In an article published in Psychiatry and Clinical Neurosciences, a hospital psychiatrist in Japan and his clinical team tell of how they employed ECT so that the patient, a woman diagnosed with “treatment resistant” schizophrenia, could give her “consent” to treatment with clozapine. The paper’s title alone earns MIA’s psychobabble of the month award: “Restoring decision‐making capacity through ECT to enable clozapine initiation in treatment‐resistant schizophrenia: An ethical and clinical case report.”
Here is a summary of their “case report.”
The patient, a woman in her late 30s, was forcibly hospitalized and initially treated with a long-acting antipsychotic (paliperidone palmitate), which can be given in Japan without the patient’s consent. When that treatment failed to reduce her psychotic symptoms, the hospital’s clinical team wanted to give her clozapine, but in Japan this drug cannot be administered without the patient’s consent. The reason is that clozapine may cause potentially fatal side effects, most notably agranulocytosis, and thus requires careful monitoring and regular blood tests. The woman briefly consented to take clozapine (CLZ), then withdrew her consent. “If I take this, I will die,” the woman said.
The psychiatrist, Shimpei Hanaoka, and his clinical team viewed her refusal as evidence of her reduced insight and decision-making capacity, as they had determined that clozapine was “clinically indicated.” They met with the woman’s family and told them that ECT could help “restore” her decision-making capacity. The family agreed that ECT could be used for this purpose, as ECT can be given without the patient’s consent in Japan. The authors write:
“A critical distinction exists between ECT and CLZ regarding consent requirements. While ECT can be administered under presumed consent when decision making capacityis clearly absent, CLZ initiation and continuation under the CPMS system practically require sustained patient cooperation, owing to mandatory long-term hematological monitoring. Thus, although family consent may technically support CLZ initiation, treatment is unlikely to be safe or sustainable without the patient’s own agreement. This asymmetry explains why ECT, but not CLZ, was considered procedurally permissible at the point of decisional incapacity.”
The plan was to give her two shock treatments a week. After the third, the woman’s hallucinations and delusions “partially subsided,” and she “voluntarily” agreed to take clozapine. Her Clinical Global Impression-Severity score had been seven at admission but had dropped to six by the time of the initiation of the shock treatments. After three ECT sessions, the clinical team lowered her CGI-S score to five. This drop of one point was deemed sufficient to give her “decision-making” capacity to take clozapine.
However, the clinical team still needed to obtain the patient’s ongoing consent to take clozapine and cooperate withregular blood monitoring. She was given 12 more sessions of ECT, and after this longer course of ECT, she consented to ongoing clozapine treatment. The authors wrote:
“Over 12 sessions of ECT, her insight and decision making capacity gradually returned. She began to recognize the relationship between medication discontinuation and relapse risk. Even when akathisia emerged, she acknowledged the trade-off and actively chose to continue CLZ. By Day 100, she stated, ‘If I stop CLZ, I will almost certainly relapse.’ ”
The authors, as they set forth this case of “ethical care,” acknowledged that “ECT is associated with transient cognitive adverse effects,” meaning that the woman gave her consent while suffering such cognitive impairment. Indeed, the research they cited regarding such adverse effects was even more emphatic on this point, telling of how a meta-analysis had found that ECT “is associated with significant cognitive impairment evident within days of finishing an ECT course.”
Thus, the woman was in a cognitively impaired state when she gave consent to the clozapine treatment. However, the authors of this case report, apparently eager to assert theirs was an evidence-based decision, wrote that there are “isolated reports that a reduction in psychotic symptoms may temporarily enhance patients’ capacity to reflect on their illness and treatment,” and that “ECT can potentially enhance patients’ autonomy.”
The study they cited for this assertion of ECT-induced transient insight was a report of a single instance of a patient’s “insight that lasted for less than eight hours.” That study also reported that “a systematic review of the literature on electroconvulsive therapy-induced illness awareness in schizophrenia and psychotic disorders produced zero relevant results.”
In a nutshell, that was the case study, which was published in the January issue of Psychiatry and Clinical Neurosciences. The article argues that a schizophrenia patient who has the right to refuse clozapine treatment can be forcefully given multiple shock treatments, and yet, while suffering from adverse cognitive effects known to be associated with ECT, which is administered repeatedly (a total of 15 sessions in this case), now has the “decision-making capacity” to understand that clozapine is a drug they should take.
The authors conclude:
“This case demonstrates that ECT can function as a capacity-restoring intervention enabling voluntary CLZ initiation in selected [treatment resistant] patients who initially lack [decision making capacity]. In the context of low CLZ utilization in Japan, a staged approach combining acute stabilization and pharmacological consolidation may provide a clinically and ethically acceptable pathway when supported by multidisciplinary review and procedural safeguards.”
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Hanaoka, S., Suzuki, H., & Sugeno, A. (2026). Restoring decision‐making capacity through ECT to enable clozapine initiation in treatment‐resistant schizophrenia: An ethical and clinical case report. Psychiatry and Clinical Neurosciences Reports, 5(1). (Link)
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Editors’ note: Psychobabble is a new monthly feature of our science coverage. Readers may submit suggestions for journal articles to be featured as Psychobabble of the Month to [email protected].
Questions that immediately sprang to my mind upon reading this article:
Who in this appalling travesty of medical “treatment” decided what is “ethically acceptable” and provided “procedural safeguards?”
Was there an independent team of qualified observers who monitored all these procedures and could have reported questionable or demonstrably harmful practices to the authorities?
How was the victim’s “decision-making capacity” evaluated and determined to be deficient? Are there universally recognized precise, objective criteria for making such a judgment?
Do psychiatrists worldwide agree unanimously on what constitutes appropriate mental healthcare, or is this a matter that is largely dependent on the culture and mores of a given country?
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What a troubling story!
I had no idea Japan allows such things. I guess this could happen anywhere under the right ( or wrong) circumstances, but that country’s apparent rules about voluntary and involuntary treatment are hard to fathom.
I read the original case report in addition to the psychobabble story in MIA.
The case report says that the patient didn’t have decision making capacity, though she did apparently accept some oral and injectable antipsychotics, which tells me that she did have that capacity. Her reported concerns about clozapine seem quite valid – agranulocytosis and myocarditis – so to say that her refusal to take it was evidence of lack of capacity is indefensible.
Also, it’s unclear if the patient was offered ECT as a treatment and refused, or if the fact that the law allowed the family to OK it allowed the doctor to bypass the patient. that’s also a big lapse in good and ethical care. Just because he may have been allowed to, it’s not ethical to do so
Giving ECT to a floridly psychotic patient who has not benefited from meds is ethically defensible ( leaving aside the consent issue for the moment) if the primary intent is to improve the psychosis. If it has the secondary effect of making a better treatment acceptable to the patient, that could be good BUT not if that’s the PRIMARY reason for the ECT.
Intent matters in ethics. If you give sedation to a terminally ill patient who is in pain for the purpose of relieving pain but the med depresses respiration, that is considered ethical unless your intent was to kill the patient by depressing breathing.
The MIA report uses quotes in its report, which suggests a possible editorial bias rather than a more journalistic stance. I don’t think it’s out of line to use a term like treatment-resistant schizophrenia for someone who isn’t benefiting from reasonable and standard meds. If you don’t think schizophrenia exists, or that meds are appropriate ( if not coerced), then the quotes make sense, but you’re still putting your finger on the scale.
Also, it is definitely true that ECT can have cognitive side effects, most commonly short term memory. There is nothing in the case report that tells us if this particular person had any or all of the possible side effects. Could be, but your report makes it sound like there was no doubt the clozapine conversation was inflicted on a cognitively compromised person and you can’t tell that from the report. It would have been good if the report addressed that. It’s fine to have a. negative view of ECT side effects, but it’s not something that happens to all who receive it, and this person agreed to clozapine after 2-3 treatments. There is a difference between the incidence of side effects in people who have just a few and those who have 6-12-24 or more. It’s a distinction worth making.
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“The MIA report uses quotes in its report, which suggests a possible editorial bias rather than a more journalistic stance. I don’t think it’s out of line to use a term like treatment-resistant schizophrenia for someone who isn’t benefiting from reasonable and standard meds.”
Your use of the phrase “reasonable and standard meds” to refer to neuroleptic drugs suggests a possible editorial bias.
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I’d add that it’s kind of disrespectful to blame the client or his/her “schizophrenia” for the fact that your “reasonable and standard” treatment fails.
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(1) I didn’t see blame in their report – did you, or are you inferring it?
(2) I don’t like the term ‘treatment-resistant” anything because it implies the person is somehow resisting, which is not the truth at all. It’s awkward, but more accurate to say the treatment failed the patient because the condition itself is hard to treat. Same for treatment-resistant infections or cancers
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“It’s awkward, but more accurate to say the treatment failed the patient because the condition itself is hard to treat. ”
Or, it’s more accurate to say the “treatment” failed because it targets symptoms rather than a discreet condition.
“Same for treatment-resistant infections or cancers”
This is a false equivalence. Infections and cancers are testable, “schizophrenia” is not. Additionally, if an antibiotic or cancer treatment didn’t work for the majority of patients, the treatment would be deemed ineffective for most people. Those patients would not be labelled “treatment-resistant” if there was controversy about the efficacy of their treatment.
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I like how people compare things like “schizophrenia”, “bipolar disorder” etc. to infections and cancers. It gives Psychiatry the “medical” credence. Internet Gaming Disorder (IGD) should also be compared to those things then. “Schizophrenia” is just as real as IGD. Under the categorisation of IGD are obviously behaviours that people engage in. But there’s a multitude of reasons behind it.
Poor Japanese woman was fraudulently “diagnosed” with “schizophrenia”, but that’s meaningless because NOTHING in Psychiatry is a diagnosis. It’s a categorisation.
Whether they call them “diagnoses” in the US, UK, Japan, India, Kenya or Iran, it’s still a form of scientific fraud. I don’t care if they do this in other medical branches (“Chronic Compartment Syndrome” being an example). Those things aren’t about people’s thinking and the implications aren’t the same.
In terms of her ACTUAL thoughts, apart from other things, the woman thought her husband was fake. Why she thought that? (the answer to that would be an actual diagnosis). None of us know.
To me, Shimpei Hanaoka and Hiroki Suzuki, much like all their other mental health industry colleagues in all other countries, have both engaged in a type of fraud by presenting “schizophrenia” as a diagnosis for this woman’s issues.
I hope the Japanese woman has a reasonable life in the remainder that is left. I don’t know how feasible that will be now given that she’s been branded as a “schizophrenic”.
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Especially, Steve, since the “reasonable and standard” treatments – the antipsychotics / neuroleptics, can actually create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome and they can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome – which they can and do.
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Richard, I have also read this article and yes, in Japan only the family has to agree to a person’s ECT: “When DMC is absent, interventions may still be permissible under the doctrine of presumed consent, provided that family agreement is obtained and the intervention constitutes accepted standard care. JSPN‐endorsed clinical practice recommendations explicitly allow ECT under such conditions.” and earlier: “At the conference, the rationale for ECT… was explicitly explained to the family before treatment initiation. The conference confirmed family proxy consent and that the proposed procedure complied with the clinical practice recommendations for ECT endorsed by the Japanese Society of Psychiatry and
Neurology (JSPN); therefore, ECT was initiated…”.
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Richard, I don’t think that giving mandatory ECT to a psychotic patient is ever ethically defensible. People should always have the right to refuse such treatment. Psychosis should not be seen as a state which must be stopped at any cost and regardless of what the patient thinks.
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Agree 1000%
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Yes. The demonization of non-ordinary states is not science, or medicine.
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Richard, I am not in the least surprised that the authors don’t discuss the cognitive impact of ECT on this patient. The authors’ goal is clearly to portray their decisions as reasonable and justified. It is also thought-provoking that they don’t say anything on the patient’s attitude towards the ECT sessions.
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Japan has some work to do.
I agree that mandatory ECT is not ethical, and that psychosis is not to be stopped at any cost, though the rights of people who are seriously a threat to the community due to their psychosis need to be balanced against the right of society to be protected from reasonably foreseeable danger.
I agree that the authors thought they were doing good and used the report to justify. In a way, I’m glad they wrote this so we could know more about what goes on there. How much goes on that we don’t?
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Richard, since you wish to protect society from the “reasonably foreseeable” danger posed by those whom you consider to be a threat to the community, I would urge you and other psychiatrists to focus much-needed attention on the clear and present danger posed by unscrupulous corporate sociopaths and their venal, apathetic, or complicit enablers responsible for pollution, economic exploitation, and the other manifold ills of the neoliberal order.
I dare say that these players account for a great deal more harm to public health and safety than the solitary troubled individuals whose acts are sensationalized by corporate-friendly mass media.
By the way, do mental health “experts” have a unique ability to gauge reasonably foreseeable harm? I can think of any number of cases where their judgment failed miserably.
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Joel, unfortunately there are cases where a young man with a psychatric diagnosis kills a family member (usually his mother). I don’t think that these young men become killers only because of their mental health issues (there are other factors involved and many perpetrators of matricide don’t have a diagnosis of a psychotic disorder, see e.g. this study: https://www.sciencedirect.com/science/article/abs/pii/S1344622323000688), but this is the simplistic conclusion drawn by the mainstream society.
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Richard, I agree with you that it’s a good thing that this report has been published. To return to the issue of psychosis, only some psychotic people are a threat to their community. This Japanese study does not suggest in any way that the patient was violent and dangerous. As you surely know, there are factors which increase the risk of violence in the case of psychiatric patients, including street drug use and male gender.
And regarding dangerous people with psychiatric diagnoses, psychiatric treatment in the community may be insufficient to protect others. I sometimes read about young men with a history of violence who killed their own family members while allegedly taking psychiatric drugs.
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It’s much more than thought-provoking: it reveals the lack of true interest, concern, and respect for this patient as a thinking, feeling, and autonomous human being.
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Yes, Birdsong, I deliberately used a euphemism…
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Rhetorical aikido. Love it 🙂
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Richard, it seems you’re only interested in symptom reduction, in “proving” the “effectiveness” of drugs or electrical shock. A very reductive orientation.
Time to show some genuine interest in the situations that actually caused this woman to become psychotic in the first place.
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Birdsong, you have always tended to read way too much into what is in my mind and presume I’m just another of those psychiatrists you think so little of.
You have your personal story, and, well, so do I.
To say that I’m reductive is to literally ignore me and what I’ve been writing here after my so-far 3 blogs. You might like shades of gray and more subtle points, but they are there to be seen.
To say that I think psych treatments do so good and can reduce symptoms, as if that’s all I’ve been saying, is, to be charitable, selective reading.
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Richard, my comment wasn’t about you personally. I’m speaking to the epistemic posture you’re using here and how it shapes the discussion. Symptom reduction isn’t the same as understanding a person’s life conditions.
I’m asking you to stay with the framework I’m critiquing rather than shifting the conversation to my psychology.
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Okay, Richard, I was mostly with you in the beginning, right up until you said this: “Giving ECT to a floridly psychotic patient who has not benefited from meds is ethically defensible ( leaving aside the consent issue for the moment) if the primary intent is to improve the psychosis.”
Let’s break this down.
First of all, define “benefitted” and “improve.” According to whom? According to the patient? Because they’re the only one who should be deciding what “better” means to them. They’re the only one whose opinion matters in their own treatment. It doesn’t matter if you think they’re “crazy” or “incapable” or what. That’s just your editorial bias. Believe it or not, not everyone who hears voices or sees things others can’t wants to get rid of that. Some individuals find meaning or significance in these experiences. Others simply learn to live with it. These experiences are not INHERENTLY negative or destructive to all who have them.
Second of all, what do you mean “leaving the consent issue aside for the moment”? How can one EVER leave that aside?? I have no more words for that at the moment.
Moving on, you say, “The MIA report uses quotes in its report, which suggests a possible editorial bias rather than a more journalistic stance. I don’t think it’s out of line to use a term like treatment-resistant schizophrenia for someone who isn’t benefiting from reasonable and standard meds. If you don’t think schizophrenia exists, or that meds are appropriate ( if not coerced), then the quotes make sense, but you’re still putting your finger on the scale.” Interesting. So you don’t see that believing in “treatment-resistant schizophrenia” or “schizophrenia” or “meds” & using those terms without quotation marks is also a bias? You see that as inherently neutral, and anything that deviates from that default is “bias”? You don’t realize that the very concept of “schizophrenia” or “mental illness” or “treatment resistance” is NOT neutral, but a collection of politically weighty social constructs devised to uphold racism, misogyny, homophobia, ableism, and colonialism, both historically and present-day? That purporting these cultural ideas as objective facts & exporting them around the world is ITSELF a form of modern-day colonialism, eugenics, and cultural erasure?? Interesting.
Now onto what you said about ECT. Memory loss is not a rare side effect, it’s not only short-term, and it’s not the only side effect. In fact, even “side effect” is a misleading term. For any kind of psychiatric treatment — whether it’s drugs or a shock to the brain — there are no “side” effects, only effects. We’ve simply decided which of those effects are desirable or undesirable, but that doesn’t influence their probability of occurring. For example, according to some research, SSRI-induced sexual dysfunction is more common than the drug’s ability to relieve depression! But when it’s being prescribed as an “antidepressant,” we call sexual dysfunction a “side effect.” However, when it’s being prescribed “off-label” to treat premature ejaculation, we call elevated mood a potential “side effect.” Same drug, different framing. In fact, if you read Robert Whitaker’s “Anatomy of an Epidemic,” you’ll learn that most psychiatric drugs were originally designed to treat something else, before they observed elevated or calm mood as a “side effect” in a certain percentage of patients, and then they got the bright idea to repackage & market the very same drug as an “antidepressant” or “anti-anxiety medication.” Anyways, I digress. Basically, the same thing applies to ECT. Both memory loss & a reduction in “symptoms” are neither “side effects” nor “main effects,” they are simply potential effects. Lastly, please type “ECT” into the search bar of this site & read literally any article that comes up. I think that’ll change your view of it pretty quickly, if you’re open-minded & willing to have your view changed. I’ll link a few down below for your convenience:
https://www.madinamerica.com/2025/11/electroconvulsive-therapy-ect-its-not-just-the-memory-loss/
https://www.madinamerica.com/2025/08/ect-new-studies-detail-harms-lack-of-efficacy-lack-of-informed-consent/
https://www.madinamerica.com/2025/07/ect-proponents-deny-harms-as-the-tide-begins-to-shift/
https://www.madinamerica.com/2025/09/i-cant-remember-a-single-day-new-survey-shows-disastrous-memory-effects-of-ect/
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Excellent points, Jasmine.
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This is going to be a longer read. I have enjoyed and benefited and appreciated the exchanges with all who’ve posted comments to this and the groupthink essay. I have now done this 3 times and at some point it becomes difficult on my end to track all the comments and respond to almost all, and so this is going to be my final post on these 2 threads, though I will read any other comments that you all make. I’ll respond here to the most recent comments that I saw from 4 of you from last night to now. The MIA forum is a good tool, though I sometimes wish we could just sit together and talk rather than write, but so be it. I see that some of the points you all make I may have addressed in response to others that you didn’t see, but we’re doing the best we can.
(1) Reddy – You’re right that Sackheim is supported by ECT companies and we should make room for that. Some would dismiss it as 100% self-serving. We have the serious problem of – assuming we need research – who is going to do it, who is going to pay for it and how will they influence the findings, who will publish the findings ( negative ones tend not to get published), and who are we going to trust. The government? private foundations? Takes money to do good research. Personal stories are a kind of research, but they can have biases, too.
(2) Birdsong – maybe those Japanese psychiatrist do have a lack of interest, etc., in their patients
(3) Steve – I disagree that intent doesn;’t matter in judging ethics. Just as in law, robbery is against the law, but we allow for other factors in determining punishment. Even malpractice laws take intent into account.
Adverse effects of CPR? – rib fractures, aspiration pneumonia, possible trauma to liver, blood clots and strokes ( as happened to my dad)… And of course these are not intentional
Those who are psychotic and are untreated have every right to refuse treatment; yes, they would continue as before, but it’s not as if that’s no big deal for many. Yes, some people want to keep their psychosis, but it’s hard to accept that that’s the majority.
Jasmine – Something barbaric may be, as I see it, either tolerable or intolerable based on other factors. Nothing barbaric is always tolerable; rape, abuse etc fall into the ‘never tolerable” category. So there is zero equivalence between different barbaric acts. It does fold back on what the word barbaric means, and I don’t think it connotes any kind of intent.
Some people appreciate that I can see more than one side to most issues, and it totally aggravates others. If someone says to me, there is no such thing as schizophrenia, or that ECT is an unalloyed evil, and states it as unquestioned fact, I can’t go there. I know well that the former is tough to define or to find ‘organic pathology,” but to say the alternative is that it doesn’t exist is a bridge too far.
I totally agree that when it comes to evaluating treatment, the treatment-receiver is the captain. I’m allowed to say “maybe you should consider this as well,” but not to say “you’re not better because I don’t think you are.”
And about ECT, I never said side effects were rare. I did respond to those who stated ECT is (case-closed) always the cause of severe and irreversible brain damage by saying it’s less common that 100%. Sorry, but I see that as on a spectrum from zero (rare) to disabling. Hate to say it, but there is a place somewhere between zero and 100 – and I’m not saying it’s some idealized golden middle of 50.
Again thanks to all.
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If you didn’t intend to hit someone with your car and they die, you can still be charged with vehicular manslaughter. There are plenty of examples of the road to hell being paved with good intentions. In every other circumstance, a seizure is a thing to be absolutely avoided if possible, same for electrocution. If someone electrocutes me with the intention of helping me, they would still be responsible if I died. Any reasonable person would know that electrocution or intentional induction of a seizure is medically extremely dangerous. It doesn’t matter that you think it might help. The general danger clearly outweighs any ostensible “benefits” to a minority of individuals. And we do need to remember that the judgement of “positive outcome” for ECT often comes from someone other than the client. I refer you back to my Mack Truck therapy example. Just because some people who have a near-death experience have sudden insight and change their lives for the better does not excuse us pushing people into traffic in order to “help” them. Even if we intend to “help,” and even if it does “help” in some cases, it’s still a criminal act. I see ECT exactly the same way. It’s not acceptable to risk inducing loss of historical memories through brain damage and increase the probability of suicide for some speculative “benefit.” Some things are just wrong. Electrocution is one of them.
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This is a perfect capstone to the debate on “good intentions” in the context of psychiatric treatments that are based on unproved hypotheses.
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“Even if we intend to “help,” and even if it does “help” in some cases, it’s still a criminal act.”
Yup, ‘spike’ the drink, plant a knife and tell the cops he’s an “outpatient” …… and then claim a good faith defense which ……well, we’ll have to “edit” the documents for the lawyers too. Did he know it was criminal? Took the time to conceal the ‘spiking’ from police and the doctors and other staff at the hospital (mens rea)
I’m wondering Steve if this ‘study’ is not going to be produced as evidence every time a psychiatrist wishes to use known torture methods on people who do not wish to have their brains damaged?
I mean, you guys are fortunate to live in a place where the law at least provides some form of protection, but in Australia we have situations like the Garth Daniels one. The Courts literally sit and watch as a doctor tries to kill someone. Glad it was documented, though accountability is not a strong point here. Well, in fact the word has been removed from any medical literature as it is considered a laughable myth…… nobody believes it actually exists.
But I was just thinking about the way that ‘study’ that Whitaker ripped apart was used for years to prove the ‘efficacy’ of anti depressants?
And consider the amount of ‘experimental material’ that would become available if the option to participating in ‘research’ was to have electricity put to your head until you agree? And efficacy of the method was proven by a Japanese study done in ……
It’s not like anyone has even listened to the critique of a lack of efficacy being shown with ECT as is (numerous articles on this on MiA), and so the political use of this study might have the effect of ‘well a psychiatrist said it, it must be true. The evidence is there and the patients chemicals are imbalanced’.
So whilst the circular reasoning might be obvious to those who read here, it may not be so obvious to those who get snared in the web of deceit of those looking to extract cash from the medical insurance companies, and on the lookout for experimental material for pet projects.
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Richard, regarding the concept of schizophrenia, psychiatrists may diagnose “schizophrenia” in a person who clearly does not have a lifelong mental illness. I had a severe psychosis in 2012 and I was diagnosed with paranoid schizophrenia, but the diagnosis was clearly wrong. Not only I don’t have any psychotic symptoms (though I used neuroleptics only for a few months in 2012), but I am also much more mentally resilient than before my psychotic episode.
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I said the other day that I wasn’t going to respond any more, but I’ll suspend that temporarily to respond to Joanna, after which I will declare that I’m not to respond again.
I am more than glad that you, Joanna, have done so well without treatment. Whatever else you’re doing is clearly working, and I hope it continues forever.
I will make a comment here about your diagnosis, even though I wasn’t there, don’t know the history, and didn’t do the evaluation. And I don’t know how accurate your diagnosis was, though I get that you say it was wrong.
schizophrenia is a diagnosis made either using DSM criteria, or even more haphazardly by a careless evaluator. I don’t know which applied to you.
If one believes that there is no such thing as schizophrenia, there’d be no point in going further.
And again, I am not not not here to defend DSM, but since you were diagnosed somehow, maybe they used DSM. We good so far?
I need to get a bit into the weeds. Per DSM definition, schizophrenia has to last 6 months, counting positive, prodromal, and residual symptoms. Nothing there – nothing – about its being a lifetime disorder. You might not like this, but if that was true, then the diagnosis fit based on DSM. If that was not true, you were misdiagnosed. So a person – based on DSM – can be diagnosed accurately if they had some combination of symptoms for 6 months and zero days. One can debate all the rest, but if that’s the basis and those are the criteria, then that;s how the diagnosis should be made. Don’t believe schizophrenia exists? Think DSM is totally bogus? could be, but that’s a separate conversation from the one you brought up about being misdiagnosed. For what I hope is the final time, I’m saying that I’m explaining, not excusing or defending. I hope that’s acceptable.
Thanks. Over and out.
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Many thanks for replying to my comment and for your kind and supportive words, Richard. I really appreciate them!
I was diagnosed with schizophrenia a month after the beginning of my psychotic episode. Before that episode I was normally working (as an academic) and travelling. I had never even seen a psychiatrist or a psychologist before the psychotic episode.
Yes, the psychiatrist who diagnosed me may have simply been a careless evaluator who focused only on the symptoms I had during the psychotic episode and on its length. It is also possible that he jumped to certain assumptions on the basis of what he knew about me. The fact that I do not have a partner (I live in a society much more conservative than the US) and that I had travelled alone to Africa to visit a much older friend may have influenced this psychiatrist’s attitude towards me. He may have seen my “unusual” lifestyle and behaviour as one of the signs of my mental illness.
And all the psychiatrists I have talked to since 2012 have either assumed that the 2012 diagnosis was correct, that I have a lifelong mental illness and that I should take neuroleptics, or that I have been misdiagnosed. No psychiatrist has ever said that I had schizophrenia and recovered, though this would actually make me quite happy!
I simply don’t want to be pressured to take neuroleptics. Unfortunately most psychiatrists don’t focus on my real problems (like the long-term psychological impact of various distressing experiences since my childhood), but on the diagnostic label “schizophrenia”.
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Of course, the unsolvable problem is that because of the utterly subjective nature of the “schizophrenia” diagnosis, there is no way for anyone to objectively determine if you were “correctly diagnosed and recovered” or “wrongly diagnosed.” So it just comes down to the opinion of whoever you are talking to, and if they believe “schizophrenia is incurable,” then you either had to be “misdiagnosed” or you “still have it.” Evidence to the contrary is not considered, because again, the diagnosis is utterly subjective. This leaves patients/clients with no means to establish any kind of accountability, and lets the psychiatrists do exactly as they please without oversight or consequence.
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Steve, I totally agree with you. As you said, the psychiatrists I have talked to assume that schizophrenia is incurable. In consequence, they believe either that I must be incurably mentally ill, or that I have been misdiagnosed.
In my experience psychiatrists who assume that a patient’s schizophrenia diagnosis is correct “see” things which are not there. As an example, a psychiatrist wrote that I have “disordered thinking”. Some psychiatrists also claimed that I have “flattened affect”. Neither of these things are true in my case (I would not be able to e.g. translate academic books if I had “disordered thinking”): these psychiatrists “saw” them in me only because of my diagnosis.
As it seems, many psychiatrists are too attached to their assumptions and usually too reluctant to question the initial diagnosis. The most courageous one said that I have “social phobia with a tendency to psychotic decompensation”. Unfortunately he also believed that I should take antidepressants. Psychiatrists somehow don’t see that my problems (e.g. my tendency to avoid social interactions if I risk feeling judged and/or rejected) are rooted in my experiences.
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My experience is that nearly all of our problems are rooted in our experiences!
It’s past time for psychiatrists to remember that the real purpose of the DSM is to bill insurance companies. The “diagnoses” are almost entirely meaningless scientifically. But they can’t admit this!
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I agree, Steve. However, some psychiatric diagnoses do summarily describe some of the patient’s problems (e.g. panic disorder, post-traumatic stress disorder, depression, narcissistic personality disorder). One can’t say it about the term “schizophrenia” which assumes the existence of such an illness.
I can understand psychiatrists who are convinced that “schizophrenia” exists because they come across patients who have constant or recurring – and undeniable – delusions for many years. However, psychiatrists should not jump to conclusions about a person on the basis of patterns they have observed in *some* patients.
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I agree, I think. It seems that “schizophrenia” exists as a DESCRIPTION OF REALITY, but not as a discrete “disorder of the brain.” I once wrote a post proving that two people could both be diagnosed with “schizophrenia” and not have even one “symptom” in common with each other. I’m not opposed to describing phenomena, but I am opposed to allowing descriptions to be assumed to be reflective of some unifying underlying truth. I don’t think you’re disagreeing with me on that.
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Yes, Steve, I agree with you. You are absolutely right that (even according to the DSM criteria) two people can be diagnosed with “schizophrenia”, though they don’t have any symptoms in common.
When I was at the hospital, one of the other patients I talked to was a young man who said that he had schizophrenia. Despite my efforts I was unable to understand what he was talking about. Me, I once reread the emails I wrote during my psychotic episode and they were very easy to understand, though I was then experiencing terrifying “voices” and delusions.
Unless an objective test proves that people diagnosed with “schizophrenia” have something biological in common, there is no rational reason to assume that this diagnostic label is more than a construct. And this label is so pessimistic and stigmatizing that it does more harm than good.
Because of the “schizophrenia” label I needed many years to stop mistrusting my brain and my intuition, to stop thinking that maybe I was simply having “paranoid symptoms” when I could sense that someone is not honest with me or is unfriendly. Only gradually I realized that my intuition is usually correct, that I sometimes have very good reasons to mistrust a person or that I have correctly interpreted someone’s behaviour as unfriendly.
If I had continued to believe that psychiatrists were to some extent right when they diagnosed me with “paranoid schizophrenia”, I would be very vulnerable because I would keep interpreting thoughts and emotions which protect me from harm as symptoms of a mental disorder.
Someone who is convinced that s/he has paranoid schizophrenia can actually become a perfect victim! I experienced it myself when a person was dishonest and exploitative and I was often trying to suppress my discomfort and mistrust, repeating to myself that I was probably merely being “paranoid”.
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Joanna, you were being psychiatrically gaslit. It happened to me, too. It took time, perseverance, and completely disengaging from psychiatry’s skewed narrative for me to begin trusting my own intuition again after years of trauma and conditioning that taught me to override it.
Not easy to do in a culture that teaches deference to medical authority.
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Birdsong, yes, gaslighting is a very accurate term for what happened to us. What I find striking in my own case is that even though I quickly started questioning and then rejected my diagnosis, it continued to have an impact on me for years.
The “schizophrenia” label also deeply affected my self-esteem. For some years after my release from the mental hospital I felt grateful – too grateful – when “healthy” people did not reject me. I also wanted to prove to others that I was “normal”. This made me very vulnerable.
I now fully accept myself and the life I am leading, I deliberately avoid contact with narrow-minded and/or toxic people instead of worrying that my tendency to solitude might be perceived as a sign of my supposed “mental disorder”.
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Joanna, I so get what you’re saying because I went through the same kind of hell as you, and all because of stigmatizing labels that messed with my head in worse ways than the traumas that got me into their psychiatrized orbit in the first place.
The long, lonely road back to true “mental health” thankfully for me has been worth it 🙂
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Birdsong, I am very happy for you and I can definitely say the same about myself! And – as I have been able to see in recent days because of a crisis experienced by a family member – when people truly need help from “the system”, their needs can be treated much too dismissively.
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Thank you, Joanna. I’m very happy for you, too! 🙂
I would never recommend the Mental Health Industrial Complex to anyone. And if they did I would warn them that it’s at their own risk.
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Birdsong, sometimes there are unfortunately situations when mental health specialists are badly needed, e.g. when a person is destroying his/her life and health through addiction to street drugs. I am experiencing this right now in my family and this is terrifying, especially because the drug withdrawal causes anger and aggression in this family member.
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I’m very sorry your family member is in a bad place, Joanna, and I understand where you’re coming from. I agree it’s of utmost importance to have help from people who know what they’re doing, but I think it imperative that mainstream psychiartists not be the ones calling the shots.
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Thank you for your supportive words, Birdsong. Fortunately the situation has already greatly improved, at least for now. A mainstream psychiatrist is unfortunately the only specialist my family member has agreed to see (I am being so cautious because some “lurker” might have identified my real name). The person I am talking about does not yet feel ready to start psychotherapy, though the psychiatrist has recommended it.
Fortunately in my country psychiatrists don’t prescribe cocktails of psychiatric drugs (and my family member knows about my own experiences). The crucial thing for now is to help the person stabilize emotionally.
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You’re most welcome, Joanna. I’m delighted to hear the situation has greatly improved for your family member, who in my opinion has some crucial advantages: the ability to sense they’re not ready for psychotherapy—a potentially destabilizing relationship, despite what most therapists would have us all believe—and living in a country where psychiatrists don’t prescribe cocktails of psychiatric drugs, almost unheard of in today’s world.
Perhaps the biggest advnatage is this: their knowing about your experience with psychiatry. It could be the very thing that makes all the difference in helping them reclaim their life.
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Birdsong, thank you so much for your very supportive and uplifting comment!
From my perspective, my family member would probably not need any mental health specialists if he had more mental and spiritual strength. I am hoping that he will develop more strength with the support of people who love him – and possibly of “higher forces”.
In fact, I personally increasingly feel that we can draw support from spiritual forces. In my own case, I can sense that I became much stronger since I focused on becoming a better person and stopped feeling uneasy because of not fitting mainstream societal expectations. And – as strange as it may seem – the mysterious inner strength I now feel seems to come from a spiritual source.
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Thank you, Joanna.
I totally agree with your perspective, that most people probably wouldn’t need professional help if they had more mental and spiritual strength.
I think mental & spiritual strength begins with building an honest and compassionate relationship with the inner self, a process made a lot easier with loving support from people who see a person for who truly they are, not as a “mental patient”, a degrading label that too often becomes the impenetrable roadblock to true psychic healing and a meaningful, joyous life built on self-respect, not dependence on professionals out to prove their worth at other’s expense in more ways than one.
I’ve found that begins with compassion for the self, because without self-compassion, life makes no sense.
And I’m thrilled you’ve been discovering this for yourself! 🙂
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Birdsong, yes, self-compassion is crucially important. I may be wrong, but I think that self-compassion can also lead to a deeper – and wiser – compassion for others.
In fact, I can now feel deep compassion for people and at the same time protect myself (as far as possible) when I know that someone can hurt me or exploit me.
To me, the “mental patient” label was not the worst thing, though the “schizophrenia” label has certainly harmed me. I would say that the worst thing for me was trying to fit societal expectations out of fear of others’ cruelty.
As an example, I used to fear that people may patronize me or even mock me as a single woman. I finally realized that I am too afraid of the judgement and cruelty of people I neither like, nor respect, and that I give such people far too much power over my life. Becoming aware of this has been incredibly liberating!
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Joanna, I relate to what you’ve been through. And I think you’re right, that self-compassion leads to compassion for others.
I think self-compassion begins with a growing awareness of how and why we feel the way we do. Self-knowledge makes it possible to question the way we think which greatly affects how we feel and vice versa. This forms the foundation of true spiritual growth.
The ancient maxim “know thyself” is key, because if you don’t know yourself, psychiatry will step in and decide for you. Not a good thing.
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Joanna, I don’t think it’s strange in the least that the mysterious inner strength you feel seems to come from a spiritual source because I often feel the same way too, provided I step back and observe my thoughts and feelings rather than react to them.
This one simple step seems to clear my head and ease my heart of the emotional static that stands between myself and a truly mysterious source of higher spiritual wisdom 🙂
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Joanna, for me, true compassion comes from a healthy self-respect — the kind that lets us feel deeply for others while still protecting ourselves from those who might, knowingly or not, take advantage of our kindness.
It’s a relief knowing you now have a firm grasp on this all-important distinction 🙂
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I definitely agree with you, Birdsong 🙂
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🙂
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YES!
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Richard, I have some serious reservations about your latest post.
You contend that intent matters in ethics. However, one’s perception of what constitutes proper intent is wholly culture-bound and subjective.
I have no doubt that eugenicists (many of whom were prominent psychiatrists in the U.S., Germany, and elsewhere) during the first half of the twentieth century sincerely believed that by sterilizing and euthanizing so-called asocials, schizophrenics, the physically disabled, alcoholics, homosexuals, and other “undesirables” they were acting quite ethically, in accordance with the prevailing values and ultimate goals of their society.
The same motivation informed the mindset of Soviet psychiatrists who forcibly drugged dissidents in mental institutions, as well as the attitude of their American counterparts who administer brain-disabling ECT to infirm dementia patients in nursing homes or prescribe neurotoxins to millions of children worldwide for the imaginary ADHD.
Do these practitioners experience any ethical quandaries? Judging from the shocking conduct of the Japanese researchers mentioned in this article, or from the continued reliance of mainstream psychiatrists on the sham categories of the DSM and their collusion with the Pharmafia in continuing to promote the false biomedical narrative, the answer should be self-evident.
Lastly, I’m troubled by your offhand remark that it’s fine to have a negative view of ECT side effects, but it’s not something that happens to all who receive it. According to what I have learned about this barbaric procedure (I refer to studies by Dr. Peter Breggin, among other experts on the subject), the great majority of people who have undergone it report severe, often lifelong consequences.
In short, based on the widespread, thoroughly documented iatrogenic harms perpetrated by mental health “professionals” over many decades, I have absolutely no faith in whatever rationale they may trot out to justify their actions.
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Experts in psychobabble agree: ‘consent’ is gained by ‘choice’ between shock treatment and chemical lobotomy, torture is ‘ethical care’, and ‘recovery’ is compliance. Take your medicine. (Professionals must be well-trained to administer it.)
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War is Peace. Freedom is Slavery. Ignorance is Strength!
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Yes, newspeak and doublethink (though Orwell himself was rather Orwellian, e.g., cold war propagandist). I also recalled the ‘logic’ of having to destroy the village to save it from the Vietnam/SE Asia war era; just insert patient (still an it) for village to apply to much of modern medicine.
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It’s definitely true that what we consider ethical is partly dependent on our culture and the historical time in which we live. Ethics is a reflection of our (presumably) shared values in a society, and that changes over time time. To pick a non-medical example, sacrificing a child to the gods was considered good and necessary, as was child labor, and (still in some places) female genital mutilation. Those cultures said those were consistent with their values.
Eugenicists in Nazi times and Soviet psychiatrists acted consistent with those cultures’ values and I suppose told themselves they were doing good ( maybe some felt they had no choice without facing their own imprisonment or death), but those values are so far from ours as to be incomprehensible and repulsive. I think it’s bad ethics on the part of the Japanese psychiatrist, too, even though the law might be on his side. Just because something is legal doesn’t make it ethical. Bottom line is to ask oneself ( or as a society) where do we get out values? NOT science, NOT law.
Just because psychiatry still uses DSM and prescribes meds doesn’t mean it doesn’t have quandaries. I follow this pretty closely and, just as an example, there is a new movement to address the problems with DSM in the APA. I hope it’ll be done in good faith or they’ll shoot themselves in the foot again.
With all due respect to Breggin, who has long had his opinions at times affect what he says are facts, to say that it doesn’t matter how many ECTs a person has, the great majority have severe consequences is not a fact. How many matters, bilateral vs unilateral matters, how you measure consequences matters. It’s as if someone said the risks of driving are the same no matter how fast you drive. You don’t believe that, either, and it flies in the face of even common sense. The remark you called offhand was not casually made.
Lastly, I totally get that the idea of ECT sounds barbaric. If you think it’s inherently barbaric to apply electrical stiimulation to the brain, then OK, and then you’ll also be against TMS and other similar treatments on that basis alone. Is that your opinion? If you have seen older (decades ago) videos of ECT, it is barbaric, I agree. But ECT as done for the last 50 (yes) years, if you witness it, is nothing like that, and if you watched it and still said it was barbaric, I think you’d be more upset at the idea of it than what you were seeing in front of you.
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The purpose of ECT is to cause a seizure through electric shock. In any other circumstance, such seizures are considered dangerous and we put people on drugs to stop them from happening. Seizures can and do cause brain damage, that’s why we try not to have people experience them. Whether the term “barbaric” applies or not, we are most certainly courting brain damage any time we electrocute a person, and the results from “adverse effect” studies of ECT bear this out completely.
“Prolonged seizures are clearly capable of injuring the brain.
Isolated, brief seizures are likely to cause negative changes in brain function and possibly loss of specific brain cells.”
https://www.epilepsy.com/stories/meeting-news-do-seizures-damage-brain#:~:text=Prolonged%20seizures%20are%20clearly%20capable,of%20injuring%20the%20brain.&text=Isolated%2C%20brief%20seizures%20are%20likely,loss%20of%20specific%20brain%20cells.
Comparing ECT to “electrical stimulation of the brain” is more than a bit disingenuous, IMHO.
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You’re right that ECT is about inducing a seizure, which is not a good thing in isolation. Yes there is a risk of significant harm which you see at way closer to 100% than I do.
Medicine is full of things that are not good in isolation, but we accept them if the informed patient agrees and we – in good faith – think there are substantial benefits. One can get one’s ribs cracked, not exactly a good thing, in order to perform heart surgery which may not be successful. Not to get into retreading the “psychiatry is not based on definable pathology” business again with you, but to say that some barbaric things deserve consideration sometimes.
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We’ll have to respectfully disagree on that one. Intentionally causing a closed head injury is not “therapy” in my view.
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How many clients are properly informed of the inherent risks in ECT and chemical lobotomies? Actually, how many psychiatrists are fully cognizant of all these risks?
The analogy with heart surgery is unconvincing. A battery of medical tests can detect cardiac pathology; there are no such reliable tests for each of the hundreds of DSM disorders. Given that fact, the possibility of gaining “substantial benefits” by haphazardly tampering with brain chemistry or inducing seizures is highly problematic.
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‘…the informed patient…’ – there’s the rub – especially since the experts (‘we’?) aren’t that well-informed themselves.
‘…some barbaric things deserve consideration…’ – you may want to reconsider that formulation, which among other things sounds like an instance of the (psychiatric) groupthink you just got through critiquing in your MIA article 1/27.
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Richard, a heart surgery in the circumstances you describe saves a person’s life. One can’t say the same about ECT in the case of psychosis.
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Sometimes the surgery itself causes death on the OR table.
Some severely suicidal people find ECT lifesaving.
In both cases the intent is to do good.
In both cases it doesn’t always work.
In both cases they’re never the first thing to try.
In both cases it can appear barbaric.
In both cases there are risks of serious harm.
In both cases they should never be coerced.
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BINGO.
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@Richard: And THIS formerly severely suicidal person found getting the hell away from psychiatry to be life-saving! Maybe THAT should be the standard treatment, eh?
But seriously, I have some food for thought for you. Barring eating “disorders” or substance use “disorders” (which are the only “mental illnesses” with direct medical consequences), name one “mental illness” that you can actually DIRECTLY die from. Technically the mortality rate of all “mental illnesses” should be zero, right? Because it’s not the “illness” itself that kills a person, it’s suicide (or other causes). But we don’t count suicides as part of the mortality rate for any other illness, do we? And if psychiatry is just like any other branch of medicine, then why do you think this is the case? For example, if a person labeled with depression kills themselves, we say the depression is what killed them & count that as part of depression’s mortality rate. But if a person with cancer kills themselves, we don’t say they died of cancer. We say they died by suicide. It’s not considered part of cancer’s mortality rate; that would be absurd. In fact, people might even say they died because they must’ve been “depressed” or had some other “mental illness” that was “undiagnosed” while they were alive. So why the double standard?
If “mental illnesses” were real, caused by biochemical malfunctions in the brain — what some consider to be the most important organ in the human body — you’d think there’d be a way to die of them DIRECTLY if left “untreated.” Why do you think there isn’t?
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Richard, good to know that you agree that ECT should never be coerced. You say that some severely suicidal people find ECT life-saving, but we are talking here about their belief, not an objective fact. A person can overestimate the effectiveness of psychiatric treatment and overlook other factors.
You say that “the intent is to do good”. When ECT is used in the case of psychosis without the patient’s consent, psychiatrists assume that they know better what is good for the patient and that the possible negative effects of the treatment are not important.
Psychosis is very often linked to psychosocial factors, including traumatic experiences. It can even be a reaction to a traumatic experience. In consequence, when ECT is used to stop or reduce psychotic symptoms, all the negative psychosocial factors in the patient’s life are completely ignored.
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And I see another problem, Richard: yes, ECT is not the first thing psychiatrists try. However, the first thing most psychiatrists try in the case of psychosis are various neuroleptics. They don’t take into account other possible ways of improving their patients’ state.
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Yes, Richard, you are right: I certainly do strongly oppose any type of electrical and magnetic stimulation or chemical lobotomy of the brain for the purpose of altering emotional states that have not been definitively proven to originate in physical pathology.
I am not convinced by your argument that there can be a “safe” or acceptable level of ECT, nor that modern ECT procedures are an improvement over previous ones. Certain vulnerable individuals may suffer irreversible damage to their cognitive functions even after brief seizures, as Steve pointed out. The risk of severe harm from such haphazard “therapy” far outweighs any of its dubious benefits.
This potential damage is also true of the neurotoxins that you continue to euphemistically and misleadingly label as “meds,” all of which can wreak unpredictable havoc, especially in the bodies and brains of elderly patients and young children.
I cannot but wonder if psychiatrists whose children exhibit intractable emotional and behavioral problems subject them to the same “treatments” which they so readily recommend for their clients.
That would be a most interesting topic for the MIA website to cover.
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Well, I appreciate your consistency in your arguments.
whoever has the most leverage in whether we call things therapy or neurotoxins or meds or treatments tends to win the arguments; some things fall into more than one category, but I know that many don’t see it that way. If one – and this will be my final point with you – says that war, for example, is by definition only a barbaric effort to kill one’s enemies ( with collateral damage), then there can never be a just or necessary one; its barbarity trumps any other view
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There’s that False Equivalence logical fallacy again! Just because you can apply a certain argument to war, doesn’t mean you can apply the same argument to anything else labeled “barbaric.”
Let’s replace war with a different barbaric act. How about child abuse? Rape? Slavery? Lobotomy? Are those ever “just” or “necessary”? I would hope the only way you would consider answering that is with a resounding “OF COURSE NOT!” So just because you could argue that not all things considered “barbaric” are always bad, doesn’t mean that all things considered “barbaric” are NEVER bad. Would you say, “well war is considered ‘barbaric,’ but it is sometimes just or necessary, so therefore child abuse/rape/slavery/lobotomy is sometimes just & necessary, too”?? So then why would you apply that logic to ECT or other forms of “treatment”?
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Richard, if, as you claim, Dr. Breggin’s opinions distort his perception of what you consider to be the facts regarding the harm of neurotoxins, ECT, and other brain-disabling treatments, would you be kind enough to cite examples of his bias? He’s had decades of experience in this field; do you question his integrity and competence?
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Cite examples? Nah. This psychiatrist has written 3 blogs on MIA and has only cited 2 sources, both of which were about group think. I think bad faith ‘debate’ and unsubstantiated arguments are all your gonna get.
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Medical professionals in North America and Denmark perform coerced sterilizations on Indigenous women. It’s less popular, but still happens. Your contention that Nazi Eugenecists values “are so far removed from our own” reflects an overall arrogance dressed up as rationality.
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Jane, that those things are done is abhorrent and counter to the values of most of us. That they are done is indefensible, but I don’t agree that their still being done means that our society endorses them as ethical.
I don’t; know if those are crimes, but they should be. That we call some things crimes ( murder, bankrobbing, assault) tells us that they’re counter to our (mostly) shared values.
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Richard, the mass drugging of children (whose parents are usually NOT properly informed of its documented harms) with neurotoxins and the mass administration of ECT to dementia patients (disproportionately elderly women) should be abhorrent and counter to the values of right-thinking sensitive people. It’s quite obvious, however, that these vile “treatments” are obviously NOT counter to the values of the practitioners who perform them, whether out of misguided belief in their efficacy, out of vanity to pose as medical professionals, or simply out of sheer greed.
Ralph Nader, citing a study from the Harvard Medical School, has stated that iatrogenic illness in the U.S. accounts for some 100,000 deaths annually as well as untold numbers of people crippled or otherwise injured as a result of medical malpractice.
No doubt a very large proportion of those cases can be attributed to practices that psychiatrists still regard as “standard,” “reasonable” and “ethical” despite all evidence to the contrary.
Flagrant psychiatric abuse of the helpless, persecuted, and marginalized, and did not stop with the defeat of Nazi Germany or the collapse of the USSR. It continues on a mass scale throughout the world to this day, with the active or tacit connivance of the APA guild, powerful corporate interests, supine regulatory agencies, and other institutions. This situation did not arise by happenstance. The sordid history of psychiatry clearly shows that, irrespective of the social and economic system in which it operates, it has always placed the pursuit of power and profit over the well-being of “patients” (i.e. victims).
I refer you to the excellent studies on this subject by Jeffrey Masson, Bruce Levine and Phil Hickey.
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“With all due respect to Breggin, who has long had his opinions at times affect what he says are facts, to say that it doesn’t matter how many ECTs a person has, the great majority have severe consequences is not a fact.”
What evidence do you have that “the great majority have severe consequences is not a fact”?
Self-reports suggest that the majority of patients suffer long-term memory loss (not just short-term memory, as you stated in your other comment.)
https://www.bmj.com/content/bmj/326/7403/1363.full.pdf
https://www.sciencedirect.com/science/article/pii/S2666915325001386
https://connect.springerpub.com/content/sgrehpp/early/2025/09/19/ehpp-2025-0009
“Lastly, I totally get that the idea of ECT sounds barbaric. If you think it’s inherently barbaric to apply electrical stiimulation (sic) to the brain, then OK, and then you’ll also be against TMS and other similar treatments on that basis alone. Is that your opinion?”
Yes, that is my opinion. It’s inherently barbaric to apply ‘electrical stimulation’ (i.e., electric shocks) to the brain. Animals are given electric shocks before being slaughtered; this isn’t done to “treat” their mental health symptoms, but to anesthetize them.
“If you have seen older (decades ago) videos of ECT, it is barbaric, I agree. But ECT as done for the last 50 (yes) years, if you witness it, is nothing like that, and if you watched it and still said it was barbaric, I think you’d be more upset at the idea of it than what you were seeing in front of you.”
So, ECT is less barbaric than in the past because it’s less distressing to watch? Are you serious?
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No it’s less barbaric because the person who receives ECT these days – and for the last 50 years – gets this under supervision of an MD and a nurse-anesthetist in a sterile setting, is sedated and anesthetized for maybe 20 minutes ( this after being medically evaluated first), does indeed have a seizure which is usually manifested by a extension of the feet of about 3 inches, after which they awake from sedation, are monitored until fully awake.
It’s less barbaric because of what the patient expereiences and reports.
I respect that you think the idea of inducing a seizure is in itself barbaric.
I understand that you think the treatment itself has no value and only causes harm, and maybe that’s part of why you call it barbaric (ie, not what I just described).
I wonder if you see applying electricity to a stopped heart barbaric. Maybe, since you are against using electricity to shock a person, you’d say it’s barbaric and worth doing. The intent there, as in ECT (OK you probably won’t agree) is to do good. Maybe you’d say electricity makes it barbaric and we shouldn’t do that, either.
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Oh, come on, Richard, comparing this to a stopped heart is beyond the pale! If a stopped heart isn’t restarted, the person dies. If a person isn’t given ECT, they simply continue to experience what they did beforehand. And again, the intent is not the point here. The adverse effects are well documented, and can be quite serious, including a fairly dramatic increase in suicides. Does that happen after cardiac resuscitation?
I find your argument quite disingenuous.
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“It’s less barbaric because of what the patient expereiences and reports.”
Where are these reports? Where are the patients who experienced both kinds of ECT, and deemed the new method “less barbaric”. I’m seriously asking. Also, I’m unsure how ECT being “under supervision of an MD and a nurse-anesthetist in a sterile setting” makes the practice “less barbaric”. Is female genital mutilation less barbaric if it’s done by a doctor in a sterile setting? No. The “sterile setting” is to make the practitioners feel better. One could argue that a “sterile setting” is more barbaric because it’s hiding the practitioners’ true intentions:
“No better judge of therapeutic results can be had than the exhausted and pessimistic employees who have labored for years with these people.”
http://www.ectresources.org/ECTscience/Brussell___Schneider__1951_regressive_ECT__brain_damage.pdf
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“electricity makes it barbaric”
The voltage, yes it does.
Electricity applied to the brain in ECT is inducing brain damage. That is it. The normal operating voltage of the human brain is in the micro volt range. To see a (normal) brain waveform on a monitor it has to be amplified a thousand times. Using electricity is a magicians trick, to pretend a lobotomy has not taken place. If the person is healthy enough they usually survive from the injury. The friends and family of the person do not see any brain operation scars afterwards.
A claim of “no harm to the patient from the procedure” can be made with no visible scars, as the elite judge themselves.
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It’s a fair challenge. I suppose I could say that I’ve also had decades of experience, which I point out for 2 reasons (1) it’s true and some consider me an expert and more importantly (2) trying to balance who’s more credible when you have experts on both sides of an issue is tough, as I expect you’d agree. Court cases are full of ‘expert witnesses’ supporting opposite sides of some issue.
In reading Breggin, I find that his starting point is that biological treatments are generally unjustifiable, and he tends to be selective in pointing out evidence that supports that view. He leaves out or minimizes or downplays evidence to the contrary. We all are prone to that, it’s confirmation bias. It just leads to a skewed view.
Examples re ECT (1) outcomes are the same or worse than placebo (2) ECT is always traumatic to the brain (3) ECT always causes severe and irreversible brain damage (4) He sees ECT in a way that blurs clinical and political and ethical issues (5) He sees it as a moneymaker
I am not saying that everything he says is false or invalid. I am saying that, as a source of fair-and-balanced information, he’s not reliable. I suppose you can say that of me if you like, but to think there is only one side to the ECT story and it’s Breggin’s, it’d be like getting your news from a single source.
Joel – what follows is long and a little technical, but it’s posted by David Healy, a longtime MIA friend. it’s a post from the Critical Psychiatry Network, another MIA friend, in which some of Breggin’s conclusions are looked at with, as I see it, more balance than he provides. Just trying here to give you a full answer.
Critical Psychiatry Network list [mailto:CRITICAL-
[email protected]] On Behalf Of Bernard Carroll
Sent: Friday, May 16, 2014 11:06 PM
To: [email protected]
Subject: ECT thread
It seems that at least some CPN folks want this ECT thread to continue, so I will try to oblige.
This post will discuss the issue of brain damage related to ECT. This post is a long one – but
you asked for it. It is long because Peter Breggin has disseminated so much reckless dogma
to suit his dire narrative of ECT and its horrid dangers. Other CPN members have raised
some further issues, which I will think about for a future post. Sufficient for this day is the
content thereof.
In this thread I already put paid to Peter Breggin’s misinformation about cognitive side
effects of ECT. The Sackeim report isn’t what he says it is. Now he darts to the issue of brain
damage caused by ECT. Okay, let’s look at that.
Within this thread, Peter Breggin has asserted “In very careful animal experiments, we see
small hemorrhages and cell death” (associated with ECT). He also stated “ECT is closed-
head injury caused by multiple traumatic effects of ECT (heat injury, electrical injury,
breakdown of the blood brain barrier, exhaustion of neurons from extreme seizures,…” He
further mentioned “…how ECT disconnects the frontal lobes in depressed patients…” His
major source for these claims – called “the most important study” on his website – is a 1952
report by Hans Hartelius from Sweden about the neuropathological effects of ECT in cats
[Acta Psychiatr Neurol Scand. 1952;27(Suppl. 77):1-128].
Yesterday I did some homework reading Hartelius – all 128 pages of his monograph. Except
for one key section, it is exemplary for its judicious balancing of the evidence and for its
consideration of potential bias. Sadly, I cannot say the same for Peter Breggin’s account of
its findings – his characterization of Hartelius is just as biased and tendentious as was his
characterization of Sackeim.
Regarding brain hemorrhages, Hartelius was crystal clear that hemorrhages are NOT
caused by the ECT. Hartelius returned to this subject several times in his monograph. He
concluded that hemorrhages occurred during the surgical process of extracting the brains
from the cats, which were still alive at that time. They occurred in control and shocked
animals. He opined that ECT made the shocked cats more likely than controls to develop
these traumatic surgical hemorrhages, but he went no further than that. This clear and
balanced statement was transformed into misinformation by Peter Breggin, who asserted
that ECT causes brain hemorrhages. It doesn’t. Period.
As for cell death, Peter Breggin again misrepresents what Hartelius reported. Here is
Hartelius: In the frontal lobes, “…the nerve cell changes noted were slight and fairly
infrequent. The majority of the nerve cells, even in those animals subjected to most intense
treatment, exhibited no changes” (page 100). Finding possibly irreversible neuronal changes
(shadow cells) was like finding a needle in a haystack – the proportions were not stated
explicitly, but from the context it seems they numbered under 1% of neurons. For instance,
only 18 such cells were seen in 3 frontal lobe regions across 31 cats that received ECT on
very intensive schedules (3-4 ECTs daily at 2-hour intervals for up to 4 days). This
represents examination of 93 frontal lobe region specimens, with hundreds of cells viewed in
each section. Hartelius commented, “If the extremely large number of nerve cells examined
– several hundred in each specimen – is taken into account, the very small figures are
remarkable.” Most importantly, there was no difference on this measure between
control and ECT cats (page 102). [Keep in mind that brain cells are constantly dying. Large
numbers of them die during migration and differentiation, and we now are aware of
neurogenesis and migration of neurons in the adult brain – something of which Hartelius in
1952 had no knowledge.] Hartelius goes on to state “True neuronophagia seemed to be still
more rare. It was not observed in any of the control animals and could only be suspected on
seven occasions [out of many hundreds of cells examined] in the animals subjected to
ECT.” Hartelius went on to state: “Single, small areas with suspected dropping out of cells
were observed sporadically in animals subjected to larger series (11-16) of ECT’s and with a
longer survival time (group B). In only one specimen could this finding be considered as
definite… It was a question of a few cells in 7 specimens out of the total
282examined…” (page 103).
On the basis of these findings involving either 7 dying cells out of unspecified hundreds or a
few suspected but not definite cells in 7 specimens out of 282 or just a single definite
observation in 282 specimens, and supported by no statistical analysis, Hartelius concluded
that the question of irreversible neuron damage should be answered in the affirmative. He
went on to qualify this conclusion as follows: “The changes found were not, however,
extensive; they affected only a small minority of the nerve cells and occurred principally in
those animals given the largest series of ECT’s.” Those animals were subjected to intensive
ECT regimens – three to four treatments at 2-hour intervals daily for 3 to 4 days (11-16
ECTs total over 3-4 days).“With regard to the animals given less intensive treatment – i.e., 4
ECT’s only [at 2-hour intervals on a single day] – it may be concluded that it was not
possible to demonstrate any irreversible nerve cell damage of any consequence” (page
103).
The first question for us is how solid is the key finding? It is impossible to tell, because the
results were described so vaguely and inconsistently. This is one area where Hartelius’
rigorous presentation of the data was substandard. A hard-nosed statistician would say the
key finding is not solid – the Fisher Exact 2-tailed probability on the one confident call out of
282 versus zero for the control group is 0.9999. The second question for us is how
generalizable are these results anyway to the clinical setting today? The old regimens of
regressive ECT or multiple monitored ECT are not in use today, so the ECT schedule (11-16
ECTs over 3-4 days) of the cats in which Hartelius found “true neuronophagia” is not
comparable to today’s clinical context. Considering the small effect size, there is no basis in
Hartelius for Peter Breggin’s assertion of “disconnection of the frontal lobes” resulting from
the minor neuronal dropout reported.
In saying this I do not adopt a cavalier attitude towards loss of any neurons. At the same
time, I do call out Peter Breggin for extrapolating his inference about functional significance
well beyond what can be supported by the observed changes.
Turning now to the alleged heat injury caused in the brain by ECT, Hartelius once again
contradicts Peter Breggin. What heat injury? Hartelius discusses this matter on page 106 as
follows:“The quantity of electricity passing through the brain was therefore so small that it
would only raise the temperature in it by at most 0.003o C. … this thermal effect… would
never reach such a level at any site that it could be considered as a possible pathogenic
factor in the neuropathological changes.” So, this scare tactic by Peter Breggin is not based
on solid science – or on any science. It is just another fabrication in service of Peter
Breggin’s dogmatic narrative.
Next we have Peter Breggin’s claim of electrical injury. Once again, here is Hartelius (pages
23 and 106): “Broadly speaking, the existing experimental data warrant the conclusion that,
with the doses of current applied in ECT, the current is distributed relatively evenly over the
whole brain, with a moderate increase in the direct path between the electrodes. In other
words, the brain behaves as a relatively homogeneous conductor.” And, “… the greater part
of the current was received by the integument and only a small proportion – about 5 per cent
– by the brain.” Finally, “In view of the small quantity of energy, it does not appear
reasonable to ascribe the neuropathological changes associated with ECT directly to the
effect of the electric current.” Once more, Peter Breggin’s scare tactic has no foundation in
Hartelius – whose work Breggin himself calls “the most important study.”
Another claim by Peter Breggin in this thread is that “exhaustion of neurons from extreme
seizures” occurs. Again, Hartelius disagrees: “Summing up the observations made in various
physiological experiments, it may be stated that a considerable increase in neuronal activity,
with concurrent relative hypoxaemia, takes place during the seizure.
“It nevertheless appears unlikely, on several grounds, that neuronal hyper-activity – either
exclusively or mainly – could explain the neuropathological observations made in the present
study. It is scarcely conceivable that only a minority of the nerve cells would take part in this
activity, yet few of them exhibited changes. On the contrary, Toman et a1.
105 pointed out that
all the neurons could be assumed to partake in the output of energy during the convulsions.
Therefore, if this factor is to be assumed to contribute to the pathogenesis, it must
reasonably only be in combination with some other factor and would then play only a minor
ro1e” (pages 107-108). Here again, Peter Breggin’s assertion is not supported by the
primary source – quite the opposite, in fact.
Additional, nonspecific, pathological changes were described in the form of microvascular
changes, glial reaction, increase of satellite cells, breakdown of the blood-brain barrier, and
altered chromaffinity of nerve cells (increased in the nucleus and decreased in cytoplasm).
Based on these pathologic features, Hartelius attempted an unbiased (i.e., blinded) global
assessment of shocked versus not-shocked status in brain sections. These global judgments
were only moderately accurate. The casewise accuracy for correctly recognizing that the cat
had received ECT was 7 of 13 (54%) at 2-4 days. At 8 days the accuracy was only 1 of 9
(11%). He found the nonspecific changes most often in the period between 2 days and 4
days after the series of ECTs. By 8 days, the incidence of these changes decreased
significantly: 54% (20/37) of frontal lobe specimens examined at 2-4 days were rated as
having received ECT, and at 8 days only 26% (7/27) were so rated (p < 0.025) (page 47).
Hartelius did not look past 8 days, so his data do not allow a statement of the permanence of
these nonspecific pathologies. Clearly, however, they were resolving by 8 days. Moreover, in
the hippocampus and cerebellum, these nonspecific pathological changes were even less
obvious than in the frontal lobes, and control cats could not be distinguished from the ECT
cats (page 76). Once again, the drastic picture suggested by Peter Breggin is not supported
by the primary source. In particular, there is no basis here for the assertion of “permanent”
brain damage resulting from even these highly intensive ECT schedules.
In summary, the 1952 report of Hartelius is described by Peter Breggin as “the most
important” study of brain pathology following ECT. However, Dr. Breggin’s interpretations of
the Hartelius study either have no basis in the primary report or go well beyond permissible
inference. In addition, the research design in respect of the ECT session schedule was
inappropriate for today’s clinical context, and the duration of follow-up was inadequate to
address the question of permanent brain damage. The key reported finding in Hartelius of
neuronal death after ECT is not supported by strong evidence; it has no statistical power;
and it cannot support the strong inference claimed by Peter Breggin about ECT as a “brain-
disabling” treatment.
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“…to think there is only one side to the ECT story and it’s Breggin’s, it’d be like getting your news from a single source.”
No one said that Breggin was the only side / single source of information on ECT.
“…he tends to be selective in pointing out evidence that supports that view. He leaves out or minimizes or downplays evidence to the contrary. We all are prone to that, it’s confirmation bias. It just leads to a skewed view.”
With all due respect, the email you posted says David Healy disagrees with Peter Breggin’s interpretation of the Hartelius report. That’s all it says. Healy ignores Breggin’s other sources (Alpers and Hughes, Ferraro and Roizen) and editorializes throughout, e.g., “It is just another fabrication in service of Peter Breggin’s dogmatic narrative.”
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Well, Joel asked about Breggin, whom he considers a reliable source.
I’m jut saying there’s more than one view on that, and I didn’t say that Breggin is totally off, but I do think he’s got biases not based on a fuller look at the data.
Healy disagrees with Breggin.
Can’t speak for Healy, but he’s the one who called Breggin’s work a fabrication and dogmatic. I didn’;t go that far.
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“Well, Joel asked about Breggin, whom he considers a reliable source.”
No. Joel asked “would you be kind enough to cite examples of his bias?” Your response was “… as a source of fair-and-balanced information, he’s not reliable.”
“…but he’s the one who called Breggin’s work a fabrication and dogmatic. I didn’;t go that far.”
I said: “Healy… editorializes throughout, e.g., “It is just another fabrication in service of Peter Breggin’s dogmatic narrative.” Please don’t misrepresent my words.
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All I’m hearing is “both sides, both sides!” There’s that Middle Ground Fallacy rearing its ugly head again!
Some issues don’t have two valid sides. Not everything is better in moderation.
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The classic “reasonable middle” posture is meant to protect psychiatry as the center of power; it’s the structure beneath its performance.
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“All I’m hearing is ‘both sides, both sides!'”
Exactly. Fog dressed up as nuance.
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David Healy: “The anti-psychiatrists had a number of powerful weapons in their armoury. One was ECT and the other was Tardive dyskinesia. There is no question that ECT works – the problem with it and for psychiatry was its visibility, which led to its pivotal role in the movie One Flew over the Cuckoo’s Nest.”
https://www.pharmapolitics.com/feb2healy.html
“There is no question that ECT works…”
David Healy, a reliable source of fair-and-balanced information.
I’d also like to add the ‘unbiased’ dedication from Shock Therapy–A History of Electroconvulsive Treatment in Mental Illness: “It was a small band of European émigrés—Italians, Germans and Austrians, and Jews for the most part—who saw the merits in electroconvulsive therapy and sustained its use despite professional antipathy and ostracism, and public and governmental attacks. They are unacknowledged heroes in the twentieth-century history of psychiatry. This book is in their memory.”
Furthermore, Sackeim’s lab was partially funded by MECHA and Somatics, the manufacturers of ECT machines. His research is not ‘unbiased’ either.
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Presumably, there are studies, findings, etc., etc. determining safe levels of ECT or absence of harmful effects if not help from exposure. How independent are these sources of the very racket going by the name of health care? Time and again, all that’s proved is the metrics of the so-called science are determined by industry like big pharma and self-enriching elites of capital rule. “Lies, damned lies, and statistics.” (Mark Twain)
Besides, why trust any source at all telling us there’s acceptable levels of harmful things people in positions of power would like to expose us to? As in there’s a certain amount of poison that’s good for us, and all the better for profiteers of business long operating like organized crime (i.e., the pharmafia). It may amount to more psychobabble or cliche to use the all too familiar term, but doesn’t this sound like gaslighting we deny at our own risk?
A book well worth reading in regard to the subject of electricity, including its contribution to modern ‘disease’ of industrial capitalism, is Arthur Firstenberg’s The Invisible Rainbow. Common sense and basic knowledge, which have been misshapen and destroyed by industrial medicine, goes far (though not far enough in altering our conditions of slavery) in this and so many other cases of human health. Then there are, as here with MIA, the personal stories of people exposing the truth, often after having suffered the lies, which are predictably discounted, merely anecdotal for instance, or simply censored and repressed by Science, Inc.
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It is just MK Ultra rebranded as beneficial….
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Posting as moderator:
You are correct, it was a “strawman argument.” I’m afraid this whole exchange was extremely complicated, and I may have allowed some things I perhaps should not have because they were embedded in some long posts with many aspects. I do appreciate you pointing that out. I am hoping you feel your response is sufficient to counter the mischaracterization of your post. If it is not, please feel free to contact me off line at [email protected] and we’ll come up with a plan to address it.
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This reality of over-reach with ECT and coercion makes me existentially sick and brings me to tears. . When my deceased daughter as a young teen was more intact, coherent and NORMAL before coercion, she timidly begged not to take antipsychotics while following the departing attending physician and his resident down the hall. I shared this observation in a group meeting. The psychiatrist did not like being outed and with restrained indignation he stood up and said, “ECT works really well for that affective stuff, ” and walked out. Just like that he telegraphed his plan, and that’s the way things eventually went within two years and we lost our daughter, and she lost everything that made life worth living.
I failed to protect my daughter because I was ignorant, too trusting, and at a critical moment made a hasty decision because I feared that she was in danger of having a seriously bad reaction to Bactrim, based on a recent problematic exposure. Our family history had already stigmatized us and that dynamic was very harmful. There is no incentive to slow the process for allopathic designs once a psychiatric history or symptom is present, due to the conflicts of interest.
Especially for children, the laws need to change. A parent should not be expected to have the Treatment Plan all figured out. The first thing that needs to be done is to apply a holistic lens to avoid psychiatric capture. I am expecting and demanding the impossible; yes that’s TRUE. Psychiatry, take your toxic plans OFF children!
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