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By Max Fink, New York, Oxford University Press, 1999, 157 pages, ISBN 0-19511-956-8, $22.00
Dr. Fink is five years short of a half-century of experience and research in the use of convulsive therapy. He has been responsible for the development of the pioneering journal for physicians who perform electroconvulsive therapy and has taught a large number of those physicians, both directly and indirectly.
Electroshock is an attempt to present a comprehensive review of the origins and practice of convulsive therapy for both a lay and a professional audience. The latter should include all professionals who come into contact with patients or families who may require this treatment, as well as psychiatrists who do not administer convulsive therapy. While one might expect the lay public to be unaware of the risks and benefits of ECT, it is surprising to find that the majority of physicians in all areas of medicine who have no experience with patients who have received ECT are no different from lay people in their response to the prospect of a patient's undergoing treatment. Internists who have not previously cleared patients for ECT have no understanding of the benignity of the treatment and have great trepidation about medically clearing the frail elderly or impaired younger patients for ECT.
Earlier reviews of ECT were not directed at lay audiences, were limited in their endorsement of convulsive therapy, or were components of textbooks of other somatic treatments. The primary thrust of this book is the explication and endorsement of electroconvulsive therapy. Examples are drawn from Dr. Fink's vast clinical experience, and all of the examples have positive outcomes.
I am concerned about the use of Electroshock as the title of this book. It would be more appropriate for the title of a book on cardioversion. Dr. Fink clearly outlines the origin and development of electroconvulsive therapy in the early part of his book. Earlier treatments caused great difficulty for the patient and would not always predictably cause a grand mal seizure. Convulsive therapy is accomplished with the use of electricity because it is the most expeditious means of causing a seizure that has been found to date; if other means can be promulgated that are more effective, they will replace the use of electricity, but it will still be convulsive therapy. Some of the negative perception of the treatment derives from its old appellation, which should be abandoned.
Dr. Gabriel is Chief of Electroconvulsive Therapy at Lenox Hill Hospital, New York, NY.
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