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132-470: Originally built to accommodate 350 people, the facility, having been expanded several times, reached a high of over 7700 patients resulting in unprecedented overcrowding conditions. In 2008, the facility was ordered to be closed as a result of deteriorating conditions and overcrowding. A new facility was built on the large Greystone campus nearby and bears the same name as the aging facility. Despite considerable public opposition and media attention, demolition of

264-422: A Unitarian . After Dix's health forced her to relinquish her school, she began working as a governess on Beacon Hill for the family of William Ellery Channing , a leading Unitarian intellectual. It was while working with his family that Dix traveled to St. Croix , where she first witnessed slavery at first hand, though her experience did not dispose her sympathies toward abolitionism. In 1831, she established

396-623: A gneiss quarry, which was the source of the Greystone building material. Below the building, a series of tunnels and rails connect the many sections. By the 2000s, many of the buildings were vacant and needed major repairs. Preservationists had been working for several years to guarantee the survival of this complex of buildings and Morris County had been negotiating with the State of New Jersey to take over vacant structures for non-profit agencies. Citizens of Morris County and surrounding areas formed

528-475: A stroke ; who have increased intracranial pressure (for instance, due to a solid brain tumor ), or who have severe pulmonary conditions, or who are generally at high risk for receiving anesthesia. In adolescents, ECT is highly efficient for several psychiatric disorders, with few and relatively benign adverse effects. A meta-analysis from 2017 found that the death rate of ECT was around 2.1 per 100,000 procedures. A review from 2011 reported an estimate of

660-445: A full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s, psychiatrists began to experiment with curare , the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of suxamethonium (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. A short-acting anesthetic

792-534: A greater risk of memory impairment. Retrograde amnesia is most marked for events occurring in the weeks or months before treatment. Anterograde memory loss usually resolves 2–4 weeks after treatment, whereas retrograde amnesia (which develops gradually after repeated treatments in the initial course) usually takes weeks to months to resolve, and amnesia rarely persist for more than 1 year. Retrograde amnesia after ECT usually affects autobiographical memory, rather than semantic memory . One published review summarizing

924-534: A guest to Greenbank, their ancestral mansion in Liverpool . The Rathbones were Quakers and prominent social reformers. At Greenbank, Dix met their circle of men and women who believed that government should play a direct, active role in social welfare. She was also introduced to Great Britain's reform movement for care of the mentally ill, known as lunacy reform. Its members were making deep investigations of madhouses and asylums, publishing their studies in reports to

1056-514: A half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT. Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more severe cognitive impairment without additional therapeutic gains. Seizure threshold is determined by trial and error (" dose titration "). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given

1188-541: A large effect size (high efficacy relative to the mean in terms of the standard deviation ) for ECT versus placebo, and versus antidepressant drugs. Compared with repetitive transcranial magnetic stimulation (rTMS) for people with treatment-resistant major depressive disorder, ECT relieves depression as shown by reducing the score on the Hamilton Rating Scale for Depression by about 15 points, while rTMS reduced it by 9 points. Other estimates regarding

1320-425: A meta-analysis found in terms of efficacy, "a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo , ECT versus antidepressants in general, ECT versus tricyclics and ECT versus monoamine oxidase inhibitors ." In 2003, The UK ECT Review Group published a systematic review and meta-analysis comparing ECT to placebo and antidepressant drugs. This meta-analysis demonstrated

1452-546: A model school for girls in Boston, operating it until 1836, when she suffered a breakdown. Dix was encouraged to take a trip to Europe to improve her health. While she was there she met British social reformers who inspired her. These reformers included Elizabeth Fry , Samuel Tuke and William Rathbone with whom she lived during the duration of her trip in Europe. In hopes of a cure, in 1836 she traveled to England, where she met

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1584-493: A narrow range of severe psychiatric disorders. Because of the backlash noted previously, national institutions reviewed past practices and set new standards. In 1978, the American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference confirmed

1716-427: A new fire station, power plant, greenhouse, and auxiliary buildings. The Men's Occupational Therapy Building opened that same year, allowing for patients to take on new duties in service to the hospital such as tailoring and woodworking. 1929 and 1931 proved to very trying times for Greystone. In the two-year span, three fires severely handicapped the institution's ability to treat the mentally ill. The most devastating of

1848-465: A pauper, helpless, lonely, and yet conscious of surrounding circumstances, and not now wholly oblivious of the past—this feeble old man, who was he?" Many members of the legislature knew her pauper jurist. Joseph S. Dodd introduced her report to the Senate on January 23, 1845. Dodd's resolution to authorize an asylum passed the following day. The first committee made their report February 25, appealing to

1980-461: A report to the January 1847 legislative session, which adopted legislation to establish Illinois' first state mental hospital. In 1848, Dix visited North Carolina , where she again called for reform in the care of mentally ill patients. Her first attempt to bring reform to North Carolina was denied. However, after a board member's wife requested, as a dying wish, that Dix's plea be reconsidered,

2112-536: A room. To reduce the likelihood of fires, Greystone and other Kirkbride asylums were constructed using stone, brick, slate and iron, using as little wood as possible. A street on the Greystone Park campus bears Buttolph's name. The Greystone campus itself was once a self-contained community that included staff housing, a post office, fire and police stations, a working farm, and vocational and recreational facilities. It also had its own gas and water utilities and

2244-399: A sanitary point of view these cots are an abomination," declared the board of managers. Cots were set up and taken down on a daily basis on the hallways, and were not able to be cleaned between uses. Patients often soiled themselves during the night, and the cots were simply handed out again the following evening. The asylum scrambled to create more housing. By 1901, the new dormitory building

2376-763: A school all for girls in Worcester, Massachusetts at fourteen years old and had developed her own curriculum for her class, in which she emphasized ethical living and the natural sciences. In about 1821 Dix opened a school in Boston, which was patronized by well-to-do families. Soon afterward she also began teaching poor and neglected children out of the barn of her grandmother's house, but she suffered poor health. It has been suggested that Dorothea suffered from major depressive episodes, which contributed to her poor health. From 1824 to 1830, she wrote mainly devotional books and stories for children. Her Conversations on Common Things (1824) reached its sixtieth edition by 1869, and

2508-700: A second audience with her that "a woman and a Protestant, had crossed the seas to call his attention to these cruelly ill-treated members of his flock." During the American Civil War , Dix, on June 10, 1861, was appointed Superintendent of Army Nurses by the Union Army , beating out Dr. Elizabeth Blackwell . Dix set guidelines for nurse candidates. Volunteers were to be aged 35 to 50 and plain-looking. They were required to wear unhooped black or brown dresses, with no jewelry or cosmetics. Dix wanted to avoid sending vulnerable, attractive young women into

2640-549: A shortage of about 75 beds. Ground was ceremonially broken on November 16, 2005, for the new psychiatric hospital on the Greystone campus, located up the hill across the street from the Ellis complex. The new hospital is two-thirds the size of the Kirkbride building and can house about 450 patients, with another 100 patients living in hospital-run cottages on the grounds around the main building. The entire Curry Complex, including

2772-484: A similar project in the Channel Islands , finally managing the building of an asylum after thirteen years of agitation. Extending her work throughout Europe, Dix continued on to Rome. Once again finding disrepair and maltreatment, Dix sought an audience with Pope Pius IX . The pope was receptive to Dix's findings and visited the asylums himself, shocked at their conditions. He thanked Dix for her work, saying in

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2904-402: A study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime ECT treatments. Kellner stated "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness." Two meta-analyses find that ECT is associated with brain matter growth. If steps are taken to decrease potential risks, ECT

3036-476: A successful campaign to send upgraded life-saving equipment to the island. The day after supplies arrived, a ship was wrecked on the island. Thankfully, because of Dix's work, 180 people were saved. In 1854, Dix investigated the conditions of mental hospitals in Scotland , and found them to be in similarly poor conditions. In 1857, after years of work and opposition, reform laws were finally passed. Dix took up

3168-568: A systematic review found this an unestablished intervention. For major depressive disorder , despite a Canadian guideline and some experts arguing for using ECT as a first line treatment, ECT is generally used only when one or other treatments have failed, or in emergencies, such as imminent suicide. ECT has also been used in selected cases of depression occurring in the setting of multiple sclerosis , Parkinson's disease , Huntington's chorea , developmental delay , brain arteriovenous malformations , and hydrocephalus . A meta-analysis on

3300-466: A wing on each side with three wards on a floor. Each ward would be set back from the previous one to allow patients to take in the beautiful grounds from their wards. Each ward was designed to accommodate 20 patients, with a dining room, exercise room and activity room. The wards were furnished with the highest quality materials such as wool rugs, pianos and fresh flowers. Patients worked on the farms growing and raising food and performed hard labor tasks in

3432-468: Is a psychiatric treatment during which a generalized seizure (without muscular convulsions ) is electrically induced to manage refractory mental disorders . Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple (bilateral ECT) or from front to back of one side of

3564-427: Is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by suicidality , psychosis , stupor , marked psychomotor retardation , depressive delusions or hallucinations , or life-threatening physical exhaustion associated with mania)." It has also been used to treat autism in adults with an intellectual disability, yet findings from

3696-402: Is evidence and rationale to support giving low doses of benzodiazepines or otherwise low doses of general anesthetics , which induce sedation but not anesthesia , to patients to reduce adverse effects of ECT. While there are no absolute contraindications for ECT, there is increased risk for patients who have unstable or severe cardiovascular conditions or aneurysms ; who have recently had

3828-404: Is generally accepted to be relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments. Suggested preparation for ECT during pregnancy includes a pelvic examination , discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid . During ECT, elevation of

3960-407: Is generally acknowledged". For people with autism spectrum disorders who have catatonia, there is little published evidence about the efficacy of ECT. ECT is used to treat people who have severe or prolonged mania ; NICE recommends it only in life-threatening situations or when other treatments have failed and as a second-line treatment for bipolar mania . ECT is widely used worldwide in

4092-541: Is given for a shorter duration of 0.5 milliseconds where conventional brief pulse is 1.5 milliseconds. In a review from 2022 of neuroimaging studies based on a global data collaboration ECT was suggested to work via a temporary disruption of neural circuits followed by augmented neuroplasticity and rewiring. ECT is used, where possible, with informed consent in treatment-resistant major depressive disorder , bipolar depression , treatment-resistant catatonia , prolonged or severe mania , and in conditions where "there

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4224-420: Is no defined schedule for maintenance ECT, however it is usually started weekly with intervals extended permissibly with the goal of maintaining remission. When ECT is followed by treatment with antidepressants , about 50% of people relapsed by 12 months following successful initial treatment with ECT, with about 37% relapsing within the first 6 months. About twice as many relapsed with no antidepressants. Most of

4356-457: Is one of the least harmful to the fetus . ECT is often used as an intervention for major depressive disorder , mania , autism , and catatonia . The usual course of ECT involves multiple administrations, typically given two or three times per week until the patient no longer has symptoms. ECT is administered under anesthesia with a muscle relaxant . ECT can differ in its application in three ways: electrode placement, treatment frequency, and

4488-405: Is well recognized that the application of water at varying degrees of temperature and pressure exerts influences of a valuable therapeutic character upon the entire human economy and aids the recuperative powers of the body." Female patients were able to receive treatment for their afflictions through use of douches , massages, and hot air cabinets. A hydrotherapeutic treatment room for male patients

4620-749: The Harrisburg State Hospital . In 1853, she established its library and reading room. The high point of her work in Washington was the Bill for the Benefit of the Indigent Insane , legislation to set aside 12,225,000 acres (49,473 km ) of Federal land 10,000,000 acres (40,000 km ) to be used for the benefit of the mentally ill and the remainder for the "blind, deaf, and dumb". Proceeds from its sale would be distributed to

4752-790: The House of Commons . Reform movements for treatment of the mentally ill were related in this period to other progressive causes: abolitionism , temperance , and voter reforms. After returning to America, in 1840–41 Dix conducted a statewide investigation of care for the mentally ill poor in Massachusetts. Dorothea's interest for helping out the mentally ill of society started while she was teaching classes to female prisoners in East Cambridge . She saw how these individuals were locked up and whose medical needs weren't being satisfied since only private hospitals would have such provisions. It

4884-499: The Marlboro Psychiatric Hospital in 1931, and patients were transferred over the next few years down to the new hospital to help with overcrowding issues. However, Greystone officials were faced with a new problem: patients transferred to Marlboro had to pass a series of tests, and often the most able-bodied patients were removed from the campus, leaving older or more seriously ill patients behind. A change in

5016-594: The New Jersey Department of the Treasury announced plans to demolish the main Kirkbride building. In response to the community preservation group, Preserve Greystone, the Department worked with a consultant who found that redevelopment of the building would be too costly. The following year the state announced the awarding of a $ 34.4 million demolition bid to Northstar Contracting Group to take down

5148-648: The New Jersey State Hospital , formerly known as Trenton State Hospital, that she built years prior. The state legislature had designated a suite for her private use as long as she lived. Although in poor health, she carried on correspondence with people from England, Japan, and elsewhere. Dix died on July 17, 1887. She was buried in Mount Auburn Cemetery in Cambridge, Massachusetts . Numerous locations commemorate Dix, including

5280-630: The Preserve Greystone society to save the buildings. After the transition of the hospital's activity to its new location, the remaining property, including the historic Kirkbride building, was turned over to the state's treasurer in October 2007 as excess property with the intention that it would be sold. In the summer of 2008, the Curry building, as well as the surrounding vacant buildings, were demolished. In August 2013, state officials from

5412-599: The Rathbone family . During her trip in Europe and her stay with the Rathbone family, Dorothea's grandmother died and left her a "sizable estate, along with her royalties" which allowed her to live comfortably for the remainder of her life. It was also during this trip that she came across an institution in Turkey, which she used as a model institution despite its conditions being just like other facilities. They invited her as

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5544-764: The South . Her nurses provided what was often the only care available in the field to Confederate wounded. Georgeanna Woolsey , a Dix nurse, said, "The surgeon in charge of our camp ... looked after all their wounds, which were often in a most shocking state, particularly among the rebels. Every evening and morning they were dressed." Another Dix nurse, Julia Susan Wheelock, said, "Many of these were Rebels. I could not pass them by neglected. Though enemies, they were nevertheless helpless, suffering human beings." When Confederate forces retreated from Gettysburg , they left behind 5,000 wounded soldiers. These were treated by many of Dix's nurses. Union nurse Cornelia Hancock wrote about

5676-471: The 16th century, agents to induce seizures were used to treat psychiatric conditions. In 1785, the therapeutic use of seizure induction was documented in the London Medical and Surgical Journal . As to its earliest antecedents one doctor claims 1744 as the dawn of electricity's therapeutic use, as documented in the first issue of Electricity and Medicine . Treatment and cure of hysterical blindness

5808-417: The 1970s forbidding patients to work unless paid fairly, which meant at least minimum wage. Suddenly hospital costs skyrocketed, as patients were no longer able to work in order to defray fees. Due to the landmark Doe vs. Klein case in 1974, Greystone Park Psychiatric Hospital was forced to build community homes for patients to provide halfway house type living situations, and adequate staffing and patient care

5940-493: The 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression". In 1985, the National Institute of Mental Health and National Institutes of Health convened a consensus development conference on ECT and concluded that, while ECT was the most controversial treatment in psychiatry and had significant side-effects, it had been shown to be effective for

6072-848: The Dix Ward in McLean Asylum at Somerville, Dixmont Hospital in Pennsylvania, the Dorothea L. Dix House, and the Dorothea Dix Park located in Raleigh, North Carolina. She wrote a variety of other tracts on prisoners. She is also the author of many memorials to legislative bodies on the subject of lunatic asylums and reports on philanthropic subjects. and other books. Electroconvulsive therapy Electroconvulsive therapy ( ECT ) or electroshock therapy ( EST )

6204-468: The Greystone main building prior to its controversial demolition. The Kirkbride building has been used as a filming location for multiple shows and films, including Marvin's Room as well as "Mayfield Psychiatric Hospital" in two episodes of the FOX series House, M.D. . Dorothea Dix This is an accepted version of this page Dorothea Lynde Dix (April 4, 1802 – July 17, 1887)

6336-510: The Kirkbride Building as well as other structures of the old hospital. Governor Chris Christie announced that the state was not considering a bid by Alma Realty to restore the property at no cost to the state. The plans for the demolition included the designation of an area on the property to memorialize the Kirkbride Building. State officials announced the demolition was scheduled to begin on April 6, 2015 and that work to clean up

6468-704: The Medical Clinic Building, the Curry Reception Building and the Employee Cafeteria came down in 2007 and 2008. The trio of buildings known as the Ellis Complex were cleared to make way for a parking lot. On July 16, 2008, after countless unexplained delays, patients were moved into the new hospital building. Administration and other departments followed suit. Today, almost all hospital services have relocated to

6600-464: The New Jersey legislature to act at once. Some politicians secretly opposed it due to taxes needed to support it. Dix continued to lobby for a facility, writing letters and editorials to build support. During the session, she met with legislators and held group meetings in the evening at home. The act of authorization was taken up March 14, 1845, and read for the last time. On March 25, 1845, the bill

6732-691: The Sick and wounded Soldiers of the United States on the Battle-Field, in Camps and Hospitals during the recent war." Dix ultimately founded thirty-two hospitals, and influenced the creation of two others in Japan. At the end of the war, Dix helped raise funds for the national monument to deceased soldiers at Fortress Monroe . Following the war, she resumed her crusade to improve the care of prisoners,

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6864-573: The State Lunatic Asylum was operating at 365 patients over capacity. The overcrowding was a major health and cleanliness issue, resulting in a small outbreak of typhoid fever , eventually blamed on the water supply. The passing of years brought no relief for a bursting hospital, occupied with 1,189 patients bedded down in an institution meant to hold only 800 every night. Cots were placed in activity rooms, exercise halls and hallways in order to try to find sleeping arrangements for all. "From

6996-659: The Swiss psychiatrist Max Müller. The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide. The ECT procedure was first conducted in 1938 by Italian neuro-psychiatrist Ugo Cerletti and rapidly replaced less safe and effective forms of biological treatments in use at the time. Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his assistant Lucio Bini at Sapienza University of Rome developed

7128-603: The base of this building was the alleged largest continuous foundation in the United States from the time it was built until it was surpassed by the Pentagon when it was constructed in 1943. However, many other Kirkbride asylum buildings (such as the Athens Lunatic Asylum in Ohio) also lay a claim to this fame and it has not been verified which one is true. The building has a characteristic linear arrangement, which

7260-593: The bill for reform was approved. In 1849, when the (North Carolina) State Medical Society was formed, the legislature authorized construction of an institution in the capital, Raleigh , for the care of mentally ill patients. Dix Hill Asylum, named in honor of Dorothea Dix's father, was eventually opened in 1856. One hundred years later, the Dix Hill Asylum was renamed the Dorothea Dix Hospital , in honor of her legacy. A second state hospital for

7392-590: The brain, the general physical risks of ECT are similar to those of brief general anesthesia ; the US Surgeon General 's report says that there are "no absolute health contraindications " to its use. Immediately following treatment, the most common adverse effects are confusion and memory loss. Some patients experience muscle soreness after ECT. Other common adverse effects after ECT include headache, jaw soreness, nausea, vomiting and fatigue. These side effects are transient and respond to treatment. There

7524-506: The building. Upper floors in the center section contained apartments for employees, and the third story contained the amusement room and chapel for patients. Samuel Sloan was named architect of the main building and its smaller supporting buildings. Sloan chose to follow the Kirkbride Plan, a list of ideals pertaining to hospital design created by Thomas Story Kirkbride. There would be a center section for administrative purposes, then

7656-494: The clearing away of building debris, excavating for roads, and sodding grounds. The plan of the institution called for carriage drives ending at all doorways, and a central road leading up to the front entrance flanked by trees on both sides. Grounds on both sides of the wings would provide for simultaneous exercise of both sexes while keeping them separate. An industrial building opened in 1894, allowing for more jobs for patients than just manual labor jobs in farming or groundworks. It

7788-436: The concern surrounding its use. However, the methods used to measure memory loss are non-specific, and their application to people with depressive disorders, who have cognitive deficits related to the depression, including problems with memory, may further limit their utility. The acute effects of ECT can include amnesia , both retrograde (for events occurring before the treatment) and anterograde (for events occurring after

7920-603: The counties, jails and almshouses in New Jersey in a similar investigation. She prepared a memorial for the New Jersey Legislature , giving a detailed account of her observations and facts. Dix urgently appealed to the legislature to act and appropriate funds to construct a facility for the care and treatment of the mentally ill. She cited a number of cases to emphasize the importance of the state taking responsibility for this class of unfortunates. Dix's plea

8052-457: The department of building construction. The Voorhees Cottage and Knight Cottage were opened as homes for nurses, as well as cottages for senior physicians and the superintendent. The Psychiatric Clinic Reception Building opened in 1923 and all operating rooms, laboratories and x-ray equipment were moved to the new building. A Social Service Department was instituted, in charge of letting patients out for "trial" visits to help them assimilate back into

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8184-412: The design phase of the main building at Greystone, though the two main designers were architect Samuel Sloan and Trenton State Asylum Superintendent Horace Buttolph (a friend of Kirkbride's). The building was constructed and furnished according to Kirkbride's philosophy, which proposed housing no more than 250 patients in a three-story building. The rooms were to be light and airy with only two patients to

8316-613: The disabled, and the mentally ill. Her first step was to review the asylums and prisons in the South to evaluate the war damage to their facilities. In addition to pursuing prisons reforms after the civil war, she also worked on improving life-saving services in Nova Scotia, establishing a war memorial at Hampton Roads in Virginia and a fountain for thirsty horses at the Boston Custom Square. In 1881, Dix moved into

8448-403: The dose and duration of the stimulation is determined on a per-patient basis. In unilateral ECT, both electrodes are placed on the same side of the patient's head. Unilateral ECT may be used first to minimize side effects such as memory loss. In bilateral ECT, the two electrodes are placed on opposite sides of the head. Usually bitemporal placement is used, whereby the electrodes are placed on

8580-463: The effectiveness of ECT in unipolar and bipolar depression indicated that although patients with unipolar depression and bipolar depression responded to other medical treatments very differently, both groups responded equally well to ECT. Overall remission rate for patients given a round of ECT treatment was 50.9% for those with unipolar depression and 53.2% for those with bipolar depression. Most severely depressed patients respond to ECT. In 2004,

8712-540: The electrical waveform of the stimulus. These treatment parameters can pose significant differences in both adverse side effects and symptom remission in the treated patient. Placement can be bilateral, where the electric current is passed from one side of the brain to the other, or unilateral, in which the current is solely passed across one hemisphere of the brain. High-dose unilateral ECT has some cognitive advantages compared to moderate-dose bilateral ECT while showing no difference in antidepressant efficacy. As early as

8844-404: The evidence for continuation therapy is with tricyclic antidepressants ; evidence for relapse prevention with newer antidepressants is lacking. Adjunct maintenance ECT paired with cognitive behavioral therapy has also been shown to reduce relapse rates. Maintenance ECT may safely continue indefinitely, with no set maximum treatment interval established. Lithium has also been found to reduce

8976-562: The experience: "There are no words in the English language to express the suffering I witnessed today ...". She was well respected for her work throughout the war because of her dedication. This stemmed from her putting aside her previous work to focus completely on the war at hand. With the conclusion of the war her service was recognized formally. She was awarded with two national flags, these flags being for "the Care, Succor, and Relief of

9108-437: The first American Psychiatric Association (APA) task force report on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). The report endorsed the use of ECT in the treatment of depression. The decade also saw criticism of ECT. Specifically, critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT. The use of ECT declined until

9240-553: The formation of the Scottish Lunacy Commission to oversee reforms. Dix visited the British colony of Nova Scotia in 1853 to study its care of the mentally ill. During her visit, she traveled to Sable Island to investigate reports of mentally ill patients being abandoned there. Such reports were largely unfounded. While on Sable Island, Dix assisted in a shipwreck rescue. Upon her return to Boston, she led

9372-506: The hallmark of the Kirkbride Plan for treating the mentally ill. The building form itself was meant to promote treatment and have a curative effect. Each ward was initially set up to accommodate 20 patients. Each was furnished with a dining room, exercise room, and parlor. Most wards had wool rugs that ran the full length of the corridors. Other amenities included Victorian stuffed furniture, pianos, pictures, curtains and fresh flowers. Though not all wards were created equally. Wards that housed

9504-478: The head (unilateral ECT). However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance. Aside from effects on the brain, the general physical risks of ECT are similar to those of brief general anesthesia . Immediately following treatment, the most common adverse effects are confusion and transient memory loss. Among treatments for severely depressed pregnant women, ECT

9636-414: The home with their families and being treated by the community than staying in removed surroundings in a hospital for a long-term stay. Two factors caused this sudden change. New psychological drugs were able to control patients much more effectively than previous methods ever could, and suddenly dangerous patients were capable of existing in the community in a less harmful state. Secondly, laws were passed in

9768-551: The hospitals, where she feared they would be exploited by the men (doctors as well as patients). Dix often fired volunteer nurses she hadn't personally trained or hired (earning the ire of supporting groups like the United States Sanitary Commission ). At odds with Army doctors, Dix feuded with them over control of medical facilities and the hiring and firing of nurses. Many doctors and surgeons did not want any female nurses in their hospitals. To solve

9900-643: The idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1938, experimented for the first time on a person affected by delusions . It was believed early on that inducing convulsions aided in helping those with severe schizophrenia but later found to be most useful with affective disorders such as depression . Cerletti had noted a shock to the head produced convulsions in dogs. The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state. Cerletti and Bini practiced until they felt they had

10032-747: The impasse, the War Department introduced Order No. 351 in October 1863. It granted both the Surgeon General ( Joseph K. Barnes ) and the Superintendent of Army Nurses (Dix) the power to appoint female nurses. However, it gave doctors the power of assigning employees and volunteers to hospitals. This relieved Dix of direct operational responsibility. As superintendent, Dix implemented the Federal army nursing program, in which over 3,000 women would eventually serve. Meanwhile, her influence

10164-524: The initial years before anesthesia was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media." The New York Times described the public's negative perception of ECT as being caused mainly by one movie: "For Big Nurse in One Flew Over the Cuckoo's Nest , it was a tool of terror, and, in the public mind, shock therapy has retained

10296-404: The large main building to be completed in sections as usage detailed. The plan of the main building was drafted to allow for a total of 40 wards split into two wings, one wing for each sex. There was to be no communication between wards. The corridors served a purpose other than just separating wards: they provided for fire protection, so that a fire would be unable to spread past a single section of

10428-543: The larger decaying buildings which still stood, and were viewed as eyesores, began in 2005 with the demolition of the dormitory. On September 8, 2005, the New Jersey Health Care Facilities Financing Authority closed a $ 186,565,000 bond issue on behalf of the State of New Jersey Department of Human Services for the completion of a new, 43,000 m (460,000 sq ft) Greystone Park Psychiatric Hospital, still with

10560-540: The main Kirkbride building began in April 2015 and was completed by October 2015. The idea for such a facility was conceived in the early 1870s at the persistent lobbying of Dorothea Dix , a nurse who was an advocate for better health care for people with mental illnesses. At that time in history, New Jersey's state-funded mental health facilities were exceedingly overcrowded and sub-par compared to neighboring states that had more facilities and room to house patients. Greystone

10692-531: The majority of New Jersey's population. After visiting approximately 42 different locations, officials approved purchase of a portion of a few farms and lots, on August 28, 1881, near Morristown and a short distance from the Morris and Essex Railroad . The plots of land contained fertile soil, rock quarries for mining stone, a sand pit for building materials and reservoirs for water and ice access. The new asylum, when completed, would hold approximately 600 patients, with

10824-404: The memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse. It took many years for brief-pulse equipment to be widely adopted. In the 1940s and early 1950s, ECT was usually given in an "unmodified" form, without muscle relaxants, and the seizure resulted in

10956-663: The mentally ill was authorized in 1875, Broughton State Hospital in Morganton, North Carolina ; and ultimately, the Goldsboro Hospital for the Negro Insane was also built in eastern part of the state. Dix had a biased view that mental illness was related to conditions of educated whites , not minorities (Dix, 1847). She was instrumental in the founding of the first public mental hospital in Pennsylvania ,

11088-455: The mortality rate associated with ECT as less than 1 death per 73,440 treatments. Cognitive impairment sometimes occurs after ECT. The American Psychiatric Association (APA) report in 2001 acknowledges: "In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss". It is the purported effects of ECT on long-term memory that give rise to much of

11220-407: The most excitable patients were sparsely furnished – presumably for their own safety – with sturdy oak furniture. During the time that Greystone was built, the predominant philosophy in psychology was that the mentally ill could be cured or treated, but only if they were in an environment designed to deal with them. A major proponent of this philosophy was Thomas Story Kirkbride , who participated in

11352-477: The new complex. Morris County has installed skating rinks and a ball field on its 300-acre share, and plans to incorporate a dog park where the Curry Complex once stood, as well as an athletic complex for disabled athletes. The Central Avenue Complex is planned to become a mall for nonprofit charitable agencies. The original Second Empire Victorian style building was 673,700 square feet (62,590 m). At

11484-707: The now 550-bed facility closed within the next three years in 2000. Morris County purchased approximately 300 acres (120 ha) of the Greystone Park Psychiatric Center property in 2001 for one dollar, with the stipulation that it would clean up asbestos and other environmental hazards on the site within its decaying buildings. When this land was sold, a law was also passed that Greystone land cannot be used for any purpose other than "recreation and conservation, historic preservation or farmland preservation." This meant no commercial development and no condos or townhomes. The major effort to clean up

11616-530: The patient's capacity for informed consent. ECT can cause a lack of blood flow and oxygen to the heart, heart arrhythmia , and "persistent asystole ". A 2019 systematic review and meta-analysis of 82 studies found that the rate of major adverse cardiac events with ECT was 1 in 39 patients or about 1 in 200 to 500 procedures. The risk of death with ECT however is low. If death does occur, cardiovascular complications are considered as causal in about 30% of individuals. The placement of electrodes, as well as

11748-468: The population began, and there was a shortage of patients capable of work or occupational therapy. Some of this need was filled by working men brought in by the state through the WPA program and other similar programs starting around 1935. The 1970s and 1980s saw a redirection in mental health towards deinstitutionalization . States around the country decided that mental health patients were better off living in

11880-427: The pregnant woman's right hip, external fetal cardiac monitoring, intubation , and avoidance of excessive hyperventilation are recommended. In many instances of active mood disorder during pregnancy, the risks of untreated symptoms may outweigh the risks of ECT. Potential complications of ECT during pregnancy can be minimized by modifications in technique. The use of ECT during pregnancy requires thorough evaluation of

12012-465: The procedure has in modern medicine. By 2017, ECT was routinely covered by insurance companies for providing the "biggest bang for the buck" for otherwise intractable cases of severe mental illness , was receiving favorable media coverage, and was being provided in regional medical centers. Though ECT use declined with the advent of modern antidepressants, there has been a resurgence of ECT with new modern technologies and techniques. Modern shock voltage

12144-495: The procedure is safe and does not cause brain damage. Dr. Charles Kellner, a prominent ECT researcher and former chief editor of the Journal of ECT , stated in a 2007 interview that, "There are a number of well-designed studies that show ECT does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to ECT." Kellner cites

12276-499: The real world. Parts of the hospital are set aside of "War Risk Patients" or veterans from World War I suffering from various mental diseases, including the yet-to-be-named post-traumatic stress disorder (PTSD). The hospital was given with its modern-day name, Greystone Park Psychiatric Center, in 1924. The new reception building, dubbed the Curry Building after Medical Superintendent Marcus Curry, opened in 1928, as well as

12408-429: The response rate in treatment resistant depression vary between 60–80%, with a remission rate of 50–60%. In addition to reducing symptoms of depression and inducing relapse, ECT has also been shown to reduce the risk of suicide, improve functional outcomes and quality of life as well as reduce the risk of re-hospitalization. Efficacy does not depend on depression subtype. With regards to treatment resistant schizophrenia,

12540-408: The response rate is 40–70%. There is little agreement on the most appropriate follow-up to ECT for people with major depressive disorder. The initial course of ECT is then transitioned to maintenance ECT, pharmacotherapy or both. When ECT is stopped abruptly, without a bridge to maintenance ECT or medications (usually antidepressants and Lithium ), it is associated with a relapse rate of 84%. There

12672-415: The results in a fiery report, a Memorial , to the state legislature . "I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth , in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience." Her lobbying resulted in a bill to expand the state's mental hospital in Worcester . During the year 1844 Dix visited all

12804-434: The results of questionnaires about subjective memory loss found that between 29% and 55% of respondents believed they experienced long-lasting or permanent memory changes. In 2000, American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with more persistently impaired memory of public events as compared to right unilateral ECT. However, bilateral ECT may be more efficacious than unilateral in

12936-431: The right parameters needed to have a successful human trial. Once they started trials on patients, they found that after 10–20 treatments the results were significant. Patients had much improved. A positive side effect to the treatment was retrograde amnesia . It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it. ECT soon replaced metrazol therapy all over

13068-399: The risk of relapse, especially in younger patients. ECT is generally a second-line treatment for people with catatonia who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia. There is a plethora of evidence for its efficacy, notwithstanding a lack of randomised controlled trials, such that "the excellent efficacy of ECT in catatonia

13200-484: The site had already begun. Preserve Greystone filed an appeal to halt the demolition which the state court declined to hear. Despite considerable public opposition and open protest and media attention, the main Kirkbride building was demolished in a process that began in April 2015 and was completed by October 2015. However, some items of the stunning architectural details (manifesting unique Victorian motifs) and other items with symbolic and historic value were rescued from

13332-661: The states to build and maintain asylums. Dix's land bill passed both houses of the United States Congress ; but in 1854, President Franklin Pierce vetoed it, arguing that social welfare was the responsibility of the states . Stung by the defeat of her land bill, in 1854 and 1855 Dix traveled to England and Europe. She reconnected with the Rathbone family and, encouraged by British politicians who wished to increase Whitehall's reach into Scotland, conducted investigations of Scotland 's madhouses. This work resulted in

13464-589: The study submitted focused too much on the Kirkbride building, and that they wanted to see the entire hospital system submitted as a National Historic District. However, one student did manage to get the gas house placed on the Register. Greystone had dark years in the 1990s. Patient escapes became commonplace, including some that involved criminals and sex offenders. Staff were accused of abuse and rape, and some female residents became pregnant. Buildings were falling apart and lacking in basic creature comforts. Greystone

13596-411: The tarnished image given it by Ken Kesey 's novel: dangerous, inhumane and overused". In 1976, Dr. Blatchley demonstrated the effectiveness of his constant current, brief pulse device ECT. This device eventually largely replaced earlier devices because of the reduction in cognitive side effects, although as of 2012 some ECT clinics still were using sine-wave devices. The 1970s saw the publication of

13728-619: The temples. Uncommonly bifrontal placement is used; this involves positioning the electrodes on the patient's forehead, roughly above each eye. Unilateral ECT is thought to cause fewer cognitive effects than bilateral treatment, but is less effective unless administered at higher doses. Most patients in the US and almost all in the UK receive bilateral ECT. The electrodes deliver an electrical stimulus. The stimulus levels recommended for ECT are in excess of an individual's seizure threshold: about one and

13860-406: The therapeutic role of ECT in certain circumstances. The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented. Finally, in 2001 the American Psychiatric Association released its latest task force report. This report emphasizes the importance of informed consent , and the expanded role that

13992-456: The three fires, on November 26, 1931, was ruled to have originated from faulty electrical wiring on the sixth floor of the center section. Some patients were tied to trees with fireman's ropes to prevent escape after evacuation. The fourth floor north wards were destroyed as well as the central tower. Once rebuilt, the fourth floor in the north wards never matched the rest of the hospital in construction and style again. The state of New Jersey opened

14124-578: The treatment of schizophrenia , but in North America and Western Europe it is invariably used only in treatment resistant schizophrenia when symptoms show little response to antipsychotics ; there is comprehensive research evidence for such practice. It is useful in the case of severe exacerbations of catatonic schizophrenia , whether excited or stuporous. There are also case reports of ECT improving persistent psychotic symptoms associated with stimulant-induced psychosis . Aside from effects in

14256-727: The treatment of mood disorders. ECT has not been found to increase the risk of dementia nor cause structural brain damage. Considerable controversy exists over the effects of ECT on brain tissue, although a number of mental health associations—including the APA—have concluded that there is no evidence that ECT causes structural brain damage. A 1999 report by the US Surgeon General states: "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals." Many expert proponents of ECT maintain that

14388-581: The treatment). Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with outdated sine-wave rather than brief-pulse currents. The use of either constant or pulsing electrical impulses also varied the memory loss results in patients. Patients who received pulsing electrical impulses, as opposed to a steady flow, seemed to incur less memory loss. The vast majority of modern treatment uses brief pulse currents. A greater number of treatments and higher electrical charges (stimulus charges) have also been associated with

14520-581: The two Italian inventors had competitive tensions that damaged their relationship. In the 1960s, despite a climate of condemnation, the original Cerletti-Bini ECT apparatus prototype was contended by scientific museums between Italy and the US. The ECT apparatus prototype is now owned and displayed by the Sapienza Museum of the History of Medicine in Rome. In the early 1940s, in an attempt to reduce

14652-464: The world because it was cheaper, less frightening and more convenient. Cerletti and Bini were nominated for a Nobel Prize but did not receive one. By 1940, the procedure was introduced to both England and the US. In Germany and Austria, it was promoted by Friedrich Meggendorfer . Through the 1940s and 1950s, the use of ECT became widespread. At the time the ECT device was patented and commercialized abroad,

14784-403: Was a German immigrant who moved to New Jersey before WW1. He was the landscaper and won international acclaim for his florist work. In his honor, the avenue was named after him. In 1997, the original tuberculosis pavilion was demolished, along with the morgue, a large garage, the print and tailor shops, and several employee dormitories and cottages. A new era for Greystone had begun, and the state

14916-464: Was a widely popular belief that putting the insane to work in certain circumstances was beneficial both to the patient and the institution. Those who were chronically ill, restless in the day and night, were thought to be aided in their general well-being by working out some of the oversupply of blood to the brain. Within the walls of the new building, male patients were able to make brooms, rugs, brushes, carpets, and do printing and bookmaking . By 1895,

15048-538: Was an American advocate on behalf of the indigent mentally ill who, through a vigorous and sustained program of lobbying state legislatures and the United States Congress , created the first generation of American mental asylums . During the Civil War , she served as a Superintendent of Army Nurses. Born in the town of Hampden, Maine , she grew up in Worcester, Massachusetts , among her parents' relatives. She

15180-513: Was being eclipsed by other prominent women such as Dr. Mary Edwards Walker and Clara Barton . She resigned in August 1865 and later considered this "episode" in her career a failure. Although hundreds of Catholic nuns successfully served as nurses, Dix distrusted them; her anti-Catholicism undermined her ability to work with Catholic nurses, lay or religious. Her even-handed caring for Union and Confederate wounded alike assured her memory in

15312-464: Was built, all 673,700 square feet (62,590 m) of it, in part to relieve the only – and severely overcrowded – "lunatic asylum" in the state, which was located in Trenton, New Jersey. Because of her efforts, the New Jersey Legislature appropriated $ 2.5 million to obtain about 743 acres (301 ha) of land for New Jersey's second "lunatic asylum". Great care was taken to select a location central to

15444-417: Was completed and quickly filled, slightly easing crowding issues. Patients were once again able to be grouped according to disease classification and had access to exercise and activity rooms again. The new dormitory building would gain infirmaries and operating rooms in the coming years, as well as a bowling alley which was extremely popular among patients and staff during the winter months when outdoor exercise

15576-464: Was designed to the specifications of the Kirkbride Plan . The main building has a center section that was used for administrative purposes with three wings radiating out from the center, each about 140 feet (43 m) long. They were set back from the previous one so that patients could enjoy the beauty of the outside surroundings. This was a central concept, along with moral treatment, that was

15708-566: Was documented eleven years later. Benjamin Franklin wrote that an electrostatic machine cured "a woman of hysterical fits." By 1801, James Lind as well as Giovanni Aldini had used galvanism to treat patients with various mental disorders. G.B.C. Duchenne, the mid-19th century "Father of Electrotherapy", said its use was integral to a neurological practice. In the second half of the 19th century, such efforts were frequent enough in British asylums as to make it notable. Convulsive therapy

15840-684: Was during her time at the East Cambridge prison, that she visited the basement where she encountered four mentally ill individuals, whose cells were "dark and bare and the air was stagnant and foul". She also saw how such individuals were labeled as "looney paupers" and were being locked up along with violently deranged criminals and received treatment that was inhumane. In most cases, towns contracted with local individuals to care for mentally ill people who could not care for themselves and lacked family/friends to do so. Unregulated and underfunded, this system resulted in widespread abuse. Dix published

15972-569: Was finished and occupied the following year, as well as a new larger fire department house, and enlargements to the greenhouse and piggery. In 1916, women began participating in sewing and arts and crafts on the top floor of the Industrial Building, and a small patient library was founded with 184 volumes of books. Annexes to the Dormitory building opened in 1817 to provide more space for housing. The next few years saw much progress in

16104-504: Was in danger of losing its accreditation from the Joint Commission on Accreditation of Healthcare Organizations . If this had happened, the hospital would have lost approximately $ 35 million annually from Medicaid and Medicare. A Senate task force was appointed to conduct a six-month probe on how to improve conditions, and the hospital was able to pass. The hospital is located on "Koch Avenue", named for Otto Adolf Koch. Otto Koch

16236-472: Was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures first with camphor and then metrazol (cardiazol). Meduna is thought to be the father of convulsive therapy. In 1937, the first international meeting on schizophrenia and convulsive therapy was held in Switzerland by

16368-408: Was not an option. By 1903, the hospital had crossed over the 1,500-patient mark, continuing its steady climb. Once again, the numbers were an issue. A state-of-the-art electroconvulsive therapy room was installed in the main building, and the women's wing of the dormitory received a hydrotherapy room. Medical Director Britton D. Evans described this new treatment in his report in 1961, writing, "It

16500-432: Was opened the following year. By 1911, the newly renamed State Asylum at Morris Plains held 2,672 patients, and cots were once again placed in corridors and activity rooms. A photographic department was established and began documenting patients in hopes of cataloging facial expressions and characteristics which go with certain mental disorders. A dental clinic opened for treatment of teeth ailments. A tuberculosis pavilion

16632-506: Was passed for the establishment of a state facility. Dix traveled from New Hampshire to Louisiana , documenting the condition of the poor mentally ill, making reports to state legislatures , and working with committees to draft the enabling legislation and appropriations bills needed. In 1846, Dix traveled to Illinois to study mental illness. While there, she fell ill and spent the winter in Springfield recovering. She submitted

16764-491: Was realizing it did not include many of its decaying antiquated buildings. The State of New Jersey released a report in 1999 stating the behemoth Kirkbride building was "not suitable for long-term future use." The report went on to say that a new smaller building should be built and the hospital consolidated under this structure, and that while older structures should be razed, the main building should be saved due to historical significance. Governor Christine Todd Whitman ordered

16896-452: Was reprinted 60 times and written in the style of a conversation between mother and daughter. Her book The Garland of Flora (1829) was, along with Elizabeth Wirt 's Flora's Dictionary , one of the first two dictionaries of flowers published in the United States. Other books of Dix's include Private Hours, Alice and Ruth, and Prisons and Prison Discipline. Although raised Catholic and later directed to Congregationalism , Dix became

17028-534: Was required of the institution. Twenty "independent living" cottages opened in 1982 and by 1988 all patients had been moved out of living in the main Kirkbride building, and the wings were basically abandoned. Now only the center section was used for administrative purposes. Students of Drew University led an effort to try to get Greystone Park Psychiatric Center listed on the National Register of Historic Places, but were turned down. The Register claimed that

17160-655: Was the first child of three born to Joseph Dix and Mary Bigelow, who had deep ancestral roots in Massachusetts Bay Colony . Her mother suffered from poor health, thus she wasn't able to provide consistent support to her children. Her father was an itinerant bookseller and Methodist preacher. At the age of twelve, she and her two brothers were sent to their wealthy grandmother, Dorothea Lynde (married to Dr. Elijah Dix) in Boston to get away from her alcoholic parents and abusive father. She began to teach in

17292-434: Was to provide moral treatment for the mentally ill, which consisted of three values: modesty, chastity, and delicacy. She gave as an example a man formerly respected as a legislator and jurist , who, suffering from mental decline, fell into hard times in old age. Dix discovered him lying on a small bed in a basement room of the county almshouse, bereft of even necessary comforts. She wrote: "This feeble and depressed old man,

17424-416: Was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants. The steady growth of antidepressant use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 1950s to the 1970s. The Surgeon General stated there were problems with electroshock therapy in

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