Shocking the Homeland

David Healy, M.D.

May 11, 2012

The thriller Homeland reached its denouement in the UK at the weekend – in an Electroconvulsive Therapy (ECT) scene. Claire Danes, a Homeland security agent supposedly taking Clozapine to contain her paranoia has to distinguish reality from psychosis to save the United States (see Homeland Security). Quite obviously to anyone who knows anything about Clozapine, she was not taking it. She is having ECT, which you are expected to think will wipe her memory, when she solves the plot. Quite obviously to anyone who knows anything about ECT, this is not a reliable way to wipe her memory – giving a benzodiazepine at the key moments would have been much more reliable.

Homeland adds to a growing list of psychiatric treatments featured as characters in plots. While inaccurate it does not portray ECT as horrifically as Clint Eastwood’s The Changeling, which starts with a clip saying it is a true story – not just based on a true story. The Changeling portrays the horrors of psychiatry as they have been since One Flew over the Cuckoo’s Nest – through involuntary ECT – even though the heroine’s incarceration happened 10 years before ECT was invented.

The only explanation for getting the history so wrong in a “true” story is that ECT inflicted in this way clearly epitomizes fears about psychiatry. But forced treatment with ECT is vanishingly rare. In practice insiders, staff and patients, are more likely to fear forcible and indefinite medication with long-acting antipsychotic injections – a treatment that is more clearly brain damaging, memory disturbing and likely to turn a person into a zombie than ECT.

In terms of the greatest amount of damage done to the greatest number of people, the real abuses, the real dramas, lie in primary care treatment with prescription only drugs like the antidepressants, statins, asthma inhalers and other drugs. Where ECT given punitively, as has happened in the past, might be compared to rape, something closer to sexual abuse or sexual harassment happens with prescription drugs (see Pharmacological Abuse).

The psychiatric detention or treatment papers aren’t in evidence when we are prescribed a prescription drug. We are free to walk out the door after a consultation, and we think as a consequence that there is nothing to worry about.

But prescription links us inescapably to a prescriber. For most of us, going to the doctor is like going to the bank manager or the head teacher – we feel a few inches tall, absurdly grateful for the smallest signs of favor, and often completely forget what we had meant to say. If things begin to go wrong after treatment starts, the doctor may quickly seem like our only way out. We become ever more dependent on him, and grateful.

We head into a medical version of Stockholm syndrome – the puzzling state where hostages are often close to being in love with those who have taken them hostage. If the difficulties we develop are caused by the treatment and the doctor doesn’t recognise that what he is doing is wrong for us, we become hostages to fate.

It can be extraordinarily difficult to distinguish between the anxieties, insomnias, and morbid thoughts that treatments can cause even in healthy volunteers and the anxieties, insomnias and morbid thoughts stemming from the problem we took to the doctor in the first instance. It is effortless for the doctor to blame any worsening on our original problem, rather than his treatment. With much less going for them, surgeons blamed the victim faced with the evidence of memory problems after cardiac surgery, and psychiatrists routinely blame patients hooked on antidepressants or tranquilizers or who get diabetes from antipsychotics.

We can become isolated astonishingly quickly. If we approach someone for help in the case of an antidepressant, we have to risk the stigma of being seen to have a mental problem and then also risk being stigmatised as a loser. We risk incomprehension – even if we approach mental health professionals, none of whom are likely to side with us rather than the doctor. We risk having our next prescription increased to treat our illogical thinking. No one will call this a reprisal. If for some reason, we are listened to and treatment stops and we get worse, no-one is likely to counsel patience to help see us through what might well be a withdrawal syndrome.

Our questions will be put in the weighing scales against the scientific answers and found wanting. There is no-one on our side who is likely to point out that the so-called scientific evidence has been carefully constructed by companies, who suppress trials that don’t suit their interests, and who selectively publish data from trials so that even a trial that has shown a drug fails to work and can trigger suicide can be transformed into a trial that shows unparalleled evidence of efficacy. No one to point out that pretty well all the trials published in even the best journals are likely to be ghostwritten. No-one to point out that lawyers and others looking after the interests of pharmaceutical companies regularly take advantage of medical innumeracy to hide even more dead bodies by constructing trials so the results will not be statistically significant.

As in other areas of abuse, if we wait for the abusers to recognise the problem we are likely to wait for ever. As in so many other areas from Enron to sexual abuse, it is likely to be women who will blow the whistle.

Rebekah Beddoe’s 2007 book Dying for a Cure does this. Following a post-partum depression, Beddoe outlines a drama of seduction, increasing personal confusion, family bewilderment and finally survival against the odds.

Dying for a Cure calls out for a movie to be made of it – but we are likely to be waiting a long time for Clint Eastwood or a future episode of Homeland to take on this challenge. What stops them? In contrast to The Changeling, the problems found in Dying for a Cure are ones in which we are all complicit.

If directors are not prepared to take on the challenge, as a matter of honor they should desist from making movies like The Changeling, which by picking out the wrong villain play a part in perpetuating the kinds of abuse that makes medicine induced death possibly the leading cause of death in the Western world today.

Readers can also view my blog posts (Shocking the Homeland) and find further information at www.davidhealy.org or visit my Facebook page.

David Healy, M.D.

David is a founder of RxISK.org, whose mission is to capture the data that is missing from anyone taking treatments in order to help make medicine safer for all of us.

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19 thoughts on “Shocking the Homeland

  1. Spot on again. Reflects perfectly my experience with the mental health services and doctors in general. Most of them, as well as a lot of their “patients”, live in cloud-cuckoo-land. Not to mention the press and film industry. Then their is the governement as well who thinks it owns you: body and soul.

  2. Dr. Healey,

    You write “But forced treatment with ECT is vanishingly rare. In practice insiders, staff and patients, are more likely to fear forcible and indefinite medication with long-acting antipsychotic injections – a treatment that is more clearly brain damaging, memory disturbing and likely to turn a person into a zombie than ECT.”

    I know you are a proponent of ECT, but like everyhing else to do with psychiatry, there may be more going on with ECT than pointing to Hollywood caricatures of forced treatment to show people how naive we are. You say it isn’t forced, but what if, like meds, there is not full disclosure when ECT is being urged as a treatment? Certainly, my experience at CAMH in Toronto, hints at this. My son was admitted to the hospital at the age of 19, put on Respirdal, and a mere month later the doctors are telling us his parents, that if he doesn’t snap out of this soon, they are going to administer ECT. My son and my husband and I were treatment naive – what did we know about the drugs let alone any controversies (which you refute) concerning ECT. One might say we were being taken advantage of for the benefits of a teaching hospital. Naive parents will sign anything, won’t they, when the doctors are fear mongering (to quote another of your posts)? There are enough people who claim that their memories have been wiped out to some extent or another that their claims should be taken seriously, and brought up in the course of any suggestion of electroshock treatment. I also was under the impression that ECT is given as a last resort after continuous and severe depression. In my opinion, the doctors did not try a first resort (no drug empathy) and someone of 19 years of age has not had a history of continuous and severe depression, but had situational depression, should not have been considered a candidate for electroshock, no matter how innocuous you claim it is.

      • My parents were told that without ECT, there was nothing that could “help” me. As a fearful and paranoid teenager, the other option was to release me where the (imaginary) enemies would kill me.

        Yes, they used my own paranoid delusions to coerce me.
        They also said it would erase bad memories.
        I was terrified with every one of them, or should I say terrorized?

        Keeping journals, writing and receiving letters helped me piece everything together later.

        I really think if a doctor believes ECT is harmless, go ahead and have a round, then come back and we’ll talk.

  3. Healy likes to paint Electroshock as harmless and likes to say it is ‘rare’ the it is forced on people. Whatever. The truth is it remains legal around the world in most places for it be forced on people.

    I liked Changeling. I like all movies that show psychiatry’s brutality for what it is.

    Read what Peter Breggin had to say earlier this year when he warned us about Healy.

    http://www.huffingtonpost.com/dr-peter-breggin/electroshock-treatment_b_1273359.html

  4. People are not given true informed consent when it comes to ect. And they may not tie you up and drag you down to the ect machine screaming and kicking, but the coercion is force. Don’t try to minimize the damage done by thie so-called treatment. My grandmother was forced into numberous episodes of having her brain fried, during the time when they did it the old fashioned way, without the muscle relaxant where your body convulses and twists and you can end up with broken bones. They told my grandfather that they would never let her out of the state hospital if he didn’t agree to this “treatment.” This is no treatment and it’s as barbaric as the good old frontal lobotomy! Methinks I see a Trojan Horse!

    • I haven’t heard about forced ECT here in Britain. It might exist, I don’t know. Plenty of it in the US, I read on the Internet. Forced medication is very much in vogue though and the psychiatrists act all surprised because patients die 25 years earlier than expected and blame it on patients’ life-style.

      • ECT happens in the UK, the government does not collect the numbers for some reason. It is several thousand a year (my memory says the guess is somewhat less than 10 000 but more than 5000 – but I am trying to remember someone’s guess from inaccurate figures).

        I don’t know how many times it happens involuntary, although I know an advocate who unsuccessfully tried to prevent it happening to an elderly woman. She had it several times and although she was a bit manic afterwards it did not work once the initial effect had worn off – so they stopped forcing it on her. My friend says she was an isolated elderly woman who felt guilty about living on benefits and had become depresssed and she had some unusual beliefs. When he talked to her she calmed down and told him about her life (he is very nice and most people like him) but she went off into some weird place when the psychiatrists talked to her. So it looked like the staff did not try to find out about her problems before she got the ECT.

        Oh no, not that old story, I hear you say, staff having no empathy and not being very nice and instead forcing nasty treatments on people! Oh yes, I say, Hey ho – time to invade the psych wards I think!

        Here is a report of a study by Lucy Johnstone, the implications of which are that true informed consent are as difficult, or perhaps more difficult, than Dr Healy implies in his article for conventional outpatient psychiatric and other medication (ie, people trust the Dr, are too intimidated to disagree, the Dr is insulted if you disagree etc etc).
        http://www.ect.org/effects/adverse.html

        Opinions vary on ECT, John Read and Richard Bentall conducted a literature review and say it should be banned, their study is easy to find on the net.

        But overall I would agree with Healy’s analysis of how we trust our GP’s and find it hard to get them to believe us when we way their treatments have damaged us, or even worse, do not recognise that these treatments have damaged us. As I would also, tentatively (as I have not read enough on this to assess the evidence) agree with him on drug company influence of psychiatry and the rest of medicine and how profit for the drug companies comes before helping people – it’s the logic of poorly regulated capitalism – in’it.

    • I am mystified by why something being ‘rare’ is used as a positive. The death penalty is ‘rare’. Murder is relatively speaking ‘rare’. So what if something is ‘rare’? does that make it ok?

  5. Perhaps forced ECT is rare, but rare is still too much. And I think that fully informed consent does not happen. Sackheim, the great ECT guru, now finds that even 6 months out many people have cognitive changes after ECT like slowed reaction times and decreased STM- and long term memory problems that don’t always resolve for the time preceding and surrounding the treatments. And I wonder how many people are told what the relapse rates are after ECT. I have no idea what I was told before my ECT, as I have no memory of it- or for quite a bit before. People who tell you that it is a good thing to not remember a year of your life have no idea what they are talking about.

    • It doesn’t matter if it is forced, persuaded, threatened, whatever. The fact is that it is barbaric, terrifying, cruel, and feels like a punishment.

      Not to mention that people who do it to others under any circumstance are believing that the physical brain is the problem, not the “psyche.” When I had them I was in a research/teaching/university State hospital. They needed subjects for their experiments.

      And come on, people, this disgraceful treatment was invented in the 1940′s, the same time that pre-frontal lobotomies were being “bopped” by that sociopath, Walter Freeman.

      I truly hope that Dr Healy change his thinking on this, since he has been so helpful in the past.

  6. Here is Dr. Healy’s own explanation of his position on ECT at http://davidhealy.org/shocking-the-homeland#comments

    David_Healy says:
    May 15, 2012 at 5:47 am

    Rossa
    I am a proponent of nothing except people’s ability to get a treatment that might help them when they need it. I wish no-one needed any of these treatments, but in practice we do need them.

    There is almost certainly greater disclosure with ECT than with the meds, but still there will be abuses with ECT. Whatever about the abuses, there are roughly 10 people per 250,000 people in this region who get ECT per year (1 without consent – 9 with what may or may not be reasonable consent). There are between 10,000 and 20,000 on psychotropic drugs per 250,000 – almost none of whom can have given proper consent. The issue isn’t does ECT cause harm; its whether ECT or drugs are a better symbol of the problems we are faced with in terms of disclosure and the sheer volume of people affected. These problems extend to other prescription drugs also.

    ————–
    In my opinion, Dr. Healy’s is a reasonable position. He surveys the entire battleground of bad psychiatric care. He points out that relative dangers in treatment (from statistics in his locality, probably Wales):

    10 people at risk from ECT versus
    10,000-20,000 at risk from psychiatric drugs

    If I’ve worked my calculator right, according to Dr. Healy’s estimate, .004% of the entire population are at risk from ECT vs 4%-8% at risk from psychiatric drugs. (In the US, the proportions may be somewhat higher; more than 12% are at risk from psychiatric drugs.)

    In terms of public health and policy, risk from ECT is not non-existent, but it is dwarfed by the problems with the drugs.

    • I think Alostrata would change her tune if the issue was about SSRI’s and denial of damage and withdrawal problems as irrelevant and she was forced to take them again instead of another more disabling treatment like ECT.

      And comparing one brain damaging treatment with another brain damgaging treatment and saying that the brain damage isn’t relevant for the so called treatment one promotes as is definitely the case with Dr. Healy with ECT is ludicrous and dangerous at best.

      Dr. Healy shows his mainstream psychiatry views by going along with the pretense that emotional distress must be stigmatized and “treated” by psychiatrists with their preferred profitable method of torture and brain damage whether it is toxic drugs or ECT. The would be victims of the drugs or ECT never get full informed consent ever since the stigma and brain and other damage from so called treatments destroy the person’s life!

      True reform psychiatrists like Dr. Breggin never put those already in distress or traumatized in such a no win life destroying position, which is why those on Dr. Healy’s site attack Dr. Breggin and his supporters so viciously to deny the truth he has exposed about these barbaric treatments throughout his career.

      CAVEAT EMPTOR!

  7. I think the issue of ECT with versus without informed consent, coercion, threat, fear, and so forth bears a relation to sex between fully consenting adults versus rape or sexual assault. Sex of many kinds between fully consenting adults is legal. Adults who are forced, coerced, frightened into, or threatened into having sex are victims of a legally defined crime.

    At what point is the victim’s right to say “no” upheld or abolished in the case of ECT? In some states in the USA a person receiving ECT must sign a consent form for every single treatment, but even that signature can be coerced in some ways.

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