The Return of ECT by Peter R. Breggin THE PR ACTICE OF ELECTROCON­ wholl y geneti c and biological in ori g in. of sessions or the age at which it can be VULSIVE THERAPY: RECOMMEN DA­ Despite an absence of evidence to given, and require second opinions and TIONS FOR TREATMENT, TR A IN­ support this new biopsychiatric dogma. informed consent. Whi le these efforts ING, AND PRIVILEGING. Task Force genetic and biochemi cal speculations have proved almost impossible to en­ Reporl of th e Ameri ca n Psychiatric As­ force in the face of psychiatric resis­ sociation. 1990. 200 PI'. $22 .00. Amer­ served to justify a renewal of psychiatric tance, they have rai sed further questions ica n Psychiatric Association, Wash ing­ authority within the mental health pro­ ton, D.C. fessions. and to rationalize the use of about the use of shock treatment. As physical lreatmenrs. such as drugs and criticism has grown, so have the number electroshock. As by far the most remu­ of lawsui ts against ECT. ( It is not he last decade hns seen a re surgence nerative treatment in psychiatry. shock coincidental that th e present Task Force T in the promoti on and use of electro­ holds a special place in the financial report thanks APA' s legal consultants convulsive therapy (ECT). a tec hn ique recovery of Illany psychiatric units and for their contribution.) that originated in Italy in 1938 and that individual practitio ners. I:! The moSt dramat ic threat to shock ha s been referred to variously as elec­ Psychiatry' s econo mi c crisis was treatment became known as the Berke­ troshock treatment (EST), or s imply compounded in the 1970s by growing Jey Ban. Ted Chabasinski. who had shock treatment. and (because the aim is public critic ism . much of it ai med been subjected to electroshock as a (0 produce a gra nd mal sei zure) convul­ directly a, ECT itself. This helped child. organized a grassroots citizens' sive therapy. Nowadays ECT is gener­ moti vate APA to publi sh its 1978 Task movement in support of iJ referendum to ally recommended for major (severe) Force report,:! to wh ich the present ban ECT in Berke ley. California. After depress ion. A ll other indicati ons rema in volu me is a successor. The challenge to the proposition was overwhelmingly subject to di sagreement, even among ECT was launched by neurolog ist John approved by the electorate, the psychiat­ advocates of the method . At prese nt, Friedberg,26 whose book was soon ri c establishment. led by APA. inter­ probably morc than 100,000 patients a fo llowed by a volu me edited by "shock vened and had the ban overturned in year in the Uni ted States receive this survivor" Leonard Frank.:!:! and a book cOllrt-but not before a "power outtage" treatment. T he majority are women: by the present reviewer. K Critiques have of forty-one days in the winter of 1 9"-~n . increasi ng ly. they are elderl y women. In continued to be published in profes­ In 1979. the FDA c lassified shock 9 10 23 Californ ia. for example. two-thirds of sional joumals. In 1985. criticism devices as demonstrating "an unreason­ shock patient s are reported to be issued from within the hean of the able risk of illness or injury ... 21 This women. more than hal f of whom are establishment it self, when the NIH/ would have embarrassed psychiatry by sixty-five or older ..~:1 NIMH Consensus Confere nce on Elec­ requiring renewed animal testing. How­ The recent renowering of ECT has its troconvul sive Therapy call ed the treat­ ever, under pressure from APA . the roots in the early to mid- 1970s. whcn ment controversial and estimated that, FDA gave notice of its in tent to psychiatry experienced a steep and on average, patient s endure memory loss reconsider its original decision and to unprecedented economic decline. The extending from six mo nths prior to the reclassify ECT machi nes as safe. The A merican Psychi atric Associat ion treatment to three months afterward . 1-4 APA Task Force report was timed to (APA) was in fina ncial trouble and Former patients have become an come o ut in the midst of the FDA's many psychiatrists were fi nding it diffi­ increasingly active force. In addition to poli tical squimling over ECT. While not cult to competc for patients with a writing and appeari ng in the media. formall y issued until 1990. it was burgeoning field of nonmedical th era­ Illany who have un dergone ECT con­ hurriedly presented as an unpublished pists, including clinical psycho logists, tinue to protest at national psychiatric manuscript at an APA press conference social workers. counselors. family ther­ conventions and shock symposia. and in mid-December 1989. MC<JJl while, apists. nurse practit ioners, and mental even chai n themselves to the gates and health associates. doors of "shock mill s." A shock Organi zed psychiatry. spearheaded by survivor in Alexandria. Vi rginia, has PETER R. BREGGIN, MD., a psychia­ APA and the National Institute of formed the Committee fo r Truth in tri st in private practice in Bethesda, Mental Health (N IMH ). put into acti on a Psychi atry, with a membership of sev­ Mel., is d irector of th e Center for the national program to revitali ze psychiatry eral hundred individuals who feel dam­ Study of Psychiatry and Professor (Ad­ junct) of Conflict Analysis a nd Resolu­ based on the "re-medicalization " of the aged by the treatment. tion at George Mason Univers ity. H is profession. It called for the redefinition Many states have passed leg islation to latest book is Toxic Psychiatry (SI. Mar­ of psychosocia l problems as .:dmost monitor ECT, set limits o n the number tin's Press). 72 MARCH 7992 hundreds of injured ECT sur,:, ivors Abrams. who would appear to be the spective study by Avery and Winokur.5 wrote to the FDA protesting its inte ntion Task Force's Illost valued expert. One of \vhich found no improvement in the to relabel the devices as safe. Abrams's aJ1icles is recommended under suicide rate compared to matched con­ Not surprisingly. APA and organized ·'Materials for Patients and Their Fami­ trols who had 110 shock treatmenl- "'n psychiatry won the contest with the lies" and another under "Materials for the present study. treatment was not fortner patients and the cri tics of the Professionals." Nine of his publications shown to affect the suicide rate·' (p. therapy. The FDA's fin al report reads are cited in the general bibliography. l033)-is presented in the Task Force remarkably like the APA's report. Al­ making him by far the most heavily report as suppol1ing the position thar though no large animal studie s have represented author. Abrams is also listed ECT results in "a lower in cidence of been done with shock devices since the among those individuals who ··provided suicide" (p . 53). The Task Force also 19505. and although those earlier studi es comment on the draft of the ECT Task mentions threc other studies as support­ consistently demonstrated brain damage . Force Report.·· However. his Illost ing J bcneficial effect on suicide, yet 5 JO the FDA defined ECT devices as safe interesting affiliation is absent: AbrJl11s two of them . ~pec ifi cally find 110 such for depressed patients. C uri ousl y. and owns Somatics. Inc .. which. in a recent beneficial effect and the third .?:') doesn't without any JppJrent logic. the FDA deposition . to he acknowledged to be the even deal with suicide. reclassified the treatment as safe Oll/Y for source of fifty percent of his income. Although elderly women ha ve be­ depressed patients. However, psychia­ Although there have been numerous come the single largest target population trists will not find it difficult to diagnose controlled studies comparing ECT to for ECT. despite the absence of con­ their patients to fit the trCJtment. sham ECT. in whi ch the patient is trolled studies on its usefulness in the anesthetized but not shocked. APA did elderly. there is little attention to this he political nature of the report under not revi ew the literature. Crow and issue in the report. The Task Force T review is made clear by the compo­ Johnstone, t5 in a review of controlled advises that ECT can be used ·'regJrd­ sition of the cOlllmittee-largely studies of ECT efficacy, found that both less of age" (I'. 15) and cited the staunch ad vocates of ECT. The chair­ ECT and sham ECT were associated successful treatment of a patient aged person. Riclwrd Weiner. was APA's with "substantial improvcments." and 102 (pp . 71-72). It does warn. how­ official representative in defense of ECT that there was little or no difference eve r. that "some e lderly pati ents may at the FDA hearings. and has for some between the two , concluding: ·· Whether have an increased likelihood of appre­ time been APA's chief spokesperson on electrically induced convulsions exert ciable memory deficits and confusion the subject. Two of the other six therapeutic effects in certain types of during the course of treatment·' (p . 72 ). members are psyc hiatrist Max Fink and depression that cannot be achieved by The aged are. in fact. gravely at ri sk psychologist Harold Sackeim. among other means [placebo] ha s yet to be when exposed to any form of head the nation' s most zealous defenders of clearly established" (p. 27) . Crow and trauma, including electrically-induced.