ect.org

Tuesday August 29, 2006

By Martin Johnston

New Zealand Herald

Former New Zealand psychiatrist Dr Selwyn Leeks has been ordered to pay $55,000 in damages for sexually abusing a former patient.

The payment was ordered by an Australian court which found that Dr Leeks “took advantage … of a disturbed psychiatric patient”.

The 77-year-old is also being investigated by New Zealand police over claims by former child and youth patients that he abused them at Lake Alice Hospital near Wanganui in the 1970s.

He escaped a potentially damning disciplinary hearing before the Medical Practitioners Board of Victoria last month by effectively surrendering his medical licence in return for the case being shelved.

A five-year investigation into complaints from 50 former Lake Alice patients found a case of unprofessional conduct to answer in 16 of them.

Dr Leeks, who left New Zealand in the late 1970s, is accused of punishing patients with electric shock therapy.

The sexual abuse claim was heard as a civil case in the Victoria County Court.

Judge Jim Duggan said in his verdict: “I conclude that a senior and well-credentialled psychiatrist took advantage of the vulnerability of a disturbed psychiatric patient for the purposes of sexual gratification.”

He awarded the woman $55,000 damages.

Dr Leeks said he had no recollection of the woman, and denied any sexual impropriety.

The Australian woman, who has had depression and anxiety and is now aged 54, claimed Dr Leeks fondled her breasts and put his finger into her vagina during consultations in 1979 or 1980.

She said that when she stopped her visits, he urged her not to disclose what he had done, telling her: “You’re a long-term psychiatric patient and no one will believe you.”

The judge said she made complaints to the police and the medical board, but “these were not taken any further”.

The board’s spokeswoman said yesterday its investigation had been halted by the court case, but it would now consider the judge’s ruling in deciding what action to take.

Steve Green, executive director of the anti-psychiatry group Citizens Commission on Human Rights NZ, said Judge Duggan’s ruling was the first public, official finding of wrongdoing by Dr Leeks. Mr Green said his group was helping 10 more former patients prepare complaints.

The Government has apologised to 183 former Lake Alice patients and paid them $10.7 million compensation.

3 Responses »

Patient abused by Leeks awarded $A55,000

29.08.2006
Wanganui Chronicle

A VICTORIAN County Court judge last week awarded a woman $A55,000 in damages after finding that psychiatrist Selwyn Leeks had taken advantage of her for his sexual gratification.

The woman was a psychiatric patient, The Melbourne Age reported.

Dr Leeks headed the Child and Adolescent Unit at Lake Alice Hospital, near Bulls, from 1972-77.

Australian judge Jim Duggan said the controversial doctor’s behaviour was reprehensible and a gross dereliction of duty.

The patient, whose history includes physical and sexual abuse and psychiatric illnesses, saw Dr Leeks about eight times in 1979 or 1980.

During the consultations, which became increasingly more sexual, he fondled her breasts and digitally penetrated her.

Dr Leeks claimed he had no recollection of the woman and denied any sexual impropriety.

But Judge Duggan said: “… this was a most serious series of assaults.

“The defendant grossly abused his position and took advantage of a particularly vulnerable patient.”

Dr Leeks, 77, recently undertook not to practise any more, avoiding an inquiry by the state’s medical board into allegations that he had used electric shock treatment to punish children and adolescents in New Zealand in the 1970s.

The board had been investigating the electric-shock allegations for seven years.

But after Dr Leeks promised to give up practising on the eve of a board hearing last month, the board wrote to 16 New Zealand complainants saying it had decided not to proceed with a formal hearing into his professional conduct.

RESEARCHER WELCOMES DECISION

Former Wanganui man Victor Boyd said the Australian finding against Dr Leeks was further evidence that what he was doing at Lake Alice Hospital in the 1970s was not medicine. Mr Boyd now lives in Auckland and is a researcher for the Citizens’ Commission on Human Rights, an organisation started by the Church of Scientology which investigates mental health treatments.

“The judge believed one of his former victims,” Mr Boyd said.

“What she said was taken seriously. It’s the first time that has happened.

“It’s a pity New Zealand authorities didn’t do a proper investigation in 1977. Instead he went off to Australia with a certificate of good standing from the Medical Council.”

New Zealand police were still interviewing some of Dr Leeks’ patients from the 1970s, and the cases of 34 of them are being reviewed. As a result, the psychiatrist may eventually be extradited to New Zealand to face charges. One former New Zealand patient has made allegations of sexual misconduct, but the bulk of New Zealand complaints are to do with physical abuses.

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NEWS Journal editor quits in conflict scandal

Neuropsychopharmacology’s chief steps down after a paper
he co-authored omitted significant financial disclosures

By Stephen Pincock

[Published 28th August 2006 05:28 PM GMT]

The editor of a leading psychiatry journal announced last Friday (August 25) that he was stepping down after he published a paper about a treatment for depression without disclosing that eight of nine authors–including himself–had financial ties to the company that makes the device.

Charles B. Nemeroff, editor in chief of Neuropsychopharmacology, a publication of the American College of Neuropsychopharmacology (ACNP), will not serve another term as editor, the college told its members in an Email. The decision was made “in part, based on the recent adverse publicity to the journal and the ACNP,” the Email said.

That publicity arose after the journal’s July issue carried a positive review of a vagus nerve stimulation (VNS) device made by Cyberonics, Inc, of Houston, Texas. Nemeroff was the lead author for the paper, which described VNS as a “promising and well-tolerated intervention that is effective in a subset of patients with treatment-resistant depression.”

The article acknowledged funding from Cyberonics, and listed coauthor Stephen Brannan as an employee of Cyberonics. But it did not reveal that the eight other academic co-authors were all consultants for the firm.

The story, one of several recent conflict-of-interest cases, first made news in July, prompting the journal to print a correction

This isn’t the first time that Nemeroff has hit the headlines for undisclosed financial ties. In 2003, a review he coauthored in Nature Neuroscience neglected to mention significant financial interests in three therapies that were reviewed favorably (including owning the patent on one of the treatments), prompting the Nature Publishing Group to widen its disclosure policies. At the time, Nemeroff and his co-author Michael Owens said: “Going forward, we intend to provide all financial disclosure information, even if it is not requested by the journal editor.”

Clare Stanford, past president of the British Association for Psychopharmacology and an editor at several journals in the field, said Nemeroff was an influential researcher in his field who was unlikely to have been swayed by the Cyberonics money.

“I don’t believe for a minute that the fact the paper was funded by a company would have influenced his conclusions,” she told The Scientist. “It is unfortunate that he has had to stand down over this incident which is largely a reflection of the scientific community’s paranoia rather than any failing of his professional integrity.”

Not everyone shares her view, however. In a blog entry posted earlier this month on the Health Care Renewal blogspot, Bernard Carroll, scientific director of the Pacific Behavioral Research Foundation, called the incident a “slick, coordinated, public relations-disinformation campaign in which ACNP and its journal were exploited by paid consultants of the corporation.”

Nemeroff, chairman of psychiatry and behavioral sciences at the Emory University School of Medicine, told The Scientist in an Email that the financial disclosures of all authors were submitted to the journal, but due to an “oversight,” were not included in the print version. “There was absolutely no intent to withhold any information concerning financial disclosures.”

He added that he has served as the journal’s chief editor for five years, during which time the journal has “improved in all objective indices including manuscripts submitted, ISI rankings … I feel that we have accomplished our goals and I have opted not to accept the ACNP Council’s invitation to serve another three years.”

The group Alliance for Human Research Protection, meanwhile, has raised concerns that a professional writer paid by Cyberonics wrote the first draft of the paper. The writer was not listed as an author but was thanked in the acknowledgements.

Ronnie Wilkins, executive director of ACNP, told The Scientist that Nemeroff would serve out the rest of his current term as editor in chief, which ends in December. Earlier this year, he had been voted in for another term.

Meanwhile, the college wants to ensure the same thing doesn’t happen again, Wilkins said. “The council met on August 23 … and one of the things we asked the publication committee was to look at our policies and procedures to make sure that we have a checklist to avoid this kind of oversight happening again,” he said.

Stephen Pincock
spincock@the-scientist.com

Links within this article

Charles B. Nemeroff
http://www.psychiatry.emory.edu/NeuropsychopharmacologyLaboratory/Charles%20Nemeroff.htm

Neuropsychopharmacology
http://www.nature.com/npp/index.html

American College of Neuropsychopharmacology
http://www.acnp.org/default.aspx?Page=Home

C. Nemeroff, et al, “VNS Therapy in Treatment-Resistant Depression: Clinical Evidence and Putative Neurobiological Mechanisms,” Neuropsychopharmacology (2006) 31, 1345-1355.
PM_ID: 16880768

Cyberonics
http://www.cyberonics.com/

A. McCook, “Conflicts of interest at Federal agencies,” The Scientist, July 24, 2006.
http://www.the-scientist.com/news/display/24056/#24128

D. Armstrong, “Medical Reviews Face Criticism Over Lapses,” Wall Street Journal, July 19, 2006.
http://www.postgazette.com/pg/06200/706933-114.stm

B. Carey, “Correcting the errors of disclosure,” New York Times, July 25, 2006.
http://www.nytimes.com/2006/07/25/health/25news.html?ei=5070&en=794c681583ce7296&ex=1156910400&adxnnl=1&adxnnlx=1156760425-D1Sb+JF5FgICzW9qEslWjQ

“Corrigendum: VNS Therapy in Treatment-Resistant Depression: Clinical Evidence and Putative Neurobiological Mechanisms,” Neuropsychopharmacology advance online publication, 31 July 2006; doi: 10.1038/sj.npp.1301190
http://www.nature.com/npp/journal/vaop/ncurrent/full/1301190a.html

S. Pincock, “Full disclosure?” The Scientist, October 1, 2003.
http://www.the-scientist.com/article/display/21640/

Clare Stanford
http://www.ucl.ac.uk/Pharmacology/Research/scs.html

B. Carroll, “Money and Medical Journals,” Health Care Renewal, August 8, 2006.
http://hcrenewal.blogspot.com/2006/08/money-and-medical-journals.html

“ACNP journal editor quits amid exposure of conflicts of interest,” AHRP, August 27, 2006. http://www.ahrp.org/cms/content/view/327/55/stating the authors had submitted disclosures in accordance to journal policy, but that the information simply had not been included in the acknowledgement section of the published paper.

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Chris Bond
Yorkshire Post Today
August 24, 2006

Grandmother tortured by Chinese – all for her beliefs

Falun Gong is a spiritual movement that once had nearly 100 million followers in China. But since it was banned by the government, thousands of practitioners have been tortured and even killed.

ZHEN is perched on the edge of the sofa. If she sits back you fear her tiny frame may be swallowed up completely.

Listening to the softly-spoken grandmother it is difficult to comprehend how anyone could bring themselves to harm her – but they have.

The 66-year-old claims she’s been beaten, force fed and suffered electro-shock therapy at the hands of the Chinese police – all because of her beliefs.

Zhen is one of the lucky ones, though, she’s alive.

According to the Falun Dafa (Falun Gong) Information Centre, more than 2,300 followers of the meditation practice have been beaten and tortured to death while in detention in China, although Amnesty International believes the numbers imprisoned could run into tens of thousands.

The Chinese authorities have repeatedly denied allegations of brutality and murder and rejected recent, disturbing, reports of “organ harvesting”, but just what is Falun Gong?
The meditation practice, similar to Tai Chi, is based on the principles of truthfulness, compassion and tolerance and involves a series of controlled exercises. It was introduced in China in 1992 and within seven years had as many as 100 million followers.

Among them was Zhen. Before a friend introduced her to it she claims she suffered various health problems, including anaemia, dermatitis and hepatitis which forced her to retire early. Within a few months of taking up Falun Gong, though, she says her ailments disappeared.

“After six months I became a new person,” she says.

Zhen was not alone in finding Falun Gong a life-changing experience and encouraged other family members to take it up.

But as its popularity soared, the Chinese authorities became increasingly nervous by what they perceived to be a growing cult and in July 1999 Falun Gong was banned from public life.

Since then the communist government has set about systematically eradicating the movement and has reportedly detained thousands of practitioners in “reform” centres where detainees are “rehabilitated”.

Many people, like Zhen, continued to practise Falun Gong and, despite the risks, joined fellow practitioners in Beijing to appeal against the ban only to be arrested.

“They used a lot of methods of torturing us, they beat us up and used electric shock treatment and I was locked up for 22 days,” she says. “They arrested so many there wasn’t enough space so eventually they let go the people who were over 60 and I was allowed out.”

A few days later she was informed she had been secretly sentenced and told the police were coming to arrest her.

“I left my home two hours before the police arrived,” she says. “They left the message that I must come home and be ‘transformed’ (give up Falun Gong], or they would arrest me.”

Along with her husband, she hid with relatives staying for no more than a couple of months in one place until a friend told her about a disused flat where they could stay.
“I learned ways of keeping safe, I dug a hole in the wall behind a shoe rack in the living room and we lived inside the next room.

“This way, if someone came into the flat they would see a layer of dust everywhere and wouldn’t think people were living there,” she says, speaking via an interpreter.
For the next two years they lived in a single room.

“I had to sleep on newspapers on the floor under a quilt, because there was a window and this way if somebody looked in they would just see the empty bed.

“Because the situation was very dangerous I had to gather water drop by drop so this way it would make no noise. Also I could only flush the toilet once a day when other people were asleep.

“We had to keep the windows closed all the time even in the summer when the weather was so hot. In the winter there was no heating and outside the weather was minus 20 degrees.”

Because their pension had been stopped they were forced to survive on what little savings they had.

“We didn’t have any vegetables during this time and because we had so little money we often went hungry. It felt like we had been given a life sentence.”

With the help of friends and relatives, though, the couple were able to buy two passports for £5,000, money raised by selling the family’s flat.

Last October, they escaped to the UK, where their two sons now live, and were granted asylum in May.

But although Zhen, she has changed her name to protect her family, is grateful to have escaped her own nightmare she still has relatives back in China, including one of her two grandchildren.

“I am one of the lucky ones,” she says. “Most of my fellow practitioners who used to practise with me were beaten or killed and some of them disappeared and we don’t know what happened to them.”

It is why she, and a group of fellow practitioners, are travelling throughout the country to raise awareness over the persecution of Falun Gong followers in her homeland.
This persecution has led to claims that Falun Gong practitioners have been used for organ harvesting.

Horrific photographs, reportedly smuggled out of China, show the bruised and battered bodies of alleged victims minus their eyes, with crude stitch marks showing where the organs have been removed.

Last month, Canada’s former Secretary of State David Kilgour and international human rights lawyer, David Matas, published a report into these allegations concluding that they believed large-scale organ removals was still happening.

This has been denied by the Chinese. A spokesman for the Chinese Embassy said there was no persecution of Falun Gong and that stories of organ harvesting were simply propaganda spread by practitioners.

“This is a big lie made by Falun Gong,” he said. “Falun Gong is banned in China and to survive outside China they need to make big lies from time to time.”

Edward McMillan-Scott is vice president of the European Parliament and one of six Euro MPs serving Yorkshire and Humber and has spoken to former Falun Gong prisoners.
He described the treatment of its followers in China as “one of the cruellest religious repressions in human history”.

The Tory MEP also believes there must now be an international inquiry into the allegations of brutality and organ harvesting.

Until this happens human rights campaigners fear that Falun Gong practitioners will continue to be persecuted.

It might be an emerging super power, but in the People’s Republic of China it seems not even grandmothers are safe.

3 Responses »

New York Times
August 23, 2006

The University of Southern California sued the Tenet Healthcare Corporation yesterday in an attempt to take over a Los Angeles university hospital that Tenet owns and operates, saying the company’s reputation is in tatters.

Years of disputes, litigation and settlements have reduced Tenet’s unrestricted cash, forcing the company “to substantially alter and vary its funding and capital investment” for the hospital, the university said in its complaint, which was filed in State Superior Court in Los Angeles. The lawsuit seeks to terminate Tenet’s lease and operating agreement.

“With the material difficulties Tenet has brought upon itself, the company has cut back on its financial support for the hospital,” said Marshall B. Grossman, a lawyer for U.S.C. “The university has taken this step to protect its reputation and that of its doctors.”

Tenet agreed in June to pay $725 million in cash and to give up $175 million in fees to settle allegations that it defrauded the Medicare program. Tenet’s revenue has fallen since it disclosed in 2002 that it had used price increases to win higher payments for some of Medicare’s sickest patients.

Tenet, which is based in Dallas, disagreed with the university’s assessment of its financial support.

Tenet has made “substantial” investments in U.S.C. University Hospital, including $120 million in a 10-story patient tower that will open in the next few months, a spokesman, Steven Campanini, said.

“The partnership between Tenet and U.S.C. has been successful for 20 years,” Mr. Campanini said. “This appears to be an unfortunate negotiation tactic better left to the arbitration provisions in our agreement.”

2 Responses »

Associated Press
August 23, 2006

SAN DIEGO - A former executive of a troubled San Diego hospital owned by Tenet Healthcare Corp. was sentenced to three years’ probation and fined $27,000 for conspiracy in an alleged scheme to give doctors kickbacks for patient referrals.

Mina Nazaryan, 45, pleaded guilty to one count of conspiracy in 2005 and was sentenced Monday. According to court documents, she admitted that, as associate administrator of Alvarado Hospital Medical Center, she plotted to make illegal payments to doctors disguised as compensation for relocation expenses.

Nazaryan could have spent 27 months in prison under federal sentencing guidelines, but prosecutors asked for leniency because of her cooperation. Nazaryan testified in the first of two trials against Barry Weinbaum, the hospital’s former chief executive, the 306-bed hospital and Dallas-based Tenet.

Both trials ended in hung juries. Tenet settled the federal case against the facility in May by agreeing to pay a $21 million fine and close or sell the hospital by February 2007.

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Shock rise in electric treatment

Published: 21st August 2006
The Local

The use of electric shocks in psychiatric treatment has more than doubled in the last five years in Sweden.

In 2000 around 18,000 electric shock treatments were administered in Sweden, according to statistics presented by Swedish Radio. Five years later that figure is 40,000.

Electric shock therapy began to be used during the 1930s. Today the method is used primarily on patients who are psychotic, or suffering from deep depression and abnormal mood swings, and when medicine or therapy have failed to have any effect.

Håkan Odeberg, a psychiatric consultant at the Karolinska University Hospital in Huddinge, supports the method.

“In cases where the patient is severely depressed and you have already tried many other forms of treatment, electric shock therapy can have an almost miraculous effect,” he told Svenska Dagbladet.

However, Kjell Broström from the National Association for Social and Mental Health, is not convinced. He told SvD that some patients experience terrible memory loss and that the treatment’s effects can be short-lived.

7 Responses »

19 August 2006
By GEOFF TAYLOR
stuff.co.nz

An opponent wants to stop shock treatment for the mentally ill, but medical experts believe it has positive results. Geoff Taylor reports.

More than one in four people at Waikato Hospital who get electric shock treatment do not consent.

One opponent calls the statistic barbaric, but medical staff say her views are based on out-dated ideas of the treatment.

They say electro-convulsive therapy (ECT) is performed under general anaesthetic and allows many mentally ill people to live normal lives.

Hamilton patients rights advocate Anna de Jonge wants all ECT stopped.

Health Ministry statistics show that in the 2004-05 year 93 non-consented treatments were given to patients at Waikato Hospital. This amounted to 30 per cent of all treatments.

Nationally, 23 per cent of the 307 patients who received ECT did not give their consent.

Waikato Hospital staff said that in the year to March 2006, 23 patients received treatment, six of whom did not give consent.

Anna de Jonge called it barbaric slaughterhouse treatment.

“Treatment without consent is assault,” she said.

“You can’t just grab somebody and shock them. Because it’s done in secret behind closed doors that doesn’t make it okay.”

Waikato Hospital consultant psychiatrist John Strachan said the treatment was used for depression when anti-depressants failed or for people who were psychotic or suicidal.

Patients were deemed not competent to give consent if they lacked the ability to understand information, process it rationally and communicate a choice. At this point, a second opinion was needed from another psychiatrist before treatment could start.

No one was ever forcibly held down and given the treatment. Unlike in the 1950s, patients were fully anaesthetised and had muscle relaxants.

Waikato Hospital general manger mental health Chris Harris said Ms de Jonge’s views were based on perceptions of what occurred about 50 years ago. He said it would be wrong to remove ECT as an option. For a number of people it had been a positive, life-changing experience.

Hamilton woman Margaret Parry, who received treatments in the 1950s, disputed that the treatment was better now.

“I think it’s the worst thing you can do to another human being.”

ECT works in the same way as anti-depressants, affecting the messages sent by neurotransmitters in the brain.

2 Responses »

August 19

Juli Lawrence
ect.org

This isn’t exactly about electroconvulsive therapy, but it’s too moving to fail to acknowledge and praise this site…and the artist.

I’m also not quite sure what category to put it in, so I’m going to put it in self help. For some, this site could be cathartic. For others, a warning: it could trigger bad memories.

Can there be pure beauty in the midst of despair? I’ve always thought that much of Kurt Cobain’s music came from the depths of his own hell. Yet his music was some of the best music (at least in my opinion) ever. I say the same of Beethoven. Sylvia Plath. Hemingway.

A woman on the East coast has found comfort and healing in photography, specifically pictures of decay. This website moves me, as do the photographs. I imagine myself with a camera in some of the places I’ve been, particularly a state hospital called Anna State Hospital (Choate) in extreme Southern Illinois.

Many of these photos could have been taken there, though the place still functions. It embodies the term snake pit. The outside looked almost surreal; lovely, manicured grounds with huge old trees, a fountain (I think I illegally splashed in it just to annoy the staff, but maybe that was somewhere else), and even old-fashioned garden swings.

On the inside, however, it looked like these pictures. Decay. Despair. Wounded souls.

And yet there’s something enchanting about this website, and I’ve been drawn there again and again.

If you aren’t haunted by bad memories - or at least think you can stand it - go there and spend some time.

CathedralsOfDecay.com

3 Responses »

August 18 2006
Daily Post
New Zealand

By Rebecca Devine

Shock treatment use has plummeted nationally but that’s no reason to believe it’s a “fringe” method, a leading psychiatrist says.

Ministry of Health director of mental health Dr David Chaplow said there had been decline in use of electroconvulsive therapy (ECT) nationally but that did not make the increasing use among Rotorua and Taupo people wrong.

He said the ministry looked at the use of ECT about two years ago and found it was a valuable treatment.

Lakes District Health Board has the highest use of the treatment in the country with 22 people per 100,000 receiving the treatment. It is three times the national average of 7.5 per 100,000 people.

Nationally the use of ECT has plummeted since the beginning of the decade.

In the 2001/2002 year 92 people per 100,000 were treated with ECT but just 7.5 per 100,000 received the treatment last year.

The figures prompted Dr John Read, a senior psychology lecturer at Auckland University, to call for the health board to launch an urgent inquiry, saying the figures were of concern.

ECT involves passing an electric current through the brain to induce a seizure, altering brain chemistry to regulate a patient’s mood.

Advocates for the procedure say it is one of the most effective ways to treat depressed patients who don’t respond to other forms of treatment.

Those against it say it is primitive, causes long-term brain damage and should be banned.

Lakes District Health Board isn’t commenting but has said it is looking at the figures quoted in the report and carrying out “some analysis around that information”.

Dr Chaplow said nationally ECT had gone out of fashion but that was no reason to think the Lakes board was over-using the treatment.

“There is also a perception among lay people that putting electricity through [someone’s] head must be a bad thing.”

Some found ECT was more effective and worked rapidly.

Some suicidal people found they were feeling much better the next day, while medication often took 14 days to become fully effective.

ECT was particularly effective in elderly people as ECT did not have the same heart side effects that medication could.

Dr Chaplow said rather than being labelled a barbaric treatment it should be seen as lifesaving. The whole point of the annual statistics was to be open and frank about the use of ECT, he said.

Dr Chaplow said the Lakes figures were interesting but it didn’t mean the treatment was overused.

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Dr. Bonnie Burstow explores electroshock as a form of violence against women. She is a feminist therapist, an anti-psychiatry and anti-fascist activist. She is also the former co-chiar of the Ontario Coalition Against Electroshock and is the author of Radical Feminist Therapy: Working in the Context of Violence.

Two versions:
An edited version runs just under 30 minutes and the full speech runs just over 60 minutes.

Listen to an edited version (30 min) or full speech (60 min)

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Rotorua electric shock capital

August 17, 2006
The Daily Post
New Zealand

By REBECCA DEVINE Mental health patients in Rotorua and Taupo are three times more likely to get shock treatment than anywhere else in the country.

Latest figures show the area is the shock capital of New Zealand with Lakes District Health Board notching up the highest rate of people receiving electroconvulsive therapy (ECT), or shock treatment.

The figures have prompted at least one psychologist to call for the health board to launch an urgent inquiry.

The rate of treatment for the Lakes area in the 2004/05 year was 22 per 100,000 people - three times the national average of 7.5 people per 100,000.

ECT involves passing an electric current through the brain to induce a seizure, altering brain chemistry to regulate a patient’s mood.

Advocates for the procedure say it is one of the most effective ways to treat depressed patients who don’t respond to other forms of treatment.

However, those against it say it is primitive, causes long-term brain damage and should be banned.

The Lakes District Health Board also had the highest percentage of patients over 20 who were seen by a mental health service and went on to receive ECT. Nationally just 0.4 per cent of people seen by mental health services get the treatment but Rotorua’s rate is more than 1.1 per cent.

Five per cent of those who received the treatment in the Lakes area were given it without their consent under the Mental Health Act.

A statement from Lakes District Health Board communications officer Sue Wilkie said the board was “looking at the figures quoted in the report and carrying out some analysis around that information”.

“Until such time as that work is complete, it would be inappropriate for the DHB to make any further comment,” the statement said.

The report released by the Ministry of Health does not explain why the rate is so high in the Lakes region. However, it says regions with smaller populations are more likely to have fluctuations from year to year and some areas have better access to the service.

Dr John Read, a senior psychology lecturer at Auckland University, said its use had generally either stabilised or declined so it was troubling the Lakes figures had increased.

There was certainly no evidence there were three times as many seriously depressed people in the area, so the only explanation had to be that it was simply being used more often, he said. Dr Read described the treatment as an overly medical approach and there were better ways to treat depression, like looking at the causes.

He said women between 60 and 70 were common recipients of the treatment because they were prone to depression.

“Why is that? The best predictions are loneliness and poverty. How is electricity going to solve that?”

But the country’s top psychiatrist has said Lakes’ figures are still low on an international scale.

Health Ministry mental health chief adviser David Chaplow, who was in Rotorua yesterday, said he was happy with the figures. While he would look at any investigation carried out, Dr Chaplow said the jump certainly wouldn’t prompt the ministry to order such an investigation.

Dr Chaplow said because Lakes was a tiny health board in terms of population the results could be easily skewed. The increase could be caused by more people being seen for depression or psychiatrists who are happier using the treatment, Dr Chaplow said.

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Shocks given without consent
15 August 2006
By KIM RUSCOE
Stuff.co.nz

About 130 people have been given shock treatment without their consent in the past two years, a Health Ministry report shows.

Mental Health deputy director Jeremy Skipworth said that, of the 612 severely depressed patients who received electroconvulsive therapy between mid-2003 and mid-2005, only 80 per cent consented.

Two-thirds of those treated were women, most aged over 40.

“Sometimes people are so unwell they are not actually able to give consent,” Dr Skipworth said.

“It’s not appropriate for them to be deprived of the ability to be treated just because they’re so sick they can’t agree to it.”

Those people were committed under the Mental Health Act and given shock treatment after a second opinion had been given from a qualified psychiatrist, Dr Skipworth said.

Family members were also consulted.

Green Party health spokeswoman Sue Kedgley said the controversial treatment was being given without consent more often in some districts than others. The highest rates of unconsented-to treatments last year were given by Tairawhiti, Capital and Coast and Auckland health boards.

Dr Skipworth said no one in New Zealand was given ECT against their wishes if they were competent to make decisions about their treatment.

ECT was proven internationally to be an effective treatment for severe depression, with eight out of 10 patients responding well to it.

It was used when anti-depressant medication, psychotherapy or both had been ineffective, or when medication was too slow or caused severe side effects.

It was also the safest form of treatment when patients were also suffering a physical illness or were pregnant.

Side effects included short-term memory loss, headaches, muscle soreness and nausea.

Methods of administering ECT had improved greatly since its “misuse” in the 1960s and 1970s, when large numbers of people suffering a variety of mental illnesses were given it without anaesthetic or muscle relaxant.

A new treatment for severe depression being tried in the United States had produced promising results, he said. But the trial group was small and it was yet to be seen if the results could be replicated in a larger group.

The US study found a single intravenous infusion of a general anaesthetic agent, Ketamine, could relieve symptoms of severe depression within two hours and remain effective for up to one week. Most medications available at present did not start to relieve the symptoms of depression for several weeks.

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An absolutely fantastic response to the June report on the consumer/survivor movement in Psychiatric Services. Well done, my friends.

Psychiatr Serv 57:1212, August 2006

David Oaks

To the Editor: The essay “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism” (1) in the June issue attempts to impose false labels and a skewed history on activists for human rights in mental health, including the nonprofit organization that I direct, MindFreedom International.

The origin of our social change movement cannot be traced to a few antipsychiatry theoreticians and campus intellectuals. Many of us actually credit the civil rights movement and our own experiences of psychiatric abuse as the original sources of our inspiration. We can and do organize on our own. The authors use the undefined term “antipsychiatry” 34 times in their essay, applying that label to many of us who do not describe ourselves or our groups in that way. There are, for example, compassionate, practicing psychiatrists who play an active role in MindFreedom.

The authors claim that psychiatry has addressed our key grievances “to some degree.” Even if some psychiatrists have reduced the dosages of neuroleptics prescribed, overall neuroleptic prescriptions are skyrocketing. Neuroleptic prescriptions for youths have shot up more than fivefold in less than a decade (2). From our perspective, both electroshock and psychosurgery have experienced a resurgence in popularity within psychiatry and the mainstream press. Many states have greatly expanded commitment criteria, and most states have implemented involuntary outpatient commitment. Courts now order some MindFreedom members who live peacefully in their own homes to take neuroleptics involuntarily.

The authors appear to observe us from afar through a flawed lens, which may explain their factual errors. The well-respected activist Leonard Roy Frank is not the founder of Support Coalition International. Support Coalition International and MindFreedom International are not two separate organizations—our name change occurred in 2005. The essay aligns the history of our movement with the “radical left” to a great extent, ignoring decades of outstanding work by conservatives and libertarians in fighting psychiatric abuse. Today, conservatives lead the grassroots opposition to mental health screening in schools.

Consider the bias inherent in this sentence: “Psychiatry continues to fight antipsychiatry disinformation on the use of involuntary commitment, electroconvulsive therapy, stimulants and antidepressants among children, and neuroleptics among adults.” The authors appear to transmogrify into “antipsychiatry disinformation” all public education efforts that are inconsistent with the American Psychiatric Association’s official position.

This is my 30th year working for human rights and alternatives in the mental health system. We have made mistakes. We are not perfect. But I am very proud of our social change movement, which includes concerned family members, advocates, attorneys, mental health professionals, and interested members of the public. The authors claim that the psychiatric profession finds it difficult to communicate with us. The fact is that the American Psychiatric Association has generally refused our repeated invitations for conversation.

Somehow, some people who have experienced serious human rights violations in the mental health system—including unscientific labeling, forced drugging, solitary confinement, restraints, involuntary commitment, electroshock, and more—have reached deep within the human spirit and found the power to speak out and unite nonviolently (3). Please reply with dialogue, not distortion.

David Oaks

Footnotes

Mr. Oaks is director of MindFreedom International, Eugene, Oregon.

References

1. Rissmiller D, Rissmiller J: Evolution of the Antipsychiatry Movement Into Mental Health Consumerism. Psychiatric Services 57:863–866,2006

2. Carey B: Use of antipsychotics by the young rose fivefold. New York Times, June 6, 2006, p A18

3. Mahler J, Unzicker R, Foner J, et al: Taking issue with taking issue: “psychiatric survivors” reconsidered. Psychiatric Services 48:601,1997

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Paolo del Vecchio

To the Editor: The Rissmillers’ Open Forum article in the June issue linking antipsychiatry with the mental health consumer movement does a disservice to the thousands of consumers working to improve the lives of people with mental illnesses. The essay also fails to acknowledge the many psychiatrists who partner with them.

Today’s consumer movement is not “radical.” It is a mainstream, cornerstone approach to improve mental health care quality as called for by the U.S. Surgeon General (1), the President’s New Freedom Commission on Mental Health (2), and the Institute of Medicine (3).

Rather than “fighting against pharmacological treatment,” the movement supports the consumer’s choice of treatments—including medications—and is often active in promoting increased financing for mental health services, insurance parity, and the protection of individual rights, such as health care privacy.

The movement comprises courageous individuals who, at some risk to their own livelihoods, come out of the closet about their own experiences with mental illness and give back to their communities by forming support groups, operating drop-in centers, and educating the public against stigma and discrimination. It is unjust to discredit mental health care consumer advocates and their hard work by linking them with antipsychiatrists, including Scientologists.

Contrary to the authors’ assertions, psychiatrists are engaged in ongoing collaborations with the consumer movement, with activities that range from conducting local public awareness events to convening a national dialogue series to identify collaborative approaches to improve care (4). Past APA president Steven S. Sharfstein, M.D., reinforced this effort when he endorsed the need for “a collaborative approach with input solicited and accepted from the patient” (5).

Psychiatry recognizes that alliances with those served—whether on the clinical, community, or policy levels—are in our mutual interest: the promotion of mental health recovery.

Paolo del Vecchio, M.S.W.

Footnotes

Mr. del Vecchio is associate director for consumer affairs at the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.

References

1. Mental Health: A Report of the Surgeon General. Washington, DC, Department of Health and Human Services, US Public Health Services, 1999

2. Achieving the Promise: Transforming Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President’s New Freedom Commission on Mental Health, 2003

3. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC, Institute of Medicine, 2006

4. Consumers and Psychiatrist in Dialogue. Rockville, Md, Department of Health and Human Services, 1997. Available at www.mentalhealth.samhsa.gov/publications/allpubs/OEL00-0009/

5. Sharfstein S: Recovery model will strengthen psychiatrist-patient relationship. Psychiatric News, Oct 21, 2005, p 3

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Gregory Ludwig

To the Editor: During the past 27 years, I have studied psychiatry and psychology as a student, as a patient, and as a professional, and since college I have written and edited published work in these areas. From this perspective, I would say that although the Open Forum by the Rissmillers, which claims to survey the “antipsychiatry” movement, aims for a worthy goal, it is weak because of its imprecision about concepts, its less-than-adequate research, and its rather stereotyping characterization of certain intellectual figures in the 1960s and 1970s and the significance of their more responsible ideas.

Perhaps the best way to undermine the authors’ central apparent argument—that antipsychiatry was a golden banner that started as an intellectual game among a few radicals and then, after virtual exhaustion, was picked up by a movement among obstreperous consumers that seemed nostalgic for 1960s leftist political and intellectual styles—is to quote from Dendron, a sort of samizdat newsletter that eventually provided the basis for the organization Support Coalition International, whose name was changed last year to MindFreedom International. In a 1988 interview with none other than the renowned psychiatrist R. D. Laing by David Oaks, editor of Dendron at the time and currently director of MindFreedom, Oaks asked, “How can ex-inmates [of psychiatric wards] and progressive therapists work together?” Laing answered, “I’d have to sit down with actual people, and simply talk about it. I don’t know enough about what Americans call the ‘hands-on’ situation to come up with a formula, some key to open up possibilities. The whole thing is: this is stitched together by personal trust [and] confidence between actual people” (1).

If he was describing how a “progressive therapist” might help the budding “psychiatric survivor” movement, Laing was also characterizing the most fundamental method of relating between doctor and patient. But if this was so, it may have been unintended and ironic because he definitely seemed surprised that Americans—with their homely “hands-on” efforts—could have a pragmatic way of organizing a pro-patient movement. In fact, his tone seems that of a musty old European doctor-patient fundamentalist.

So much for the Rissmillers’ claim or suggestion that there is some substantive continuity—almost on the order of a grand, insidious historical error—between Laing, Szasz, and others and between their hermetic intellectual efforts and the more modern consumer efforts, now enabled by the Internet.

The more likely reason for the growth of the consumerist movement might be today’s widespread style of practice of psychiatry and such things as the pharmaceutical industry’s medical hegemony. More fundamentally, the better reason among many people involved in the movement might simply be good sense.

Gregory Ludwig

Footnotes

Mr. Ludwig is a freelance editor and writer, Highland Lakes, New Jersey.

Reference

1. Exclusive Dendron interview: R.D. Laing. Dendron, Feb 1988, pp 1,6,7

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Kathleen M. Hill

To the Editor: The description in the June Open Forum of consumer activists and their history might lead your readers to conclude that the consumer movement is a fringe group—marginalized and bent on spreading disinformation. Readers should understand that the movement to ensure the human rights of people with disabilities is international in scope.

After many years of advocacy by the disability community, the United Nations General Assembly established a committee in 2001 to develop an international convention on the rights of persons with disabilities. The International Disability Caucus, currently composed of more than 50 nongovernmental organizations, was established the next year to help draft such a convention. The committee will hold its eighth session in New York this month to discuss the current draft of the convention.

Mental health advocacy groups have sought to include in the convention a universal prohibition of involuntary hospitalization and involuntary treatment. They oppose any language or action that would allow for mental health treatment, such as drugs or electroconvulsive therapy, to be forced upon any individual. They oppose any exceptions to be made to this prohibition for “exceptional circumstances,” with “appropriate legal safeguards,” or when it is “in the best interest of the person.” Advocates oppose the model of substituted decision making because it gives away a person’s legal capacity to another person, including a person’s right to make treatment decisions (4). Instead, they stipulate a model of supported decision making to be the keystone of a voluntary system of services that provides noncoercive support for an individual experiencing a mental health crisis.

Users and survivors of psychiatry are not “antipsychiatry”—we are anti-psychiatric oppression, because we have witnessed or experienced such oppression under existing mental health laws and practices.

More information about the United Nations Programme on Global Disability and the work of the International Disability Caucus can be found on the United Nations Enable Web site at www.un.org/esa/socdev/enable.

Kathleen M. Hill, B.S.

Footnotes

Ms. Hill, who lives in Cobalt, Ontario, is a mental health industry reform activist and a member of Support Coalition International and Survivors of Psychiatry.

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Ted Chabasinski

To the Editor: Psychiatric Services has done a disservice to any of its readers who might want an accurate picture of our movement for the human rights of psychiatric consumers/survivors. Anyone familiar with our history would have a hard time recognizing us from the bizarre and highly inaccurate article that appeared in your most recent issue.

The authors got it partly right when they mentioned two of our long-time leaders, Leonard Frank and Judi Chamberlin. If the authors had interviewed either of them, their account might have some resemblance to reality. Instead, the authors seem to have relied completely on articles and books, rather than first-hand reports from the people who have actually been involved.

As for myself, my 35 years of activity in our movement wasn’t inspired by any books written by Drs. Szasz or Laing or the other seminal thinkers named, although I respect their contributions. It came about from my ten years in a state hospital as a child, after I received electroshock treatment at age six at the hands of one of the profession’s most honored child psychiatrists. And most activists in our movement have also become involved because of their own experiences.

Though I would hardly expect a journal of the American Psychiatric Association to support our criticisms of psychiatry, I think that it would be much more useful for your readers—and more interesting—if you exposed them to accurate reports of our positions and activities. Any psychiatrist who relied on articles such as this to get a picture of our movement would be living in a dream world.

Ted Chabasinski, J.D.

Footnotes

Mr. Chabasinski is a patients’ rights attorney, Berkeley, California.

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Nathaniel S. Lehrman

To the Editor: The Open Forum essay by the Rissmillers in the June issue omits the real reason for the antipsychiatry and consumer movements—the spectacularly harmful effects of biological, drug-based psychiatric treatment. That harm is reflected in the sixfold increase in the number of people receiving Social Security disability payments for psychiatric disabilities since psychopharmacology took over psychiatry 50 years ago (1). During this period, the percentage of the population said to be mentally ill has nearly tripled and the total number of inpatient care episodes for severe mental disorders, on a per capita basis, has quadrupled (1). This wave of mental illness is accelerating. The number of people disabled by mental illness has almost doubled in the past 15 years (1).

Another major omission is an account of how the replacement of psychoanalysis by psychopharmacology as the specialty’s ideological basis (which the essay mentions) produced these effects. In presenting psychoanalysis and psychopharmacology as the specialty’s only therapeutic alternatives, the paper omits, and thus denies, the role of counseling and psychotherapy, which has always been a major tool of physicians. The psychoanalysts maintained that their method, with its primary focus on childhood experiences and passive free association, was deeper than other methods. When its uselessness as a treatment for psychosis was finally recognized, the role of present-focused nonpsychoanalytic psychotherapy was ignored and a new emphasis on drugs took its place. However, when psychiatrists limit their therapeutic focus to medication and to its effects on symptoms, they abandon a fundamental part of their treatment armamentarium: a trusting relationship within which the psychosocial problems behind the patients’ symptoms are actively addressed.

Effective treatment should be the first demand of psychiatry’s critics (2). To attack what is wrong, which is the approach taken by the antipsychiatry movement, is necessary but not sufficient. The Rissmillers’ focus on Foucault, Laing, and Szasz, and their omission of respected professionals, such as Loren Mosher and Peter Breggin, erroneously imply that antipsychiatry’s criticisms have come almost entirely from a small, marginal, left-wing group. The authors do not, for example, mention either the International Center for the Study of Psychiatry and Psychology or its peer-reviewed journal Ethical Health and Human Services.

The Rissmillers’ account makes other errors. Although the Support Coalition International became MindFreedom International in 2005, the essay lists them as separate organizations, and David Oaks, not Leonard Roy Frank, is the founder.

The consumer-survivor movement has problems not mentioned by the Open Forum authors. In objecting to psychiatric abuses, the movement ignores the importance of good psychiatric care—as though such care does not exist—and essentially denies that professionals know how to provide it (3). The movement’s focus on the national and international political scene ignores where public mental health care decisions are really made—in individual states. The movements’ efforts at times to place supporters on psychiatric payrolls (as “consumer advocates,” for example) represent a co-optation that provides benefits to past survivors of the system while ignoring its current victims.

The Rissmillers’ account raises important questions about these movements. Its answers fall short.

Nathaniel S. Lehrman, M.D.

Footnotes

Dr. Lehrman is former clinical director of the Kingsboro Psychiatric Center, Brooklyn, New York, and is currently retired.

References

1. Whitaker R: Anatomy of an epidemic: psychiatric drugs and the astonishing rise of mental illness in America. Ethical Human Psychology and Psychiatry 7:23–35,2005

2. Lehrman NS: Effective psychotherapy of chronic schizophrenia. American Journal of Psychoanalysis 42:121–132,1982[CrossRef][Medline]

3. Lehrman NS: The rational organization of care for disabling psychosis: “if I were commissioner.” Ethical Human Sciences and Services 5:45–55,2003

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Michael Haan

To the Editor: Of particular interest to me were a few sentences near the end of the June Open Forum on antipsychiatry and the consumer movement: “Organized psychiatry has found it difficult to have a constructive dialogue with the evolving radical consumerist movement. Consumerist groups are viewed as extremist, having little scientific foundation and no defined leadership. The profession sees them as continually trying to restrict ‘the work of psychiatrists and care for the seriously mentally ill.’ “

Our message is actually very simple. We don’t like the way the profession treats people. The purpose of a consumer-driven mental health system, as suggested by the President’s New Freedom Commission Report, is to give life to the voices of the people who are being affected by the system.

Michael Haan

Footnotes

Mr. Haan is a consumer advocate in Seattle, Washington.

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Wesley Sowers

To the Editor: In the June issue, Rissmiller and Rissmiller provide an interesting report on the development of alternative perspectives on the nature of mental illness and the role of treatment. The authors describe two movements: the intellectually and academically based antipsychiatry movement and the community-based-populist “consumerist” movement. They contend that as the antipsychiatry movement lost momentum in the early 1980s, it was essentially transformed and incorporated into the more mainstream “consumerist” movement. They believe that antipsychiatry tactics had a significant impact on the course followed by the “consumerist” movement and that it became more radicalized as a result.

Although there may be some controversy with regard to this view, their report does provide an accurate assessment of the reforms that these two movements, alone or in combination, brought about. Their concluding remarks are unfortunate, however, stressing divisions between psychiatrists and consumer activists. Although it is true that some psychiatrists have had difficulty interacting with the more hostile elements of the consumer movement, and these elements have likewise had difficulty softening their perception of psychiatry, psychiatrists and consumers have made great strides in creating a dialogue in recent years, regardless of sometimes divergent viewpoints. Failure to acknowledge this evolution misses the key to the transformation that is currently under way.

Wesley Sowers, M.D.

Footnotes

Dr. Sowers is president of the American Association of Community Psychiatrists and medical director of the Office of Behavioral Health, Allegheny County Department of Human Services, Pittsburgh.

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Laura Van Tosh

To the Editor: I am writing in regard to the Open Forum essay, “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism.” From a historical perspective the essay was interesting and provocative. However, I was left with a hollow feeling. I wondered about patients and psychiatrists who work hard every day and toward greater understanding of mental illness and recovery. I especially wondered about the hesitancy a patient may have to take the first step for help, either in a self-help program or a psychiatrist’s office.

The authors’ conclusion was profoundly concerning in that it maintains acrude and cold separation between patient and doctor that does not further the relationship on which so many depend. In fact, it could easily drive help-seeking consumers from the development of a therapeutic relationship. This relationship must be seen as key to consumers who wish to delve further into analysis or clinical interventions that are required for many of us to maintain lives rooted in recovery values.

At a time when consumers are most vulnerable, we must foster the clinical dialogue, not drive a wedge that creates a problem to which there is really no solution. The authors’ message, while academically controversial, merely emphasizes this schism. Yes, some psychiatrists and consumers may be at war over ideology, but it is the struggle and eventual healing that can result in ultimate recovery. In this most fundamental instance, psychiatrists and consumers can make a new history that is based on mutual understanding and compassion.

Laura Van Tosh

Footnotes

Ms. Van Tosh, who is an editorial consultant for Psychiatric Services, is director of consumer affairs at Western State Hospital, Tacoma, Washington.

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David J. Rissmiller and Joshua H. Rissmiller

In Reply: We appreciate the numerous letters regarding our article, “Evolution of the Antipsychiatry Movement Into Mental Health Consumerism.” We apologize for erroneously listing Mr. Frank as the founder of Support Coalition International. We also acknowledge that a fundamental problem was the need to summarize in 3,000 words three decades of history. This required limitation necessitated, as Mr. Oaks points out, “the authors appear[ing] to observe us from afar.”

Mr. del Vecchio writes, “Today’s consumer movement is not ‘radical.’ It is a mainstream, cornerstone approach to improve mental health care quality.” We disagree. Quoting from the eighth edition of Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, “it is important to distinguish between the mental health ‘consumer movement,’ which has been positive through empowering patients … and the ‘consumer/survivor’ movement, which has advanced a radical reform.”

Mr. Oaks, Mr. Ludwig, Dr. Lehrman, and Mr. Chabasinski all maintain that our basic hypothesis is false. They maintain that the survivor movement had nothing to do with the antipsychiatry movement. We dispute this point of view. As Tomes (1) noted, “The modern consumer/survivor movement arose in the wake of a radical restructuring of the U.S. mental health system between 1950 and 1970, resulting from deinstitutionalization, new psychotropic drug treatments, the widening legal conceptions of patients’ rights, and the intellectual critiques associated with the antipsychiatry movement.” We maintain that the antipsychiatry ethos, as disseminated by its seminal thinkers, was maintained as the antipsychiatry movement declined. It significantly affected two other movements: the consumerist movement that had been in existence since the late 19th century and the survivor movement, which dates back to worldwide deinstitutionalization. Many of the resultant hybrid radical consumer-survivor coalitions have carried forward, to this day, a message almost identical to that of the earlier antipsychiatry movement: that organized psychiatry is a self-serving guild that oppressively sacrifices consumers’ needs and has little basis in science.

Mr. Haan and Ms. Hill state that the survivor movement is “not ‘anti-psychiatry’” but is against “the way the profession treats people” and against “psychiatric oppression,” which Ms. Hill defines as “any language or action that would allow for mental health treatment … to be forced upon any individual.” Her listed doctrine could have been taken directly from the 1960s antipsychiatry manifesto, which contended that society deals with undesirables by locking them away. Foucault, as noted in our article, argued against society’s pressing need to sequester members who would not comply with its definition of “Reason.”

Mr. Oaks notes that survivor organizations encompass many disciplines, including psychiatrists. We never asserted otherwise. As Dain (2) notes, “Over the years psychiatry has been a target for antipsychiatry groups competing for influence or authority over the mentally ill. At various times these groups have included neurologists, social workers, new religions, consumers, and psychiatrists themselves.” The authors of several letters state that members of their movements do not consider themselves antipsychiatrists. However, many members do. Weitz (3), in an article titled “Call Me Antipsychiatry Activist—Not ‘Consumer,’” made the point, and organizations such as the Antipsychiatry Coalition emphasize it.

Mr. Oaks disputes our contention that in response to pressure from the antipsychiatry movement, psychiatry marginalized electroconvulsive therapy and psychosurgery, and he states that both are now resurging. In 1991 Fink (4) noted, “In spite of its acknowledged efficacy and safety … electroconvulsive therapy remains a controversial treatment, with limited use … the controversy results from attack by the antipsychiatry movement.” The demise of psychosurgery following the antipsychiatry movement has also been documented by Feldman (5). He noted that after the turbulent 1960s, “Public and political scrutiny severely restricted, or actually banned, the use of psychosurgery in many American states, as well as in other countries such as Germany, Australia, and Japan.”

Finally, the authors respectfully disagree with Ms. Van Tosh, who maintains that our essay widens an already existing schism and “could easily drive help-seeking consumers from the development of a therapeutic relationship.” We believe our essay offers a balanced view of the antipsychiatry movement’s evolution. However, we applaud and close with her sentiment, “Yes, some psychiatrists and consumers may be at war over ideology, but it is the struggle and eventual healing that can result in ultimate recovery. In this most fundamental instance, psychiatrists and consumers can make a new history that is based on mutual understanding and compassion.”

David J. Rissmiller, D.O. and Joshua H. Rissmiller

References

1. Tomes N: The patient as a policy factor: a historical case study of the consumer/survivor movement in mental health. Health Affairs 25(3):720–7292006

2. Dain N: Reflections on antipsychiatry and stigma in the history of American psychiatry. Hospital and Community Psychiatry 45:1010–10141994

3. Weitz D: Call me antipsychiatry activist—not “consumer.” Ethical Human Sciences and Services: An International Journal of Critical Inquiry 5:71–722003

4. Fink M: Impact of the antipsychiatry movement on the revival of electroconvulsive therapy in the United States. Psychiatric Clinics of North America 14:793–8011991

5. Feldman RP, Goodrich JT: Psychosurgery: a historical overview. Neurosurgery 48:647–6592001[CrossRef][Medline]

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