Then & Now: A Comparison of Treatment Modalities in …



Then & Now: A Comparison of Treatment Modalities in Mental Health in the 1960's versus TodayTrina SkinnerStenberg CollegeThe Sociology of Mental Health and IllnessSOCI 201-3(A)Debbie McCreedyAugust 29, 2013Then & Now: A Comparison of Treatment Modalities in Mental Health in the 1960's versus TodayThis paper will present a comparison and contrast of two treatment modalities implemented in the care of institutionalized psychiatric patients in the early 1960’s versus today. Electroconvulsive therapy and group psychotherapy will be examined as far as their therapeutic role and the motivating factors behind the history of these treatments as compared to modern day psychiatric care. Rather than present an in-depth description of each treatment, the emphasis of this paper will be placed on ethical considerations and standards of practice in psychiatric nursing.After watching the famous 1960’s film “One flew over the Cuckoo’s nest”, it was clear to see some distinct differentiation where psychiatric nursing roles and sociological factors are concerned across the span of the 21st century. Though it is an undisputed fact that progress has been made where sociology and mental health are considered, one might question to what degree psychiatric care has actually evolved. Insight is commonly defined in a cyclical fasion. To elaborate, Rogers & Pilgrim (2010, p. 171). Kendrick (1993), outlines three key points based on Kantianism and Kant’s moral theory. According to this theory, “An action is only moral if you are willing for it to be applied to everyone, yourself included, as a universal law” (p. 924). Secondly, Kant states that for an act to be considered ‘moral’ it must refrain from viewing people as a means to an end, but consistently as “ends to their own right” (p. 924). The third and final component highlighted in Kantianism regarding ethical treatment, in a attempt to maintain high morality, “individuals must act as members of a community where everybody is seen as having intrinsic worth (ends in their own right)” (Kendrick, 1993, p. 924). Three ethical principles that were null and void as far as patient care is concerned in the film will be explored. First the use of electroconvulsive therapy (ECT) will be explored. In the film, ECT was used as a behavioral modification tactic to the point of a punitive measure in the interest of redirecting a patient’s unfavorable action on the ward. The initial concept of ECT can be linked back to 1933 when it was discovered that treatments that include concurrent comas and seizure induced by insulin (injection) were determined to relieve symptoms of schizophrenia. A year later, this discovery led to the effectiveness of chemically induced seizures to relieve catatonia, (Fink, 2011, p, 3) By 1938, chemically induced seizures were taken over by electrical induction of seizure activity in the brain, and came to be regarded as safe and effective, initiating universal adoption as ‘the treatment standard’ (Fink, 2011, p. 3). The procedure and rationale behind ECT has changed dramatically over the course of the past seventy five years. ECT became obsolete due to the introduction of psychotropic drugs in the 1960’s, a change that offered relief for many critics who believed that interventions were abusive to patients (Fink, 2011, p. 3). By the late 1970s, “increasing numbers of patients with severe illness failed to improve, even with the cornucopia of new chemical elements and imaginative psychotherapies, experienced clinicians resurrected ECT and found it still effective” (Fink, 2011, p, 3). In regards to the question of informed choice insight becomes a critical concept, as health care professionals have the ability to override consent from patients regarding treatment if they are of the opinion a patient is lacking insight into their state of mental health (Rogers &Pilgrim, 2011, p. 171). McMurphy was dragged into a room involuntarily where without consenting or having had the procedure explained to him, was physically restrained and administered shock therapy while completely conscious. ECT in the film demonstrated a gross violation of basic human rights, defying ethical principles in mental health care. Fink (2011), asserts that critics of ECT have contributed to “broad stigmatization, marked by interdiction in some venues and rejection in many psychiatric treatment facilities”(p.4). A practice that Fink (2011), has deemed such practice as unethical and unjust (p. 4). In contrast ECT is used today as a last resort for patients living with severe psychiatric illness in which medication and psychotherapy have proven ineffective. The clinical experience of this treatment has improved the delivery of care to the point that no “absolute contraindication for the treatment is acknowledged and the efficacy for the principal psychopathologies - psychotic and melancholic depression, catatonia, malignant catatonia, and delirious mania - is well established with greater than 85% remission rates” (Fink, 2011, p. 4). Many patients consent to this treatment, not only on the Inpatient Psychiatric Unit (IPU). Members of the community also come to hospital in order to receive their treatment as determined by the patient and his/her psychiatrist. Today the procedure is much more humane approach as opposed to the not so distant past.. ECT has become a means of therapeutic intervention that has improved the health and wellness of many people living with severe mental illness today. Secondly, as far as the notion of group psychotherapy is concerned, the film presents a gross misconduct of one nurse’s determination to dominate and control every patient and the general environment on the ward. Wilkin, as cited in Stuart (2010), states that the only ‘acceptable nursing agenda’ is to keep the lines of communication open “and the door open to brand new ways of being” (p.43). Nurse Ratched used passive aggressive methods such has humiliation and indirect threat of unfavorable methods of ‘treatment’ in order to manipulate patients into maintaining order as she saw fit. Yalom (2005), in discussing the development of key elements of effective group therapy argues that, social learning and the development of basic social skills is a therapeutic factor “that operates in all therapy groups” (p. 16). In the film, nurse Ratched represents the detrimental effects of one person having full authority over individuals in a vulnerable state, in legitimate need of effective psychotherapy to increase the likelihood of a patient’s mental health improvement and relapse prevention. Motive is a key factor in terms of effective group therapy, who do the sessions benefit, the leader, the patient, or ideally both? In conclusion, the major difference between mental health care then vs. now, the slow but consistent influx of therapeutic intervention, as opposed to ‘power over’ and coercive measures that trample people’s basic human rights. This assignment demonstrates the detrimental effects of punitive and coercive treatment of a population of individuals who require genuine therapeutic intervention. Such intervention becomes meaningless in the absence of trust and lack of establishment of a therapeutic relationship between nurse and client. It is not about taking control over a person’s life and extinguishing their basic human rights so much as creating an alliance in which the psychiatric nurse assists the patient in their journey to recovery. Ethical conflict and issues such as lack of consent continue to remain a problem in current mental health. Needless to say, the discipline of psychiatric nursing is still very much undefined and a lack of cohesion ensues. This issue must be addressed on a consistent basis before patients can truly receive the therapeutic experience vital to their health and well being. ReferencesFink, M. (2011). Electroconvulsive therapy resurrected: Its successes and promises after 75 years. Canadian Journal of Psychiatry, 56(1), 3-4. Retrieved from , K. (1993). Understanding ethics in nursing practice. British Journal Of Nursing, 2(18), 920. Retrieved from , A. & Pilgrim, D. (2008).A sociology of mental health and illness. (3rd Ed). New York, NY: McGraw Hill?Sundeen, S.J. (2009). Recovery and Psychiatric Rehabilitation in: Stuart, G & Sundeen, S.J. (Eds.).Principles and practices of psychiatric nursing 9th Edition. (pp 199 - 216). Mosby: St.LouisYalom, I. D. & Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy (5th Ed.). New York,? NY: Basic Books?Zaenta, S., & Douglas, M. (Producers) & Forman, M. (Director). (1975). One Flew Over The Cuckoo’s Nest [Motion picture]. USA: Fantasy Films.. ................
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