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the reason I'm speaking about ECT today is really quite simple quite apart from the fact that I'm one of the practitioners of ECT here at CAMH yesterday marked the 80th anniversary exactly to the day of the world's first ECT treatment and accordingly I thought it was appropriate that we devote some time at Grand Rounds to this this is actually my eleventh Grand Rounds at CAMH and its predecessors since 1986 when I did my first one at the former addiction Research Foundation and it seems like about every three years since I'm taken out of the VAT of formaldehyde in which I otherwise sleep and brought in to give Grand Rounds the last time Benoit asked me to give Grand Rounds it was on Shakespeare creativity and madness and the audience response was such that they said please bring this guy back in several years so I'm here today now as you know at all academic Grand Rounds we have disclosure statements mine is that I have no funding ever from the manufacturers of ECT devices no funding of any kind from the pharmaceutical industry for more than a quarter century but like any physician in Ontario I do receive OHIP remuneration for administering ECT and I get royalties from my book that has a long chapter about giving ECT and I also have disclaimers and for those of you are unsure about the difference between a disclosure and a disclosure is about conflict of interest a disclaimer is why you shouldn't even to this talk in the first place so my disclaimer is that I'm not a professional historian unlike people like Ned shorter who's written probably the definitive history of ECT but I am a practitioner of ECT regularly for the last thirty years and I'm a believer in knowledge of history making us better clinicians so let me ask you some questions about Ivan Silver's not here because Ivan loves audience participation at all these Grand Rounds so in Ivan's honor I'm going to ask you a couple of questions how many of you here just for the show of hands recall the first patient you saw undergo a course of ECT so the majority of people and in my experience it's actually quite a clinically memorable encounter for physicians and other health professionals in training how many of you have referred a patient for ECT in the last year hands up okay it's a slightly smaller number how many of you have administered ECT in the last year even smaller how many of you assess and treat patients with moderate to severe depression a much larger number how many of you would want ECT for someone with moderate to severe depression in your own family okay what about in yourself okay thank you I make this point just to set a little context for what is about to follow and what is about to follow is some history that most people in the...