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When psychotherapy fails, often times other medically oriented measures are needed to address the mental problems of those suffering with more severe disorders. These types of therapies are known as somatic therapy and include a number of different approaches including pharmacotherapy, psychosurgery, and electroconvulsive therapy. Almost all the time these therapeutic measures are administered in a psychiatric hospital as opposed to the offices of psychologists.

One of the most controversial methods of somatic therapy is electroconvulsive therapy (ECT). In this form of treatment, a 150 volt electrical current is passed through the brain for a little less than one-second at a time. This is mostly used to treat patients suffering with major forms of depression for which psychotherapy alone proves ineffective in curing. The current triggers a convulsion and causes the patient to lose consciousness for a short period of time. Muscle-relaxers and sedatives are give to the patient to soften the physical effects of the electrical current. Typically, treatment is dealt in a series of six to eight sessions over a span of three to four weeks.

It's not the shock itself that does anything, but rather the seizure that follows that is alleged to provide relief. The shock induced seizures alter the biochemical and hormonal balance in the brain and body, bringing an end to severe depression and potentially suicidal behavior. This has led to much skepticism amongst mental health professionals though. Some contend that ECT doesn't really have any positive effects, but rather confuses the patients so they have trouble remembering why they were depressed to begin with.

Thus, over the years debates have ensued about the empirical evidence in support of ECT. Many professionals consider it distasteful, unprofessional, or even downright harmful to the patients. However, even amongst proponents, the limitations of ECT are agreed upon. First, it produces only temporary relief for patients suffering from acute episodes of depression. It's never proposed as an overall cure for major depressive episodes. Secondly, ECT alone cannot be said to relieve patients of their depression without a combination of other treatments, such as psychotherapy. It has also been confirmed that the shock induced seizures cause permanent memory loss in many patients. ECT should only be considered as a last resort after pharmacotherapy has failed. Thus, professionals have concluded that for immediate treatment for severe depression, ECT should be recommended for ending rapid or imminent self-destructive behavior.

However, there still remains some serious ethical questions that remain surrounding the use of ECT. The ones I would like to focus on here have more to do with the ethical issue of informed consent, rather than the efficacy or empirical evidence in support of electroconvulsive therapy.

Unlike traditional forms of medical informed consent, the issue at stake with ECT is that patients come with a mind-set altered by some severe form of mental disorder, namely depression. Often times this makes obtaining true informed consent a difficult task. Ensuring that the patient is aware that ECT treatment has its limitations, what to expect, and all the associated harms/benefits falls upon the responsibility of the doctor involved. Questions have been raised surrounding the capacity for which those suffering from extreme mood disorders or psychosis can possibly give their consent to undergo treatment.

Obtaining informed consent is a staple of the medical profession, and involves many sensitive issues. Often times, patients come to sessions with unrealistic or irrational expectations because they've tried everything else and they are looking for any means of relief. This may obscure the reality of what they're facing and how they are perceiving the potential harms/benefits of any possible ECT treatment. Much of the debate has focused on whether or not patients fully understand the actual expected relief offered by ECT.

Concerns regarding informed consent ultimately break down to questions of autonomy. Is the patient consenting to electroconvulsive therapy making an autonomous decision? Even more, what is really meant by autonomy? In order for someone to make an autonomous decision of their own accord, they must satisfy certain requirements that any rational person could be expected to make similar decisions if found in the same situation. However, are those suffering from severe depressive mood disorders truly autonomous? The answer to this question continues to be at the center of the debate regarding autonomous decision making and ECT.

More factors may be involved with gaining informed consent, which are not strictly limited to ECT. As in any patient/doctor relationship, the power is centralized in the hands of the doctor or medical professional. Since most patients seeking treatment know little regarding how the brain functions, how treatment is expected to relieve them, and the bio-neurological effects occurring during treatment – they enter the patient-doctor relationship in a submissive role. The disproportional amount of power in the hands of the doctor leaves many concerned that uninformed patients might easily be convinced to consent to something they fundamentally know nothing about. With the contested efficacy and ethical standing of ETC, this remains a heavily debated topic in ECT.

Another major concern surrounding ECT is the principle of doctors from refraining from committing any harm unto the patient. Considering how ECT works through shock-induced seizures which may have serious consequences on the patient, the question has been asked whether or not this is considered harmful and in violation of the ethical standards for which members of the medical profession are supposed to act upon? Furthermore, the situation is made even more complicated by the fact that shock-induced seizures are not necessarily life saving, nor is the evidence that they reduce the number of suicides above scrutiny. In fact, some researchers and medical professionals say that ECT may cause more suicide attempts than it prevents.

In conclusion ECT continues to remain a hotly debated issue in the mental health community as well as those specifically focused on medical ethics in general. Many have contested not only its efficacy, but the remote possibility that any truthful and valid consent could ever be obtained for a therapeutic measure that could possibly result in far worse consequences than that for which it is supposed to relieve. Further, many doctors and medical ethicists believe that succumbing to ECT is in fact a medical harm and a violation of the ethical principles for which doctors have been subscribing to for centuries. Finally, they contest that no treatment that isn't a life-saving measure can possibly be justified when it involves the potential for harm (seizures) like that of electroconvulsive therapy.

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Actress Brittany Murphy died today, December 20, 2009 at the age of thirty-two. This was confirmed by the Los Angeles County Coroners Office to Access Hollywood. The Los Angeles Fire Department responded to a 911 call made from the home of the actress at 8:00 AM this morning and she died at Cedars-Sinai at 10:04 AM.

A mini biography
Perhaps it was being born in Atlanta, Georgia and raised in Edison, New Jersey that bestowed Brittany Murphy with the adaptability that has allowed her to conquer a fairly prodigious amount of projects for her short years. Brittany first honed her acting skills in regional theater at the age of 9. By age 13, she had signed on with a manager and began appearing in television commercials. In 1991, at the age of 13, Brittany and her mother moved to Burbank, California, where she landed her first television role on the show “Blossom” (1991). This lead to a starring role on “Drexell's Class” (1991), a series that proved to be short lived. Brittany's major breakthrough film appearance was in Clueless (1995), the Emma meets “Beverly Hills, 90210″ (1990) comedy, in which she starred opposite of Alicia Silverstone. She has gone on to demonstrate her versatility and talent for not only comedy but drama; Brittany was nominated for best leading female performance in the Young Artist Awards for her role in the television film David and Lisa (1998) (TV). Aside from the 25 screen appearances since her Clueless (1995) breakthrough, Brittany has lean her vocal talents, established in the early 1990s as a lead singer of her band “Blessed Soul”, to the cartoon “King of the Hill” (1997) as the voice of Luanne.

She married screenwriter Simon Monjack in a private Jewish ceremony in May of 2007 and when asked recently she admitted to wanting to have a child in 2010.

Autopsy will be performed tomorrow.

Sources:
http://omg.yahoo.com/news/coroner-brittany-murphy-dead-at-32/32963?nc

huffingtonpost.com

http://www.imdb.com/name/nm0005261/bio

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The best thing you can do to start gathering a following and getting yourself seen, is to begin gigging as soon as your band feels comfortable about the act. Gigs range from bar and nightclub gigs, to even more lucrative moneymakers such as weddings and private parties. Although DJ's have become quite the rage, many functions would still prefer live music. There are also touring gigs and the question of booking your own gigs or hiring a booking agent. Other topics to consider are decisions on equipment, costumery, etc. We will touch on all of these topics in this article.

Before even looking for a gig, you'll need a submission package. Packages should contain a cover page, a page bio, at least one page of press clippings, a business card, photo, and demo. Video tapes can be an optional extra. Your cover letter should be short and to the point, stating who you are, a few accomplishments, and why your band/performer would be good at that particular venue. Bio should be self-explanatory, just keep it to one page and be honest and don't exaggerate. Clippings should be a couple of lines of brief description from each article including the by-line and the name of the publication that it came from. Business cards should be hard stock and have a logo if possible which you should also use on your letter head paper and envelope. Photo should be taken professionally and should have all contact information printed at the bottom. A video would give the owner of a venue a great idea of how you are as a performer, so I encourage you to make one. Demos can be done in several ways, all acceptable to bar/club owners, the most obvious is going into a recording studio and producing a demo. You don't have to spend a lot of money, there are studios that range from 20 to 80 dollars per hour that are just as qualified as the $150 plus range studios.

Next it is time to do the foot work. You will want to start a log including the names and contact information of local bar/club owners. If you have friends in the business, ask them if they can tell you what certain clubs pay, as this would be very helpful information when it comes to setting a price for your fee. Some clubs have a standard rate which they pay all performers, but some still ask what you would charge and deal with you accordingly from there. You don't want to sell yourself short, nor do you want to shock them with extremely high rates. Call the club before you send or deliver a copy of your demo and ask for permission, this also allows you to make a pre connection with the club. Keep a record of who you spoke to each time you called in the log you have created. If you do go in person, try to get the contact person to watch your video or listen to your CD while you are still there, but don't be pushy. Once they have your demo pack, keep following up on calls (without being a pain) until you get results. Some of the things you might watch out for are club owners who may ask you to perform live before hiring you. You may want to invite them to other gigs you have scheduled. If by chance you have no scheduled gigs anytime soon then you may want to set up a freebie gig somewhere.

WARNING: This is the only time that you should ever play for free, unless you do something that benefits a charity. Beware of anyone who claims they will hire you if you perform for free or anyone that offers to “allow” you to play for free for exposure. Although playing for the door can sometimes be to your benefit, be very cautious about accepting door gigs. Playing for the door does not guarantee any money, except a percentage of what's made at the door, which is usually minus what the club decides it needs to pull off the top, usually including taxes, publicity and promotional costs, production costs, and any other surcharge that they may decide is feasible. Other problems that may arise can be getting shorted by the club or not drawing enough people to make it all worth your while. Some clubs have an audition night. If you take advantage of situations such as these, make sure you invite as many friends and family the night of the audition to insure your acceptance. The same method goes for any public establishment that you are allowed to invite your friends and family. One big piece of advice concerning
guest lists is to make sure your guest list does not exceed the money you make, you do not want to get caught forking out something such as mandatory production costs, or exuberant bar tabs from your own pocket, or worse, not have enough money to stand up to your end of the agreement. You should keep your guest lists tapered to about 1 or 2 guests per member. Most of your friends, and even family members understand this etiquette, and you can always make it up to them at another gig.

College gigs are usually handled in the same manner as clubs and bars. You can contact the college and find out who handles bookings for such events. Also try on campus venues like coffeehouses and pubs, and even fraternities and sororities, as each has an entertainment chairperson who handles bookings. You may also want to consider hotels that have occasional dinner/dance where local band/performers are needed. Just beware of what is called a “continuous engagement”, which means the band never stops playing. Since these gigs can last four hours, band members will have to take turns breaking, which WILL require a lot of planning.

Touring is a whole other story. Booking agents are generally not a good idea for local gigs, but they are a necessity for tour gigs. They typically take 15% of your earnings, but some independent agents may take less, depending on the gig. I personally have always been flexible working with local bands, but may earn a slightly higher percentage when it is a guaranteed good money gig. Your act should be polished and you should have been playing local gigs for quite some time before you consider touring. Make sure that the agency that you decide to go with is legitimate, there are sharks everywhere. You can check with former clients and the Better Business Bureau to see if any complaints have been lodged against them. Be wary of “exclusive” contracts. You should always be guaranteed a certain amount of work, and have an escape clause in the contract in case the agency doesn't live up to its promises. Always have a good entertainment attorney look over any contract before signing. Don't go with any attorney that is suggested by the agent.

If you are planning on setting up touring gigs yourself, you have your work cut out for you. It's handled in the same manner as local gigs, but you have to call long distance. Send out your promo package first, then follow up with calls to the venue. This can be very difficult for an individual without the connections that a booking agent has. You, unlike a booking agency, probably have no idea what clubs are where. You run the risk of setting up gigs in dives or in horrible neighborhoods. Hotel gigs are a little easier. If you stay with the bigger name hotels, your lodging is usually free. This brings us to another problem with club gigs: lodging. Some clubs include lodging, others don't. You have to be careful with club funded lodging as they often go with the cheapest flea bag hotel in town. And when clubs don't supply lodging, you need to be sure that the payment for the gig will be enough to lodge you in that area and still make a profit. It's very difficult to know the good clubs in areas that you have never been before, which is a main reason why we suggest a booking agent for tours. A reputable agency will take good care of you. One word of caution, make your first tour a short one, just in case you decide that touring is not for you. You can always extend it if you decide that you like it. Whether you are touring or performing locally, you'll need a lot of gear. You probably already have your instruments, and some other equipment already. You need good professional microphones, and they can be very expensive. Make sure that you have sufficient capital for this financial undertaking. If not already provided by some venues, then you will need a good PA system that includes speakers and a mixing board and separate monitor speakers and mixing board if your budget allows. A solo act may need drum machines, synthesizers, and sequencers. Your attire could also end up costing you some bucks. If you are playing a wedding, you'll want to wear a tux or formal wear; and a hotel or private party may want you to dress up a little or wear costumes. If you're playing an event with a theme, it is probably a good idea to go along with the theme. Always make sure you know what the dress code is, don't be afraid to ask, the owner will appreciate your concern.

Now that you know how to get gigs, let's talk about gig etiquette. You'll always want to be early, no matter where you're playing. This allows for traffic and gives you time to set up equipment. If you don't know where a gig is, ask for directions from the club/bar owner/party host and write them down. Pass out flyers at casual gigs (with the owners permission), and have business cards on hand at all gigs for those who inquire about your availability. Have a guest book so that people can sign up on your mailing list. When you have begun to develop a following, alternate your material so that they don't get bored with the same old set. Treat the servers and the bartenders nicely, you should tip them even though you are an employee. They may persuade the owner to hire you again. Assuming you are of legal age to drink, DO NOT GET DRUNK. There is nothing more pathetic than a drunk sloshing around on stage. Talk to the audience, you need to have a good personality to pull gigs off. Always have a songlist and setlist. The songlist is for songs requested by the audience, the setlist is for your prepared material. Make sure to have extras of the essentials, like guitar strings, drum heads & sticks, guitar picks, etc… Do your sound check early, when the least amount of people are present, and make sure that your levels are set before you begin playing. And finally, you can never be too eager. Check with club and bar owners about being the opening act for nationally known performers that are playing there in the future.

GOOD LUCK – BE CAREFUL.

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