Sunday, July 23, 2006

Shock, and treatment.

Well, the end of the third week of my study programme, and I'm more than half a week behind. Today I have fed the chooks, done the clothes washing, cleaned the kitchen, and burnt the excess rubbish - anything other than work. I have, not thirty centimeters from my hand, a copy of "Pharmacokinetics made easy", but until they give me "Pharmacokinetics made interesting" or "pharmacokinetics made sexually enticing" or whatever, it's going to have to wait.

So, I have not been studying, and I have developed the guilty habit of avoiding looking at my textbooks, of averting my eyes when I see them marshaled accusingly on the table, or accidentally glance at them slouching angrily on the passenger seat of the car.

Because I know I've let them down. I know I haven't done what I've promised. And I know, when I go back, that they're going to make me pay.

So - what have I been doing?

Well, there's a lot been going on. The friend of ours who had been in and out of hospital all year looks to have turned some corner and is now on open release - can enter and leave the hospital virtually as he chooses. He is still unwell, although it's difficult to tell which of his symptoms are due to his bipolar and which are due to his treatment (two anti-psychotics, two antidepressants and a mood stabilizer, plus the electro-convulsive therapy (ECT)).

But he now sleeps more than three hours a night, can get those recurring ideas out of his head and the persistent, fleeting images out of the corner of his eye, and for the first time a few days ago mentioned his plans for what he would be doing next year.

ECT, by the way, is a treatment about which opinions are polarized. I saw it done one morning at Clearwater, years ago. The patient comes in, an anaesthetist puts a line in his or her arm or hand (my friend has terrible veins, he bruises easily and often, even now, a fortnight later, the back of his hand is tender and dark), sensors are placed on the chest, the head, the arm.

A small amount of a clear liquid is infused, he or she becomes unresponsive. Another infusion - muscles relax, the oxygen mask hisses. A few quiet words, a tap on a keyboard.

The literature assures us that the amount of electricity is not large, and the procedure does not take long - although it seems longer - and that although there are miniscule twitches of the stimulated muscles, the opening and closing of a fist or the blowing out of the cheeks, there is no true convulsion and no pain is felt.

We'll get back to the pain in a moment. But the thing I remember most about ECT was the psych registrar (a freckled, blue-eyed blonde, the same one whose first discharged patient died) assuring me that ECT was "not a violent procedure".

I dispute this. I am a supporter of ECT - if opinions are polarized, I am a conservative on this, a supporter of more and better machines - but I don't know that anyone can honestly look at what goes on in ECT, the effects and side effects, the pathophysiology, and say it is anything other than an act of violence.

It is an act of violence, as high-functioning psychopaths everywhere know.

But then, so is surgery. Surgery is cutting people up. Chemotherapy is poisoning them, xraying is giving people cancer, and sticking needles in people hurts them.

And like all these things, you have to weigh up how much it'll hurt to have the procedure versus how much it'll hurt to miss out. ECT is horrible, and two antipsychotics, two antidepressants and a mood stabilizer are horrible, but untreated psychotic depression is horribler.

Anyway. Tonight I want to write this post that's been kicking around in my head for a while about pain, and what the Clearwater psych reg said is a damn good place to start.

Thanks for listening,
John

3 Comments:

Blogger Prom said...

I believe that there are two potentially seperable aspects to pain. There is the sensation itself carried by C fibers from the point of the pain. It hurts but in reality that sensory input is no more violent than neurons that fire in our eyes that let us see.

Then there is the emotional response to pain. It is adaptive. If we didn't respond emotionally to pain we wouldn't be motivated to do anything to solve it.

The problem for me comes from chronic pain to which an emotional response is maladaptive. Pain that is a false signal of harm. It produces anxiety because you can't fix it. That makes it ever so much worse. Control the emotional response to that pain and you solve half the problem and the bigger half at that.

8:53 PM  
Blogger Niamh Sage said...

And like all these things, you have to weigh up how much it'll hurt to have the procedure versus how much it'll hurt to miss out. ECT is horrible, and two antipsychotics, two antidepressants and a mood stabilizer are horrible, but untreated psychotic depression is horribler.


This is a world I know next to nothing about, but that such a severe sounding treatment is actually better than the ailment gives me...well, more than a little pause for thought.

I hope your friend's recovery goes well, and that he gets to realise his plans for next year.

3:19 AM  
Blogger Benedict 16th said...

Well as for ECT it is one step further away from Psychosurgery

8:53 PM  

Post a Comment

<< Home