Speaking Out Against Electric Shocks

Philip Hickey, PhD
74
2213

“…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.

. . . . . . . . . . . . . . . .

“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.

. . . . . . . . . . . . . . . .

“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!

. . . . . . . . . . . . . . . .

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]

. . . . . . . . . . . . . . . .

 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.

. . . . . . . . . . . . . . . .

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)

. . . . . . . . . . . . . . . .

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.

74 COMMENTS

  1. Thank you Philip for this article. I have just checked out the editorial board of the Journal of ECT. Forty men and eight women. They did some years back publish an article by someone who had experienced memory loss after ECT. I can’t remember her name but I do remember she had met Mother Teresa and couldn’t recall it after ECT. I wonder if they would say now that they shouldn’t have published that article? By the way it is the late Ian Reid https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046795/.

  2. So what do we do to please these shock docs? Censor, with every voice of criticism and complaint, the voice of dissent? That bug-a-boo of psychiatry, antipsychiatry, rears it’s head again, only, I doubt it’s the head of antipsychiatry at all. Instead it’s the original definition German psychiatrist Barnard Breyer came up with in 1908, a pejorative term applied to anyone with the audacity to question the authority of psychiatry. Then there’s this thing they call anti-ECT. I imagine these doctors would not see that the two are not necessarily synonymous, and that just because a person has been damaged by shocks, that doesn’t mean that they are necessarily against all psychiatry. What is this ‘editorial’ really about? We don’t want any negativity hampering our sales of shock treatments and devices. Believe the advertising copy, buy our treatment, hush up, and get with the program. Problem, I don’t know about you, but I, for one, can’t stomach that much dishonesty. I imagine they are thinking when we have managed to censor every critical voice from the mainstream media we will be happy. Okay, I suppose, but not so long as we have what is referred to as a free press. I don’t imagine we’d be better off having psychiatry run the media than we would having the state run it. Thing is, given the amount of drug advertising in the media, what with direct to consumer advertising, they now have much more control over the mass media than they should have. No shock treatment advertising though, not in the mass media anyway, hence the perceived need for articles and opinion pieces like this one that appears in the New York Times. Good thing we’ve got Dr. Hickey to call them out on it.

    • Can you imagine what direct to consumer advertisements for shock would be like on television?

      I guess that watching a person being shocked jerking and twitching due to the convulsions induced probably wouldn’t sell the public on their wonderful product. Maybe they could include the two lines that I heard psychiatrists use about shock. One said that the convulsions that they induce with shock are beneficial and good.This was his answer to me when I asked him why psychiatry likes to induce convulsions while every other medical specialty tries to keep people from having convulsions. A second psychiatrist stated that the electricity knew how to differentiate between good brain cells and bad brain cells and only affected the bad cells! I nearly fell off my seat to try and keep from laughing as all his psychiatrist colleagues nodded sagely to one another in agreement. Yes, these would be great lines for a shock commercial. And the problem is that the American television audience would probably fall for it, hook, line and sinker!

      • Shock advocates are quick to point out the difference between shock in the old days of One Flew Over the Cuckoo’s Nest and today, mainly sedatives. They are also quick to advance the deception that the procedure is less harmful that it once was, and that it is improving. I don’t think they are ever going to use a video of a person undergoing ECT for advertising purposes. If they did, people might begin to get it. This shocked person is having a seizure, and these quack doctors and nurses are calling it therapeutic.

        • Well, we only have to turn on TV and watch Dr. Oz’s “The Shock That Could Save Your Life!” Promoting shock, showing the only thing visible showing the seizure is a small toe twitch. A nuclear bomb is going off in the patient’s brain- electrical injury and seizures, but it “looks” so serene. Evil. Good old Dr. Oz did another show calling the treatment “humane” and “lifesaving”.
          Of course his sponsor Kaiser Permanente administers huge numbers of shock to unwitting victims…Dr.Oz failed to give time to any of the hundreds of brain damaged victims out there, decimated by ECT, memories gone, careers destroyed…

          • Wow, that’s sedation for you, and selling shock!

            What you don’t see, can harm you.

            Dr. Oz should know better, but then you’ve got these shock docs making these arguments, and brudah shrinks, like Dr. Oz, defending them.

            Given these very lopsided circumstances, I’d say “the hundreds of brain damaged victims” out there have a great case for demanding equal time.

            Especially if it upsets a couple of editorial writers for them to do so.

        • What I’ve read about modern day shock is that it’s actually much more dangerous than in the old days because of the anesthetic that they use now. Supposedly it raises the threshold that is required for the actual seizure to take place, meaning that it takes more electricity to get beyond the threshold. So, when I hear them claim that it’s safer today all I can do is laugh.

          • Yes, you are correct. Stronger machines, longer time current applied, more power to overcome the paralyzing drugs. So, the “scary” looking shock of the 50’s and 60’s may have been less mentally damaging.

          • This isn’t true actually. In the old days they just took current directly from the wall, 60 hz alternating current, to deliver ECT. Now they actually give a series of brief electrical pulses so it’s much less energy.

          • Rational

            And where do you get your information from to substantiate your claim? And if your are correct the fact remains that if it’s done by brief electrical pulses they still produce seizures, which are extremely detrimental to the brain receiving the wonderful “treatment”. Remember, all other medical specialties other than psychiatry try their hardest to keep people from having seizures. Why? Because the seizures are harmful, period. And yet, psychiatry claims that shock is a valuable treatment.

          • I’ve looked into it a little Stephen. You don’t have to take my word for it, I just think it’s important to be accurate when discussing these things. The establishment has a way of writing off opinions when they see an inaccuracy. Please don’t take offense, I wasn’t intending to make an argument in support of shock.

          • “ECT” = Electro-Cution Torture
            Electrocution Torture = “ECT”
            I don’t want to censor/”moderate” the comments from “rational_moderation”, but I must note that ALL of them are irrelevant.
            Electrocution Torture was invented in the 1930’s, in the era of ice-pick lobotomies, insulin coma, cold water immersion, etc. There is NO legitimate reason that it is still used. That it *is* still used, is simply more PROOF that psychiatry is a pseudoscience, a drug racket, and a means of social control. It’s 21st Century Phrenology, with potent neuro-toxins. I repeat:
            “ECT” = Electro-Cution Torture
            Electrocution Torture = “ECT”
            This barbaric form of human torture pretending to be “therapy” should be banned completely.

        • I think what rational_moderation is referring to is the difference between machines that deliver an electric shock with sine-wave current and those that deliver an electric shock with brief-pulse current. They are both electric shocks, although some people misleadingly describe the latter as if they deliver a lot of little shocks rather than one big shock.
          As far as energy is concerned, modern ECT delivers just as much, if not more, than olden days ECT. The convention is to measure ECT energy in millicoulombs and the number of millicoulombs has not decreased over the years.
          The proof of the pudding is in the eating, and when people have done experiments with the different wave-forms there has not been an enormous difference between sine-wave and brief-pulse, less for example than between bilateral and unilateral electrode placement. Which is probably one of the reasons why psychiatrists took so long to switch wave-forms and why in some countries sine-wave is still used. And of course people who have ECT today experience similar effects on memory, etc., to those who had ECT many decades ago.

          • In response, this is the first thing I came across when I just googled it now. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990832/

            The most relevant bit is below. I’m sure I could have found a better explanation of how this has changed, but in a hurry right now. Basically the total energy delivered is proportional to the area under the curve, so a sine wave will in general deliver far greater energy than brief pulses. I guess you could alter the pulse parameters to have equivalent energy to a smaller sine wave, but I don’t think that’s what is happening. If someone can show that I’m wrong I’d be interested to see the evidence for that though. Bramble – it seems like you know what you’re talking about, but I don’t think that’s true. Not saying modern ECT doesn’t cause the problems you describe with memory, but I don’t think it’s as bad as if you got ECT in 1950.. Again, open to being proved wrong.

            From the article:
            “There are two important categories of electroconvulsive therapy (ECT) devices: constant voltage, sinusoidal wave devices and constant current, brief-pulse devices. The sinusoidal wave devices are currently considered obsolete for the following reasons.[1]

            Current flows almost continuously with the sinusoidal waveform. As a result, far more electrical charge is delivered than is necessary to trigger the seizure. The extra charge may not increase efficacy but does increase the cognitive adverse effects of the treatment. In contrast, with constant current, brief-pulse ECT devices, current is delivered in short pulses. The seizure which is triggered can be as effective as that with sinusoidal wave ECT, and is associated with less cognitive adverse effects.”

          • At the end of the article that you quoted the authors give two examples of calculating the electrical charge – one of 63 millicoulombs and one of 163 millicoulombs. Those are both fairly low charges but the second one a fairly typical one. Now let’s look at the charge used in the 1950s. One article for example described a patient as receiving ECT with energy of between 10 to 17 joules. Slight problem – we have to convert joules to millicoulombs. Charles Kellner (and for once I will believe him) says to multiply by 5.7, which means 1950s patient got about 60 to 100 millicoulombs. So less energy in the 1950s than nowadays. Why – if the waveform is more efficient? Mainly I think because the duration of the shock has increased considerably since the early days of ECT. Nowadays people usually get shocks lasting several seconds while in the early days it was usually a fraction of a second.
            Interestingly, in a survey published in 2001, some hospitals in New York were still using sine-wave machines even though brief-pulse ones had been available for at least two decades.

          • Can you explain how you are converting directly from energy to charge? As you alluded to they aren’t the same thing, i.e. not like converting between miles and kilometers. They are related, but you’d have to make some assumptions and you’ve not given enough information to do that. You can’t just take energy in joules from a 1950s publication and assume it relates directly to how you convert between joules and millicoulombs for a modern machine. A further point is that energy delivered will depend on other factors since most of the energy is used to overcome resistance in the actual electrodes, tissue and skull (not the brain). You’re actually making something complex appear super simple and it isn’t, charge is the accepted metric to use for comparing and that’s not even completely straightforward.

            Aside from that, when I suggested something pretty general, a source was immediately demanded. You give some really specific numbers without any source. The bit of the text I referenced specifically says the charge with sine wave ECT is far greater. I’ve read it a few times in other places too, so that’s why I’m skeptical.

            Here are a couple other reasons: 1) The other aspect of brief pulses is that they are more efficient at driving neuronal responses. Neurons have a refractory period between action potentials and so any energy delivered during the refractory period is wasted in terms of driving a seizure. Therefore, if there is a certain seizure threshold, you necessarily must deliver greater energy with a sine wave than with pulses to elicit the same seizure. 2) I have a hard time understanding why a device would be engineered to convert sine waves to brief pulses if it wasn’t an improvement in some way. It’s obviously more technically challenging than just using current from the wall, so why do it if it was going to deliver more charge and cause worse side effects? Then further why is it being repeated in scientific articles that less charge is delivered if that’s not true? Maybe your position is that it’s the same (ie not any improvement), but multiple people were repeating the idea that modern ECT is way stronger and much worse and that’s what I responded to as a potential inaccuracy 3) You mention that sine-wave ECT was still practiced in New York as recently as 2001 as though that’s is a bad thing (maybe I’m misinterpreting?). However, based on what you’re saying wouldn’t it be better to use sine-waves? If it’s true as was suggested that modern ECT is more charge, more dangerous, more damaging then it would seem better to use an older design. If sine-wave ECT is largely considered obsolete, where does the idea come from that it is no longer appropriate to use it at all?

            I anticipate that my position will be unpopular, but a family member of mine received ECT and I think it saved her life. I’ve read a lot about it since and have come across this site only recently. I’m not trolling anyone, just trying to square what I’ve learned in my own reading with what’s being said here by some apparently reasonable people. I’m not a huge supporter of ECT really, but I come from a more libertarian perspective and don’t think it should be outlawed. All interventions to treat dire conditions come with risks, I won’t get into it, but in my sister’s case it was a matter of life or death. The ECT did help her and she has no ill effects, I don’t think she would be alive now if it wasn’t available. Maybe psychiatry is abusing ECT and using it as a torture weapon in some cases, I can’t really know that, but if it can sometimes help when the alternative is death, then I think it should be available. That’s another debate entirely, but suffice it to say accurate information should not be the enemy of reasonable opinions on either side of a question.

        • A reply to rational_moderation’s questions. In order to convert joules to millicoulombs (energy to charge) I was using Charles Kellner’s co-efficient of 5.7. Yes, the resistance is unknown, so the co-efficient is based on assuming an average resistance (Charles H. Kellner, Electroconvulsive therapy, in Brain stimulation in psychiatry, Cambridge 2012 pp 3-16). The 1950s example I gave is from an article published in the Journal of Mental Science in 1951 vol. 97, An account of E.C.T. given to a patient with a tantulum plate in his skull, by Humphry Osmond pp 381-387. The man was given seven treatments with 17, 12, 10, 10, 10, 10, 10 joules.
          All else being equal, brief-pulse currents are accepted as more efficient at producing seizures than sine-wave. But all else isn’t equal; other parameters have changed. For example, nowadays people receive shocks lasting several seconds while in the early days they lasted a fraction of a second. Is sine-wave for half a second better or worse than brief-pulse for 6 seconds?
          I pointed out that a minority of New York hospitals were using sine-wave equipment into late 90s early 2000s to show that it is not a simple question of olden days v modern times. Some countries of course still use sine-wave equipment.
          It is not the case that modern ECT uses “much less energy” than before. If anything it is more energy.

          • You mostly just said the same thing again though. Albeit providing some references. I feel like you’re just ignoring the questions you don’t want to answer… You can use this number, 5.7, but what evidence do you have that the assumptions you make are accurate? As you say, “all else isn’t equal: other parameters have changed.” I don’t think you can just assume that relevant variables are identical in 1950, everything would have been different. If you show me something that gives charge calculations for 1950s ECT then I’ll buy it and will apologize for being wrong. However it’s got to make sense.

            Why is sine-wave ECT considered obsolete in most of the developed world if what you say is true? Kellner himself says that sine-wave ECT uses excessive energy and this is the reason it is obsolete. Help me understand why everyone but you is mistaken.

            Some may find this irrelevant and want to “moderate” me, but I’ve been nothing but civil. Anyone who suggests I be silenced isn’t helping their credibility. What would you say to someone who feels like they benefited from ECT? “You’re wrong, be quiet, you can’t have it ever again, it’s banned?” I doubt ECT will disappear completely, unless something replaces it. For people like my sister, who was suicidal and catatonic I have zero doubt that it was helpful. It seems wrong to take it away from at least people like her, because otherwise they might die. I guess no one will believe this story, but I’m obviously not the only one telling this perspective.

            I definitely don’t see making any headway on banning ECT unless there can be some consensus developed about what is true and what isn’t. I’m becoming skeptical that this is the place where that can happen. Perhaps this is a place where people only want to have their own viewpoint repeated back to them. Anyway, I appreciate that Bramble has engaged with me on this, but I wonder whether anyone here is open to adjusting their point of view in even a very modest way.

          • What rational_moderation said was “In the old days they just took current directly from the wall, 60 hz alternating current, to deliver ECT. Now they actually give a series of brief electrical pulses so it’s much less energy.” Energy is measured in joules, and I found some examples from 1940s and 1950s of shocks using 10 – 20 joules of energy. If you want to see how much energy modern machines deliver go to the Thymatron specification page http://www.thymatron.com/downloads/somatics_color_low-res.pdf
            maximum output 99.4 joules (or double with double-dose model). Psychiatrists are advised to set %energy dial to patient’s age, which would be more than 10-20 joules for adults.
            Or perhaps rational_moderation could find an example of someone in recent years being treated with “much less energy” than 10-20 joules?

          • Oops, sorry Bramble, my response accidentally ended up at the bottom of the comment thread. I’ll repost it here to maintain continuity of our back and forth:

            Bramble, you’re not really answering any of the meaningful questions which would cast doubt on your assertion. I think that the energy values from that article may be inaccurate or at least atypical. See ‘The Clinical Science of Electroconvulsive Therapy’ by Edward Coffey, 1993 (page 34) – full link to this page in the book below.

            For your convenience I’ll paste in the relevant bit:

            “It is well established that sine-wave devices may deliver much larger amounts of energy than pulse devices, yet they have not been shown to be more efficient at eliciting seizures than carefully administered brief pulse treatments (for review, see Weaver and Williams 1982). This means that the patient is often exposed to a more intense electrical stimulus with sinusoidal waveforms, even when the electrical dose is at or near seizure threshold. Further support for this idea comes from a study by Weiner (1980), in which he compared the effects of stimulus waveforms on seizure threshold. He found that brief pulse ECT as associated with an average seizure threshold of 18.0 J and that patients receiving sine-wave stimuli had an average seizure threshold of 47.0 J. Thus, on average, sine-wave stimuli required nearly three times as much electrical stimulus energy to elicit adequate seizures as brief-pulse stimuli. ” (link at bottom)

            As I mentioned similar statements are found throughout the literature. Moreover, it just makes rational sense when considering the waveform and is consistent with a number of studies which demonstrate fewer cognitive side effects when using brief or ultra-brief pulses as compared to sine-wave stimuli.

            Perhaps the patient in your article had an unusually low seizure threshold or because of his skull defect they were using lower energy? I don’t really know, but if this one example is what you’re basing this on, I don’t think it’s a very strong case. I’ve provided a fair amount of proof, I think you would need a more detailed explanation or reference to convince me or anyone else of your position in light of this. Modern brief pulse ECT uses much less energy than sine-wave ECT.

            http://books.google.com/books?id=8IxAO4wySBkC&pg=PA34&lpg=PA34&dq=typical+energy+in+sine+wave+ECT&source=bl&ots=6A2F9SopaT&sig=pxQQSqDto-tiEPvxAE4dQpgVA-g&hl=en&sa=X&ved=0ahUKEwjHrLv9mPXYAhURwmMKHc_PAD8Q6AEIWzAI#v=onepage&q=typical%20energy%20in%20sine%20wave%20ECT&f=false

    • The talk about “balance” is classic Orwell. Over the past few decades the media has developed a technique of writing about a progressive cause or issue, then adding an obligatory set of opposition lies and calling it “balance.” What’s described above is an advanced, reversed instance of “Newspeak” wherein the lies are contained in the article, and the addition of a few grains of truth is portrayed as “false balance.”

      Who said propaganda isn’t a science?

      • Rational complains of being silenced here. But he isn’t–however many of us choose to scroll past his reiterations of the Same Tired Arguments.

        None of us would receive such a civil reception if we posted dissenting views on NAMI or Healthy Place. We are SO MEAN to people like Rational here it would make a houseplant weep. *Sob!*

        Seizures and random destruction of brain cells are good for you. Science says. Just shut up and enjoy it!

        I have never been shocked, but when a shock survivor tells me it’s horrifying I believe her or him.

        It angers me when ignorant people who have never experienced shock and never will preach how wonderful it it. I noticed a bunch of not-too-well-educated “mental health” workers (C.N.A./LPN’s/M.A’s) praising it all the sudden. Truly scary. Like something from The Manchurian Candidate. Maybe their own brain cells had been decimated.

  3. “It produces a sedating and calming effect”. And so do head injuries. I can take a baseball bat and smack someone in the head with it and produce a “sedating and calming” effect. How can they not see that this is a brutal and primitive assault on the lives of people? I think that they don’t really care about the people that they shock and it’s a very lucrative business besides.

    Shocking peoples’ brains is not a treatment so much as it is a form of torture. My grandmother was destroyed by this most wonderful of treatments and I will never forgive the system for her destruction. They didn’t kill her but it would have been kinder to her and to us her family if they had killed her. She want from being a talented artist, gardener, and wildlife advocate to someone who sat and smoked cigarettes, looking at the floor as she drooled on herself. So much for their wonderful “treatment”.

  4. widespread acceptance in the medical community.

    She means the psychiatric “community,” not real doctors. Sort of like the “law enforcement community” — no wait, they’re the same thing.

    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.

    Which is why we should start to turn away from engaging in debates about the “efficacy” of ECT, which are equivalent to “debates” about the pros & cons of the Holocaust. We should focus instead on bringing lethal propagandists such as those mentioned above to justice, and the debate should shift to what sorts of prison terms they should serve.

    More kudos to Phil, needless to say.

      • “Real doctors”, including specifically neurologists, are guilty of failing to condemn shock and to petition as a group to see it banned.
        Cowards, enablers, complicit in this assault by virtue of their silence and refusal to do the ethical thing.

        • Not defending “real” doctors, I avoid them almost entirely. Nonetheless a reference was made to the “medical community,” and it has been repeatedly pointed out that many physicians and medical students, ethical considerations notwithstanding, consider psychiatrists to be “wannabes.”

          • Frankly, I hope a day comes in the future when every human being has enough medical knowledge to reduce his/her dependence on other human beings who take up the role of medical doctors in society, so as to not be on the mercy and charity of other people for something as fundamental as our own health.

            Knowledge about our own bodies and how to ameliorate ailments must be as fundamental as learning a language or knowing how to count.

            Basic physiology, anatomy, pharmacology; at least the stuff that’s learnt in basic medical graduation.

            A person may not be able to do everything for himself/herself (like I can’t do a kidney transplant on myself), but one can learn to know signs and symptoms of infectious diseases, endocrinological conditions, heart conditions etc., and with enough knowledge make lifestyle changes or take (what are now prescription only) drugs (whilst also knowing their positive and negative effects, contraindications etc.). One could even read about them, and ask and observe 10 different people (hell, now with networking, maybe 1000s of people) who have similar problems.

            A risky and horrible idea? Maybe. But that depends on who is considering the idea.

          • Another expert you always have access to is your body itself, which is fully aware of how to heal itself if given half a chance. “Modern medicine” is based on symptom suppression — analogous to shooting the person in the window shouting “fire,” instead of fighting the fire itself.

          • That depends on what we are talking about. Some fevers due to common microbial agents, headaches etc., sure.

            But there are other things the body can’t simply fix properly on its own.

            Hell, I’d say make all mind altering prescription drugs legal in some places as well (with full disclosure about their effects on the body and any contraindications), so that those who want to take them can avoid psychiatry as an intermediary altogether.

            Drugs don’t take themselves. If someone finds some kind of relief from a sedative or an SSRI, let them try it (with instructions on how to do it in a safe manner), take it and stop it when they want to. It’s a lot better than giving yourself into a system which could force horrible crap on you, label you, indoctrinate your family, disease-monger and stultify your life. Easier said than done, but it’s possible in some places.

          • But there are other things the body can’t simply fix properly on its own.

            Good news — This is almost 100% untrue! People have been totally brainwashed into thinking they’re dependent on the AMA, whereas in most cases MDs do more harm than good, even in their basic approach.

            For example, fevers are symptoms of conditions you need to be aware of, and are the body’s effort to kill the excess bacteria, etc.; suppressing them in favor of antibiotics may lead to immediate relief but also weakens the immune system and leaves the original problem intact and smoldering in many cases.

          • That’s the example you gave. I would say the same for cancer, primarily an immune response from what I can see.

            Do you have a reason to wish the body were less resilient than it is?

          • What are you saying? Why do you think that I’m in any way implying that the body should be less resilient than it is?

            And yes, that is the example I gave and said that you gave the exact same example, and I mentioned that there are other things the body can’t fix by itself, or things which become worse if treatment is not received.

          • Well, psychiatrists aren’t real doctors so I’m not sure why that would apply. Their “faux” “specialty” has less credibility than voodoo or astrology.

          • Like a brotherhood of crooked cops dedicated to running a city by covering each other’s butts. I’m not anti-medicine. But when doctors are remorseless serial killers or actively protect those who are how can I trust any of them?

  5. There have been numerous well-researched articles/pod casts/personal stories printed in MIA for SIX years,exposing ECT for the horrific brain damaging human rights abuse that is and revealing how shrinks have lied and misrepresented the “procedure” for decades.
    Why, given the science and the horrific testimonials of victims, is it not banned, its practitioners stripped of licenses and jailed?
    Obviously all the writing and articles and evidence and trials and anecdotal horror stories and protests and marches and fictional books and real books (Doctors of Deception) are resulted in nothing. Do we need an aggressive revolution??

    • You know the answer to your own question. Most people are just afraid to state the obvious here on MIA. There are still some people who believe that we can achieve freedom from psychiatry and the “mental health” system by sitting down and dialoging with the other side. Remember, the slave holders in the South of the United States did not give up ownership of slaves voluntarily. A lot of dialoging went on and the slaves were not freed. Slave owners had to be forced to give up slavery as the basis of their economy. It took a war of epic proportions to achieve this. More people died in the Civil War than in all the wars combined that this country has fought. I suspect that it’s going to take an “aggressive revolution”, whatever we come to mean by this.

        • I believe that picketing places would be a good beginning. I’m not advocating anything like blowing up places; I’m for peaceful activism where people who up in numbers to let the public know what we think about all this. This was beginning to happen in the 70’s with the leadership of people like Judy Chamberlin but then things just fell apart all of a sudden.

  6. Yes, I would like some suggestions. Definitely rotating pickets at shock clinics/shock hospitals, with ppl handing out information with the REAL dangers and outcomes. Same kind of action in front of the factories producing these torture devices- like one would picket in front of their local land mine factory. Television ads showing brain damaged victims. Flooding media with demands for accurate reporting of the science showing ECT causes brain damage.
    Encouraging ppl without a mental health diagnosis but willing to put themselves out there for a cause, chaining themselves to shock machines or disabling them (ok, maybe jail and legal fees might make this iffy).
    Who has some workable ideas for aggressive revolution?
    How about regular doctors aggressively petitioning their members to vote on a resolution to ban electroshock? In fact, ethical psychiatrists pushing for a halt to electrical lobotomy in their
    Own organization.
    Oh, yes, what about the fact Mayo Clinic, McLeans, Kaiser promote and advertise this “service”?! They make piles of $$$ .they won’t give up without a fight, and do not care they are brain damaging their clients.
    How much is spent on pro- ECT propaganda??

    • How can the field of psychiatry have become so concentrated with pure evil? I wonder if anyone can think of another group that is so loathsome and cruel. Maybe politicians or sales people, they are also bad I think. You’d think there would be no way for this to happen almost. Are the bad individuals attracted to psychiatry as medical students or are they taught to hate and torture as part of their training?

      Many years ago I knew someone who was a psychiatrist, before I understood what was up and I actually liked him. He was kind to me and my family during a difficult time, but I’m forced now to consider he was setting a trap. Is it possible he was looking for a way to lure myself or a family member into psychiatric treatment? Sometimes I wonder if I’m going too far with this, but just thinking about a psychiatrist fills me with rage. They must have a way to orchestrate their plotting, secret message boards or the leaders meet to plot all this. If they are really as bad as I think, then they must be openly admitting their hatred and ill intent somewhere. It seems like in public they are hiding this because when I’ve encountered them it seems like they are making pains to seem caring almost. What is that about, it’s so confusing.

  7. Dr. Hickey,

    Any young credentialed people coming up in the “Phil Hickey school of psychology”? Heaven knows you’re old and when you’re gone, there will be no one else to take up your mantle (at least not in the way you do).

    Also, since you have worked in prisons, it would be very interesting to know of your experiences amongst prison inmates and your findings regarding problems in living, thinking and feeling in prison, because I am sure there will be a relatively large population in prisons with all kinds of problems hidden under all kinds of DSM labels. Why don’t you write something regarding that? It would be most illuminating.

    • Registeredforthissite,

      There are lots of great writers working in this area. I think the critical point in an anti-psychiatry writer’s perspective is when he/she realizes that psychiatry is not reformable. It’s not reformable because one can’t turn a non-illness into an illness by fiat. And if the problems aren’t illnesses, then why does one need an MD to “treat” them?

      Prisons are indeed interesting communities – microcosms of society in many respects. Thanks for the suggestion. Perhaps I’ll write something in that area. I can tell you that psychiatry is extremely active in prisons and jails, and enormous numbers of incarcerated people are taking psychiatric drugs.

  8. I could care less about the specific joules or volts being used to electrocute the delicate brain in tandem with grand mal seizures. It causes brain damage, period. It has never been proven to be safe, effective, or evidence based as shown by the research of Bentall and Read.
    It destroys lives. It is torture. It is equivalent to an electrical lobotomy.

  9. “Colleagues in various departments suggested alarming possibilities, which included some alteration to the type of fit; over-heating the tantalum plate and so, as it were, cooking the brain; bending the plate during the fit, and also depositing tantalum around it electrolytically”. None of these seemed sufficiently likely to contra-indicate treatment…”
    Anyway – another example: “the usual dosage in this series was 18 joules…. the usual duration of the shock is variable, lasting about 0.35 sec…” R.Kauntze and G. Parsons-Smith 1948 Cardiovascular changes following electro-convulsive therapy. Heart vol 10 pp 57-62.

    • Clearly there is a range of possible total energies, influenced by a variety of factors. My point is that all things being equal, sine-waves would deliver greater energy (~3x). It’s a little hard to understand these low values because the references I linked to clearly say that the average energy required to induce a seizure is 47 joules (vs. 18 joules for pulses). That would lead one to think, on average, the minimum energy one could use would be 47 joules. Unless one was taking pains to avoid going over the seizure threshold, I’d assume the energy would often be much higher than that. I do think much much less care was taken with ECT 60 or 70 years ago and I would be shocked if the energy didn’t go significantly higher.

      I’m wondering if there is something missing here, for example maybe the total energy was lower, but because of the setup back then it delivered greater charge than would be delivered with similar energy on a modern machine. Either that, or these are just atypical examples where the energy was especially low. Unless we have all the parameters of the machine, I’m not sure we will ever definitively conclude the dose delivered in mC for these examples from many decades back. From my perspective, the statements about energy used then and now from experts is more compelling. I don’t think there is a broad conspiracy to miscalculate or misstate this basic and falsifiable fact about the physics of ECT.

      Anyway, it’s been an enjoyable back and forth. Thanks for not getting mad and calling me names. None of this probably changes our respective opinions about the treatment as a whole. I think there is some concerning misinformation floating around and there is a real danger of polarization that promotes extremism. I’m sure a lot of people would embrace that, but I don’t think it helps the case for reforming psychiatry. Nor does it lend itself to people with different views being willing to listen to this “anti-psychiatry” perspective. It’s not a comment about you specifically Bramble. Like I said, I appreciate the efforts you’ve gone to in order to prove your position and I trust it was with the goal finding the truth. Nonetheless, I still think you are wrong 🙂

  10. Maybe what Stephen Gilbert said in the first place is true
    “What I’ve read about modern day shock is that it’s actually much more dangerous than in the old days because of the anesthetic that they use now. Supposedly it raises the threshold that is required for the actual seizure to take place, meaning that it takes more electricity to get beyond the threshold.”