Milieu reactions to ECT.
Milieu reactions to ECT.
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对 ECT 的环境反应。
DOI：
10.1080/00332747.1982.11024162
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发表时间：
1982
期刊：
影响因子：
2.4
通讯作者：
A. B. Willett
中科院分区：
文献类型：
--
作者：
J. Levenson;A. B. Willett
电休克治疗(ECT)在心理健康专业人员、患者和家庭中会引起强烈的情绪反应和分歧。ECT的适应症、其疗效和后遗症、其作用机制的理论、社会和政治辩论以及该技术本身都是争议的来源。自它问世以来的四十年里，人们对这些问题的认识已经发生了变化。ECT对抑郁症的疗效现在已经得到证实，但同时我们也可以排除戈登在1948年列举的解释ECT如何工作的50种理论中的大多数。虽然其作用机制似乎是一种神经化学机制，但人们还远未清楚地了解它。但仍然存在的不仅仅是ECT如何工作的不确定性。不仅在普通公众中有争论，而且就连知识渊博的精神卫生工作者在他们对ECT的看法上也存在严重的分歧(Frankel Et El)。1978年)。我们认为，即使以人道的方式，在知情同意的情况下，对那些获得持久好处而没有重大后遗症的适当选择的患者进行ECT，它也会继续在治疗师、患者和病房工作人员中引起强烈的情绪反应。在这篇文章中，通过治疗师、工作人员和患者在治疗环境中对ECT的反应来检验围绕ECT的一些持续的争议。我们假设，ECT可能特别令人不安，因为它通常会对以前没有治疗反应的患者产生快速的改善。这往往会造成对ECT的夸大估计。其他治疗方式的贬值、员工的分离以及治疗联盟的中断可能会随之而来。我们提出两个案例来举例说明环境如何对ECT作出反应，并最后提出改善治疗提供的建议。
Electroconvulsive therapy (ECT) evokes strong emotional reactions and disagreements among mental health professionals, patients, and families. The indications for ECT, its efficacy and sequelae, theories of its mechanism of action, social and political debate, and the technique itself have all been sources of controversy. In the forty years since its advent, knowledge of these issues has evolved. The efficacy of ECT in major depressive illness is now well established, but at the same time we can eliminate most of the fifty theories that Gordon listed in 1948 to explain how ECT works. While the mechanism of action appears likely to be a neurochemical one, it is far from being clearly understood. But is is not just uncertainty about how ECT works that remains. Not only are there arguments among the lay public, but even knowledgeable mental health workers are sharply divided in their opinions of ECT (Frankel et el. 1978). We believe that even when ECT is administered in a humane manner with informed consent to appropriately selected patients who derived lasting benefit without major sequelae, it will continue to evoke strong emotional reactions in therapists, patients, and ward staff. In this paper, some of the continuing controversy surrounding ECT is examined through reactions to it in the therapeutic milieu among therapists, staff, and patients. We hypothesize that ECT can be especially upsetting because it often produces rapid improvement in patients who had previously not responded to treatment. This tends to create an inflated estimation of ECT. Devaluation of other therapeutic modalities, staff splitting, and disruptions in the therapeutic alliance may follow. We present two cases to exemplify aspects of how the milieu reacts to ECT, and conclude with recommendations to improve the delivery of treatment.