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To the Editor.—
Dr Fink and Ms Johnson (Archives 1982;39:1189-1191) have performed a significant service by researching variations in electroconvulsive therapy (ECT) that can lead to a diminished impression of its effectiveness as a therapeutic modality. Since medical practice and credibility in this field are under continuing attack by persons with both political and media access, it is important that practitioners be fully knowledgeable and maximally effective therapeutically to counter this criticism.Confusion of a nonseizure treatment with a true modified ECT seizure was a serious reported deficiency. The dosage of barbiturate commonly used does not assure patient amnesia for the event in the absence of a seizure so that an iatrogenic patient management problem may well arise. Also, a series of such nontreatments can be expected to produce minimal or no improvement, thus providing additional ammunition for critics of this therapy.In my institution's practice for the past four