what are its tangible therapeutic qualities?

“Have you ever seen anyone suffering from catatonia or depressive stupor?”

“These are some of the most severe forms of mental illness we have.”

“These are people who have stopped speaking, who have stopped eating or drinking, and who – in the old days – died. They died of starvation. There was no treatment available. You couldn’t feed them. It wasn’t possible. And they died. And it’s a really very unpleasant death.”

“That happened in the era before psychotro… [tails off, but presumably was going to say psychotropics] before we had promazine [an antipsychotic]… and before we had the ability to do nutrition and before we had ECT.”

“That was quite a common occurrence in mental hospitals. We don’t see those illnesses half as commonly now as we used to, thank god, but they are still around. They haven’t gone away.”

MHT attempts to ask whether the main benefit of ECT is found in a perceived capacity to spark individuals into a conversation about food; individuals who were previously not engaging verbally or physically. The answer spoke around the subject, rather than directly to it.

There are further examples, do have a read!

 

[Alvin]

Kill brain cells until people stop complaining and are more compliant.
It has a storied past in the US and is still rather commonly used...

 

[James Morris-Lent]

From earlier discussion it seems like we figured ECT was the bees' knees in a variety of awful circumstances.

 

[Jonathan Edwards]

I thought this was interesting as it shows Wessely not really answering questions from Mental Health Today about the Mental Health Act review.

https://www.mentalhealthtoday.co.uk...on-wessely-ect-is-in-my-own-advance-directive

There are further examples, do have a read!

This looks to me more like Mental Health Today, whoever they are, being manipulative and deliberately trying to make Wessely appear incoherent. What Wessely says is actually very reasonable. He probably gave more detailed answers that MHT preferred to ignore. ECT saves lives, as he says. Moreover, I suspect many people who might want to refuse to have ECT in advance would be very grateful they got it in the end if they needed it - and stayed alive. And not just stayed alive, severe melancholic depression is far worse than death for the person and their loved ones.

 

[Pechius]

Coyne has a few blogs about ECT if anyone's interested:

https://jcoynester.wordpress.com/20...ove-that-the-electroconvulsive-therapy-works/

https://jcoynester.wordpress.com/20...a-crude-controversial-out-of-favor-treatment/

 

[Alvin]

This looks to me more like Mental Health Today, whoever they are, being manipulative and deliberately trying to make Wessely appear incoherent. What Wessely says is actually very reasonable. He probably gave more detailed answers that MHT preferred to ignore. ECT saves lives, as he says. Moreover, I suspect many people who might want to refuse to have ECT in advance would be very grateful they got it in the end if they needed it - and stayed alive. And not just stayed alive, severe melancholic depression is far worse than death for the person and their loved ones.

Brain damaging emotional pain away is not a good thing, and just because they didn't respond to ignore your problems till they go away (CBT) or blunt emotions SSRIs does not mean the only answer is to kill brain cells till they can't feel emotional trauma.
Its funny that killing intelligence and emotions by electrically "lobotomizing" patients is a good thing but psychotropic drugs are taboo and illegal. Though that is slightly changing as people want to use LSD and MDMA and so forth to "cure" depression this is yet another causality of believing in a biochemical imbalance or neuroinflammation as the cause of people's feelings instead of treating the real problem that we deny exists. So denied that most will reply to this post with complete derision.

 

[Pechius]

instead of treating the real problem that we deny exists.

Which is?

Imagine trying to explain that to someone in a catatonic state.

 

[Alvin]

Which is?

People who are traumatized have suffered great trauma. Its not a biochemical imbalance or neuroinflammation.

Imagine trying to explain that to someone in a catatonic state.

So the answer is to kill their ability to feel emotions. For generations lobotomies were defended as heroic treatments, i wonder if they will make a return as well. Its even more effective then ECT btw.

 

[Amw66]

People who are traumatized have suffered great trauma. Its not a biochemical imbalance or neuroinflammation.


So the answer is to kill their ability to feel emotions. For generations lobotomies were defended as heroic treatments, i wonder if they will make a return as well. Its even more effective then ECT btw.

I only know of 1 person who had ECT. They were an ex employee of my aunt who fell into a deep depression after her second marriage ended ( her first husband died of cancer when her twin sons were young) . It offered a brief respite - she took her own life the folliwing year .
Therefore whilst it offered a " window" sadly any follow up was not effective. It is not a " cure", it offers an opportunity for other intervention, and if this is either not forthcoming, or addresses the underlying issue then , as sadly indicated in this experience, it is ineffective. It buys time.

 

[Pechius]

People who are traumatized have suffered great trauma. Its not a biochemical imbalance or neuroinflammation.

Not sure why you're so convinced that it isn't. I think it's very likely that depression is a mixed bag of everything. Maybe some have inflammation, some trauma, some had unfortunate life circumstances, etc. All in different proportions in every patient.

Though that is slightly changing as people want to use LSD and MDMA and so forth to "cure" depression this is yet another causality of believing in a biochemical imbalance or neuroinflammation as the cause of people's feelings

I think it's actually the opposite. They're just trying to get into a state where it's easier to rewire the brain, I think. The fact that people have suffered great trauma and it's causing depression doesn't mean that it can be solved by spending years in therapy.

 

[Alvin]

deep depression after her second marriage ended ( her first husband died of cancer when her twin sons were young

I can't imagine why the deep depression happened

It buys time.

It kills brain cells and we have no idea if that damage can ever be undone, if it reduces future lifespan, if it increases risk of diseases like Alzheimers or Parkinsons or others...
In some cases it does cause permanent behavioral abnormalities and puts people in institutions permanently because they lose the metal capacity to care for themselves. In some cases the damage resembles patients who have had a stroke (which can also kill brain cells).

 

[Alvin]

Not sure why you're so convinced that it isn't. I think it's very likely that depression is a mixed bag of everything. Maybe some have inflammation, some trauma, some had unfortunate life circumstances, etc. All in different proportions in every patient.

Experience and background in this area.
There are some exceptions, people who have things like brain tumours, thyroid issues and sometimes side effects from drugs mean those things can be treated. Though sometimes brain tumours are inoperable unfortunately.

I think it's actually the opposite. They're just trying to get into a state where it's easier to rewire the brain, I think. The fact that people have suffered great trauma and it's causing depression doesn't mean that it can be solved by spending years in therapy.

If a person is spending years in therapy then they are seeing a terrible therapist.
Freudian therapy was a well meaning piece of trash and CBT is one generation ahead of freud which posits that you ignore the pain and it will go away. Unsurprisingly this does not work, not that they will admit it.

 

[Amw66]

I can't imagine why the deep depression happened


It kills brain cells and we have no idea if that damage can ever be undone, if it reduces future lifespan, if it increases risk of diseases like Alzheimers or Parkinsons or others...
In some cases it does cause permanent behavioral abnormalities and puts people in institutions permanently because they lose the metal capacity to care for themselves. In some cases the damage resembles patients who have had a stroke (which can also kill brain cells).

It i am woefully uninformed re ECT, other than the effects it had in this instance. It was not effective for this woman.

Would two teenage boys in their first year of university have lost their mother if another approach had been adopted - we will never know.

Would ECT have been proposed if it was the father - another debate , but i think perhaps other options may have been explored.

 

[Jonathan Edwards]

Brain damaging emotional pain away is not a good thing, and just because they didn't respond to ignore your problems till they go away (CBT) or blunt emotions SSRIs does not mean the only answer is to kill brain cells till they can't feel emotional trauma.

I don't think this sort of emotive picture helps us @Alvin. I was taught that there is good evidence for the efficacy of ECT and have recently read enough to confirm that. Also my wife is now alive again because of ECT.

Treating melancholic depression with ECT has nothing to do with getting rid of emotional pain. People with melancholic depression are insane. My wife expressed no emotions at all. She was very dead pan. She was just quietly convinced that her intestines were blocked so she could not drink and would have to die. She showed no reaction to this. She was mad, in simple terms. And the madness was physically caused by an anti-malarial drug. ECT sessions immediately restored emotions to her. She smiled and said she was enjoying the sunshine. It was not that she had been sad before. It is a a common misconception that severe depression is to do with sadness. Severe biological depression is not necessarily to do with sadness at all. It is to do with delusion and insanity. You will probably have never met anyone with this sort of illness. It has nothing to do with the sort of depression that we all know people with.

Please do not raise arguments on this sort of simplistic level. It is not scientific. The idea of this forum is to be rational and to consider all the scientific arguments. ECT breaks neural connections that encode memory, that is clear. But it does not kill cells. It is much more like pulling the battery out of your computer when it has crashed. You may lose some documents but the loop that has caused the crash collapses. In a good proportion of cases the original person reappears - as my wife did. Until she had ECT that person no longer inhabited her body. I realise that this is an anecdote but it is so reliable an anecdote that her psychiatrist could predict to me exactly how things would change day by day before she had the treatment. And the second psychiatrist who by law had to countersign the approval for treatment was even more precise because that was what he did week in week out and by law he had to give me sufficiently detailed information for me to sign my approval too as a fully informed spouse.

 

[Jonathan Edwards]

Therefore whilst it offered a " window" sadly any follow up was not effective. It is not a " cure", it offers an opportunity for other intervention, and if this is either not forthcoming, or addresses the underlying issue then , as sadly indicated in this experience, it is ineffective. It buys time.

That is only one case. My wife has been completely well for over ten years now. And that is not so unusual. Relapse rates are about 50%, but mostly if there is a past history of recurrent instability.

 

[Jonathan Edwards]

Experience and background in this area.

I am therefore surprised that you should talk in such emotive terms. Your view does not appear to be in line with professionals in the area.

 

[Alvin]

I don't think this sort of emotive picture helps us @Alvin. I was taught that there is good evidence for the efficacy of ECT and have recently read enough to confirm that.

Unfortunately being taught something does not make it correct, how many diseases were thought to be something then proved to be something else, from MS to narcolepsy generations of doctors were taught one thing that was then upended.
Lets not forget lobotomies were thought of as miracle treatment for a terrible disease that was untreatable.

Also my wife is now alive again because of ECT.

Treating melancholic depression with ECT has nothing to do with getting rid of emotional pain. People with melancholic depression are insane. My wife expressed no emotions at all. She was very dead pan. She was just quietly convinced that her intestines were blocked so she could not drink and would have to die. She showed no reaction to this. She was mad, in simple terms. And the madness was physically caused by an anti-malarial drug.

I am very sorry to hear about what happened to your wife.
And i have heard of more then a few drugs causing psychological symptoms, when something is induced by a chemical its different then someone who has been traumatized by life events.

It is a a common misconception that severe depression is to do with sadness. Severe biological depression is not necessarily to do with sadness at all. It is to do with delusion and insanity.

Funny that medical graduates today would state this very differently, they are not taught its delusion and insanity, its a biochemical imbalance

You will probably have never met anyone with this sort of illness. It has nothing to do with the sort of depression that we all know people with.

I have met far too many unfortunately

Please do not raise arguments on this sort of simplistic level. It is not scientific. The idea of this forum is to be rational and to consider all the scientific arguments. ECT breaks neural connections that encode memory, that is clear. But it does not kill cells. It is much more like pulling the battery out of your computer when it has crashed. You may lose some documents but the loop that has caused the crash collapses. In a good proportion of cases the original person reappears - as my wife did.

It is not scientific to state causing seizures kills brain cells?
I know its hard to believe that something you have used and seems to work is obsolete, but as i mentioned similar arguments were made about lobotomies, anti anxiety drugs, cocaine, and today MDMA, LSD and so on.

 

[Barry]

It is a a common misconception that severe depression is to do with sadness. Severe biological depression is not necessarily to do with sadness at all. It is to do with delusion and insanity. You will probably have never met anyone with this sort of illness. It has nothing to do with the sort of depression that we all know people with.

My mother had this, and I agree completely. The word "depression" is misleading; people pick up on it and think/assume they know and understand what it is. But no. My mother was diagnosed with various mental illnesses along the way, but in regards to her depression it tended to be called deep depression, melancholia, probably other things I don't remember. She was a lovely person, but her illness was horrible. And not the slightest bit like "being severely depressed".

 

[Lucibee]

I thought this was interesting as it shows Wessely not really answering questions from Mental Health Today about the Mental Health Act review.

So he answers a question about "advanced decisions (to refuse treatment)" (a legal instrument) with an answer about himself. Advanced directives (nice quotes from the article editor) are different - they are basically 'living wills' and have no legal standing. However, there is an argument that the MHA could override the former (and certainly the latter).

 

[Barry]

Funny that medical graduates today would state this very differently, they are not taught its delusion and insanity, its a biochemical imbalance

But even when my mother was very ill (many years back now, she passed on a long time ago), there was talk of chemical imbalances in the brain causing various kinds of insanity. I don't see them as mutually exclusive.