ELECTROSHOCK: Restoring the Mind (Hardcover)

~ (Author) "Electroshock is a treatment for severe and persistent emotional disorders..." (more)
Key Phrases: motor rigidity, bilateral electrode placement, delirious mania, United States, Depressive Mood Disorders, The Patient's Experience (more...)

Editorial Reviews

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

Probably a few doctors overprescribed ECT, but the vast majority shy away from it too much. This book, clearly written, concise, and assertive, should help balance the picture, educating mental health professionals and the general public alike. -- Fore Word, August 1999

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Product Details

• Hardcover: 176 pages
• Publisher: Oxford University Press, USA; 1 edition (July 15, 1999)
• Language: English
• ISBN-10: 0195119568
• ISBN-13: 978-0195119565
• Product Dimensions: 8.5 x 5.5 x 0.6 inches
• Shipping Weight: 14.2 ounces (View shipping rates and policies)
• Average Customer Review: 3.5 out of 5 stars  See all reviews (15 customer reviews)
• Amazon.com Sales Rank: #512,270 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

15 of 18 people found the following review helpful:

2.0 out of 5 stars Cautious, Not Unconvinced, October 18, 2004

By	Lynroshel "Lynroshel" (Sorrento, British Columbia, Canada) - See all my reviews

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.

23 of 31 people found the following review helpful:

5.0 out of 5 stars A must-read for anyone dealing with depression, September 6, 1999

By	[e-mail] "bethcarl" (St. Louis, Missouri) - See all my reviews

Finally, a comprehensive book that is informative, easy to read and understand for the non-medical person on ECT. Not only does Dr. Fink supply the reader with a wealth of information on ECT, but also explains many forms of mental illness and disorders. He gives thorough explanations of illnesses and disorders, what the symptoms are, how to treat the illnesses, how patients respond and length of treatments. This book is now a vital part of my personal library on the subject of severe depression and its treatment. Having been hospitalized for severe depression, not able to respond to meds, I underwent a series of nine shock treatments in 1988. I am sure I would not have survived if my psychiatrist had not prescribed ECT. I now have a book that clearly explains the reasoning behind ECT and how it works. Everyone needs to understand that having had ECT does not make me a "freak", but a living, productive example of the benefits of this treatment of severe depression. We as a society do not judge extreme treatments of cancer or other illnesses, it's about time we accepted and understood this very beneficial treatment of some mental illnesses. I thank you, Dr. Fink for sharing this information in a way that we can all understand and grow with the knowledge you provide.

29 of 40 people found the following review helpful:

5.0 out of 5 stars A must-read book for families of new patients, October 1, 1999

By	[e-mail] (New York) - See all my reviews

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.