Last month it was announced that Dr Peter Rosenquist of Wake Forest University had been named Vice Chair of the Department of Psychiatry and Health Behavior of the Medical College of Georgia at Georgia Health Sciences University, and would be joining them this month. He has, the MCG announcement said, “performed more than 10,000 electroconvulsive therapy sessions and is proficient with rapid rate transcranial magnetic stimulation and vagus nerve stimulation…”
10,000 sessions certainly amounts to a great deal of experience. I don’t know how much psychiatrists are paid per session, but it probably amounts to a great deal of money as well. But is it an achievement? Is the psychiatrist who has given 10,000 treatments any better at giving ECT than one who has only given 100 treatments? For a psychiatrist, giving someone ECT involves putting electrodes on their head and pressing a switch. The anaesthetist meanwhile takes care of the anaesthetic and nurses take care of recovery, etc. Even deciding what setting to have the machine on is relatively simple, not something that requires years of experience. One of the selling points of the Thymatron ECT machine is the fact that is has just one knob (“Because just one knob adjusts stimulus dose on the Thymatron”) unlike the rival MECTA machine which has four knobs, something which, according to Thymatron’s makers, might easily confuse a psychiatrist (“Are you sure which of the four Mecta knobs to turn to increase or decrease the stimulus dose, and in what order?”) That is how difficult it is.
Dr Rosenquist meanwhile has not written much about ECT. I could only find one article where he was the lead author, and a few where his name appears lower down the list of authors. One of his co-authors on most of these is Dr W. Vaughn McCall, who is also moving from Wake Forest to MCG, becoming Chair of the Department of Psychiatry and Health Behavior.
Dr Rosenquist’s 10,000 treatments reminded me of another doctor who said he had given over 10,000 ECTs to people, this time a British doctor from some years back. Dr Richard Woodland and his 10,000 ECTs featured in a critical article in the journal Pulse, 13 October 1984. Dr Woodland was a GP (general practitioner) rather than a psychiatrist and the 10,000 treatments were given to patients with a range of physical conditions. He explained:
“It always surprised me that a treatment capable of producing a return to health in cases of depression should never have been suspected of possessing a greater therapeutic range. So many somatic symptoms which occur in the company of depression vanish with the use of ECT so it seemed logical to conjecture that such symptoms occurring in the absence of depression still respond to ECT… My NHS [National Health Service] practice was on a council estate and I pottered round with my nurse and oxygen cylinders going to people’s homes, rendering them unconscious and leaving about 20 minutes later… I took an awful lot of trouble.”
According to the article, Dr Woodland’s hypothesis was that “the widespread synchronous discharge which ECT caused in nerves acted in some way to restore homeostasis to the autonomic nervous system” but “he admitted that many of the conditions which did respond had a background of spontaneous remission, exacerbation or relapse”.
Dr Woodland practised in Paignton, Devon, until 1968 but then moved to London, where, he said, there was less hostility to his use of ECT.