I see a bit of ECT. I have seen it at its worst (almost used punitively in cases where the research for its efficacy seems tenuous at best) and I have also seen it at its best, especially with geriatric depressions and major depressive disorder with psychotic features. I used to think of it as barbarous before I saw it done and held a patient's hand before they went under anesthesia. Seeing their progress over the course of their treatment made me a believer, so long as the evidence supports its use. I have also seen it seriously mess people up in terms of exacerbating or creating memory issues or throwing people into cardiac or respiratory issues.
I HATE putting people in locked seclusion. I HATE IM "chemical restraints". I HATE having to restrain people in four-point restraints. And I do it all the time, because as much as I hate those things I also care about their safety, the safety of my coworkers and the safety of other patients has to come first. There are certainly situations wherein a patient cannot be controlled, placated or cowed by therapeutic rapport, verbal de-escalation techniques, or simple avoidance. Anybody who believes otherwise has never worked with an acute psychiatric population. I would strongly encourage those people (I believe everybody should be a server and work on an acute or gero psych unit once in their life for humility's sake) to give it a shot for a few months.
I've seen lobotomies too, they don't do them for psych anymore but for seizure disorders...trust me, for some people what you may consider the most invasive and off-putting measures may be all they can do in hopes of something resembling an acceptable quality of life for themselves.
I would agree with the previous poster...I would much prefer an ECT trial over medications with the types of long term side-effects psych meds give. Sedatives...not so much. I have seen many, many patients act out in HOPES and straight-up demand or request benzos...that's a problem in of itself. EPS, Tardive, weight gain...no thank you. Still...all of those things may trump command hallucinations or a crushing and debilitating depression. I have no frame of reference and god-willing never will.
