http://exhibits.library.stonybrook.edu/mfp/files/original/06a02abac55ed41732d4ad21bba4159c.pdf ac9d8819d7fee14f53b45dd52eee3153 PDF Text Text ....;.., ~.- .. , “r ‘r-m . , "w—"4—,. Yaw. my ...-..—_—- WWW—wrun— 'mu'r“w mm...r<—~..~v,. ..,...,.< .,. .myqu-w-w-w—u .mwuwnu-v... April 5, 1973 a... "W Ms. Carolyn Patient Care Lamb Darien, Connecticut Dear Ms. Lamb, Dr. Kaiser makes an important complaint; one that is shared by many other professionals, the-laity and the media. Are the presentations in the 197a New Yorker article with its emphasis on permanent brain damage, or the 1976 article in Psychology today which suggested that BCT 'burns the brain', or the image in "One Flew over the Cuckoo's Nest" correct ? Does ECT cause permanent brain damage ? Dr. Kaiser also laments its unequal use in populations, its alleged overuse and abuse, and the thorny issues of consent. In raising these questions he is not alone, for since 1972 there have been numerous individual assessments of BCT, conferences and symposia, and at least three international task forces reviewing the questions. There are some answers. has been shown to be the most effective treatment for severe depressive illnesses and for catatonia. The results in these conditions are consistently better than alternate treatments. ECT is also useful in mania, but the comparisonnwith lithium therapy is lacking. In schizophrenia, the evidence is also clear, that ECT is no ECT better than pharmacotherapy, and should only be considered a secondary treatment. In the neuroses, adolescents and children, cases of psychopathy and addiction, ECT is of no value. As to safety, it is surely as safe and often more so than other treatments for the mentally ill. Suicide rates and death rates are consistently lower for ECT treated samples. The old complications of panic, fear, fracture need not occur under modern regimens. The principal complaint is still amnesia, but even this can be reduced markedly by the properttreatment which should include anesthesia, muscle relaxation, oxygenation, and proper attention to the use of minimal currents and unilateral non-dominant placement of electrodes. Under these conditions, the incidence of persistent amnesia should be less than 1/200 cases, and even when the complaint persists for some weeks, should be reversible within six months. �. -.- mt.w..ww. as". v... . ~— “when“...W‘WWWW—evv.mwv w. Trips... vw'm. .wmwwwnramlm -7“... .,__._,_.,._...._...._ . m “wuwr ...._ ._... Vi..- ._.. i_i.._,....._. ...__ .w . . ,, , is a question about training in ECT. Host physicians entered psychiatry in the last two decades received little training in HOT; and the older clinicians, many of whom learhed the techniques in the 1940's and early 1950's, may still be using techniques that are clearly outmoded. It is important that ECT training sessions There who be made a regular feature of medical review courses and that only physicians with recent experience be encouraged to use ECT. Contrary to Dr. Kaiser's opinion, BCT is a treatment of and the middle upper classes. In the APA survey and our own in New York City, we found that university private hospitals treated - “a," '(‘V'Y‘W‘mw’rlnmn _. ..._ - 2‘”1..q~,yn—gq w-r-wn-nu raw v.5 “PK-’1' my about 5% of their patients with ECT; private for profit hospitals, with middle and upper class clientele, about 30%; while public (minicipal, State and VA) hospitals used ECT in less than 1% of patients. If anything, the complaint should be that because of the expense of HOT, and the prevailing reimbursement policies, ECT is a treatment that is reserved to the insured and the self-payeing public. Consent is an important issue. There is little reason not to treat the voluntary hospitalized patient who is willing to be treated, after a reasonable explanation of the risks and benefits of the treatment. Also, there is no problem in NOT treating the voluntary patient who refuses ECT. The issue in involuntary patients is more complex and I would refer the reader to the APA Task Force report for a better discussion of the issues and the recommendations. of the technical questions would require a text—book or manual, and I am pleased to tell him that two excellent manuals are in press, and should be available by the end of the year (see below). The remainder ung- '1 nnmpmrw WWI-tn. 1'4"”!- is "WI-Urn _ Dr. Kaiser is to be commended for raising the question. He fortunate to do so at a time when the assessments have been made and are available. He should also know that the mode of action of BCT has received much intensive study, and that so much is known about the process, that it is likely that a biochemical equivalent of the BCT process should beiin the clinic before the end of this decade. I commend the following articles to him: R. and Prange, A. Convulsive therapy and other biological treatments. In Flash, FF and Draghi, SC (Eds): The Nature and Ilaria, Tfieatment of Depression, New York, John Wiley Efficacy and Safety of Induced Seizures Comprehens. Psychiat. 19: 1—18, 1978. Pink, H. 8 Sons, 1975, pp 271-308. (EST) in Man. Frankel, F. Report of the Task Force on Convulsive Therapy, American Psychiatric Association, Washington, D.C., in press. Asnis, Saferstein, S. ECT in Metropolitan New York survey of Practice, 1975—1976. Amer. J. Psychiat. 6., Pink, Hospitals: A M. and 135: u79-u82, 1978. , �—‘._.., . , "'Wrwq' v.7, a- .w w“. W quwmvmwmmwawK—‘F'm 7.“,— Psychiatrists Memorandum on the Use of Electroconvulsive therapy. Brit. J. Paychiat. 131:2II-272, 1977. Royal College of Pink, M., Kety, 8., McGaugh, J. and Williams, T. The Psychobiologz_ of Convulsive Therapy. Washington, 0.0., V. H. Winston 5 Sons. 197u, 312 pp. Convulsive Therapy: Theory and Practice. Press. (late 1978). Fink, ECT M. is alive Perhaps the New York, Raven citations alone should convince and well in academia. him that Sincerely yours, Max Fink, M.D. Professor of Psychiatry � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence to: Lamb, Carolyn Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-05-00-029-1-034 Date A point or period of time associated with an event in the lifecycle of the resource 1978 Creator An entity primarily responsible for making the resource <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a> Subject The topic of the resource Correspondence -- Correspondence Relation A related resource The Max Fink Collection Description An account of the resource Rights Information about rights held in and over the resource <a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a> Source A related resource from which the described resource is derived Special Collections and University Archives, University Libraries. 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