ECT – A Fine Meme

A main thread of my work is that what passes for sense, knowledge and rationality in communication and decision-making with any “what should we do” qualitative, ethical or moral element, is essentially memetic. A western meme that dominates western society and western dominated worlds; a meme that focusses on quantifiable values and discrete objects  than can be compared objectively; memetic because it is such a simple idea that is easy to communicate, understand and apply in Western culture, independent of any inherent value as the basis for the “should” decisions and their outcomes. This is “my agenda”.

Let’s look at one specific meme, not because it illustrates the western objectivity meme particularly, but because it illustrates the basic memetic mechanism. Its relation to the meme in my agenda will become apparent.

ECT (or EST as in Electro-Convulsive / Shock Therapy / Treatment) is a bad thing. The ECT meme, probably so widely held that it prejudices any and all specific decisions concerning ECT ?

99.99% of us have not only no direct (first or even close second hand) experience of ECT, we probably have not seen or heard any reports on specific cases, from either the patient or practitioner perspectives, or any material specifically on the subject, educational or otherwise. Anything we know about ECT is probably from exposure to literary and media dramatizations and media discussion of these.

Ken Kesey’s book, the Milos Foreman film “One Flew Over the Cuckoo’s Nest” has a lasting dramatic impression of the process of administering involuntary ECT, though ironically without any discernable after effects on the patient, good or bad. Robert Pirsig’s book “Zen and the Art of Motorcycle Maintenance” has one key passage describing starkly the technicalities and effects of the involuntary ECT, and the greater part of the book is about the ultimately positive changes in the patient’s psyche. “The Changeling” apparently depicts ECT in a bad light, but I have no direct experience of this film.

Some aspects of the impression of ECT we get from these dramatizations probably fit consonantly well with existing general pre-conceptions such as : Involuntary treatments of any kind and any treatments that cause distress and pain, are generally a bad thing, probably reserved for exceptional, justified and controlled cases. 

An aspect we cannot anchor our impression to, is any real prior knowledge of the psychiatric conditions for which practitioners might prescribe ECT nor the actual effects intended and side-effects expected. For these aspects 99.99% of us have little more to go on than the dramatic source materials and our imagination.

But, for both aspects we have these very few specific cases of dramatized (therefore factually inaccurate in detail) experience from which we draw our most generalized and probably false impression of ECT. And furthermore, this is true independent of the particular agendas or purposes of the persons creating the original dramatizations.

In this day and age we can (if we see this as a sufficiently interesting issue, amongst the multitude of competing interests) put ECT into Google and/or Wikipedia, and see what we can learn. We must bear in mind when we do this, that these are themselves democratically weighted, memetic sources of information, unbalanced in line with the general public perception, unless we spend significant effort filtering for “authoritative” sources.

We should not be surprised that general knowledge of a specific narrow interest subject like ECT is wildly misinformed.  (Which is not to say that ECT is not a bad thing, just that any public impression of it being a bad thing is guaranteed to be misinformed).

Who cares ? Does it matter ? The $64,000 question is whether the general false impression can and should be corrected and if so, specifically how and by whom ? Here of course the agendas and actions of those involved in the specific dramatic sources and those with interest in the specific practices of ECT matter greatly.

 “That ECT is bad, is a false and simplistic impression that could and should be corrected” is simple enough.

 “That ECT is bad, is a false and simplistic impression that could and should be corrected by those who created the false impression.” is however itself a simplistication, necessarily complicated by the need to take into account the memetic process, as well the actions and intentions of the identifiable individuals.

My agenda; Pirsig’s agenda in particular, is that the simplistication of reducing the problem statement to terms of the objects and subjects causally involved is the greater problem in need of correction. Greater in subject areas much wider than the ECT meme, and the interests of potential ECT patients, practitioners and public affected by decisions about those specifically. So wide in fact that all decision-making and governance in society and its institutions is at risk from the objectification meme.

This provides a wonderful opportunity to both test that general thinking and correct a specific misinformation.

3 thoughts on “ECT – A Fine Meme”

  1. Not a comment on where your going with this; but a general one. I have a personal experience with ECT – in that my aunt voluntarily opted for it about 12yrs back… she lost numerous memories about her own children growing up, among others. It did not help her in any manner and she regretted it. I have recently spoken advisement against this treatment to a family member of a friend that was considering it. I feel it’s bad- due to the frying of the brain aspect and also believe it to be psuedoscience as it’s grounds for proof exist in the destruction of cognitive capacity. It has no place in our day and age – IMO.


  2. Hi KAS, that is a very welcome comment, since it is unusual to find someone with such direct experience … which was the point of my post.

    I actually have no prejudice either way, in the sense that whilst everything I can imagine about it based on public knowledge would lead me to agree with you, I’m carefully trying to separate a public impression (which I share) from direct knowledge of any details.

    Should any debate turn to details, with practitioners or others with a positive view, it would be interesting to know about the original condition(s) and why ECT was indicated ?

  3. Based on a very unscientific 30/40 minute survey of links through Google and Wikipedia, I would say the impression gained is that ECT is widely used by professionals and there is widely published evidence of its high success rate based on inducing the necessary convulsion without significant negative physical or mental side-effects.

    This is clearly a “renaissance” from times when administering ECT was much riskier. What remains controversial is what kinds of “damage” the riskier practices could and did cause, and how recently and which changed practices yielded widespread improvements. Also unclear are questions about the actual beneficial mechanisms – the extent to which longer term benefits are learned & psychological and/or physiological & physiochemical, and causally which effects effect which causes – but that is surely an issue with mental health conditions in general ?

    I can recommend this TED Talk by Sherwin Nuland

    It is certainly not difficult to augment the shared (negative) impression with data supporting a positive impression. As ever the devil is the details of understanding good science.

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