Speaking Out Against Electric Shocks

“…they’re human beings, for God’s sake!  In the name of
everything holy, how can they do that to them?” (p 108)

The Other Mrs. Smith, by Bonnie Burstow, 2017

In the March 2017 issue of the Journal of ECT, there was an editorial titled:  Electroconvulsive Therapy (ECT) in the News: “Balance” Leads to Bias.

The authors are Melissa Choy, BA; Kate Farber, BA; and Charles Kellner, MD. Dr. Kellner is Chief of Geriatric Psychiatry and Director of ECT Services at Mt. Sinai Medical Center, NY, and is clearly the senior author. I was unable to find much information concerning Ms. Choy or Ms. Farber.

The gist of the editorial is contained in the opening paragraph:

“Many reports of electroconvulsive therapy (ECT) in the news media try to achieve journalistic balance by dedicating a sizable portion of their content to anti-ECT views. We suggest that such practice is, in fact, biased, and effectively perpetuates misinformation and stigma about ECT.”

So, journalists who write about high voltage electric shocks to the brain try to achieve balance by including anti-ECT views. But, according to the authors of this editorial, such journalists, well-intentioned though they may be, are in fact producing biased copy which perpetuates misinformation and, of course, stigma about ECT.

Here’s the third paragraph of the editorial:

“Despite its widespread acceptance in the medical community, ECT remains surrounded by ‘controversy.’  For years, journalists have paired factual reporting on ECT with sensationalized anecdotes and unsubstantiated claims.  In an attempt to intrigue readers and avoid partisanship, many news outlets have inadvertently given a sizable, unchecked platform to antipsychiatry proponents.  For example, 2013 BBC Health News coverage on ECT included a patient success story, a history of the procedure, and potential theories of mechanism of action.  However, it paired these with the story of a patient who blamed ECT for erasing years of her memory, with no discussion of her psychiatric condition or response to treatment, and quotes from a psychologist comparing ECT with ‘lobotomies and surprise baths.’  A 2016 article in STAT gave equal weight to a patient narrative on how ECT resolved her severe depression and claims from an anti-ECT proponent, who blamed ECT for ending her marriage.  A 2016 New Scientist article discussing the efficacy of ECT still included terminology such as ‘tainted treatment’ and ‘brutal and archaic.’  In their effort to capture readers’ attention, all of these articles referenced the movie One Flew Over the Cuckoo’s Nest, the ubiquitous archaic image of ECT that is conflated with modern practice.  Even informational material from the psychiatric profession includes language promulgated by the antipsychiatry movement.  For example, the ECT informational leaflet from the Royal College of Psychiatrists has a section entitled ‘what do those against ECT say’, which states that ‘some see ECT as a treatment that belongs to the past…permanently damages both the brain and the mind…[and] would want to see it banned.'”

Well there’s a lot of interesting material here, so let’s take a closer look.

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“Despite its widespread acceptance in the medical community…”

This little gambit is a bit like the old ads that used to say things like: six out of seven doctors recommend medication X, or whatever. The general idea being: who could argue with that? But the more interesting question is: is it true? Well, later in the quote, the authors refer to a 2016 New Scientist article by Jessica Hamzelou. The article includes several quotes from George Kirov, MD, of Cardiff University, who is a strong supporter of electric shocks, and “oversees ECT treatments in the [Cardiff] area.” Here’s one of these quotes:

“‘There are very mixed feelings about ECT, even among psychiatrists,’ says Kirov. ‘If I speak to medical professionals outside of psychiatry, there is almost disbelief that we are using such an archaic practice.'”

Which, I suggest, casts doubt on the Choy et al assertion that high voltage electric shocks to the brain have widespread acceptance in the medical community.

And to dispel any doubts on this matter, here’s another quote from the New Scientist article:

“But ECT ‘remains in the shadows’, says Charles Kellner, who directs ECT services at the Mount Sinai Hospital in New York City. He describes it as the ‘second most controversial medical procedure’, after abortion. In the US and UK, only a tiny fraction of people with depression that doesn’t respond to medication are offered ECT, despite evidence that it can be effective.”

And, my dear readers, please note that this is the same Charles Kellner that co-authored the Journal of ECT editorial. In the latter, he asserts unambiguously that electric shocks have widespread acceptance in the medical community, but in the New Scientist quote, he bemoans the fact that only a tiny fraction of “people with depression that doesn’t respond to medication” are even offered electric shocks. Now in both the US and the UK, the primary referrers for electric shocks are psychiatrists, other medical specialists, and GPs. And if these referrers are sending only a tiny fraction of eligible customers, doesn’t this suggest that they are, as a group, less supportive of electric shocks than Choy et al claim in the editorial?

The fact is that using high-voltage electric shocks to the brain to alleviate feelings of depression does not have widespread acceptance in the medical community. And the Kirov quote cited above suggests that even psychiatrists have “mixed feelings” on the matter.

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“In an attempt to intrigue readers and avoid partisanship, many news outlets have inadvertently given a sizable, unchecked platform to antipsychiatry proponents.  For example, 2013 BBC Health News coverage on ECT included a patient success story, a history of the procedure, and potential theories of mechanism of action.  However, it paired these with the story of a patient who blamed ECT for erasing years of her memory, with no discussion of her psychiatric condition or response to treatment, and quotes from a psychologist comparing ECT with ‘lobotomies and surprise baths.'”

The BBC Health News article is titled Why are we still using electroconvulsive therapy?, and was written by Jim Reed. [Clarificatory note: there are quotes in the article from Ian Reid, a psychiatrist, and from John Read, a psychologist, neither of whom is the author.]

Here are the passages to which Choy et al object:

“Helen Crane was given two rounds of ECT in the late 1990s. She now blames the second course for wiping years of her memory, from trips abroad to dramatic family events.

‘After ECT, I had this instinct that something was wrong with my mother. I said to my husband “What’s happened to my mother?” And then he had to tell me that she’d died nearly two years earlier,’ she says.

‘It was devastating going through bereavement again. How on Earth could I have forgotten something so important and fundamental? Getting words wrong is frustrating, but to have lost really basic stuff in your life is awful.'”

And this is what Choy et al would presumably consider a sensationalized anecdote or an unsubstantiated claim, though they voice no concerns over the equally anecdotal success story included earlier in the article.

Here’s the second passage in the BBC piece, to which Choy et al object:

“Critics of ECT claim around a third of patients will notice some sort of permanent change from memory loss to problems with speech and basic skills like addition.

‘What happens is a little like recharging a car battery,’ says the psychologist Dr John Read from the University of Liverpool, one of the most vocal critics of ECT.

‘It’s not difficult to get artificial changes in the brain, you could do it with cocaine, but it doesn’t last, and three or four weeks later the person is either back at the same level of depression or many studies show worse levels of depression.’

Opponents say that ECT patients can enter into an addictive cycle of repeated treatment and that any improvement beyond the very short term is likely to be little more than an extreme form of the placebo effect, with patients benefitting psychologically from the extra care and medical attention associated with ECT.

‘It’s not in any way addressing the cause of their depression. It’s systematically and gradually wiping out their memory and cognitive function,’ says Dr John Read.

‘I’m convinced that in 10 or 15 years we will have put ECT in same rubbish bin of historical treatments as lobotomies and surprise baths that have been discarded over time.'”

Again, this doesn’t seem particularly sensationalist or unsubstantiated to me. Indeed, it would, I suggest, be irresponsible of a journalist, on becoming aware of these kinds of concerns, not to publish them.

And, in fact, if we read the BBC piece to its conclusion, we find an extraordinary admission from the psychiatrist Prof. Ian Reid of Aberdeen University. Professor Reid is an active supporter of the practice of applying high-voltage electric shocks to human brains.

“The team in Aberdeen now hope their research will allow drug companies to develop new treatments that mimic some of the effects of electroconvulsive therapy.

‘One of the exciting things about being able to identify a change in the brain related to a psychiatric disorder is that it might make it easier to diagnose that condition over time,’ Prof Reid says.

‘No one would be happier than me if we could reproduce the changes that ECT has on the brain in a less invasive and safer way for patients.'” [Emphasis added]

Which, I suggest, entails the admission that high-voltage electric shocks to the brain are not quite as safe as proponents sometimes contend. And remember, Dr. Reid is an ardent supporter of electric shocks!

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The 2016 STAT article is titled Psychiatric shock therapy, long controversial, may face fresh restrictions, and was written by Judith Graham. Here’s the passage to which Choy et al appear to take exception:

“Many patients, however, take the opposite view: They say after decades of letting ECT proceed without rigorous evaluation, the FDA should take a much tougher stance. They blame the shock therapy for causing severe cognitive and emotional damage and call for tight restrictions or an outright ban.

Deborah Schwartzkopff, for instance, had 66 ECT treatments between 1996 and 2010 to treat depression. Schwartzkopff, 55, a registered nurse from McMinnville, Ore., said the therapy left such gaping holes in her memory that she couldn’t recall her wedding or the birth of her children. Her marriage of 28 years ended ‘because I couldn’t remember that relationship, and without those memories, I had no emotional connection,’ she said.

‘Personally, I think ECT should be banned, but at a minimum, we should be testing these devices for their safety and effectiveness,’ Schwartzkopff said.”

Contrary to Choy et al’s assertion, the article doesn’t equate this weight-wise with anything, but simply reports it alongside statements supportive of electric shocks, and, incidentally, a quote from Dr. Kellner himself:

“‘Its use for these indications [problems other than depression; and for children and adolescents] is widespread, even ubiquitous, and to deny the extensive evidence in support of that is indefensible,’ said Dr. Charles Kellner, a professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City and chief of the ECT service at Mount Sinai Hospital.”

In this passage, Dr. Kellner is unambiguously promoting the use of electric shocks for children and adolescents, an assertion that can also be found in Mt. Sinai’s ECT brochure:  “While it’s particularly useful as a geriatric treatment, ECT can help patients of all ages.” [Emphasis added]

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 Back to Choy et al.

“Even informational material from the psychiatric profession includes language promulgated by the antipsychiatry movement.  For example, the ECT informational leaflet from the Royal College of Psychiatrists has a section entitled ‘what do those against ECT say’, which states that ‘some see ECT as a treatment that belongs to the past…permanently damages both the brain and the mind…[and] would want to see it banned.'”

The informational leaflet in question runs to 4,418 words. The passage to which Choy et al object runs to 89 words (i.e., 2% of the total). Here’s the entire passage:

“Q.  What do those against ECT say?

There are different views and reasons why people object to ECT. Some see ECT as a treatment that belongs to the past. They say that the side-effects are severe and that psychiatrists have, either accidentally or deliberately, ignored how severe they can be. They say that ECT permanently damages both the brain and the mind, and if it does work at all, does so in a way that is ultimately harmful for the patient. Some would want to see it banned.”

This disclosure constitutes 2% of the RCP’s informational leaflet. Yet Choy et al present this material as an example of bias “which effectively perpetuates misinformation and stigma about ECT.”

Incidentally, there is another passage in the RCP’s brochure under the heading Long Term [Side Effects]:

“Memory problems can be a longer-term side effect. Surveys conducted by doctors and clinical staff usually find a low level of severe side-effects, maybe around 1 in 10. Patient-led surveys have found much more, maybe in half of those having ECT. Some surveys conducted by those strongly against ECT say there are severe side-effects in everyone.

Some memory problems are probably present in everyone receiving ECT. Most people feel better after the course of ECT has finished and a few weeks have passed. However, some people do complain that their memory has been permanently affected, that their memories never come back. It is not clear how much of this is due to the ECT, and how much is due to the depressive illness or other factors.

Some people have complained of more distressing experiences, such as feeling that their personalities have changed, that they have lost skills or that they are no longer the person they were before ECT. They say that they have never got over the experience and feel permanently harmed.

What seems to be generally agreed is that the more ECT someone is given, the more it is likely to affect their memory.”

Interestingly, Choy et al make no reference to this passage.

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All of which raises the question: how would Choy et al like to see the adverse effects of ECT publicized? Here’s what they say in the editorial:

“It is high time to insist that balanced reporting on ECT consist of accurate descriptions of the procedure as a modern medical intervention with known efficacy rates, benefits, and risks.”

Which superficially sounds reasonable enough. But in practice, here’s what Dr. Kellner’s electric shock unit at Mt. Sinai says in its ECT brochure:

“The Side Effects of ECT

As with any medical procedure, ECT carries its own set of risks, which need to be balanced against its benefits.

ECT has cognitive side effects, typically a small amount of recent memory loss. While the procedure doesn’t interfere with memory functioning, it may erase some newly-formed memories. For example, a patient undergoing a typical course of ECT lasting three weeks may not remember much of that three-week period (though some of those memories may eventually return).

ECT is one of the safest procedures performed under general anesthesia, and serious medical complications are extremely rare. Frequent, non-serious side effects include nausea (as a result of the anesthesia) and headaches.”

So, apparently, this is an example of what Dr. Kellner considers unbiased reporting: recipients of electric shocks may experience some memory loss for the period during which the shocks were administered! And these memories may eventually return. And that’s it! No mention of permanent loss of pre-shock memories, or the devastating effects that this can entail.

Essentially what Choy et al are seeking in their editorial is the total suppression of information concerning the harmful, extensive, and often permanent effects of high voltage electric shocks to the brain. Which in turn entails the assertion that the very large number of individuals who report more extensive and persistent damage are either not credible, or not worth listening to. And so, in characteristic psychiatric fashion, insult is added to injury.

AN ALTERNATIVE PERSPECTIVE

Joanna Moncrieff, MD, is a British psychiatrist, who in 2008 wrote a book called The Myth of the Chemical Cure. The work is “a critique of psychiatric drug treatment”, but it also contains a concise critique of electric shocks (pages 34-40 in the 2009 edition). Here are some quotes:

“…a few weeks after the ECT has taken place, people are no better than they would have been if they had never had it.” (p 35)

“…it is well known that ECT produces a syndrome of cognitive impairment consisting of disorientation, impaired attention and memory dysfunction that occurs immediately after experiencing ECT and is similar to the effects of an ordinary epileptic fit.” (p 35)

“Another characteristic of ECT is that it produces a sedating and calming effect, again similar to the aftermath of an ordinary epileptic fit.” (p 35)

“A state of disturbed behaviour similar to mania and sometimes with frank psychotic features has also been noted to occur occasionally following ECT.  Peter Breggin has likened this syndrome to the effects of having a closed head injury (Breggin 1993b) and it is also reminiscent of other brain diseases such as the late stage of multiple sclerosis.  The commonest features are the sudden development of a fatuous and over-familiar manner, spontaneous and unprovoked laughter and sexual disinhibition…” (p 35-36)

“…the acute cognitive effects may temporarily override underlying emotional states and reduce people’s ability to express their emotions.” (p 36)

“The impairment of cognitive function is also likely to impair the ability to form the complex and exaggerated thoughts that form the basis of depressive delusions, which may account for the common perception that ECT is particularly effective in delusional depression.” (p 37)

“…the organic behavioural state produced by ECT, with its euphoria and disinhibition, may be mistaken for improvement.” (p 37)

“[ECT’s] effects can also be explained by the acute cognitive impairment it causes, sometimes amounting to a brain injury-like state that may be mistaken for recovery from depression.” (p 39)

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ANOTHER ALTERNATIVE PERSPECTIVE

In September 1977, the late neurologist John Friedberg, MD, an outspoken opponent of electric shocks, wrote an article in the American Journal of Psychiatry. Here’s the abstract:

“The author reviews reports of neuropathology resulting from electroconvulsive therapy in experimental animals and humans. Although findings of petechial hemorrhage, gliosis, and neuronal loss were well established in the decade following the introduction of ECT, they have been generally ignored since then. ECT produces characteristic EEG changes and severe retrograde amnesia, as well as other more subtle effects on memory and learning. The author concludes that ECT results in brain disease and questions whether doctors should offer brain damage to their patients.”

AND FINALLY

On April 4, 2016, Lauren Tenney, PhD, wrote a post on Mad in America titled Comments by Shock Survivors and Their Loved Ones. The article includes 97 comments from people who have been harmed by electric shocks to the brain. Here’s one of those comments, chosen at random:

“‘Electroshock treatment has ruined my life. I had 30 rounds of ect for severe depression at 21 years old. Now 27 years old, I’m scared about my future as its been over 5 years and I’m still left with severe disabilities from it. It wiped out the majority of my autobiographical memories, and caused severe short term memory problems, apathy, eye movement disorder, spontaneous seizures, headaches, nightmares, ptsd. Not only did ect make my life worse and wipe out much of who I am, I’m unsure of the future. Had neuro testing 6 months after ect and my iq dropped 50 points, was a former honor student in high school. I measured at 78 which is almost borderline retardation. Have seen 2 neurologist now too. This is a very dangerous treatment and in talking to hundreds of people now, I’m convinced ect causes permanent disability and people can no longer go back to their former jobs. Downclassing shock let alone keeping this as a practice, is a crime against humanity.'”

But, according to Choy et al, by including this quote, I have now biased this article, and contributed to the stigma associated with this so-called therapy.

There are truly no depths of deception and spin to which psychiatrists will not go to promote the fiction that they are real doctors, treating real illnesses, with bona fide, safe and effective treatments. In reality, psychiatry is a self-serving, destructive, disempowering, and stigmatizing hoax, which like all hoaxes, fears nothing more than exposure. We need to keep exposing this hoax, especially including first-hand accounts from people who have been hurt by psychiatry, and whose voices have been suppressed for far too long.

Calling for the suppression of those voices, on the pretense that they promote bias, is just another example of psychiatric arrogance: how dare you challenge us; we’re real doctors, you know, and we have white coats and shining shock machines to prove it. You’re just a patient.

Psychiatry is utterly and totally irredeemable. It simply needs to go away.