Despite extensive evidence for its effectiveness, ECT remains the subject of fierce opposition from those contesting its benefits and claiming extreme harms. Alongside some reflections on my experiences of this treatment, I examine the case against ECT, and find that it appears to rest primarily on unsubstantiated claims about major ethical violations, rather than clinical factors such as effectiveness and risk.

Controversy surrounds several experiments that have addressed whether selective synaptic strengthening occurs during learning. To date, the evidence suggests that widespread alterations in synaptic strength, through either kindling or electroconvulsive shock, can disrupt this hypothetical process. The lack of evidence for selective modification of learning through LTP stimulation, however, provides difficulties for both the prevailing hypothesis and the hypothesis advanced by Shors & Matzel. Subsequent experiments may indicate a role for LTP in both learning and arousal.

Major depressive disorder is not only the most widespread mental disorder in the world, it is a disorder on the rise. In cases of particularly severe forms of depression, when all other treatment options have failed, the use of electroconvulsive therapy (ECT) is a recommended treatment option for patients. ECT has been in use in psychiatric practice for over 70 years and is now undergoing something of a restricted renaissance following a sharp decline in its use in the 1970s. (...) Despite its success in treating severe depression there is continued debate as to the effectiveness of ECT: in some studies, it is argued that ECT is marginally more effective than sham ECT. In addition, there is still no clear explanation of how ECT works; among the range of hypotheses proposed it is claimed that ECT may work by harnessing placebo effects. In light of the uncertainties over the mechanism of action of ECT and given the risk of serious side effects that ECT may produce, I contend that the process of informed consent must include comprehensive accounts of these uncertainties. I examine the possible consequences of providing adequate information to potential ECT patients, including the consideration that ECT may still prove to be effective even if physicians are open about the possibility of it working as a placebo. I conclude that if we value patient autonomy as well as the professional reputation of medical practitioners, a fuller description of ECT must be provided to patients and their carers. (shrink)

Electroconvulsive therapy (ECT), an efficient psychiatric treatment method, is one of the most controversial and the most stigmatized therapeutic approaches in medicine. ECT uses transcranial electrical impulses to induce artificial epileptiform paroxysm. For the first time it was used in 1938 by Italian neuro-psychiatrists Ugo Cerletti and Lucio Bini in treatment of schizophrenia. Efficacy of the method was proven in clinical practice, clinical studies and meta-analyses. ECT is the most efficient in the treatment of mood disorders and in lesser (...) extent in some other disorders. Important advance in ECT was the introduction of anaesthesia and muscle relaxation. It reduced adverse effect incidence and severity. Currently, ECT is associated mostly with anaesthesia adverse effects. Other adverse reactions include muscle pain, headache, prolonged paroxysm, cardiopulmonary complications. The most discussed and the most disturbing adverse effect is memory impairment which is usually transient. Incidence and severity of adverse effects is comparable to other therapeutic modalities. Examining the available information it appears, that modern practice of ECT in Europe (European Union member states) and USA is, apart from a few exceptions, in accordance with principles of beneficence and to some extent with autonomy and nonmaleficence. In many countries, the principle of justice is not respected – either because of limited availability or restrictive laws. In the Czech Republic the problem is non-existence of codified treatment guidelines and insufficient training of medical specialists. Aside from this, position of ECT in the Czech Republic is similar to that in the rest of Europe and in USA. (shrink)

After reaching the verge of obsolescence, electroconvulsive therapy (ECT) is once again on the increase. There remains, however, no sound theoretical basis for its use. By 1948 at least 50 different theories had been proposed to account for the workings of ECT. Today there are numerous more. Further, there is no good evidence for its therapeutic effectiveness. Although some studies show what are claimed to be positive results, others show significant amount of relapse, even with severe depression (the disorder (...) against which ECT is supposed to be most effective), while even other studies show ECT to have little more effect than a placebo. Finally, there is much evidence for ECTs damaging effects, particularly to cognitive functioning like memory, general intelligence level, and perceptual abilities, and quite possibly to brain functioning. Some studies even suggest that the alleged therapeutic effects of ECT are essentially the effects of organic brain damage. The question, then, is why, despite these problems, does ECT continue to be used? ECTs salient features suggest an answer here. These are the features of dehumanization, power, control, punishment, and others, all of which can be traced back to the fear of deviant psychotic behavior. (shrink)

The administration of electroconvulsive therapy (ECT) to children and adolescents remains an unresolved area of clinical debate for nurses. Thus, some nurses have refused to participate in the treatment of minors with ECT, invoking codes of conduct to justify their actions. Other nurses have supported the use of ECT with children and adolescents, via provision of technical assistance to medical colleagues. A cross-national comparison of ethical codes of conduct has confirmed that nurses should take decisive action in the clinical (...) arena when the needs or rights of vulnerable minors are compromised. The provision of clinical guidelines is suggested as one method to enshrine the rights of at-risk children and adolescents. (shrink)

Although the use of ECT has declined dramatically from its inception, this decrease has recently shown signs of leveling out because of ECT's powerful therapeutic effect in severely ill depressed individuals who either do not respond to pharmacologic alternatives or are too ill to tolerate a relatively lengthy drug trial. Notwithstanding its therapeutic benefits, ECT has also remained a controversial treatment modality, particularly in the eye of the public. Given the unsavory qualities associated with the word “electroconvulsive,” claims of (...) possible, probable, or even certain brain damage with ECT have easily found listeners. A careful, nonselective assessment of data covering the areas of pathology, radiology, electrophysiology, biochemistry, and neuropsychology leads both to certain conclusions and to certain unanswered questions. ECT is not the devastating purveyor of wholesale brain damage that some of its detractors claim. For the typical individual receiving ECT, no detectable correlates of irreversible brain damage appear to occur. Still, there remains the possibility that either subtle, objectively undetectable persistent deficits, particularly in the area of autobiographic memory function, occur, or that a rarely occurring syndrome of more pervasive persistent deficits related to ECT use may be present. Clearly, more research directed toward answering these questions needs to be carried out so that the role of ECT can be more rigorously defined. While such research is pending, however, we cannot expect that the conditions that predispose to clinical referrals for ECT will disappear. Given the misery, anguish, and risk of death by suicide, starvation, or debilitation associated with severe depressive illness, for example, it still appears that ECT, at least for the present, must continue to be available. (shrink)

This paper defends an account of moral shock as an emotional response to intensely bewildering events that are also of moral significance. This theory stands in contrast to the common view that shock is a form of intense surprise. On the standard model of surprise, surprise is an emotional response to events that violated one's expectations. But I show that we can be morally shocked by events that confirm our expectations. What makes an event shocking is not that (...) it violated one's expectations, but that the content of the event is intensely bewildering. What causes moral shock is, I argue, our lack of emotional preparedness for the event. And I show that, despite the relative lack of attention to shock in the philosophical literature, the emotion is significant to moral, social, and political life. (shrink)

Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA+ECT, n = 81) were identified. EA and ECT were conducted for 5 and 3 sessions per (...) week, respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA+ECT groups had markedly greater clinical response rate than controls on SAPS [72.7% and 90.1% vs. 64.0%; relative risk (RR), 1.974 and 2.628, respectively, P ≤ 0.004] and on SANS (67.3% and 70.4% vs. 42.0%; RR, 1.951 and 2.009, respectively, P ≤ 0.015). A significantly greater response rate on SANS than controls was also observed in the EA group (64.4% versus 42.0%; RR = 1.938, P = 0.008). EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia. (shrink)

The debate about ECT in Ireland in recent times has been vibrant and often polarised. The uniqueness of the Irish situation is that the psychiatric profession is protected by legislation whereby ECT treatment can be authorized by two consultant psychiatrists without the consent of the patient. This paper will consider if ECT is ever ethically justified, and if so, under what circumstances. The proposal is to investigate ECT from an ethical perspective with reference to the UNESCO Universal Declaration on Bioethics (...) and Human Rights. The enquiry will begin with an historical context to the origin and development of ECT as a treatment for severe mental illness. The application of various ethical principles will be considered in conjunction with the relevant literature before arriving at a conclusion. (shrink)

"Jesus Shock is the second in a series of short works on seminal concerns of the impact that Jesus Christ made in the world. The first work, The Philosophy of Jesus, explored philosophy in light of Jesus, rather than the other way around. The present work investigates the reception Jesus received both in His lifetime and continuously to the present time, not only from His enemies, but from His friends, a reception of shock, astonishment, even disgust." "Jesus-Shock (...) shows the reasons why to this day the name of "Jesus" stirs up controversy, even revulsion, in polite society. In the true spirit of ecumenism, it also points the way toward a true rapprochement among His modern-day disciples."--BOOK JACKET. (shrink)

Mathematical Logic had a glorious period in the 1930s, which was briefly rekindled in the 1960s. Any Shock Value, such as it is, has surrounded unprovability from ZFC.

I thank Julie Hersh for her thoughtful and valuable comments on the use of electroconvulsive therapy .1 Discussions with those who have experience of treatments is of the utmost importance when debating issues such as informed consent. I am therefore very pleased to be given this opportunity to respond. Hersh offers three main criticisms of my paper but I hope to show that the tenets of the paper are not undermined by her commentary.Hersh's first criticism stems from her personal (...) experience: she claims that, ‘The results of ECT for me were miraculous’. She argues that ECT ‘works’ and we have ‘70 years of remarkably positive experience’ to support this fact. In response, I agree that there are certainly patients who believe that ECT has been a highly effective intervention: but equally, there are others who have experienced intolerable side effects as a result.2 ECT is a controversial treatment precisely because of the serious long-term risk of memory loss.3 ,4 If we are to strive for the best healthcare possible, we cannot base our conclusions merely on positive cases: we need to consider all cases . Thus, I reject her conclusion that ECT is ‘remarkably positive’ for all patients: studies do not unequivocally support Hersh's fortunate experiences. In addition, I must also challenge the assumption that ECT ‘works’. Counterintuitive as …. (shrink)

There are two aims of this paper: (1) to explore the affective dimensions of moral shock and how it relates to normative marginalization of those furthest from dominant society, but also, more specifically; (2) to articulate the trans experience of constantly being under moral attack because the dominant “world” normatively defines you out of existence. Toward these ends, I build on Katie Stockdale’s recent work on moral shock, arguing that moral shock needs to be contextualized to “worlds” (...) of sense to understand how marginalized people affectively experience shocking events. My focus is the trans experience of moral shock due to the way trans people are positioned outside of dominant society, creating the conditions to experience cyclical, chronic shock. These affective conditions point to a collective responsibility to ease the affective stress that the most marginalized experience. (shrink)

We live in a reactionary culture where divisive issues arise, people on either side throw stones, and everyone ends up more entrenched in their opinions than in reaching common ground--or even exhibiting common courtesy! If there ever was a time for Christians to understand and communicate God's truth about controversial and polarizing issues, it is now. Believers must develop convictions based on research, reason, and biblical truth--and be able (and willing) to communicate these convictions with a love and respect that (...) reflects God's own heart. In Culture Shock, bestselling author, pastor, and radio personality Chip Ingram shows readers how they can bring light rather than heat to the most controversial and divisive issues of our day. Covering topics such as right and wrong, sex, homosexuality, abortion, politics, and the environment, Culture Shock is every engaged believer's must-have guidebook to replacing reactionary hate with revolutionary love. (shrink)

This is a response to Dr Charlotte Rosalind Blease's paper ‘Electroconvulsive Therapy (ECT), the Placebo Effect and Informed Consent’, written by Julie K. Hersh who has had ECT. Hersh argues that placebo effect is impossible to prove without endangering the lives of participants in the study. In addition, informing potential ECT patients of unproven placebo effect could discourage patients from using a procedure that from experience has proven highly effective.

This paper has two aims: to explore the affective dimensions of moral shock and the way it relates to normative marginalization of those furthest from dominant society and also, more specifically, to articulate the trans experience of constantly being under moral attack because the dominant ‘world’ normatively defines trans individuals out of existence. Toward these ends, I build on Katie Stockdale's recent work on moral shock, arguing that moral shock needs to be contextualized to ‘worlds’ of sense (...) to understand how marginalized people affectively experience shocking events. My focus is the trans experience of moral shock due to the way trans people are positioned outside of dominant society, which creates the conditions to experience cyclical, chronic shock. These affective conditions point to a collective responsibility to ease the affective stress that the most marginalized experience. (shrink)

A Shock to Thought brings together essays that explore Deleuze and Guattari's philosophy of expression in a number of contemporary contexts. It will be of interest to all those in philosophy, cultural studies and art theory. The volume also contains an interview with Guattari which clearly restates the 'aesthetic paradigm' that organizes both his and Deleuze's work.

The mitochondrion is known as the “powerhouse” of eukaryotic cells since it is the main site of adenosine 5′‐triphosphate (ATP) production. Using a temperature‐sensitive fluorescent probe, it has recently been suggested that the stray free energy, not captured into ATP, is potentially sufficient to sustain mitochondrial temperatures higher than the cellular environment, possibly reaching up to 50 °C. By 50 °C, some DNA and mitochondrial proteins may reach their melting temperatures; how then do these biomolecules maintain their structure and function? (...) Further, the production of reactive oxygen species (ROS) accelerates with temperature, implying higher oxidative stresses in the mitochondrion than generally appreciated. Herein, it is proposed that mitochondrial heat shock proteins (particularly Hsp70), in addition to their roles in protein transport and folding, protect mitochondrial proteins and DNA from thermal and ROS damage. Other thermoprotectant mechanisms are also discussed. (shrink)

Career shocks are the norm, not the exception. Yet, much of research and counseling on career-development holds unrealistic assumptions of a makeable career. Little is understood about the role of shocks on the career path and how the interplay of individual reactions to shocks shapes careers. The purpose of this study is to provide understanding of responses to different attributes of career shocks and career shocks as antecedents to career and job change. A qualitative approach was chosen and data were (...) obtained from 25 semi-structured interviews with a sample of mid-career individuals who had experienced shocks in their work lives. The analysis was 2-fold and aimed at unearthing of individual responses to shocks and the question of the role of shocks on changes in the career path. Firstly, the analysis of career shocks revealed a pattern of distinct agentic responses in relation to shocks of different attributes. Secondly, from the analysis of shock attributes and corresponding responses over time career changer profiles emerged which differ in regard to career change behavior and magnitude of changes in the career. A process model which depicts how post-shock careers are shaped distinctively in relation to different shock attributes and corresponding responses is presented. This study underlines the importance of understanding the unplannable in career development and shows a variety of options for individuals to develop their careers despite shocks. Limitation stems from the investigation of a sample limited to mid-career individuals. The findings provide a new conceptual lens to theorize and conduct research on career shocks and career changes and facilitate the development of coping strategies for career shocks. The originality lies in the investigation of the momentum of career shocks on career paths with detail to different attributes of career shocks and how they impact the career path. (shrink)

I propose that shock can be morally significant independently of its consequences but only as part of an ongoing commitment to certain norms, in particular norms that constitute recognizing another as a person. When we witness others in agony, or being severely wronged, or when we ourselves severely wrong or mistreat others, our shock can reflect our recognition of them as persons, a recognition constituted by our commitment to certain moral norms. However, if we do not in fact (...) respond to the suffering or wrong in accordance with these norms—if, for example, we do not act to relieve their suffering or to properly address the wrong done, and do not avoid or prevent its recurrence—then our commitment to the relevant norms is undermined. When we consistently violate the norms whose violation initially shocked us, our lingering shock upon repeated violations gradually loses its significance and becomes a mere impulse—a fossil of a past commitment, so to speak—before it disappears completely. The failure to be shocked in such instances marks the failure of our moral commitments, which is the failure to recognize others as persons. (shrink)

THE SHOCK of LOVE is a book about spirit. It is a book within a book. The book found within is a manuscript entitled THE SHOCK of LOVE. It is purportedly written by Paolo Cellini, Professor of Romance Languages and a student of the era of the troubadours and courtly love. Based on the idea of a book of the heart, current during that time, it is divided into nine chapters that give allegorical detail of the journey of (...) love, a love that completes the spirit in a person. There the reader follows the courtship, the 'alchemical' marriage, and the dark gestation before emerging transformed and completed. The outer book, the book that encloses the found manuscript, tells the story of Cellini as well as speculating on why it came to be written. (shrink)

In The Shock of Recognition, Lewis Pyenson uses a method called Historical Complementarity to identify the motif of non-figurative abstraction in modern art and science. He identifies the motif in Picasso's and Einstein's educational environments. He shows how this motif in domestic furnishing and in urban lighting set the stage for Picasso's and Einstein's professional success before 1914. He applies his method to intellectual life in Argentina, using it to address that nation's focus on an inventory of the natural (...) world until the 1940s, its adoption of non-figurative art and nuclear physics in the middle of the twentieth century, and attention to landscape painting and the wonder of nature at the end of the century. (shrink)

Sufficient doubt surrounds electroconvulsive therapy (ECT) to warrant nurses opting out of its administration and/or advising patients that it may be only one of a range of treatments open to them. In the latter respect, this discussion touches on aspects of the concept of advocacy. Relationships with the medical profession are also considered, as is the indefatigable attention given to issues of 'professional status' by nurses; this preoccupation facilitates an avoidance of therapeutic/advocacy issues.

Surprised -- Freud -- Different and scary -- Disconnected -- Bergson and high comedy -- Blind and helpless but alive -- Childhood -- Making it real -- Annie Hall -- Free but connected.

Modern empirical macroeconomic models, known as structural autoregressions (SVARs) are dynamic models that typically claim to represent a causal order among contemporaneously valued variables and to merely represent non-structural (reduced-form) co-occurence between lagged variables and contemporaneous variables. The strategy is held to meet the minimal requirements for identifying the residual errors in particular equations in the model with independent, though otherwise not directly observable, exogenous causes (“shocks”) that ultimately account for change in the model. In nonstationary models, such shocks accumulate (...) so that variables have discernible trends. Econometricians have conceived of variables that trend in sympathy with each other (so-called “cointegrated variables”) as sharing one or more of these unobserved trends as a common cause. It is possible for estimates of the values of both the otherwise unobservable individual shocks and the otherwise unobservable common trends to be backed-out of cointegrated systems of equations. The issue addressed in this paper is whether and in what circumstances these values can be regarded as observations of real entities rather than merely artifacts of the representation of variables in the model. The issue is related, on the one hand, to practical methodological problems in the use of SVARs for policy analysis—e.g., does it make sense to estimate of shocks or trends in one model and then use them as measures of variables in a conceptually distinct model? The issue is also related to debates in the philosophical analysis of causation—particularly, whether we are entitled, as assumed by the developers of Bayes-net approaches, to rely on the causal Markov condition (a generalization of Reichenbach’s common-cause condition) or whether cointegration generates a practical example of Nancy Cartwright’s “byproducts” objection to the causal Markov condition. (shrink)

In a similar way to what happens when a wave of electricity impacts the animal body and provokes a convulsive stir of muscles and nerves which can burn and ultimately paralyze the affected surface, some rough emotional experiences may lead us to sudden numbness. Keeping abreast with the most sophisticated phenomenological tools to account for an extremely damaging kind of psychological experience that can ultimately defeat the purpose of a sheer descriptive approach, this chapter does provide a descriptive analysis of (...) the kind of emotional shock that risks threatening the moral integrity of an agent. I shall zoom in my analysis on the typically acknowledged moment when disturbing information from a socially shared context outside ourselves comes suddenly to the fore of our attention, thus disrupting the focus even of the the most trivial perceptive input. I argue that in the longer run the outcome of such an experience may amount to a reconfiguration of the subject’s core values, daily routines and even her life-long expectations and projects. (shrink)

Introduction: Electroconvulsive therapy is a commonly used brain stimulation treatment for treatment-resistant or severe depression. This study was planned to find the effects of ECT on brain connectivity by conducting a systematic review and coordinate-based meta-analysis of the studies performing resting state fMRI in patients with depression receiving ECT.Methods: We systematically searched the databases published up to July 31, 2020, for studies in patients having depression that compared resting-state functional connectivity before and after a course of pulse wave ECT. (...) Meta-analysis was performed using the activation likelihood estimation method after extracting details about coordinates, voxel size, and method for correction of multiple comparisons corresponding to the significant clusters and the respective rsFC analysis measure with its method of extraction.Results: Among 41 articles selected for full-text review, 31 articles were included in the systematic review. Among them, 13 articles were included in the meta-analysis, and a total of 73 foci of 21 experiments were examined using activation likelihood estimation in 10 sets. Using the cluster-level interference method, one voxel-wise analysis with the measure of amplitude of low frequency fluctuations and one seed-voxel analysis with the right hippocampus showed a significant reduction in the left cingulate gyrus and a significant increase in the right hippocampus with the right parahippocampal gyrus, respectively. Another analysis with the studies implementing network-wise resting state functional connectivity showed a significant increase in bilateral posterior cingulate cortex. There was considerable variability as well as a few key deficits in the preprocessing and analysis of the neuroimages and the reporting of results in the included studies. Due to lesser studies, we could not do further analysis to address the neuroimaging variability and subject-related differences.Conclusion: The brain regions noted in this meta-analysis are reasonably specific and distinguished, and they had significant changes in resting state functional connectivity after a course of ECT for depression. More studies with better neuroimaging standards should be conducted in the future to confirm these results in different subgroups of depression and with varied aspects of ECT. (shrink)

In 1944 Horkheimer and Adorno warned that industrial society turns reason into rationalization, and Polanyi warned of the dangers of the self-regulating market, but today, argues Stiegler, this regression of reason has led to societies dominated by unreason, stupidity and madness. However, philosophy in the second half of the twentieth century abandoned the critique of political economy, and poststructuralism left its heirs helpless and disarmed in face of the reign of stupidity and an economic crisis of global proportions. New theories (...) and concepts are required today to think through these issues. The thinkers of poststructuralism Lyotard, Deleuze, Derrida must be re-read, as must the sources of their thought, Hegel and Marx. But we must also take account of Naomi Klein’s critique of Milton Friedman and the Chicago School and her account of the ‘shock doctrine’. In fact, argues Stiegler, a permanent ‘state of shock’ has prevailed since the beginning of the industrial revolution, intensified by the creative destruction brought about by the consumerist model. The result has been a capitalism that destroys desire and reason and in which every institution is undermined, above all those institutions that are the products par excellence of the Enlightenment the education system and universities. Through a powerful critique of thinkers from Marx to Derrida, Stiegler develops new conceptual weapons to fight this destruction. He argues that schools and universities must themselves be transformed: new educational institutions must be developed both to take account of the dangers of digitization and the internet and to enable us to take advantage of the new opportunities they make available. (shrink)

Existing debates on business ethics under-represent consumers’ perspectives. In order to progress understanding of ethical judgement in the marketplace, we unpack the interconnections between consumer ethical judgment, consent and context. We address the question of how consumers judge the morality of threat-based experiential marketing communications. Our interpretive qualitative research shows that consumers can feel positively about being shocked, judging threat appeals as more or less ethical by the nature of the negative emotions they experience. We also determine that the intersection (...) between ethical judgement, consent and context lies where consumers’ perceptions of fairness and consequences lend contextualised normative approval to marketing practice. Our research makes three original contributions to existing literature. First, it extends theory in the area of ethical judgement, by highlighting the importance of consent for eliciting positive moral responses. Second, it adds to embryonic research addressing the role of emotions in ethical judgement, by ascertaining that negative emotions can elicit positive consumer ethical judgement. Third, our research contributes an original concept to ethical judgement theorisation, namely consumer-experienced positive shock. We define CEPS as a consensual shock value judged as ethical due to its ephemerality, commercial resonance, brand alignment, target-audience appropriateness and contextual acceptability. We also extrapolate the dimensions of CEPS into an ethical judgement typology, elucidating how consumers judge some threat-based communications as ethical, but not others. Consequently, our work dovetails with wider business ethics debates on ethical judgement, adding value by clarifying the conditions that generate positive consumer ethical judgement. (shrink)