Sep 9, 2017
This week we have an interview
with Professor John Read. Professor Read worked
for nearly 20 years as a Clinical Psychologist and manager of
mental health services in the UK and the USA, before joining the
University of Auckland, New Zealand, where he worked until
2013.
He has served as Director of the
Clinical Psychology professional graduate programmes at both
Auckland and, more recently, the University of
Liverpool.
He has published over 120 papers
in research journals, primarily on the relationship between adverse
life events (eg child abuse/neglect, poverty etc.) and psychosis.
He also researches the negative effects of bio-genetic causal
explanations on prejudice, the opinions and experiences of
recipients of anti-psychotic and anti-depressant medication, and
the role of the pharmaceutical industry in mental health research
and practice.
John is on the Executive
Committee of the International Society for Psychological and Social
Approaches to Psychosis (www.isps.org) and is the Editor of the
ISPS’s scientific journal ‘Psychosis’.
He also a member of the BPS’s
Alternatives to Diagnosis working group.
In this episode we discuss
professor Read’s research interests and in particular, the science
and evidence base for Electroconvulsive Therapy or Electroshock as
its known in the United States.
In this episode we
discuss:
- How Professor Read became
interested in psychology, partly because of difficulties in his
younger years and he wanted to understand those
experiences
- That his first experiences with
patients in a psychiatric ward would be that people often wanted to
share traumatic experiences, but that the psychiatrists didn't seem
that interested
- That, by and large, mental
health services around the world prefer to count symptoms and to
medicate rather than to understand what has happened in a person’s
life
- How John came to have an
interest in and research the efficacy and safety of
Electroconvulsive Therapy (Electroshock)
- That ECT is designed to induce a
grand mal seizure and it started as a treatment for people
diagnosed as schizophrenic
- That the justification in the
1940s was that schizophrenics did not suffer with epilepsy and
epileptics did not suffer with schizophrenia, so psychiatry made
the leap to inducing epileptic seizures as a ‘cure’ for
schizophrenia
- That nowadays it is not used for
people labelled as schizophrenic but it is most often used for
treating depression
- How actually it is not the
diagnosis that is the best predictor of who gets ECT, it’s age and
gender
- Women aged over 60 are twice as
often given ECT as men, and people over 60 are given it 2-3 times
more often as those under 60
- That the other rationale given
for ECT treatment is the tendency for ECT to obscure traumatic
memories because of memory loss
- That the science and evidence
tells us that after 70 years there has never been a single study
showing that ECT is better than placebo beyond the end of the
treatment period
- That placebo in this sense is
like sham surgery, the anaesthetic is given but not the
electricity
- That during the treatment
(usually 3-4 weeks and an average of 8-10 sessions) roughly a third
of those treated gain some lift of mood but that even for this
minority of responders, the effect wears off after a few
weeks
- That this explains why some
people will give anecdotal evidence that ECT saved their life and
that they tend to have repeated treatments because they want the
same life of mood
- That the method used to assess
success of the procedure is most often a rating scale or a
‘clinical judgement scale’ and these methods are open to
bias
- That there is not a single study
that has ever shown that ECT can ‘prevent suicide’ when compared to
placebo, the claims that it can are based on anecdotal
evidence
- That Earnest Hemingway killed
himself shortly after receiving ECT saying “it was a brilliant
cure, but unfortunately we lost the patient”
- That there are temporary effects
such as headaches after the procedure, but the enduring
difficulties are often with memory loss which can be short term or
longer term memories
- Roughly a third of people will
have serious, debilitating and ongoing memory loss which is caused
by the brain damage caused by ECT
- That the Guardian newspaper
reported in April 2017 that ECT use was increasing in the UK but
that their figures were wrong
- That a third of psychiatrists
will use ECT, a third will only use it after other options have
been explored and a third will not use it under any
circumstances
- That ECT can get catatonic
people moving and speaking but it is not difficult to artificially
stimulate mood and it should not be seen as a cure
- That there haven't been any
placebo controlled trials of ECT since 1985 and that was the last
of only four that have ever been done that compared ECT with
placebo after the end of treatment
- How the fact that we do not have
any successful trials showing that ECT is effective should mean
that psychiatry either puts effort into proper research or that the
procedure should be stopped
- That John feels that eventually
we will look back at ECT in the same way that we now view lobotomy,
blood letting, rotating chairs and the like
- How the principle should be
informed consent and that people should be able to get treatment
that they feel will help them but only if they know fully the risks
and benefits and if they have been offered alternatives
- There is a low but signifiant
death rate from ECT, partly down to the general anaesthetic and
partly due to cardiovascular failure because of the induced seizure
but this death rate is never mentioned to potential
patients
- That it is probably down to the
placebo effect of having attention and a procedure that
expectations are created and hope is raised
- That there is effort being put
now into transcranial magnetic stimulation (TMS) and people can
actually shock themselves using this method
- That if we have large numbers of
people walking round depressed, we really need to start asking
questions about our society rather than trying to artificially
eradicate those feelings
- That John’s view is that
depression is largely cause by depressing things happening to
people rather than because of depressive illness and assuming that
we can identify the parts of the brain that are
‘diseased’
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