The article “Shock therapy for mental patients will be reviewed”continues the ignorant tradition of demonizing electroconvulsive therapy (ECT) in the media (the very use of the anachronistic and misleading phrase “shock therapy” is unwarranted) without presenting the compelling reasons for its continued use. Most of the facts and quotations in the article, including the gratuitous final paragraph about pigs in an abattoir, are simply taken from an article by Davar in “Issues in Medical Ethics”, without questioning whether Davar’s presentation of the issue is an unbiased and scientifically accurate one. What Ms. Davar, and by extension Ms. Jain, has done is simply cite authorities who agree with her point of view, quote statisticswithout context, use an abundance of negative adjectives, and ignore outright the empirically proven benefits (often life-saving) of ECT in many categories of mentally-ill patients. This is shabby and irresponsible medical journalism.
While this is not the place to dispute, point-by-point, Ms. Davar’s presentation of her position and Ms. Jain’s repetition of it, I would like to quote, to counter their negative emphasis, from Andrew Solomon’s widely read, intensively researched, highly respected book, The Noonday Demon: An Anatomy of Depression. Solomon writes: “Antidepressants are effective [against major depression] about 50 percent of the time, perhaps a bit more; ECT seems to have some significant impact between 75 and 90 percent of the time... Many patients feel substantially better within a few days of having an ECT treatment – a boon particularly striking in contrast to the long, slow process of medication response. ECT is particularly appropriate for the severely suicidal – for patients who repeatedly injure themselves and whose situation is therefore mortally urgent – because of its rapid action and high response rate, and it is used in pregnant women, the sick, and the elderly, because it does not have the systemic side effects or drug-interactionproblems of most medications.”
There are, indeed, problems with the administration of ECT, especially in a country like India with its poor health infrastructure. It would be foolish to deny that the practice is subject to abuse (as Solomon and numerous Indian writers report). The continued use of “direct” ECT (without the use of an anesthetic) is certainly a matter of concern – and a concerted effort to implement national guidelines making “modified” ECT (using an anesthetic) mandatory is as necessary as it is laudatory. But we can all do without more pieces of journalism which perpetuate the myth that ECT is a medically unjustified, indeed barbaric practice, tantamount to torture. This ignorant view, equally prevalent in the West as it is in India, has more to do with movies like One Flew Over The Cuckoo’s Nest than with scientific fact.
It is exceedingly difficult to make people realize that an evil is an evil. For instance, we seize a man and deliberately do him a malicious injury: say, imprison him for years. One would not suppose that it needed any exceptional clearness of wit to recognize in this an act of diabolical cruelty. But in England such a recognition provokes a stare of surprise, followed by an explanation that the outrage is punishment or justice or something else that is all right, or perhaps by a heated attempt to argue that we should all be robbed and murdered in our beds if such senseless villainies as sentences of imprisonment were not committed daily. It is useless to argue that even if this were true, which it is not, the alternative to adding crimes of our own to the crimes from which we suffer is not helpless submission. Chickenpox is an evil; but if I were to declare that we must either submit to it or else repress it by seizing everyone who suffers from it and punishing them by inoculation with smallpox, I should be laughed at; for though nobody could deny that the result would be to prevent chickenpox to some extent by making people avoid it much more carefully, and to effect a further apparent prevention by making them conceal it very anxiously, yet people would have sense enough to see that the deliberate propagation of smallpox was a creation of evil, and must therefore be ruled out in favor of purely humane and hygienic measures. Yet in the precisely parallel case of a man breaking into my house and stealing my diamonds I am expected as a matter of course to steal ten years of his life. If he tries to defeat that monstrous retaliation by shooting
me, my survivors hang him. The net result suggested by the police statistics is that we inflict atrocious injuries on the burglars we catch in order to make the rest take effectual precautions against detection; so that instead of saving our diamonds from burglary we only greatly decrease our chances of ever getting them back, and increase our chances of being shot by the robber.
But the thoughtless wickedness with which we scatter sentences of imprisonment is as nothing compared to the stupid levity with which we tolerate poverty as if it were either a wholesome tonic for lazy people or else a virtue to be embraced as St. Francis embraced it. If a man is indolent,
let him be poor. If he is drunken, let him be poor. If he is not a gentleman, let him be poor. If he is addicted to the fine arts or to pure science instead of to trade and finance, let him be poor. If he chooses to spend his wages on his beer and his family instead of saving it up for his old age, let him be poor. Let nothing be done for "the undeserving": let him be poor. Serve him right! Also -- somewhat inconsistently
-- blessed are the poor!
Early data on seat-belt use showed that seat-belt wearers were less likely to be killed in road accidents. Hence, it was initially believed that wearing a seat-belt increased survival chances in an accident. But what the early analysts had failed to see was that cautious drivers were more likely to wear the belts and were also less likely to cause ‘big accidents’, while reckless drivers were more likely to be involved in ‘big’ accidents and were less likely to wear the belts.