• • • 1 J • • • • • SHOCK ItsBrain-DisablingEffects · • • • • • P~TER ROGER BREGGIN, M.D. • • • • • •• • • (continuedfromfrontf7ap) The author also examines e case .:- . E • in the treatment of depressed and ~""""'::I.l tients. With scientific rigor and seasooerl • ment he shows thaI the efficaC\' of deCI:1ilStlOCio: for the seriously de. ,es.sed ~ no berr • that of placebos. ECT has a .e!). specific an power-r, • • o the in .. ual. one !.hat rea~ be-.,; pia ebo and be, ond intimidar"o , P - :. - •ELECTROSHOCK-a therapeutic modality Iogica! in origin the effect has ,'asr psfdJo­ helping thousands of sufferers yearly, or a ogical and erh.ica1 implicarions, This <'<v.um"" • treaunent advocated by experts leaving pa­ pIO.:des professionals, srudems, ilie .~ tients \vith disabled minds and crippled memo­ of .patients, and all concerned v,;!.h -" e treal­ • ries? The controversy over electroconvulsive mem f mental illness with a pe.,eua in~ therapy (ECT) is building in the medical, legal, anal, sis of a twentieth-centurv "miRd-<fu­ • and consumer communities. Dr. Breggin pro­ abling" therapy. ' vides a highly original, lucid, and thought­ • provoking contribution to the debate. He com­ piles and analyzes the medical literature that • points to permanent brain damage and mental dysfunction caused by ECT. • Vr'hile accurate data on the prevalence of ECT are scarce, the author presents epidemio­ • logical evidence that suggests that as many as .J. 100,000 persons are subject to electroshock each year by psychiatrists. The results include confusion, global disruption of intellectual ~ • e function, impaired judgment and insight, and shallow emotional reaction. Dr. Breggin also documents tbat permanent and serious brain dysfunction-especially retrograde and antero­ grade amnesia-is a common result of electro­ shock. Here is the evidence of ECT brain damage from animal research, human autopsy studies, brain-wave and neurological investiga­ tions, clinical reports, and the anguished ob­ servations of patients themselves: Peter Roger Breggin, M.D., is the found~r and executive director for the Center for L'le Study "Returning to a home and family following of Psychiatry, a nonprofit research and educa"­ shock was a truly bewildering experience. tional institute to examine the impact of psy­ ] had entirely forgotten how to accomplish chiatry upon' individual well-being, personal even the simplest tasks. To this time, years freedom, and civil liberty. He has served on later, many of the memories needed daily to the faculty of the Washington Schoo! of Psy­ accomplish my duties as a human being and chiatry and as Director of its Projecr to Ex­ also wife and mother ofother human beings amine Psychiatric Technology. He has a pri­ remains shrouded. Any relatively new skills vate practice in Bethesda, Maryland. or knowledge acquired prior to shock were forgotten. A few remnants remain in cor­ Jacket design by Mina Greenstein ners of my mind, but realistically speaking they are gone. So far I have not been able to relearn them, although] have tried. " SPruNGER PUBLISHING COMPANY 200 Park Avenue South, New York, N. Y. 10003 Pnnlcd in USA Electroshock: Its Brain-Disabling Effects EI Peter Peter Roger Breggin, M.D., is in the private practice of psychiatry in Bethesda, Maryland. He is the founder and executive director of the Center for the Study of Psychiatry, a nonprofit research and educational institute formed to examine the impact of psychiatry upon individual well-being, personal freedom, and civil liberty. Its board of directors includes psychiatrists, psychologists, lawyers, and congressmen con­ cerned with psychiatric reform. Dr. Breggin was graduated with honors from Harvard College in 1958 and from the Case Western Reserve University School of Medicine in 1962. He completed his psychiatric training at the State University of New York, Upstate Medical Center, in Syracuse, and at the Massachu­ setts Mental Health Center in Boston, where he was also a teaching fellow at Harvard Medical School. He has been a full-time consultant to the National Institute of Mental Health. Dr. Breggin has written many professional and lay articles dealing with scientific, ethical, legal, and political issues in psychiatry. He has previously published three books, including a novel, The Crazy from the Sane (Lyle Stuart, 1971), which deals with ethical and political issues in ~ psychiatry, His forthcoming book, The Psychology of Freedom (Prome­ 1I theus Books, in press, 1980), presents a philosophy and psychology of life based on free will, personal freedom, and the capacity to reason and to love. Electroshock: Its Brain-Disabling Effects Peter Roger Breggin, M.D. Springer Publishing Company New York For my wife and best friend, Phyllis Lundy Breggin Contents Preface 1 Major Issues Epidemiologic Data Prevalence of ECT in PrilNltf! ECTandthe Selections from One Hundred Years of Psychiatry by Emil Kraepelin (New York: Citadel Numbers of Press, 1962) and from Shock Treatment Is Not Good for Your Brain by J. Friedberg (San The Type of Francisco: Glide Publications, 1976) are reprinted with permission, The Patient p..... Copyright © 1979 by Peter Roger Breggin The Legal Statusm TheECTCon~ All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, Inc. 2 Springer Publishing Company, Inc. 536 Broadway New York, NY 10012 91 92 93 94 95 / 5 4 3 2 Pennanent)\nb5~ Library of Congress Cataloging in Publication Data The Reliability m Breggin, Peter Roger, 1936­ Subjective ~ Electroshock, its brain-disabling effects. The Subjective ~ Bibliography: p. Includes index. 3 1. Brain damage. 2. Electric shock therapy­ Complications and sequelae. 3. Electric shock­ Gross and Mio1N • Physiological effect. I. Title. [DNLM: 1. Shock Unmodi6ed therapy, Electric-Adverse effects. 2. Brain damage, Behavioral Chronic-Etiology. WM412 B833ej RC386.2.B73 616.8'912 79-15223 Biochemical ~ ISBN 0-8261-2710-X ISBN 0-8261-2711-8 pbk. <4 Human~ Printed in the United States of America Content5__________ Preface ix 1 Major Issues in Electroconvulsive Therapy 1 Epidemiologic Data 2 Prevalence of Usage 2 ECT in Private Profit-Making Hospitals 4 ECT and the Individual Psychiatrist 6 Numbers of ECTAdministered to Individuals 7 The Type of ECTAdministered 8 The Patient Population 8 The Legal Status of ECT Patients 9 The ECT Controversy 10 Basic Issue; Is There Complete Recovery from the Acute Organic Brain Syndrome? 16 2 Six Cases of Mental Dysfunction following Modified ECT 21 Background of the Losses 22 Permanent Retrograde Amnesia 24 The Assessment of Global Memory Loss 27 Permanent Anterograde Mental Dysfunction 29 The Reliability of Clinical Observations and Subjective Reports 31 The Subjective Experience of Anguish and Shame 34 3 ECT Brain Damage in Animal Experiments 38 Gross and Microscopic Pathology Produced by Unmodified ECT 38 Behavioral Dysfunction and Amnesia Produced by ECT S2 Biochemical Dysfunction Produced by ECT S3 4 Human Autopsy Studies after ECT S6 Brain Death and Pathology following Unmodified ECT S6 Brain Death and Pathology following Modified ECT 60 VI Contents 5 Human Brain-Wave and Neurological Studies 63 The EEG after Unmodified ECT 64 The EEG after Modified ECT 67 Serious Neurologic Dysfunction following ECT 70 6 Clinical and Research Reports Confirming Permanent Mental Dysfunction after ECT 74 Clinical Reports of Permanent Mental Dysfunction after Unmodified ECT 75 Research Reports of Permanent Mental Dysfunction after Unmodified ECT 81 Reports Confirming the Acute Organic Brain Syndrome after Modified ECT 88 Research Reports of Permanent Mental Dysfunction after Modified ECT 90 Clinical Reports of Permanent Mental Dysfunction after Modified ECT 94 7 Are the Patients Lying? 102 ECT and Psychological Testing 108 The Lessons of Lobotomy 110 8 The Mechanism of Brain Damage in ECT 114 Electric Current as the Cause of Damage 114 Convulsion as the Cause of Damage 122 9 The Efficacy of ECT in Depression and Suicide 125 10 ECT as Brain-Disabling Therapy: Historical Perspective 135 Somatic Treatment and the Mental Hospital 136 "Shock" as Brain-Disabling Therapy 137 ECT as Brain-Disabling Therapy 140 ECT as Mind-Disabling Therapy 146 More Subtle Aspects of ECT-Induced Tractability 155 11 Fear and Other Psychological Reactions to ECT 158 The Historical Role of Fear in Psychiatry 159 Fear and Terror Associated with ECT 164 Contents Contents vii 63 Physical Resistance to ECT 169 64 Clinical Experience with Fear of ECT 171 67 Psychological Reactions to Memory Loss 173 70 Euphoria and Apathy as Psychological Reactions 175 Other Psychological Reactions to ECT 176 74 12 The Brain-Disabling Hypothesis: An Overview 178 75 Fink's "Unified Theory of the Action of the Physiodynamic Therapies" 178 81 The Disruption of Normal Brain Function 182 The Specificity of ECT for Psychotic Depression 185 88 The Specificity of ECT for Women 187 The Philosophical Context 189 90 13 Conclusions 191 94 Informed Consent 191 Progress in Psychiatric Reform 194 102 Protecting the Vulnerable Patient 195 108 Extending Psychosurgery Precedents to ECT 198 110 ECT and Involuntary Mental Patients and Prisoners 199 ECT and Incompetent Patients 203 114 ECT and Voluntary Mental Patients 204 114 Why Consent Is Rarely Voluntary during ECT 205 122 Why ECT Patients Have Been Unable to Seek Legal Redress 206 Criteria for Informed