Treatment of mental ill health with reference to past treatment

* This is another Summer school essay, this time for a psychology course. Like the E-commerce essay, this is one of my first pieces of writing at University level and as such does not represent my best work. The small amount of psychology I studied at this time was enough to disenfranchise me to the subject, it’s a very soft science – which I say in the most derogatory way possible. I have little interest in measuring such labile and intangible things as human behaviour and so I have a very low opinion of psychology as an area of study *

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Psychology Route 3, Clinical Psychology 1

Lecturer: Rachael Jack

Give an account of how we attempt to treat mental ill health today with reference to what we learned from past treatments of ill health.

 

Alistair Cunningham

Word Count: 1459

The treatment of mental health has a chequered past. Prior to the advent of evidence based medicine, treatment of ill health often involved religious belief, cruelty or a misunderstanding of basic physiology, such as in the practice of demonology or the abuse of patients for exhibition and entertainment prior to the 20th century. In the modern era mental ill health is mainly perceived with less social stigma and with a greater focus on the physiological causes of mental disorder. Often as technology improved and medical knowledge expanded it became clear that many previous treatments were either ineffective or barbaric and as such treatments today often iterate upon these methods, usually to find a more effective treatment and occasionally to repurpose a treatment for more humane use in the present day. It is the influence of past treatments on current knowledge which this essay will focus on.

The resurgence in the use of electroconvulsive therapy (ECT) in the treatment of depression is one example of a modern treatment which benefited from past attempts at dealing with mental ill health. ECT was used excessively throughout the 1940’s and 1950’s, (at one point due to the belief that it could cure epilepsy) and during this time was often overused without proper concern for the patients comfort and safety

(BBC 2002). While it is true that the use of ECT in this era was often cruel and painful, the general perception of ECT grossly exaggerates this concept, most likely due to the bombastic portrayal of ECT in the media (Psychiatric Times 2004).

Depression is a mental disorder with symptoms which include; affective (sadness, apathy); cognitive (pessimism, guilt, suicidal ideation); behavioural (disinterest in personal appearance, agitation) and physiological symptoms (weight fluctuations, aches and pains, disrupted sleep patterns/insomnia) (Sue, Sue & Sue, 1994a), and as an ongoing disorder is both debilitating and life threatening for the affected individual. The causes are also numerous although in many cases are linked. For example a social event (such as the death of a parent) can cause stress (a psychological affectation) which in turn causes physiological changes resulting in depression.

It would appear that depression is caused by a conglomeration of factors, all of which incite biochemical changes concerning various neurotransmitters responsible for mood regulation (Sue, Sue & Sue, 1994b). Current treatments typically use pharmacological methods to adjust the concentration of specific neurotransmitters, the most prolific of these treatments being the drug prozac (the chemical name being fluoxetine). The efficacy of prozac was questioned in a study (Greenberg, Roger P, Bornstein, Robert F, Fisher, Seymour, Zborowski, Michael J, Michael D, A meta analysis of  fluoxetine outcome in the treatment of depression, 1994, Journal of nervous & mental disease) which concluded that prozac efficacy “was no greater than effect sizes obtained by previous meta-analyses of tricyclic antidepressants” and suggested that the diminished side effects of prozac when compared to alternative drugs may inflate perceived efficacy. However another more recent study (Horder J, Matthews P, Waldmann R, Placebo, Prozac and PLoS: significant lessons for psychopharmacology, 2010, Journal of psychopharmacology, Oxford) refutes a number of these claims, finding fault with specific analytical techniques used in the study.

ECT is currently reserved only for those patients whose symptoms prove unresponsive to pharmacological intervention, and while ECT is still considered a last resort, it has evolved into a much more humane procedure. In contrast with previous uses of ECT in which patients would often flail uncontrollably during seizures, patients first of all must consent to the procedure and if so are restrained so as to avoid injury. During the procedure: patients are monitored via electroencephalogram (EEG) as well as electrocardiogram (ECG), receive a sedative and muscle relaxant, outfitted with a mouth guard to protect the jaw/teeth and then an electric shock is administered

(Fink M, Electroconvulsive Therapy: a guide for professionals and their patients, 2009). The entire process is much less dangerous for the patient, and is performed much more adroitly than in the past. From the advances made in ECT, it is clear that procedures which were at one point used improperly or were ineffective can be adapted using modern technology and physiological understanding to create a much more effective and humane solution for mental disorders.

An example of a similarly brutal procedure which has been adapted by modern medicine is that of the lobotomy, an invasive neurological operation originally used to cure schizophrenia which earned it’s creator, Egas Moniz, the Nobel prize in Medicine (The Nobel Prize in Physiology or Medicine 1949). There are several variations on the lobotomy, all of which involve damaging the frontal lobes of the brain, a complex structure which controls the delicate social and emotional processes which define an individuals personality (Bruce L Miller, Jeffrey L Cummings, 2007).

However arguably the most well known variation (and the variation responsible for the proliferation of the lobotomy throughout the United States) is the transorbital lobotomy. The transorbital lobotomy was developed by neurologist Walter Freeman and neurosurgeon James Watts, with the main development being that the surgical implement was inserted through the eye socket and into the brain, however side effects such as patients being rendered completely emotionless or unable to control emotions (Shorter E, 1997) remained. While inducing hazy tranquillity at the cost of individual personality may be seen as an improvement in the condition of violent or deranged patients, these drawbacks clearly render this iteration of the lobotomy ineffective as a treatment.

 

In the modern era, very few lobotomies are performed each year. Those that are performed are characterised by a greater specificity, rather than obliterate the frontal cortex only small amounts of the brain are actually damaged and the patient usually experiences very few of the debilitating side effects previously mentioned. This adaption of the lobotomy is indicative of a broader move away from surgical intervention on psychology, with a greater emphasis on medication and the holistic approach which is being taken up across the field of medicine. Talking to patients and reassuring them has become a more favourable solution than surgery for psychologists.

A less obvious influence from past treatments on current practice may be that of the perception of ethics. Considering the abuse of mentally ill patients because of treatments such as the tranorbital lobotomy and ECT, it is obvious that any misjudgement in the function and efficacy of a treatment can be exceptionally dangerous, especially in the case of the mentally ill who are often left stripped of the typical considerations of consent. These examples may serve as a warning that in the treatment of the mentally ill special considerations must be undertaken to avoid such cruelty and negligence being repeated, as well as a more general warning about the dangers of subjectivity and ignorance in the practice of medicine.

It is clear that the field of psychology has become a great deal more complex since the practice of unfounded procedures like ECT, and has advanced the understanding of the role of neurotransmiters in psychological disorder, as well as broadening the information concerning the mechanics of the brain. Despite an increasing move towards pharmacological intervention, psychology has been able to benefit from past treatments using current technology and understanding to improve archaic techniques, and has progressed from past misdeeds to become a more ethically sound field.

 

Bibliography

 

Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT), (14th November 2002)

http://www.bbc.co.uk/dna/h2g2/A840700 [accessed 30 July 2010]

 

About To Have ECT? Fine, but Don’t Watch It in the Movies: The Sorry Portrayal of ECT in Film, (June 1 2004), Walter G, McDonald A.

http://www.psychiatrictimes.com/display/article/10168/48111 [accessed 30 July 2010]

 

Sue D, Sue DW, Sue S (1994a), Understanding Abnormal Behaviour (Fourth Edition), Boston: Houghton Miffin Company, pg 361

 

Sue D, Sue DW, Sue S (1994b), Understanding Abnormal Behaviour (Fourth Edition), Boston: Houghton Miffin Company, pg 378

 

Greenberg, Roger P, Bornstein, Robert F, Fisher, Seymour, Zborowski, Michael J, Michael D, A meta analysis of  fluoxetine outcome in the treatment of depression, (1994)  Journal of nervous & mental disease

 

Horder J, Matthews P, Waldmann R, Placebo, Prozac and PLoS: significant lessons for psychopharmacology, 2010, Journal of psychopharmacology, Oxford

http://www.ncbi.nlm.nih.gov/pubmed/20571143

 

Fink M, (2009), Electroconvulsive Therapy: a guide for professionals and their patients, New York: Oxford University press, pp 15-16

 

The Nobel Prize in Physiology or Medicine

http://nobelprize.org/nobel_prizes/medicine/laureates/1949/index.html

[accessed 30 July 2010]

 

Bruce L Miller, Jeffrey L Cummings, (2007), The human frontal lobes: functions and disorders, (Second Edition), pg 12, New York: The Guilford Press

 

Shorter E, (1997), A History of Psychiatry: From the Era of the Asylum to the Age of Prozac, John Wiley & sons inc

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