electroconvulsive therapy

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Making our way through the questions on ECT – Top 3 Reasons for Being an Advocate

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?

fancy

Ooh La La!

So much fun to play dress up! When I was a scrub, a solid big boned unkempt of the Cleveland National Forest bordered lemon groves, when I walked barefoot, disappeared for the entire day in the rattlesnake infested chaparral, when I followed my brothers around like a desperate child, I still liked to play dress-up. I would sneak into my mother’s long closet, a dressing room really, with folding doors. I could hide behind her dresses, or climb up onto her shelves and be nothing more than luggage. But mostly I remember staring at her clothes and shoes. I remember one of her all time best outfits – a blue knit bell-bottomed jumper. A wide white belt with a hand-made gold buckle was an excellent accent. Yes, it would drag down below, but all the better to cover my brown feet.

When I think of my top three reasons for being an advocate for ECT, I think of dress-up. There are so many great options to put on, and I can and do exchange them with aplomb, as Fancy Nancy would say. That’s a French word for poise. It’s fancy. If you catch sight of my brown feet here and there, well, you can’t take the hills out of the psychiatrist I guess.

For today, Reason Numero Uno, (Fancy for #1, in honor of the second language I wanna-be speak):

  • It works most consistently, and most quickly of any treatment available. One must pick her fights after all, mustn’t she?

Reason Ithnān, (Arabic for two, in honor of my fancy mother):

  • It doesn’t touch “the body,” i.e. metabolics. Clean.

Reason Trois, pronounced I think like, twa, (Fancy Nancy’s favorite language. Need anyone explain? “French is fancy”):

For example, just by requiring someone to help with transportation, it’s built in. That thereby inherently increases community awareness of mental illness, something we rarely speak of with each other.

Then there is the medical staff. Our nurses are every patient’s advocate. Our masseuse increases oxytocin and other healing neurotransmitters when the patient’s get their massage waiting for treatment and then when in recovery. Our anesthesiologists are knowledgable, see the patient in their “whole person,” often picking up other issues that then will get the patient to receive treatment and improve the patient’s quality of life (QOL); such as hypertension, obstructive sleep apnea, etc…

There’s more, but basically in ECT, none of our patient’s are alone. That stands.

Question: What are the top three reasons you prefer the treatments you engage in? 

Self-care Tip: It is always helpful to write out why you are doing what you are doing, when it comes to medical treatments.

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What are you up to?

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Hello Friends,

What are you up to?

Lately, I have been working on getting our ECT book done.  I am spending more time with the kids, exercising less, quilting more, and eating tons of fruit as it is always in season and “going to waste” (which guts me to see) around our little property.  I am still listening to tons of books from audible and I think that my portrait would show me anywhere anytime with earbuds in.  It must annoy others. …What was that?

Let us know what you are doing.

Be a friend to yourself.  Keep on.

Tower-of-Babel Syndrome

COMPLETION-OF-THE-TOWER-OF-BABEL-GENESIS-XI9-2-Q6503

From time to time, I hear complaints that someone’s brain illness got better with medications and/or ECT, but just came back when they stopped. This almost always happens when a patient never transitioned to maintenance ECT and/or medication therapy.

I dub this, the Tower-of-Babel Syndrome.  We all suffer from it at some point in life, trying to be like God.  Or maybe a lesser god?  During this Tower-of-Babel Syndrome, after we have paid the price, after we have complied with the many hard tasks, after we have built ourselves up into something glorious, we are cured from illness. Right? Once we stop perceiving it, illness that is, we are closer to God, more like Him/Her, perhaps more perfect, when we feel better and do not need medical care. Little gusts of wind are all it takes to fill our wings and off we go, living life free from disease laden earth.

But this is a mistaken expression of freedom.

The number one reason for relapse is…? You remember.  Treatment noncompliance. Is relapse most often due to life stressors? There are so many. No. All those reasons for why we think we feel what we feel and do what we do, all those forces acting on us from the outside in, they are not the reasons we relapse most often.

There is something like a super-bug growing amongst us who engage in treatment on and off. We do it four or five months out of seven. We skip here and there and do not “over-react” if we do. “They don’t control me, after-all.” We apperceive the situation. We think we, by not being consistent with medical treatment, demonstrate our freedom. We are free when we engage in medical treatment or when we do not. We are free because we are human.

The super-bug in brain illness is a progression of disease process heightened and sharpened by treatment noncompliance. A growing resistance to treatment and an acceleration of our falls, how long it takes for us to drop into a relapse and how hard and far we fall.

Let us work together to take away barriers to consistent treatment.  You may laugh when you hear about the Tower of Babel.  You can laugh.  A bonus.

The Tower-of-Babel Syndrome is familiar to those of us who stop any variety of medical treatments on our own, excluding our treatment team members, (such as our physician, Wink! Wink!) in our decision to end treatment.

By stopping medical treatment, many of us have this sense of eliminating the reason we started in the first place.  Take treatment.  Disease continues.  Stop treatment.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You are gone.  Turn back.  You reappear.  Turn.  And just like that, you have been eliminated.  Even now, remembering it delights me.

Not so cute however, is disease relapse.  Maintenance ECT and/or medication therapy has a protective effect on the brain, prophylactic against further insult. It does not increase the distance between Me and God.  It does not increase a mislabeled dependency on treatment.  Maintenance therapy is part of our life journey.  It is part of our ability to be present with ourselves.  It is friendly.

Questions:  What keeps you in treatment?  Do you feel more diseased when taking maintenance therapy?  How do you manage that?  Please tell us your story.

Self-Care Tip:  Stay in maintenance therapy.

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More videos showing ECT and discussions around the globe

The Mayo Video uses a cartoon to show the procedure

MSNBC… not a full treatment, but a “demonstration”

Here is a VERY dated video… but it includes Max Fink (the master) the the full procedure

I often recommend this TED Talk to patients.  It doesn’t show the procedure. “Sherwin Nuland:  How electroshock therapy changed me.”

The BBC in the UK showed this video of a real patient getting ECT.

Questions:  What is your evolving opinions about treatment options for brain illnesses?

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Value Yourself

tiger cat

The room is dark, shades drawn for hours. Sandra stays unwashed in her blanket.  Around her are gathering piles of laundry and stale air.  Pictures have fallen over in their frames.  Sandra hears her daughter, “Mommy, please get up now.  Let’s get up Mommy.  I want you to get up.”  Sandra’s body feels like a bag of concrete and she tries to explain this to her seven-year-old.  “I’m just so tired, Honey.  You go play.”

Days and then months go by, like this.  Some of them, Sandra is up and functioning.  But mostly just.  She finds her thoughts are not clear.  It is hard to find words, let alone anything around the house.

“Who is this person?” Sandra thinks about herself.  She wonders if her husband will leave her.  He is trying to have sex less and less.  They do not talk and she is pretty sure her last real orgasm was a year ago, Thursday.  She cannot believe he even likes her when she dislikes herself so much.

Sandra is not treating anyone very well.  She has lost what was in her bank and cannot account for her own value.

Our value is not a very politick thing to celebrate, to speak of, or to put at the front of the line, but we, individually are worth it.  Sandra is worth it.

You are worth it.

Sandra was having trouble like this.  She had been missing more and more work, for “sick days” and she was worried she would be replaced.  “Who are these people?” she wondered about her colleagues, whom she used to enjoy, joke with, and compete with.

It occurred to Sandra, at last, that everything that was worth living for was only insecurely hers.  She thought, if she lost them, she would die.  She needed to get better.  She wanted to get better.  All the way better, back to herself, funny and sexy and showered.  That would be real nice.

Sandra took, what for her felt like, a desperate action.  Sandra went to see a psychiatrist.  It was not easy understanding her treatment options but basically they came down to, medications, psychotherapy, and stimulation therapies of which electroconvulsive therapy, or ECT, is the gold standard.

To grasp what these options meant, Sandra needed to think about how long it takes to respond to treatment, the chance of responding to treatment compared with not responding, either at all or only partially, and side effects.  Because of knowing she was about to lose “it all,” (home, marriage, employment, possibly parenting rights, and more,) she decided she needed treatment that was the most likely to work and work fast. (ECT can be up to 90 percent effective in reducing the severity of symptoms.)  Sandra did not want to gain weight.  “I would rather die,” she said.  And she did not want to get other medical problems from trying to treat another.  (We call these iatrogenic, when a medical treatment causes another disease, such as an antidepressant causing obesity.)  Because ECT allowed for all these, Sandra launched her ECT index treatment.  She started in treatment even before she started having hope.  Sandra took the action she was able to, toward her value.

This a a short story about Sandra, but her story goes on in a much richer, and pleasure filled way.  I wrote her story to give you an idea of how someone who has never tried medication therapy may decide on choosing ECT as their first treatment effort when struggling with brain illness.  Because of her value.  Because of our value.

Question:  When you explore your value, what would you like to do that more directly honors you?  What does valuing yourself do for those you value outside of yourself?  How can you show that you value others but caring for yourself?  Please tell us your story.

Self-Care Tip:  Care for yourself to care for others.

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Treating Depression with Electroconvulsive Therapy

mcfadden-moMaureen McFadden, a two time Emmy Award winning journalist, at WNDU.  In November 2007, she documented a winning medical series called Rewiring the Brain. 

  See part of the Emmy award winning story on a local man’s path to a better life in the series “Rewiring the Brain.”

I am sharing my response to Ms. McFadden with you, my friends, colleagues, and community, because I choose you for company.  Thank you for that.

Hello Ms. McFadden,

Thank you so much for your work increasing community awareness of ECT and diminishing social stigma.  Thank you for having a life-work, such as this, for obtaining a powerful voice that people want to listen to, and doing what you have done to get attention.  Your influence, hard-earned, is collateral and that you spent it “here” is huge.  I am so grateful.
I am a psychiatrist.  It is difficult for me to work with these, community awareness and social stigma.  I am not special in this difficult experience, of course, and I know that the bummer feeling that I am “alone” in it is a distortion.  Thank you for your company and illuminating presence.  Keep on.
Sana Johnson-Quijada MD
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Nurse tells her experience – Suicide

Guest Post

by, Leslie Oneil, RN

Nurse extraordinaire! Person to know. More.

Nurse extraordinaire! Person to know. More.

In The Ring

I sat at a table in a large meeting room watching Dr. as she stood in front of the room. She stood in front of us with poise…armored with stories, analogies, statistics, and invisible red boxing gloves to match her red dress. She was ready to defend mental illness, and fight for its proper place in medicine and in the spot light where it belongs…right next to the heavy hitters: cancer, heart disease, diabetes.

Dr. delivered the statistics….”1 in 5 people suffer from depression.” She counts the room, “1, 2, 3, 4, depressed. 1, 2, 3, 4, depression.” She continued, “Put all of the depressed people in a room, and look around. 1 in 15 of those suffering from depression will go on to commit suicide.” It’s dramatic. The room was silent. It usually is. I am not comfortable with the topic anymore than I was the first time, but I am getting used to hearing the same phrases, the same statistics, and responding to the same questions from the audience. I am now familiar with the language of mental illness.

Last Friday, as I stood in the middle of the PACU, our eyes met. It felt intense. it was an emergency, and an emergency in behavioral health means…

Then I heard Michael Buffer, the master of ceremonies, in my head. He introduced the statistic to the ring. Dramatic music played, and before I had the chance to raise my gloves, the statistic nailed me…First with a left hook, then went below the belt. I was knocked out. Speechless with my face in my hands. Gloves were off.

 

Your patient committed suicide.

 

No amount of training prepares you. No power point presentation. No book. No doctor.

TKO.

I never even imagined how I would handle the news. I was weak in the knees and shook.

The patient was starting electroconvulsive therapy in 3 days. The patient had just called me. The patient denied any suicidal thoughts. The patient…….It doesn’t stop.

The gravity of what I do hit me. It hit me hard.

As I drove home I thought, “Have I entered a losing battle? I’ve wanted to be a nurse to comfort people, advocate for them, care for them, and try to help improve their quality of life if possible.” If possible are the key words.

Am I okay with, “We did everything we could. Stop. Time of death….”

 

My question to you: “Do you find gratification with the result or with the process?”

You think you know the answer…until you’re in the ring.

 

Leslie Oneil, RN, is a ECT specialist nurse.  She writes at a blog worth following, A Very LOshow.

 

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Answering Jim, professionally and personally – ECT

A few days ago, Jim, from blog, “I Don’t Want To Talk About It,” asked in his comment to my blog post,

What is your educated opinion about this?  A friend of mine is seriously considering this.

Jim was asking regarding ECT – electroconvulsive therapy.

021 Side Effect

021 Side Effect (Photo credit: Jester Jay Music)

Responding to a question that asks me to answer both personally and professionally is a little uncomfortable but this is my best effort.

…Alright, Provocateur Jim, I have been chewing my cheek on this, wanting to say something profound, considered “educated,” 🙂 yet not to turn anyone off with an up-tilted schnoz.

I do love ECT as a treatment option.

ECT is not for everyone of course, as nothing is, but consider it if you are looking for a treatment to work quickly and effectively .

Quickly is important.

  1. Can be life-saving, (“Timing is everything,” they say)
  2. Brain health short and long-term
  • less dementia,
  • less onset of other brain illnesses that come when one brain illness is not fully treated,
  • easier to respond to any future necessary treatments when we get more rapid and full treatment response to current illness episode,
  • ECT (as with medication therapy) that is done earlier in illness episode has a more robust response,
  • relapses are less severe, and we do not drop as rapidly when treatment is obtained more quickly for current illness episode

3. Quality of life,
4. Halt the damage to interpersonal relationships,
5. Diminish financial demise secondary to disability of brain illness,
6. Minimize side-effects,
7. Minimize medications.

Efficacy… do we really need to even say that the goal is to use a treatment that works?  ECT works more often and more thoroughly than any other treatment options.

Furthermore, we suffer less illness relapse when ECT is continued in maintenance.

Treatment response is much more robust when ECT is combined with medication.

Side Effects:

The side effects can only be measured on an individual basis, as qualified by the person going through them.

First off, there is no brain damage done by ECT, as seen in medical studies. This is a common fear.

Neither does ECT go through the body systems, it is not metabolized, and does not touch our body organs.  Yay, right!?  Medication side effects are a huge pill-dotted elephant in the room.  ECT does not touch the body (i.e. It is not a substance ingested or entered materially into the body,) all related potential side effects never happen.

The number one reason for relapse in brain illness is medication noncompliance.   This is due to many reasons, such as intolerable side-effects and the cascade of subsequent related issues.  Even dry mouth can lead to root canals.  We do not think of osteoporosis from serotonin agents.  Not taking our medication daily can be for more obvious reasons, like not climaxing during orgasm.

Zoloft Side effects in women

Zoloft Side effects in women (Photo credit: Life Mental Health)

Plus, it is just hard to remember.  Even the most consistent of us generally miss one to two days of medication a week or a month.  It is tough to be consistent.
ECT is less difficult to remember and maintenance ECT is much less frequent than taking pills every day.  Even when the ECT is combined with medication, if a day or two is missed, at least the ECT will be consistent as it has the support of the community of ECT staff and the transportation person to and from the surgery center.

In these regards, ECT has fewer barriers to treatment compliance that the majority of us suffer with medication therapies.  That is a big deal.

The side-effects of ECT are generally headache and temporary memory loss.

During index treatment, (about the first 3-4 weeks,) it is common to experience difficulty imprinting/recording memories. This typically takes about five weeks after the index treatment to return toward baseline. 80 years of data do not demonstrate that there is other memory loss but there are individual complaints of that.

Headaches are common for the the first couple treatments until the anesthesia becomes customized to the individuals experience. Generally after the first few treatments, the personalized anesthesia medications are able to resolve these from causing too much suffering. Not universally of course, but generally. Then once the maintenance treatments get going, memory loss and headaches are not common complaints.

…Big breath…

Did I do it?  Any questions about this diatribe?  🙂  Thank you for your patience.  I am trying…  Please let me know.  Keep on.

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Past week, latest on ECT on the web

  1. Shock therapy used to treat depression video from wzzm13.com community
  2. Wrong Planet Autism Forum Index -> Bipolar, Tourettes, Schizophrenia, and other Psychological Conditions
  3. Why are we still using electroconvulsive therapy?
  4. By Jim ReedBBC Newsnight
  5. PLOS ONE  :  Electroconvulsive Therapy Induces Neurogenesis
Cured by Electroshock Therapy,  Wall Street Journal

And, refreshing our memory… from http://www.FriendtoYourself.com, Related:
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Use something other than your condition to mark your value

typical American family, September 1940

typical American family, September 1940 (Photo credit: austinevan)

I do not really want to examine my faith.  It is just a paper flower.  Where my faith comes from, now that excites, like a outlet into energy.

Watching, The Grapes of Wrath 1940 drama film directed by John Ford, tonight with my family, we all knew that we were frail, one or two missteps from disaster.  One of us asked,

“Why wasn’t it a big deal when someone died?”

Oh, but it was.  The people were breaking, could barely dig a grave for their family member, and that may have come across to a youngin’ as if they did not care.  When we are breaking, we look at life differently.  It is a big deal.

Casy says it at Grandpa’s burial, “All that lives is holy.” Chapter 13, pg. 184

I see this in patients sometimes.  People who are done with the bull.  People who know that whatever it is they thought was so great about themselves is just rubbish.  People who know they are more than the sack of skin that holds their fire.  These people are looking for where their life comes from, for a moment of realness to fuel on.  And these people taking medications, getting electroconvulsive therapy, dialectical behavioral therapy, scraping at life to survive, these people are.

However, we do not really want to examine our hard work, though it is so close to what makes life great.  Our courage and grit rises up like a green mountain.  Where our grit, hard work and courage comes from, that is Holy.

There is strength and Holiness there, no matter about our condition.

Question:  What is special about humanity?

Self-Care tip:  Use something other than your condition to mark your value.

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A Note of Thanks For Collaborating

typewriter 1

June 30, 2013

You
Friend to Yourself
Colleagues
Practitioners
Referral Sources

Hello,

I just wanted to send a note of “Thanks!!!!”
Thank you so much for including us in the care of your patients.  I hope we continue in your and their trust.

Practicing variety psychiatry brings me toward my quality of life experience and I am grateful.  I am not alone in this but blessed to be included in a fantastic team and community of treatment providers.

We believe passionately that our own quality of practice experience is the first step to engaging in a patient-doctor relationship.  Connection brings change and so our patients become a changing force in our lives with their courage.

Our patients work through multiple modalities, pressing toward healing and presence with electroconvulsive therapy, treatment-options awareness groups, medications, psychotherapy, and homeopathic remedies.  If there is more we might benefit from in practice, please let us know.  This is a life-journey we are honored to share.

Keep on.

Dr. Q

951-677-2333 ECT Centers, Medical Director
PrimeTelepsych.com Personal cell available, Concierge Telepsychiatry
951-677-2333 Treatment-Options Awareness Community Groups
800-670-4960 Pharmaceutical Research, such as, for those who cannot afford care otherwise – Principle Investigator
PatientFusion.com or (951) 514-1234 Outpatient Psychiatry Clinic
FriendtoYourself.com Us, you and I, Writing and Public Speaking

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another answer to ECT questions

Yesterday, we discussed seven bullet points on ECT.  I disclosed that I have a personal agenda in pursuing knowledge and community awareness about ECT.  (Maniacal laugh! j/k)

In my questions at the end, I asked for ways to continue to improve in this effort, and happily, Nance responded with these scintillating questions!  I’m listing the questions in her words, and responding to them one at a time because really, they are what I hear asked about so often from many others that it’s a no-brainer.  We have to talk about it.  🙂

Good looking lady

1.  Please help those of us who fear good memory loss to understand (or feel better, at least) how ECT is still a viable option. Is the good memory loss permanent?

Studies demonstrate, as does the collective opinion of physicians anecdotal experience, that ECT memory loss is temporary.  Some mild memory loss happens during treatment of course because of the seizures, (also known as convulsions.)  Within a few weeks of the index treatment course ending, the memory returns to normal.

When we have seizures, it is typical, whether artificially induced, such as with ECT, or because of pathology, for us to feel sleepy, not remember events surrounding the seizure and even possibly disorientation.

After a seizure, the brain has a period of “quiescence,” or becomes quiet, when its natural electrical activity rests.  During this time, (the index treatment,) it makes sense therefore, that we will not imprint memories well.

ECT starts out with what we call the index treatment – around four weeks of ECT dosed generally three times a week, on Mondays, Wednesdays and Fridays, for a total of twelve treatments.

Index treatment = 3 ECT treatments/week x 4 weeks = 12 treatments total

This is not set in stone and some people have fewer or more.

Furthermore, most people say that within fifteen days of initiating ECT, memory is actually better!  That’s pretty cool.  It ties in with our understanding that our perception of how we concentrate and remember things is worse with brain illness.  However, in many brain illnesses, it stops there.  It is just our perception, when in reality, our memory is just fine.

Soooo, connect that with what we said yesterday about ECT taking about 1-2 weeks to start working, (i.e. round 15 days!)  And, when the brain illness is healing, the symptoms of the brain illness, (in this discussion it is memory loss,) is better.  Yay!  The term to describe this kind of perceived memory loss is “pseudodementia” because there really is no memory loss in the first place.

2.  How often, after the couple of weeks that you mention, would ECT be necessary?

ECT, like most treatments for brain illness, is not a cure.  Healing does happen, but the genetic predisposition remains.  Most of the time when people c/o that their illness got better with ECT but just came back when they stopped, it is because they never transitioned to maintenance ECT.

After the index treatment is done, we need to taper the ECT doses down slowly, monitoring all the while for symptoms of brain illness resurfacing.  When we decide that the symptoms are just starting to come back, we stop the taper and continue the ECT treatments at that frequency.  For example, if you Nance were at this point getting one ECT treatment every three months, we’d continue you with that.  Every three months you would get one ECT treatment and we would monitor to see that your brain illness remained fully treated.

If you relapsed, we would increase the ECT dosing again until you responded fully and then try to taper down again.

3.  Would it completely replace the need for medication or talk therapy?

ECT works alone, as does medication treatments and talk therapies.  However, any of these work best when used together.  We know that our goal is full treatment response and not just – “Ah, she’s better.  That’s great!  We’ll just see how she does for now.  She soooo much better than she was after all.  We should just be glad and not complain.”

Our goal is not to only improve the illness some, but get it fully responding to treatment and allow for maximum brain health.

Leaving a brain illness only partially responding to treatment equals leaving the disease to progress.  When we fight for full treatment response, we are fighting for our brain health fifteen years from now.

One of the beauties about ECT is that is gets us to this great place where we are giving ourselves a healthier brain in our futures.  For example, we know that there is more dementia and earlier onset of dementia if brain illnesses are not fully treated.

Thank you Nancy for these questions and opportunity to further discuss this important, underutilized treatment option for brian illness!

Thank you readers for joining us in this discussion.  Let us connect with our community, increase community awareness and decrease stigma together.

Everything starts and ends with Me.  Keep on.

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Marcos and his brain illness

Man portrait

Man portrait (Photo credit: @Doug88888)

He had always been a small man with wizened lines, a moguled nose that sloped over a deep philtrum and two ears that flew like flags on the sides of his head.  Looking at Marcos has always been a study of human terrain.   For someone with so much activity and exchange with just being seen by others, it was an apparent contrast to how disconnected he remained emotionally.  Brain illness had harmed Marcos.  It was as if he had been scooped out in places.

Marcos and I had worked together for ten years in psychotropic and psychotherapeutic remedies with only partial treatment responses that curved up toward an imagined healthy baseline on currents of hope.  His improvements however, never reached where he would call himself, “well,” and too soon they drifted down despite our cumulative efforts.

About that time, I had returned from Duke University for an update in training on electroconvulsive therapy, (ECT,) and had just opened up a new outpatient ECT surgery treatment center.  When Marcos and I discussed this as a new option, (new for our living location,) he wanted it without contest.

The evidence for efficacy as compared with the side-effect profile in ECT is dramatic.  When I tell patients about it, ECT might sound too good.  However, it has been around for so long that it celebrates itself. Marcos wanted in.

It has been a year already since we started ECT together but I still remember the way he leaned back in his chair that day in my office, animated almost for a change.  His scrubber eye brows were like punctuation marks around his eyes.  “Yes.  I want it.”

Marcos has not been able to taper down ECT at this point in his treatment to less than one treatment every two weeks.  He and his wife argue for it.  We have tried many times to taper down but every time we do, his symptoms come back.  He and his wife ask me separately and together, “Why doctor?  What is the point of decreasing treatments?  I do not understand?  When they work so well and we are not having any problems from them, why are we trying to reduce them?”  So, for now, he maintains one ECT treatment every two weeks.

His wife tells me he is better than he was on their wedding day.  She has never known him to be doing this well and they both think he is closer to whatever that baseline is for brain health he has always thought he was never going to get.  More connected with her, their sex life is having a run.  More connected with their kids, everyone feels like he has become a giver and the kids grades are even getting better.  By taking, Marcos became more of a giver; taking time, courage, emotional energy, even a ride there and from ECT, Marcos took and then was able to give.

Marcos is reading everything he can get his hands on about ECT; personal biographies, scientific articles, he has become his own advocate.  He could not read before ECT.  His concentration was too poor.  Now, with improved focus and attention, he perceives his memory is better.  Marcos believes he is interesting because he is interested in himself.  He is more aware of how others see him and smiles back when he catches the looks he gets just by wearing that face.

ECT is not a cure, but it is a treatment option.  It leads to brain healing, quality of life and improved connections.

Questions:  Have you struggled with quality of life?  How do you describe quality of life?  Please tell us your story.

Self-Care Tip:  Consider changing treatment paradigms to improve brain health.

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Hatred and Brain Health

Hatred

Hatred (Photo credit: dton23)

Have you ever noticed that hating the person who hurt you is never enough?  The damage does not respond.  The edges do not come back together.  Hating them harder, hating them more effectively, with your voice, with your body, committing your talents toward their detriment, recruiting forces, community – this is not enough.  Finally, you grow plans from dragon teeth.  You wish them death and an after-life of repeating hateful deaths.  It is still not enough.  You are left with you.

When the extreme, when the hate that is to say, is not enough something is wrong.  But it’s not what you think.  The thing that is wrong is not that.

We could say you are a sinner.  We could say pray more.  We could say exercise, destress, do yoga, karate, eat less sugar and drink grass juice.  We could and perhaps we do.  But this time, please put that aside.  It is not disqualified.  It’s just not the bit we are going to talk about.  Don’t be mad at me.

The hate is in the brain.  The brain picked this to perseverate on and return to like the tongue over a canker.  Lick.  Ouch.  We don’t ask for these emotions.  We don’t ask for these behaviors.  They come, symptomatically telling us a story about our condition.  Hear the story?

It goes something like this.  We are persons who know enough to know that this is a feeling stronger than deserved. This is a response not entirely rational.  This is a behavior that we would choose not to do otherwise and nor would a friend of ours support.  Our mother would tell us, “No.”  We experience a whole body response that surprises some level of our awareness and that part stands by uncertainly with her fingers picking at her lip.

The story tells about the other times when we endured worse and responded without as much personalizing.  We remember that someone else we knew acted like this and we didn’t think much of it.  We thought they were “off.”  We realize that what we are experiencing might not have as much to do with the crime as we thought.  It might just be that we are not feeling and behaving well.  It might be our brain.

That darn double-crossing organ!  How is anyone supposed to trust themselves?  It’s tough but we have each other and we have our story and we have grass juice.  We have God.  We have medication.  We have ECT (electroconvulsive therapy.)  We have acupuncture, our support groups and DBT (dialectical behavioral therapy.)

Considering where emotions and behaviors come from is the bit that gives us a chance to find and be found by help.  Hate is a very strong emotion from the brain and it isn’t so friendly to Me.  If we can’t put it aside, consider the brain.

Self-Care Tip:  When emotions and behaviors come that you don’t want, and won’t go away even when you say, “Please,” consider your brain health.

Question:  What has helped you disentangle the effect from a cause that wasn’t really the cause?  

How do you allow for the biology of brain health when it comes to feelings so personal?  

How is considering the brain a friendly thing to Me?  Please tell us your story.

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More on ECT – TV Episode happened upon

Hello Friends.  I don’t know if you’re interested or not, but we’ve opened discussion on ECT (electroconvulsive therapy) in the past and because it remains open, I wanted you to know that I just ran across this TV episode online that is done surprisingly well.  Check it out and let us know what your thoughts are.  Keep on.

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AfterShocks (…Smile) From our ECT Series

Reference cat

I am hoping to get a running stream of references for those interested in finding out more about ECT.  To start, some are:

  1. As relayed in our last blog post, check out Mayo Clinic
  2. Kitty Dukakis: Shock Therapy Saved My Life – ABC News on abcnews.go.com
  3. Kitty Dukakis And ECT – CBS News Video
  4. Kitty Dukakis And ECT video – CNET TV
  5. Katherine Kitty Dukakis on ECT | Psych Central
  6. Kitty Dukakis & Shock Therapy | World of Psychology
  7. Shock: The Healing Power of Electroconvulsive Therapy – Amazon …
  8. Kitty Dukakis Backs ECT for Depression : NPR
  9. Scientific Articles on Neurogenisis From ECT as described on PubMed
  10. Mortality Rate From ECT
  11. University of Maryland describes their understanding of ECT as a treatment option for Bipolar Mood Disorder and Depression
  12. Currently under research at Duke University, “Not-So-Deep Brain Stimulation:  Transcranial Magnetic Stimulation (TMS)
  13. I also really love the 1st hand words from    Here is one of her excellent statements – “No one really knows how ECT works. For the longest time everyone just said it “rebooted” the brain. Hardly scientific. What we now know is that ECT creates neurogenesis, in other words, neuron growth. And this is needed because long term depression kills brain cells and shrinks the brain. (Antidepressants also induce neurogenesis, FYI.) So ECT is able to make connections in the brain that weren’t previously there, and it makes them very, very quickly compared to any other method.”  She has done her research.
  14. Also, enjoy reading The Bipolar Badger who is going to be writing more on his experience with ECT this week (he’s promised).  The Badger says, “there is very little positive or objective is more like it out there on the interwebs. While I do not expect every post out there to be positive as not everyone has a great experience with ECT. It as important to mention positive outcomes as well.”
If you know of more, please tell us!
Be a friend to yourself.  🙂

 

 

 

 

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The Non-Dramatic Ending To Our ECT Series

Bert the Turtle

Image via Wikipedia

Not much traffic over here since drifting into electroconvulsive therapy (ECT) territory.  That’s alright.  Everything in its own time.  We got some feedback from some who didn’t find ECT helpful, some who would never be interested in ECT but not much from anyone who has found ECT helpful – and I know you are out there.  Healthy and quiet about it.  I know because I know from my patients and from the studies and statistics available.  You are there.  And you are not alone.

I was corresponding with my trusted mentor on this subject, Richard Weiner M.D., from Duke University, who has treated patients with ECT for 40+ years.  He referred us here at FriendtoYourself.com to the clean presentation by Mayo Clinic.  If you are interested in further introduction into ECT, check it out.  They have a lovely video, outline and inquiry resources.

On a slightly shifted topic, I’d like to introduce you to my friend, B.D.Erline.  This guy’s really rocking the friendship thing to yourself these days.  He’s writing and spending himself on his new, “Act-Like-You-Wanna-Live” series.  It’s brilliant.  Say hello if you’d like.

That’s all for tonight my friends.  I thank you for coming along even when topics interest you less than other days.  Keep on.

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Celebrating Your Courage Will Connect You With Your “Me” and With Community

Veterans Day

A seriously cool veteran was cruising Old Town today on his Harley with about fifty American flags affixed in mysterious ways to his bike and person.  I cannot figure how, but those flags were not going anywhere he was not.

I had forgotten today is Veterans Day, even though my kids were all home, off from school, properly running amok.  This man, in his leather skins and industrial number of stars and stripes, reminded me.  As we approached each other from opposite sides of the street, I saw him nod to another biker passing him by.  His nod was enough to say, “Hello.  You are not alone.  I am not alone.  We connect by this brotherhood.”  I watched him in my rearview mirror and immediately dialed my dad, of course.   “Happy Verterans Day.”

Sometimes we do not wear our history as confidently as this cool vet.  How messy that would be, right?  Imagine a world where people used their hard-earned losses as a tool to empathize with themselves and others.  Where people’s pain was used as a force to connect with their Me and with others.  How tiring to receive nods, to accept judgments and applause, as it may be.  Right?  Company can be a burden.

This is my guess as to why not many of us speak up about what electroconvulsive therapy (ECT) has done for us.  We hear about the miracles of medication therapies from first person reports, heck, even second, third or tenth hand.  We do not hear much about the miracles of ECT.  Instead, we hear the sound of quiet or else hopeless barbarism.

I was talking with a patient, Carla, about ECT as an option for treatment, and we laughed that we are anesthetized for a colonoscopy for much longer amounts of time than we would if we had ECT.  They seemed like such funny things to juxtapose.  The convulsion lasts around thirty seconds and you are done.  There are no broken bones.  No tongues bitten through.  There are no chickens sacrificed on anyone’s chest.  Carla had never heard about the physician-patient who had undergone thirty-six ECT treatments as a patient, whose morbid melancholia resolved and who later returned to practicing medicine in full capacity.  Why would the physician tell people about his history?  What kind of nods do you think he would get?  What patients would be willing to go to him for medical care?  Carla had not heard about the gamers, computer programmers, the nurses or anyone from the functioning productive public who had the courage to fight for themselves by choosing ECT.

My patients with whom I discuss ECT have concerns.  You have concerns.  Much of the world is concerned.  There are reasons.  ECT has improved farther than Jack Nicholson’s report on One Flew Over The Cuckoos Nest, though many of us were alive when his movie was first viewed.  The distance we have come in refining the practice of ECT is out of proportion to the distance in time from when ECT was not much more than sticking your finger in a socket and getting voltage in a continuous sine wave for therapy.  Is it shameful being connected to that history?  Is it too soon to say, “These are the ancestors I claim?” You know what to do with shame.

There are few medical specialties that gather as many opinions as psychiatry.  Yes.  Well there are even fewer medical treatments that are found in the company of so much frothing opinions than ECT.  No wonder we are quiet.  No wonder we are concerned.

So, although we veterans of ECT perhaps have not spoken up in our community, although we may not tear up at ceremonies for what our courageous self-care has done for our country or understand how we fit in, although we may not hang flags or tattoo it into our skin, we are courageous important citizens in company.  We are heroes.  Maybe not as cool in leather, but we are where we are because of those who have come before us and for what we have carried on.  We have suffered and died and lived and we are connected.  We have community and we are not alone.

Happy Veterans Day.

Self-Care Tip – Celebrate your courage.

Questions:  How do you celebrate what others think is shameful but you know is not?  What have you found in doing so?  What has gaining your community done for your ability to celebrate?  Please tell us your story.
Series on ECT:
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Consider the Barrier Stigma Plays in Your Ability to Take Care of Yourself

Esther... The Girl Who Became Queen DVD Cover

I am just going to come right out and say it.  I have been trying to be clever, a Queen Esther toward her King and Hamon, on behalf of the people she loved.  (Yes.  I am Queen Esther in this story.  You can play her in another one.  Maybe tomorrow.)  I have been talking about treatment options for brain health and it is just not going where I was trying to take us – ECT.

ECT, my friends.  Electroconvulsive Therapy.  Many people see this as an extreme option for the dire, filtered out treatment failures.  That is an ugly description but I believe pretty close to what we have culturally got.  Many of you have told us how you escaped receiving electrically induced convulsions.  You hid from the boogie man and lived to tell us.  (There are chemically induced convulsions but we have more control of the convulsions through electricity, so that is the standard of care.)  Others have testified that it destroyed them with a catalog of specific and nonspecific complaints.

Interestingly we have not heard from you who have received ECT.

Come out, come out wherever you are.

Stigma perhaps hides you, and we can understand why.  Stigma toward ECT is like stigma toward anything – pretty off topic and hurtful.  Although it is improved by education and empathy, it is not fun challenging it “alone.”

Tonight I am not going to talk about the pros and cons of ECT, but to say that you are not alone.  You who are in treatment or have been in treatment or are considering ECT – would you tell us what you know, personal or impersonal?  There are many of us who would benefit from your education and empathy.

(What would that do to stigma?  What would that do for us?)

It would be wonderful to hear questions any of you have, as well, and anything related to ECT that you would like to share.  Please tell us your story.

Self-Care Tip – Consider the barrier stigma plays in your willingness to receive treatment and to connect with others.

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