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Comment by paytonjjones | Hacker News Reader

I don't know the details here but I am a psychologist.

The "electric shock" normally used in psych studies is tiny, it's like the equivalent of one of those little toy prank buzzers. You couldn't possibly hurt someone with it, this is really a non-issue.

Related side note: Electroconvulsive therapy uses much larger electric shocks but, administered safely by a clinic, is extremely safe, has relatively minor side effects compared to e.g. SSRIs, and is very effective for severe depression. It's a huge shame that it's undeserved reputation prevents it from being more popular. Blame "One Flew Over the Cuckoo's Nest" for its inaccurate portrayal.

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ECT can be very, very unsafe. 70% of patients experience some form of memory loss and at least 30% of patients experience self-reported permanent memory loss. The rate of major adverse cardiac events found in a 2019 meta-analysis was 1 in 39 patients. For the people that it helps, I'm happy they've found relief, but it's a tool with significant costs and I know a fair amount of people who underwent it as children or otherwise were pressured to undergo it and I don't know any of them who have a positive impression of it.

Yes, memory loss surrounding the hours/days of the treatment is the major side effect.

Care to share the meta-analysis? How does 1/39 compare to the base rate of those with severe depression who did not receive ECT?

The stats are from the Wikipedia page for ECT--I'm not sure about the base rate/risk ratio.

https://pubmed.ncbi.nlm.nih.gov/30557212/

About 1 in 50 patients may experience a major cardiac event (or death) during the course of ECT

This isn't responsive to the parent's question, in a way that ironically underscores the point: you can tell me that "1 in 50 patients experience X", but that's meaningless, unless I know what X is in the selected population at baseline.

I don't mean to pick on you. This problem is widespread in academic research.

ECT is a very specific subset of electrical shocks. Just because ECT can have adverse effects doesn't mean all electric shocks will.

> Electroconvulsive therapy uses much larger electric shocks but, administered safely by a clinic, is extremely safe, has relatively minor side effects Blame "One Flew Over the Cuckoo's Nest" for its inaccurate portrayal.

YMMV. I’ve encountered people who have had ECT forced on them whilst inadequately sedated. They have been older/elderly but it would be a mistake assuming it’s always without causing harm.

That does sound rough. The initial shock, without sedation, could cause mild to moderate pain and would certainly be a scary experience.

Even then, though, it's a far cry from being the antiquated mental lobotomy that many people wrongly assume it to be.

There are multiple accounts that describe severe pain and the New Zealand government has paid out compensation for the torture that it was. What was being done here was most definitely intended to be painful torture, so maybe isn’t a fair comparison with clinical ECT for actual treatment?

‘Bryon Nichol spent six months in the Lake Alice unit at the age of 12. He said he received electroconvulsive therapy (ECT) many times, which was always unmodified, and without a muscle relaxing anaesthetic. "The nurses would come down and drag me upstairs. I was often so petrified that I soiled myself. They would put a mouthguard in my mouth and held me down while Dr Leeks gave me ECT. The ECT would give me vicious pains in my head and make me feel dizzy and as it continued the pain got worse. My arms and legs flailed about. It was absolute agony."’

And another:

‘Rangi Wickcliffe, 59, is another survivor of the Lake Alice unit. He was 10 when he was first given electric shock treatment. Dr Selwyn Leeks turned the machine on, the pain that you feel from the electricity surging through your head is indescribable. The scream that comes out of your mouth is also indescribable. "The terror was so intense that you lost all bowel movement." He said it felt like his bones would break.’

https://www.rnz.co.nz/news/national/444800/abuse-in-care-inq...

For what it’s worth, I wasn’t even thinking about the physical danger when I was… shocked… that you only need a one hour online course. It’s that they’re interacting with people in a somewhat clinical way as an implicit authority. The shock would obviously cause discomfort and therefore stress (or why even do it).

Do you think a potential bad actor would change their behavior if they took, say, a 12 hour course instead?

I am of course biased, but I have often been exasperated by the various "trainings", IRB processes, ethics classes, etc, that are required to run even basic psychology studies such as surveys.

Meanwhile, down the hall, the medical department is opening the skulls of mice, implanting electrodes, giving them supercancer, and then euthanizing them en masse. Often with less approval burden.

The hard truth is that it's tricky to decide what's ethical in science; we mostly allow or disallow things because they've been done that way for years, and all the added "process" is nothing but paper pushing and ass covering to quiet concerned outsiders.

It’s not about bad actors. It’s about putting untrained people in a position where subjects might be vulnerable and come to depend on them being the trusted expert in the room.

> Do you think a potential bad actor would change their behavior

What is the appropriate way to help a righteous but underpaid lab assistant find the guts to call out a process as unethical and insist that the boss’s claim that the IRB has approved it is bogus?

The most important thing is they know how to report issues and have assurance that reports will not hurt them. If you can show other reports were acted on and the reporter not harmed that helps.

It also helps to always have more than one person who could call so they compete with each other to be first because they don't want to be the one seen as an accompanist to fraud.

> Electroconvulsive therapy uses much larger electric shocks but, administered safely by a clinic, is extremely safe, has relatively minor side effects compared to e.g. SSRIs, and is very effective for severe depression.

The evidence base for these claims appears to be missing.

https://theconversation.com/no-evidence-that-ect-works-for-d...

It's liked by some practitioners, not by others, but actual studies in this area are low quality, didn't follow up with longer term checks, and are generally inadequate.

"The failure to find any meaningful long-term benefits compared to placebo groups are particularly distressing."

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