I had a really interesting day yesterday. I went to Richmond to learn about electroconvulsive therapy, or ECT. Yes, shock treatments. Now we have ECT in Baltimore, and all residents see patients on the inpatient unit who have ECT, and all residents do ECT. I wanted to see it again because it's been a long time since I was a resident in an ECT suite, and thought perhaps something might have changed. Nothing changed, except that now the psychiatry resident spends a lot of time looking at a computer.
Why did I go to Richmond? I'm doing research for our book on involuntary treatments, and in Maryland ECT is only used for people on a voluntary basis. The only way around this for someone who is so sick that they are in danger of dying if their condition doesn't get treated, is to have a guardianship appointed, and this is quite rare and for quite extreme cases. In Virginia, ECT is treated like any other involuntary treatment, a magistrate comes to the hospital to hear civil commitment cases, have medication review panels (I'm not sure what they call it there, that's the Maryland lingo) and involuntary ECT is considered another treatment. Obviously, it's reserved for the very sick, who have not responded to other treatments, or where a quick response is imperative. I heard about one patient who had been catatonic with a feeding tube and unresponsive to any treatments - a man in his early 50's -- the treating facility's plan had been to transfer him to hospice to die, and instead he was transferred for ECT treatments and he recovered.
The doctors who do ECT regularly see it as a highly effective treatment, often life-saving, when all else has failed. Clearly, this is the most controversial treatment we have in psychiatry, some might even say it's barbaric.
I've hesitated to blog about the research I've been doing as I work on the book -- not because there's anything secretive about it, and it's been a fascinating project for me -- but because I'm not sure how are readers will respond. Obviously, involuntary treatments make for a controversial and heated discussion.
And if you're interested in the latest on what Maryland's Department of Health and Mental Hygiene is planning to recommend to out state legislature on involuntary outpatient commitment, Here is an article in the Baltimore Sun to check out.