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How Electroconvulsive Therapy Works

I have read the blog of Steven Novella with interest. I have even left comments but have waited a few days for them not to appear because they are still under ‘moderation’ . I presume this is a form of censorship that Dr Novella employs.

Here is the link.

Here is a comprehensive paper to counter such views.


I fail the test. Now I really am depressed.

Most psychiatric tests used in all studies are based on the concept of  ‘cold reading’ used by the psychics. I took the Montgomery Asberg
Depression Rating Scale
today just to see if I qualified for extra welfare benefits. Here are my results.

printable version
Original reference: Br. J. Psychiat. (1979), 134, 382-389

The rating should be based on a clinical interview moving from broadly phrased questions about symptoms to more detailed ones which allow a precise rating of severity. The rater must decide whether the rating lies on the defined scale steps (0, 2, 4, 6) or between them (1, 3, 5) and then report the appropriate number. The items should be rated with regards to the state of the patient over the past week.  

1 – APPARENT SADNESS – Representing despondency, gloom and despair, (more than just ordinary transient low spirits) reflected in speech, facial expression, and posture. Rate by depth and inability to brighten up.
  0 No sadness
  2 Looks dispirited but does brighten up without difficulty
  4 Appears sad and unhappy most of the time
  6 Looks miserable all the time. Extremely despondent.
I had a bit of a hangover that morning… needed a little whisky top-up (dis-spirited) but I did laugh at the psychiatrist’s jokes… so score 2.

2 – REPORTED SADNESS – Representing reports of depressed mood, regardless of whether it is reflected in appearance or not. Includes low spirits, despondency or the feeling of being beyond help and without hope. Rate according to intensity, duration and the extent to which the mood is reported to be influenced by events.
  0 Occasional sadness in keeping with the circumstances.
  2 Sad or low but brightens up without difficulty.
  4 Pervasive feelings of sadness or gloominess. The mood is still influenced by external circumstances.
  6 Continuous or unvarying sadness, misery or despondency.
 Well I had just moved to New York and realised the rental market was very expensive so I was feeling a bit low about my finances. Influenced by my external circumstances.. so say score 3.


3 – INNER TENSION – Representing feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to either panic, dread or anguish. Rate according to intensity, frequency, duration and the extent of reassurance called for.
  0 Placid. Only fleeting inner tension.
  2 Occasional feelings of edginess and ill-defined discomfort
  4 Continuous feelings of inner tension or intermittent panic which the patient can only master with some difficulty.
  6 Unrelenting dread or anguish. Overwhelming panic.
Yes… I have occasional feelings of edginess and ill-defined discomfort especially when confronted by psychiatrists. But I thought that was normal. Score 2.

4 – REDUCED SLEEP – Representing the experience of reduced duration or depth of sleep compared to the subject’s own normal pattern when well.
  0 Sleeps as usual.
  2 Slight difficulty dropping off to sleep or slightly reduced, light or fitful sleep
  4 Sleep reduced or broken by at least two hours.
  6 Less than two or three hours sleep.
I suppose my excitement at being in New York and wanting to fit in as much experience as possible reduced my need for having to sleep. Score 5.

5 – REDUCED APPETITE – Representing the feeling of a loss of appetite compared with when well. Rate by loss of desire for food or the need to force oneself to eat.
  0 Normal or increased appetite.
  2 Slightly reduced appetite
  4 No appetite. Food is tasteless.
  6 Needs persuasion to eat at all.
Well it is well known that the food in the USA is rubbish. Tasteless. Score 4.

6 – CONCENTRATION DIFFICULTIES – Representing difficulties in collecting one’s thoughts mounting to incapacitating lack of concentration. Rate according to intensity, frequency, and degree of incapacity produced.
  0 No difficulties in concentrating.
  2 Occasional difficulties in collecting one’s thoughts.
  4 Difficulties in concentrating and sustaining thought which reduces ability to read or hold a conversation.
  6 Unable to read or converse without great difficulty.
Ok I admit to times when I have difficulty in concentrating… I don’t collect my thoughts but I do have a large collection early Marvel comics. score 2.

7 – LASSITUDE – Representing a difficulty getting started or slowness initiating and performing everyday activities.
  0 Hardly any difficulties in getting started. No sluggishness.
  2 Difficulties in starting activities.
  4 Difficulties in starting simple routine activities, which are carried out with effort.
  6 Complete lassitude. Unable to do anything without help.
I love my bed… sleeping and being lazy on the weekend. Score 2.

8 – INABILITY TO FEEL – Representing the subjective experience of reduced interest in the surroundings, or activities that normally give pleasure.The ability to react with adequate emotion to circumstances or people is reduced.
  0 Normal interest in the surroundings and in other people.
  2 Reduced ability to enjoy usual interests.
  4 Loss of interest in the surroundings. Loss of feelings for friends and acquaintances.
  6 The experience of being emotionally paralyzed, inability to feel anger, grief or pleasure and a complete or even painful failure to feel for close relatives and friends.
Normal interest ( whatever that means?) Do I react with ‘adequate’ emotion? Not sure. Score 0.

9 – PESSIMISTIC THOUGHTS – Representing thoughts of guilt, inferiority, self-reproach, sinfulness, remorse and ruin.
  0 No pessimistic thoughts.
  2 Fluctuating ideas of failure, self-reproach or self-depreciation.
  4 Persistent self-accusations, or definite but still rational ideas of guilt or sin. Increasingly pessimistic about the future.
  6 Delusions of ruin, remorse and unredeemable sin. Self-accusations which are absurd and unshakable.
I have fluctuating ideas of failure. Sometimes I do not think I am as good as I would like to be. (self-depreciation).  Score 2.

10 – SUICIDAL THOUGHTS – Representing the feeling that life is not worth living, that a natural death would be welcome, suicidal thoughts, and preparations for suicide. Suicidal attempts should not in themselves influence the rating.
  0 Enjoys life or takes it as it comes.
  2 Weary of life. Only fleeting suicidal thoughts.
  4 Probably better off dead. Suicidal thoughts are common, and suicide is considered as a possible solution, but without specific plans or intention.
  6 Explicit plans for suicide when there is an opportunity. Active preparations for suicide.
I enjoy life mostly. Sometimes I am weary but that is caused by reading Camus and Nietzsche.  So score 1.My total score is thus 23. I will have to look at the results now to see where on the depression scale i fit.Looking at wikipediaHigher MADRS score indicates more severe depression. The overall score ranges from 0 to 50.[4]Usual cutoffpoints are:

  • 0 to 6 – normal[5] /symptom absent[4]
  • 7 to 19 – mild depression[5][4]
  • 20 to 34 – moderate depression[5]
  • >34 – severe depression.[5]

0-6 normal. Can this be right?A normal person will have a score of 0-6? No way!

So I have moderate depression. Not even mild…. I feel even more depressed now.


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Mental illness is a disease just like diabetes.

How much more of this rubbish can we take?

Symptoms of diabetes. (from wikipedia)

The classical symptoms of type 1 diabetes include: polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), fatigue, and weight loss.


Diabetes diagnostic criteria[17][18]  edit
Condition 2 hour glucose Fasting glucose HbA1c
mmol/l(mg/dl) mmol/l(mg/dl) %
Normal <7.8 (<140) <6.1 (<110) <6.0
Impaired fasting glycaemia <7.8 (<140) ≥ 6.1(≥110) & <7.0(<126) 6.0-6.4
Impaired glucose tolerance ≥7.8 (≥140) <7.0 (<126) 6.0-6.4
Diabetes mellitus ≥11.1 (≥200) ≥7.0 (≥126) ≥6.5

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:[19]

  • Fasting plasma glucose level at or above 7.0 mmol/L (126 mg/dL).
  • Plasma glucose at or above 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.
  • Symptoms of hyperglycemia and casual plasma glucose at or above 11.1 mmol/L (200 mg/dL).
  • Glycated hemoglobin (hemoglobin A1C) at or above 6.5. (This criterion was recommended by the American Diabetes Association in 2010, although it has yet to be adopted by the WHO.)


Further information: Diabetes management

[edit] Insulin therapy

Type 1 is treated with insulin replacement therapy—either via subcutaneous injection or insulin pump, along with attention to dietary management, typically including carbohydrate tracking, and careful monitoring of blood glucose levels using glucose meters.

In psychiatry.

The  symptoms are  frequent urination, increased thirst, fatigue, and weight loss.


Social Anxiety Disorder comorbid with depression.  Or possibly ADHD?  Who knows? Take some Ritalin and SSRIs and see if things improve. .

Szasz’s views still current.

A new study supports Szasz’s views that mental illness is not a disease but the result of problems in living.

Cambridge psychotic disorders study charts the past to

anticipate the future

March 23, 2012 in Psychology & Psychiatry 

A new Cambridge-led study has examined the past 60 years of incidence data on psychotic disorders in England in the hope that the data can reveal clues about the possible social factors which appear to underpin such conditions.

The systematic review published in PLoS One, which was conducted by the Department of Psychiatry EpiCentre at the University of Cambridge in collaboration with the Institute of Psychiatry, KCL, examined of schizophrenia and other psychotic disorders in between 1950-2009.

Dr. James Kirkbride, Sir Henry Wellcome Postdoctoral Research Fellow at the University of Cambridge, explains: “Our review confirms that the social environment is an important determinant of risk for psychotic disorders; genetic factors are not the sole causes and, where important, must often operate in conjunction with the environment.”

By analyzing the results of all relevant studies available since 1950, the research team showed that urban settings tended to experience higher rates of some psychotic disorders, such as schizophrenia. The study also confirmed that rates of psychotic disorder were elevated in several migrant groups and their offspring in England.

The findings mark an important step in being able to anticipate how the risk of varies according to sociodemographic factors and characteristics of the social environment, so that appropriate healthcare can be provided. It shows that both the brain and its environment are crucial elements in understanding serious mental illnesses such as schizophrenia.

The results also have important implications for public health and planning services in the NHS. Dr. Kirkbride said “These data will allow us to build prediction models for the expected number of new cases of psychotic illness in different regions of England, according to the exact sociodemographic composition of their populations, and according to other such as economic deprivation or social cohesion.”

The study found no evidence to support an overall change or increase of psychotic disorder over time, though the study did chart a diagnostic shift away from schizophrenia.

The study Incidence of and other psychoses in England, 1950-2009: a systematic review and meta-analyses was funded by the Department of Health Policy Research Programme, the NIHR and the Wellcome Trust. 83 citations from previous studies spanning the 60 years qualified for inclusion into the analysis.

Dirk Steele on the couch….. initial rambling…

Psychiatry is a pseudoscience. A very sophisticated one. A ‘disease of the mind’ is an idea that everyone today adheres to and accepts as a fact. But when one looks at this claim with a critical eye – the idea falls apart. Over fifty years ago Thomas Szasz exposed the myth. The mind is not a thing. It is a concept. It cannot be examined with a microscope or an fMRI scan. The mind cannot be touched by any physical technology. A disease can be objectively measured. Whether it is a cancerous cell, a tumour,  a bacteria attempting to take over its host, a clogged artery caused by plaque causing heart failure, a stroke due to disturbance in the blood supply to the brain. This is disease and can be objectively measured. By true scientific tests.

The term ‘mental disease’ is therefore a metaphor. A metaphor that is believed to be literal. A ‘sick’ economy has as much scientific validity as a ‘sick’ mind.

George Lakoff has shown how much of our language is metaphorical and can mislead us in our search for scientific proof. We all use the idea, the metaphor that the mind is a thing. An object. We can ‘lose’ our mind. We can find ‘ourselves’. He points out that our mind is a container in which we can ‘store’ our views. We can be ‘out’ of our minds. So our concept of mind as thing is very strong as conveyed by our language and the concepts it describes. But this is false. It is unscientific.

So where is the science in psychiatry? This is what I want to explore.