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Pardon me while I break from ECT stuff and scream: WORLD CHAMPIONS ST. LOUIS CARDINALS!!!!

I’ve waited 24 years for this - the last time Cards won the series, I happened to be living in the former Soviet Union and had no TV, no news. My only link to the west was VOICE OF AMERICA and that’s where I learned it.

Cardinals baseball: I LIVE FOR THIS!!!

YADI YADI YADI! (And I’ll always love Jim Edmonds…woo hoo!)
Congrats to my beautiful Cardinals. Detroit - be proud of what you’ve done…you’ll be back. Detroit rocks!

I AM CRAZY HAPPY. I LOVE THE CARDINALS TIL THE END OF TIME!

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Dr. Bronner attempts to save the world with soap
By Molly Snyder Edler

OnMilwaukee.com
Oct. 26, 2006

“If we ever advertised, I would have a billboard reading ‘Our soap makes your crotch tingle,’” jokes Ralph Bronner, vice president of Dr. Bronner’s Magic Soaps, a 60-year-old company based in Escondido, California.

But Ralph, who lives in Menomonee Falls, doesn’t advertise. Instead, he promotes his family’s business in unconventional ways. He and his wife road trip across the country with cases of soap, stopping at health fairs and natural food stores. Also, he interviews frequently with journalists, and articles about his company have appeared in the Chicago Tribune, The Washington Post, Fortune.com and Vogue, among many others.

Ralph inherited his anti-advertising philosophy and free spirit from his eccentric father Emmanuel Bronner — AKA “Dr. Bronner” — who started the business in the ’40s.

Although “Dr. Bronner” never attended a university, he earned a “soapmaster’s degree” — basically a completed apprenticeship — and declared himself a doctor of soap. Over the years, he also referred to himself as “The Pope of Soap” and “Rabbi E.H. Bronner.”

Dr. Bronner was from an Orthodox Jewish family, and much of the company’s vision and philosophy were born out of devastation from the Holocaust. Dr. Bronner believed that humans are all from the same divine source and often he printed the words “All-One!” on his bottles of soap.

Dr. Bronner was also a pioneer in the environmentalist movement, and today, the company is still ecologically friendly and socially conscious. The company donated a rain forest territory worth $1.4 million to the Boy’s and Girl’s Club for a camp. They also give over 10 percent of profits annually to a slew of non-profit organizations, use only natural ingredients (including hemp), never test their products on animals and offer fantastic wages and benefits to their employees.

The soap, available in liquid or bar form, comes in a variety of scents, including peppermint (which, for the record, does make things rather tingly “down there”), almond, tree tea oil, lavender and rose. It can be used on skin, hair, teeth, floors, cars, pets and as mosquito repellent, denture cleanser, athlete’s foot medicine and diaper deodorizer.

Over the years, rumors have surfaced claiming that the soap can be used as a douche and as birth control, but Bronner says the company doesn’t recommend these practices.

The Dr. Bronner product line expanded over the past few years. New products include Dr. Bronner’s & Sun Dog’s Magic lotions, lip balms and tattoo balms, and a line called Gertrude & Bronner’s Magic Alpsnack energy bars.

Dr. Bronner started the soap company in the late ’40s, but the business didn’t begin to gel until the late ’60s when Haight Ashbury hippies discovered the soap through word-of-mouth advertising. Hippies embraced the product because it was simple, natural and inexpensive, and because the label quoted poets, spiritual leaders and other visionaries.

The label, crammed with more than 3,000 words of copy and not a single graphic, looks more like a page torn from a book rather than a product label. Dr. Bronner used the label as his personal soapbox (no pun intended) to promote his ideas of environmental protection, peace, global unity and one-love/one-God.

Originally, Ralph was a non-believer in Dr. Bronner’s labels that quote a diverse group of people, including Jesus, Oprah Winfrey and Carl Sagan. He thought the label was aesthetically unpleasing and that no one would read it. He also thought the product needed a catchier name than “Dr. Bronner’s.”

“I thought he should call the soap ‘Mint Glow,’” Ralph says.

Prior to the computer age, Dr. Bronner coerced Ralph to type the labels on typewriters, sometimes just to change a single word. Although the labels were a source of frustration for Ralph, he is sentimental about them today. In the late ’90s, when Dr. Bronner was dying of Parkinson’s Disease, Ralph spoke all 3,123 words of the peppermint label onto a cassette and gave it to his dying father.

“He called me and said, ‘Did I write all of this?’ and I said ‘Yes, Dad. You did.’”

Ralph has not changed a single word on the labels since his father died in March of 1997.

Dr. Bronner was born Emmanuel Heilbronner (he later dropped the “Heil” to disassociate his name from the phrase “Heil, Hitler!”) to a family of German soap makers in 1908. He moved to Milwaukee in 1930 and married Paula Wolfart in 1933. They had three children: Ellen, James and Ralph.

Aside from being a fourth generation soap maker, Emmanuel was a visionary obsessed. He gave speeches, handed out flyers and sent 200 telegrams to President Roosevelt demanding “Peace on earth through one God!”

Despite his peaceful ideas and harmless nature, a bizarre event quickly changed Dr. Bronner’s life for the worse. In 1945, Chicago police found a man nailed to a cross under an elevated train track, and the man claimed he was dying for “Dr. Bronner’s peace plan.” Although Bronner did not know this man or what he meant by “peace plan,” he was arrested and committed to a mental hospital in Elgin, Ill.

Emmanuel underwent six months of manual labor and electric shock treatment (which caused the blindness he suffered for the last 30 years of his life). Finally, on his third attempt, Dr. Bronner escaped from the institution after stealing $20. However, he didn’t return to his family in Milwaukee, rather went to California where he started his soap company out of a Los Angeles hotel. Meanwhile, Ralph and his siblings lost their mother to an illness and lived in more than a dozen foster homes.

“Creative geniuses don’t always make good fathers,” says Ralph. “I don’t think Mozart would’ve stopped writing a symphony to take his kid to the park.”

Despite the strained relationship with his father, Ralph has grown to appreciate the man who spent most of his life running a soap company while wearing a leopard skin bathing suit. Ralph now understands that the soap was simply a way for his passionate father to spread his message to hopefully improve the planet he called “Spaceship Earth.”

“Dad used to say ‘Everybody, Jew or Gentile, uses soap,’ and he’s right. I’d hate to be downwind from someone who didn’t,” says Ralph.

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News flash: New York Times takes a crap on the small amount of credibility it had left. Stick a fork in it…they should merge with CBS News and just call themselves THE BIG PILE.

Jane Pauley Sues New York Times
Broadcaster claims fraud over appearance in drug industry advertorial

Oct. 25, 2006
The Smoking Gun

OCTOBER 25–Claiming that The New York Times duped her into granting an interview for what turned out to be a drug company-funded advertising supplement, Jane Pauley has sued the newspaper for fraud. In a lawsuit filed Tuesday in U.S. District Court, the 55-year-old broadcaster charges that she believed that the Times interview was for a news article on mental health issues, but that the story (accompanied by a full-page photo) ran in an October 2005 “special advertising supplement” promoting psychotherapeutic drugs sold by Eli Lilly and other pharmaceutical firms. Pauley, who in September 2004 disclosed her battle with bipolar disorder, alleges that the Times “duped” her into lending her name to its advertising gambit, according to the lawsuit, an excerpt of which you’ll find below. After going public about her bipolar disorder, the lawsuit notes, Pauley has worked with several mental health advocacy groups, including the National Mental Health Association. Pauley’s lawsuit seeks unspecified damages from the newspaper and DeWitt Publishing, which helped arrange the advertorial.

Court records

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An interesting report from John Dawson reviews laws in New Zealand, Switzerland, the UK and Canada.

from: COMMUNITY TREATMENT ORDERS: INTERNATIONAL COMPARISONS
John Dawson
May 2005
Funded by the New Zealand Law Foundation

Referring to the canton of Geneva:

“There is an active consumer advocacy organisation, known as the Patients’ Council, and the use of ECT is banned by law in the canton.”

Page 82:
Full report

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Jill Nawrocki
Corporate Counsel
October 19, 2006
Law.com

Tenet Healthcare Corp. didn’t admit any wrongdoing when it reached a civil settlement with the government earlier this year over alleged Medicare fraud. But the company voluntarily made a significant number of personnel changes, an apparent acknowledgment that not everything was right at the Dallas-based hospital chain. In addition to bringing on several new executives and directors, about 80 of the 97 vice presidents who were at Tenet prior to January 2003 are now gone. The shake-up was one of several major reforms that the company has implemented over the last few years.

The sweeping personnel overhaul at Tenet was “uncommon,” says Peter Henning, a former lawyer in the criminal division of the U.S. Department of Justice. Now a law professor at Wayne State University, Henning adds, “When you get down a couple of levels into management, that’s a substantial change” — and one that rarely happens.

Still, despite the employee shake-up, Tenet managed to avoid criminal charges, and that was what was most important for GC Peter Urbanowicz. Tenet’s settlement, which was announced June 29, comes at a time when other companies under investigation for alleged criminal violations have had to enter into more severe deferred and nonprosecution agreements with the government. On Sept. 28 Tenet also signed a “corporate integrity agreement” with the U.S. Department of Health and Human Services, which administers Medicare.

Urbanowicz supported the decision made by Tenet CEO Trevor Fetter to settle with the government. A former deputy general counsel at Health and Human Services, Urbanowicz became Tenet’s legal chief at the end of 2003. “When I joined the company, I let them know we couldn’t afford to have a bad relationship with the government,” Urbanowicz says. But, he adds, “you don’t want to agree to [settle claims] just for the sake of expediency,” and Tenet fiercely defended itself against any accusations of criminal wrongdoing.

Tenet’s problems started in October 2002 when nearly a dozen whistleblower suits were filed against the company, alleging it had inflated Medicare claims to increase payments for the sickest patients in its hospitals nationwide. By the end of that month, the FBI was looking into additional claims that two doctors in one of Tenet’s San Diego hospitals were performing medically unnecessary surgeries. The Justice Department quickly jumped in with its own investigation of the claims against Tenet.

In November 2002 Fetter was hired as the company’s new CEO. A new CFO and COO also came on at that time. The hires were part of the company’s attempts at changing its reputation with the government. Amid these changes, Tenet had to contend with the criminal trials of both San Diego doctors, which twice resulted in a hung jury.

This summer Tenet finally reached a settlement with the office of the U.S. attorney in Los Angeles and the civil division at the Justice Department’s headquarters in Washington, D.C., which shared the lead on the probe of the company. Tenet agreed to pay $725 million over a four-year period, plus interest, to the government for restitution of excessive Medicare payments. The company also agreed to fork over $47 million to resolve claims that it paid kickbacks to physicians who patients referred to its clinics. In addition, Tenet will pay $46 million for “upcoding” payments, which caused already costly procedures to be billed at an even higher rate. The settlement also put an end to the whistleblower suits.

In a prepared statement released after Tenet signed the deal with the DOJ, CEO Fetter said, “Some of the company’s past actions did not measure up to the high standards that we have imposed on ourselves since these issues first arose.”

The settlement with the DOJ was followed by the corporate integrity agreement with Health and Human Services’s inspector general. The agreement formalizes several changes that Tenet had already put into place, such as creating a compliance program headed by a chief compliance officer. Under the agreement, which will last for five years, the company must create a database to track patients, services, and activities. The stated aim of the agreement is to avoid violations of two federal statutes: one that bars a physician from referring patients to products or services in which he has an interest, and one that imposes criminal penalties on anyone in the Medicare system who accepts bribes.

Urbanowicz, 42, was charged with negotiating the settlement with the government. He says that his experience at Health and Human Services was one of the reasons he was hired at Tenet: “I think the board wanted … someone who knew the rules [at HHS], and knew them very clearly.”

After he arrived at Tenet, Urbanowicz made sweeping changes to the legal department. He streamlined the staff, reducing the number of lawyers from about 60 to around 40 today. He also severed relationships with several outside counsel in a quest for a “fresh viewpoint,” and hired a defense team headed by Latham & Watkins.

David Schindler, a Latham partner who worked on the agreement, says that the biggest challenge for Tenet was establishing trust with the government prior to and during the negotiations. The government was “particularly skeptical,” he says. Tenet’s lawyers had to “persuade [the government’s lawyers] that the company that lives today bears no resemblance … to the old one.”

But the organizational changes weren’t the only steps Tenet took. Urbanowicz also moved the corporation’s compliance program outside the legal department to encourage transparency. He helped develop a new position — independent compliance officer — who reports directly to the board. At Urbanowicz’s urging, Tenet’s compliance department has grown from just three staffers to more than 100 full-time employees (there’s one in almost every one of the company’s hospitals).

In Urbanowicz’s view, it was especially important for Tenet to figure out a way to cure itself. “It’s not like a number of other companies [in other fields] where someone else could pick up the slack,” he explains. “In many cases we [operate] the only hospital in town.” Thanks to the settlement, those hospitals are staying in business.

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If you’re hospitalized and unable to make health decisions, a living will can guide doctors about how much medical intervention you want.But what if you have a mental breakdown? A similar document, called a psychiatric advance directive, details the mental health treatments you would prefer.

Psychiatric advance directives, or PADs, have been available for years, and Illinois’ document is among the best, experts say. But PADs are little known and seldom used.

To raise awareness, the National Resource Center for Psychiatric Advance Directives has started a Web site, www.nrc-pad.org, providing state-by-state PAD information and downloadable forms.

A PAD is prepared when a patient is lucid. “The benefit is that the patient feels heard,” said Dr. Marvin Swartz, co-director of the center. “The patient feels empowered.”

The center was developed by Duke University Medical Center and the Bazelon Center for Mental Health Law.

PADs are intended for people with a history of severe and persistent mental illness such as schizophrenia or bipolar disorder — about 3 percent of the population.

The Illinois PAD allows you to state whether you agree to be hospitalized for up to 17 days, and whether you would consent to electroconvulsive (shock) therapy. It also lists what psychotropic drugs you would take. You might, for example, agree to take a certain drug, but only after your doctor has tried your preferred drug.The directive takes effect if two doctors or a court determine you are unable to make reasonable decisions. (You can name one of the doctors in the PAD.) The PAD must be followed, unless there is an emergency or unless a court contradicts your wishes. And you still could be hospitalized, regardless of what your PAD says, if it’s determined you are a danger to yourself or others.

The PAD designates a friend or relative to make decisions about your mental health treatment. It must be signed by two competent adults who attest you were of sound mind when you signed it.

The directive remains in effect for three years. You can revoke it only if a doctor determines, in writing, that you are competent to cancel it.

Illinois’ law is 10 years old but only recently has begun to catch on, the Illinois Guardianship and Advocacy Commission said.

jritter@suntimes.com

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The Scotsman
Oct. 8, 2006
KATE FOSTER CHIEF REPORTER (kfoster@scotlandonsunday.com)

DOZENS of psychiatric patients were given electric shock treatment without their consent in Scottish hospitals last year despite huge controversy over the safety of the treatment.

Almost 10% of patients given electro-convulsive therapy (ECT) underwent the procedure as a compulsory treatment for severe depression, according to figures seen by Scotland on Sunday.

Last night doctors revealed some patients are forcibly held down and anaesthetised for the procedure, prompting grave concerns from mental health campaigners who warn that its side-effects include confusion, headaches and long-term memory loss.

But psychiatrists insist ECT can help some patients with severe depression for whom medication is not working.

An audit of Scottish hospitals in 2005 by the Scottish ECT Accreditation Network reveals 433 patients underwent the treatment. A total of 38 had it without giving their consent. Last night, Donny Lyons, director of the Mental Welfare Commission for Scotland, said he believed it was right to treat people against their will if experts agreed ECT was the best option.

He said: “It is done sensitively and we have to be clear why we think a patient needs it. Any force should be kept to a minimum. Using force is extremely unpleasant and rare. You may get people resisting or objecting. Sometimes some general restraint is required.

“ECT is a good thing because it works in people with severe depression; 70% of people will get very significantly better. The more severe the depression, the better it works. It does work very well and it is a good treatment but it does have its risks and can cause memory difficulties.”

New safeguards on ECT were included in Scotland’s new Mental Health Act, which came into force last October. According to the new law, patients cannot be given the treatment forcibly unless they are deemed too mentally ill to be able to make an informed decision. Yet Lyons said it is too early to say whether the new laws are having any effect on the number of people treated forcibly. ECT involves placing electrodes on the temples, on one or both sides of the patient’s head, and delivering a small electrical current. Patients are treated with short-acting anaesthetics and muscle relaxants.

The current produces a seizure lasting up to a minute and can provide short-term relief from severe depression.

According to the audit, the highest rates of ECT were in Grampian, with 93 patients, and Lothian with 61 patients.

Moira Fraser, head of policy at the Mental Health Foundation urged extreme caution over the treatment because of its effects on the memory.

She said: “ECT is very controversial. The impact varies from individual to individual, so you have to be very cautious. If someone is capable of understanding the decision they are making and they have said no, for example because of the long-term memory problems, then it is only in very rare circumstances that it should be given.”

Sandra McDougall, influence and change manager at the Scottish Association for Mental Health, said: “It’s absolutely vital that people thinking about having the treatment are able to access good quality information about potential benefits and risks so that they can make an informed choice about whether to go ahead with it.

“It’s only possible for someone to be given ECT without their consent where they’ve been assessed as not having the capacity to make a treatment decision, and are being treated under relevant legislation.”

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By Lex Alexander
Greensboro News-Record

Oct. 8, 2006

Butch Kirkman, of Archdale, served eight years on active duty in the Air Force. He has spent half that long trying to get disability benefits from the Department of Veterans Affairs.

He isn’t done.

On Sept. 21, the Board of Veterans Appeals in Washington turned down his claim. It did so even though a regional office in Winston-Salem admitted misplacing his records and even though the department is required by law to give a veteran the benefit of the doubt in close calls.
Veterans often complain that the department can seem capricious and arbitrary in denying claims for benefits.

But many also say that the delay in getting any answer is a huge problem. If the veteran dies before his claim is decided, his claim dies with him. Veterans sardonically call this the “Delay, deny and hope that I die” policy. Kirkman’s case exemplifies some of the typical delays at the regional and national levels.

The News & Record last month contacted the department’s Winston-Salem regional office for this report; that office referred inquiries to Washington. The department did not return calls or respond to written questions.

James Michael “Butch” Kirkman seemed an unlikely candidate to seek disability benefits for post-traumatic stress disorder.
He had among the cushiest duties an American serviceman could have in Southeast Asia during the Vietnam era. In early 1973, he was posted for a year to an air base in Thailand, where he supervised telephone circuitry.

But at one point, as he was traveling to electronics school in Hawaii, his airport bus in Saigon was attacked. Two fellow passengers were wounded, although Kirkman escaped uninjured.

Then, on July 4, 1973, his air base was planning to shoot fireworks. Kirkman had agreed to swap some phone time to a Marine gunnery sergeant for a stint in one of two machine-gun nests on the base perimeter. He was planning to fire a .50-caliber machine gun during the fireworks.

“I wasn’t real bright,” he says now. “I didn’t stop and think about why the machine guns were out there.”

As he sat in the nest, six infiltrators slipped through the perimeter. Kirkman and a gunner in the other nest opened fire, hitting all six. One man he shot had pulled the pin on a hand grenade when the bullets, thick as a man’s thumb, struck him.

“If you’ve ever seen what a .50-caliber does to somebody …” he says, his voice trailing off.  Kirkman’s active duty ended in 1976. By 2000, he had become director of operations for a regional telephone company, making almost $125,000 a year.

Then he became depressed: anxious, suicidal, homicidal. He wouldn’t leave the house. He wouldn’t bathe. His employer laid him off in December 2000. He mortgaged his home for money to live on while he sought other work.

He tried other jobs but had to leave his last job, in March 2002, after a day and a half. His doctor certified him completely disabled. He and his wife, Myra, were forced into bankruptcy.
In mid-2002, Kirkman’s health insurance ran out, so he went to the veterans’ hospital in Durham. Doctors there advised him to seek service-related disability benefits. At 3 a.m. on Sept. 26, 2002, he sat down to do just that.

Almost a year later, Kirkman’s disability claim was denied by the department’s Winston-Salem regional office. Your symptoms, the office declared, don’t meet the official definition of post-traumatic stress disorder. But just a month prior, the department’s own doctors had formally diagnosed the disorder and classified him as completely disabled.

Regional offices are legally required to tell veterans what information or documents they need to include in their claims. But no one had told Kirkman exactly what he needed to prove a claim of PTSD, Myra Kirkman later wrote to the department.

Immediately, the Kirkmans sent copies of two letters from a psychologist at the veterans’ hospital in Salisbury. The first letter said that Kirkman displayed multiple symptoms of PTSD and recommended detailed testing. The second documented a formal diagnosis of PTSD.

Meanwhile, drugs weren’t helping Kirkman’s depression. In May 2004, he began electroconvulsive therapy — “shock treatment” — in Salisbury. He underwent 12 weekly sessions before experiencing a panic attack so severe that nurses thought he was having a stroke.

Kirkman used that treatment to try to have his case re opened. But in October 2004, his claim was denied again.

Veterans whose claims have been denied can ask for their claims to be examined by a decision-review officer in the regional office. The Kirkmans requested that in January 2005.

But they had another request: If the review officer could not overturn the denial, the couple wanted the case forwarded immediately to the Board of Veterans Appeals in Washington, D.C., without any additional documentation.

The Kirkmans took that step, Myra Kirkman wrote in a later letter to the board, because Butch Kirkman was willing to acknowledge that there were no formal military records of, or witnesses to, the events that caused his disorder.

In the meantime, Kirkman’s symptoms had become so severe that he spent six weeks in a special unit for PTSD patients at the Salisbury hospital.

At the hearing in May 2005, the decision-review officer told Kirkman his testimony was not reliable because no corroborating records or witnesses could be found — facts Kirkman already had acknowledged.
The regional office, rather than forwarding the case immediately to the Board of Veterans Appeals as the Kirkmans had asked, continued to seek nonexistent records from both them and the National Personnel Records Center in St. Louis in late 2005.

The Kirkmans didn’t get formal notification until May 12 — almost a full year after they had asked for their “immediate” appeal. About the same time, the Winston-Salem office acknowledged that it had “misplaced” the records it had borrowed from the records center in St. Louis.

Appeals normally are handled in the order in which they are scheduled with the Board of Veterans Appeals. But in light of the misplaced records, Myra Kirkman asked the board to hear her husband’s case early. Otherwise, the wait could have been years.

On Aug. 18, the board agreed to hear Kirkman’s case sooner. And it did: On Sept. 21, the board denied Kirkman’s claim.

Kirkman and his attorney, Craig Kabatchnick, plan to appeal the claim to the U.S. Court of Appeals for Veterans Claims. It will take Kabatchnick and the government months to get the case ready for the court to review. Once that happens, the court will take several months to rule on it.

If the court grants Kirkman’s claim, he will begin receiving benefits.
If it denies the claim, Kirkman can appeal to the U.S. Court of Appeals for the Federal Circuit, where a decision can take 12 to 18 months. And if, as frequently happens, it sends the case back to the regional office for additional fact-finding, the whole process starts over again.

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Washington Post
Saturday, September 30, 2006; A01

In Russia, Psychiatry Is Again a Tool Against Dissent
By Peter Finn
Washington Post Foreign Service

DUBNA, Russia — On March 23, police and emergency medical personnel stormed Marina Trutko’s home, breaking down her apartment door and quickly subduing her with an injection of haloperidol, a powerful tranquilizer. One policeman put her 78-year-old mother, Valentina, in a storage closet while Trutko, 42, was carried out to a waiting ambulance. It took her to the nearby Psychiatric Hospital No. 14.

The former nuclear scientist, a vocal activist and public defender for several years in this city 70 miles north of Moscow, spent the next six weeks undergoing a daily regimen of injections and drugs to treat what was diagnosed as a “paranoid personality disorder.”

“She is also very rude,” psychiatrists noted in her case file.

In person, Trutko presents a different profile, reserved and formal as she recounts her legal and psychiatric ordeal and invokes the minutiae of Russian law without having to refer to texts. An independent evaluation found that although she did not have an “ordinary personality,” she was “very gifted and creative” and displayed no psychiatric symptoms.

Trutko is new evidence that Soviet-style forced psychiatry has reemerged in Russia as a weapon to intimidate or discredit citizens who tangle with the authorities, according to human rights activists and some mental health professionals. Despite major reforms in the early 1990s, some officials are again employing this form of repression.

“Abuse has begun to creep back in, and we’re seeing more cases,” said Lyubov Vinogradova, executive director of the Independent Psychiatric Association of Russia, an advocacy group. “It’s not on a mass scale like in Soviet times, but it’s worrying.”

In those years, tens of thousands of dissidents were wrongfully subjected to forced hospitalization, sometimes for years, based on trumped-up diagnoses of “schizophrenia.” Dissidents were said to exhibit inflexibility of convictions and nervous exhaustion brought on by anti-government activities. “Reformist delusions,” the Soviets called it. If you were against communism, in other words, you were insane.

Some of the new cases have been abetted by institutions or doctors involved in it in the Soviet period. Trutko, who is originally from Uzbekistan, was diagnosed at the Serbsky Institute for Social and Forensic Psychiatry in Moscow, one of the most infamous of the Soviet institutions that imprisoned dissidents. It remains a secretive institution that has never faced up to its repressive past, according to human rights groups.

As recently as 2001, the institute’s director, Tatyana Dmitriyeva, denied that the Soviet Union engaged in any more psychiatric abuse than Western countries, according to the report “Human Rights and Psychiatry in the Russian Federation” by the Moscow Helsinki Group.

One of signatures on Trutko’s official evaluation, which declared she had paranoid personality disorder, is that of Yakob Landau, a longtime Serbsky psychiatrist who headed the institute’s notorious Unit No. 4 during Soviet days.

Officials at the institute, a walled and forbidding complex in central Moscow, said no one was available to comment for this article. Investigators in Trutko’s case declined to comment.

The charge that psychiatry is again being abused is not universally accepted within the profession. “The problem of forced treatment or psychiatric persecution existed more than 20 years ago, but it was solved. And since then I haven’t heard of any case of forced psychiatric examination or treatment,” said Vladimir Rotstein, president of Public Initiative on Psychiatry, an advocacy group.

The Independent Psychiatric Association, however, says that the number of activists being wrongfully hospitalized in mental facilities totals dozens of cases in recent years and is increasing. Doctors and the courts are complicit with investigators who insist on a forced psychiatric evaluation or treatment, it says. Activists have also documented an increase of family or business disputes in which wrongful hospitalization provides an opening to seize a person’s property, Vinogradova said.

Most of the targeted activists are not affiliated with major human rights groups. Rather, like Trutko, they are stubborn gadflies who are involved in long-running feuds with local authorities. Their sometimes intemperate complaints against authorities are used to open criminal investigations for slander. This allows authorities to seek hospitalization. Unlike Soviet dissidents, these activists are put away for relatively short periods of a week to several months.

Roman Lukin, a businessman in the Volga River city of Cheboksary, was hospitalized last year for “unexplainable behavior” after he held up a sign on a public square calling three judges “creeps.” Seeking redress for a bad debt that ruined him, Lukin felt he had not received justice from the courts. He spent two weeks in the local psychiatric hospital, which recommended that he undergo further examination at a specialized clinic in Moscow for possible “paranoid personality disorder.” Independent Psychiatric Association specialists evaluated Lukin and found no sign of mental illness.

Nikolai Skachkov, who protested police brutality and official corruption in the Omsk region of Siberia, was ordered to undergo a psychiatric evaluation last year because investigators said they suspected he was suffering from “an acute sense of justice.” He spent six months in a closed psychiatric facility where he was diagnosed as paranoid. The association, which conducted a separate evaluation earlier this year, found that he was healthy.

“Psychiatry in this country has always been a tool of the authorities, a tool for managing people and pressuring people. And it still is,” said Boris Panteleyev, head of the St. Petersburg Committee for Human Rights.

In an interview in her apartment, Trutko recounted her own long run-in. “Now I have this stamp on my forehead that I am a psychiatric patient,” she said. “I will always have this medical record now. That means I cannot go to court because judges say I’m a psycho and call for an ambulance.”

Trutko is well known in the courts in this town, having argued dozens of court cases against the local authorities and police. She is studying to be a lawyer, and for several years has acted as a public defender, as advocates without law degrees are called here.

Her troubles with mental health authorities began four years ago in a courtroom in Dmitrov, about 35 miles from Dubna.

Trutko asserted that the judge displayed bias against her client in a property dispute, and she moved to have the judge withdrawn. She also complained that the judge was not wearing her robe as required and that the Russian flag was improperly displayed. The judge, who later left the bench and could not be reached for comment, alleged that Trutko said, “Look at that fat pig sitting up there,” according to legal papers.

Prosecutors opened a criminal case against Trutko on charges of contempt of court. In July 2003, the court ordered Trutko to undergo an involuntary psychiatric evaluation. Psychiatrists at the hospital said she was uncooperative, illogical and displayed emotional reactions that were “not adequate” — a common phrase here for mental illness.

The Independent Psychiatric Association questioned these conclusions. Its own evaluation of her, conducted by four psychiatrists, found that “she is not an ordinary personality, but a very gifted and creative person. . . . No psychiatric symptoms were observed. She shows high intellectual ability and good memory. She does not need any treatment.”

Trutko continued to battle the criminal complaint in court. Before a hearing at the higher Moscow regional court, she filed a motion seeking the removal of a panel of judges from her case, again asserting bias. In this case there was no claim of verbal abuse, but prosecutors said her motion amounted to slander and contempt.

In April 2004, after leaving a hearing on her case in Moscow, Trutko was detained by investigators and taken to the Serbsky Institute. It was a Friday evening when she was admitted and there was no expert commission available to evaluate her, Trutko said. Human rights groups protested her detention and threatened legal action. Trutko said she was released the following Tuesday morning without having undergone any formal examination by psychiatrists.

But the institute issued a six-page evaluation that said she suffered from a “paranoid personality disorder.” The condition manifested itself in her “subjectivity,” her “tendencies to verbal aggression,” her “suspicious” personality and her “inability to understand the peculiarities of interpersonal relations and communication,” medical records show.

The report recommended that she undergo forced hospitalization and treatment.

In September 2004, a Moscow court approved that approach. But the authorities, for reasons that remain unclear, did not act on the order until they stormed Trutko’s apartment earlier this year.

Despite her subsequent release, Trutko said, the court order remains in effect and she could be institutionalized again at any time. “My career is ruined,” she said. “I just stay at home.”

5 Responses »

“Affairs Public” @LIST.NIH.GOV on 09/28/2006
11:15:44 AM

Sent by:    owner-hhs-oig-media-l@LIST.NIH.GOV

To:   
cc:

Subject:    OIG Posts Tenet CIA/Release, MFCU 04/05 Annual, 3 Audits   9/28

Hello To All,

OIG today posts a Corporate Integrity Agreement with Tenet Healthcare
Corporation and an accompanying press release.

From the press release:

OIG Executes Tenet Corporate Integrity Agreement
Unprecedented Provisions Include Board of Directors Review

Inspector General Daniel R. Levinson announced today that the Office of
Inspector General (OIG) of the U.S. Department of Health & Human
Services has reached an agreement with Tenet Healthcare Corporation on a
Corporate Integrity Agreement (CIA).  The CIA is part of Tenet’s
resolution of its civil and administrative liability for a wide range of
investigated conduct, including Diagnosis Related Group (DRG) upcoding,
improper outlier payments, kickbacks to physicians, and other fraudulent
activities.

“OIG is committed to protecting the integrity of Federal health care
programs, and today’s Corporate Integrity Agreement with Tenet
Healthcare Corporation contains comprehensive and unprecedented
provisions designed to prevent future harm to the programs.  OIG expects
Tenet to fully comply with the requirements of the Corporate Integrity
Agreement, and we will closely monitor Tenet’s compliance with its
terms,” said Inspector General Daniel R. Levinson.

For the full press release, go here:
http://oig.hhs.gov/fraud/docs/press/Tenet%20CIA%20press%20release.pdf

The Tenet CIA document is here:
http://oig.hhs.gov/fraud/cia/agreements/TenetCIAFinal.pdf
_______________

Also today, OIG is posting the Fiscal Year 2004/2005 Medicaid Fraud
Control Unit Annual Report.  Go here:
http://oig.hhs.gov/publications/docs/mfcu/MFCU%202004-5.pdf

The enactment of the Medicare and Medicaid Anti-Fraud and Abuse
Amendments of 1977 authorized the establishment of, and Federal funding
for, the State Medicaid Fraud Control Units (SMFCUs). Currently, 47
States and the District of Columbia participate in the Medicaid fraud
control grant program through their established SMFCU. The majority of
the Units are located within the Office of State Attorneys General. A
small number of the Units are located in various other State Agencies.
The mission of the Medicaid fraud units is to investigate and prosecute
Medicaid provider fraud and incidences of patient abuse and neglect.

The Inspector General is delegated the authority to annually certify
each SMFCU as eligible to receive Federal grant funds under the Medicaid
fraud control program. The Medicaid fraud units receive 90 percent
Federal funding for the first 3 years of operation and 75 percent
thereafter. A primary goal of the OIG is to ensure that each unit fully
complies with all Federal regulations governing the functions and
operations of a Medicaid fraud unit.
_______________

Finally, OIG is today also posting three new Audit reports.  As always,
selecting the link immediately following the report title will take you
directly to the full document.

Nationwide Review of Inpatient Rehabilitation Facilities’ Compliance
With Medicare’s Transfer Regulation (A-04-04-00008)
http://oig.hhs.gov/oas/reports/region4/40400008.pdf

Our objective was to determine whether inpatient rehabilitation
facilities (IRFs) coded claims as “discharged to home” in compliance
with Medicare’s transfer regulation during fiscal year (FY) 2003.  IRFs
did not always code claims in compliance with Medicare’s transfer
regulation.  Nationwide we identified 2,473 IRF claims coded and paid as
discharges to home that potentially should have been paid as transfers.
We visited or contacted seven IRFs that were responsible for 112 of
these claims and found that all 112 claims should have been coded as
transfers rather than as discharges.

We recommended that CMS:  (1) instruct the fiscal intermediaries to
review the claims in question and to recover, as appropriate, the
estimated $11,967,555 in potential overpayments, (2) instruct the fiscal
intermediaries to review claims paid after our audit period for possible
coding errors like those found in this review, and (3) implement edits
in the Common Working File that match beneficiary discharge dates with
admission dates to other providers to identify potentially miscoded
claims.  CMS concurred with the recommendations and requested that we
furnish the necessary data to initiate recovery of the overpayments.  We
have provided CMS with the requested data.
__________

Review of Durable Medical Equipment Providers’ Medicaid Claims for NY
Residents of Assisted Living Programs (A-02-05-01017)
http://oig.hhs.gov/oas/reports/region2/20501017.pdf

Our objective was to determine whether durable medical equipment (DME)
providers improperly received Medicaid reimbursement for medical
supplies and equipment not requiring prior approval that were already
included in the per diem rates paid to assisted living programs (ALPs).
New York prohibits Medicaid payments to DME providers for items
furnished by a facility or organization when the cost of those items is
already included in the per diem rate.  The DME providers improperly
received Medicaid reimbursement for medical supplies and equipment not
requiring prior approval that were furnished to ALP residents.  As a
result, $406,081 in Federal funds was improperly claimed under the
Medicaid program.  Our report recommended that the State:  (1) refund
$406,081 to the Federal Government, (2) establish eMedNY edits and
controls necessary to deny DME provider claims for Medicaid
reimbursement for medical supplies and equipment not requiring prior
approval that were furnished to ALP residents, and (3) issue guidance to
DME providers emphasizing that State regulations prohibit Medicaid
payment for items included in the ALPs’ per diem rates.  The State
generally concurred with all three recommendations
__________

Audit of Whitman-Walker Clinic’s Adequacy of Patient Care
(A-03-05-00207)
http://oig.hhs.gov/oas/reports/region3/30500207.pdf

Our objective was to determine if an allegation submitted to the Office
of Inspector General that the Whitman-Walker Clinic conducted medically
unnecessary and time-consuming testing procedures that contributed to
the medical deterioration and eventual death of an AIDS patient could be
substantiated.  There was no evidence to substantiate the allegation.
The tests performed for the patient were both necessary as a basis for
treatment and conducted within acceptable timeframes.  Accordingly,
there were no recommendations as a result of this audit.
_______________

Well, that’s all for now. As always, if we can provide you with further
information or assistance please don’t hesitate to let us know either by
email (paffairs@oig.hhs.gov) or by phone (202/619-1343) how we can help.
Here’s hoping your week is has been proceeding nicely!  — Don White,
Public Affairs   http://oig.hhs.gov

No Responses »

350 former psychiatric patients to seek compensation from government

Oct. 6 2006
New Zealand Radio

The lawyer for 350 former psychiatric patients seeking compensation from the government says there’s no difference between his clients and another set of patients who have already been paid substantial compensation.

The 350 claim they were mistreated at State-run mental asylums in the 1960s and 70s.

Their accounts of abuse are similar to those of former patients at the Lake Alice psychiatric hospital, who are sharing $6.5 million in compensation paid in 2001.

About 200 of the group have already lodged legal claims; and more are expected to do so, saying they suffered physical and sexual abuse. They also say electric shock treatment was used as a punishment.
Govt stance

The new group’s lawyer, Roger Chapman, says that puts the government in a tough position.

He says it’s difficult, morally, to defend a stand of this kind by a government that accepted that it had an obligation to the Lake Alice patients.

The cost of taking the claims through the courts will fall on the taxpayer through legal aid.

The first hearings are a year away, and Mr Chapman expects many more former patients will come forward in the meantime.

One Response »

Hey, Liz Spikol has a mental health blog at the Philadelphia Weekly. Somehow I missed it, but it’s required reading for all.

I think you need to bookmark this.

http://trouble.philadelphiaweekly.com/

One Response »

Sarah Hall
Oct. 4, 2006
Norwich Evening News 24

Health bosses have come under fire today after it was revealed that almost 3,000 patients have been given electric shock therapy in the past three years to treat depression and other mental health problems.

Campaigners have called electro-convulsive therapy (ECT), barbaric and claimed patients’ lives were being ruined.

Figures obtained from the West Norfolk Primary Care Trust and the Norfolk and Waveney Mental Health Partnership NHS Trust under the Freedom of Information Act showed there were 2,837 administrations in Norfolk since 2002. ECT is banned in countries including Holland and Italy.

Chris Wrapson, spokesman for the Citizens’ Commission on Human Rights (CCHR), founded by the Church of Scientology in 1969, said: “ECT is a violation of human rights. It is torturous and barbaric with horrendous side effects. There are nearly 3,000 cases of therapy in Norfolk and this is not acceptable.”

According to the CCHR, ECT involves:

A person being given powerful drugs;

A current reaching up to 500 volts sent through a pad on the head;

This often leads to a patient having a seizure or blacking out.

A Royal College of Psychiatrists survey conducted on psychiatrists, psychotherapists and general practitioners, confirmed memory loss was a side effect of ECT. Of the 1,344 psychiatrists surveyed, 21pc referred to “long-term side effects and risks of brain damage, memory loss and intellectual impairment”. General practitioners reported that 34pc of patients seen in the months after receiving ECT “were poor or worse”.

Dr Hadrian Ball, the Norfolk and Waveney Mental Health Trust’s medical director, said: “Electroconvulsive therapy (ECT) is a well-recognised and effective treatment for some forms of serious mental illness, most usually severe depression.

“The use of ECT is determined by strict guidelines that have been set out by the National Institute for Clinical Excellence and by the Royal College of Psychiatrists. ECT is only used within the trust in complete accordance with these national guidelines and with the law. When psychiatrists make decisions as to whether ECT is required, this is done on the basis of a full assessment of the potential risks and potential benefits to - and the views of - the individual service user.”

What is ECT?

Introduced in the 1930s as a treatment for schizophrenia, electrotherapy was found to cause changes in depressive disorders.

Medical experts say it is a rapid and effective treatment for severe depressive disorders.

Its main benefits come from its efficacy and speed and it is said to be beneficial where there is a high risk of suicide or danger to health because the patient is not eating or drinking enough.

In severe postpartum depression, it may help with the early development of the bond between mother and child.

The effectiveness of ECT depends upon the induction of a convulsion thorough an electric shock. Two important factors in ECT are the amount by which the electrical dose exceeds the seizure threshold of the patient; and where the electrodes are placed on the body.

Adverse effects include confusion, nausea and vertigo. People may also suffer muscle pain in their jaw. There have been reports of seizures for months after ECT. People’s teeth, tongue or lips may be damaged if a gag is not positioned properly and small electrical burns can occur if electrodes are not properly applied.

Anyone with information on adverse reactions to psychiatric drugs is asked to contact the CCHR on 0845 260 2247.

Do you have a mental health story for the Evening News? Contact Sarah Hall on 01603 772426 or e-mail sarah.hall2@archant.co.uk

No Responses »

By John David Sutter
The Oklahoman

Oct. 2, 2006

Michele Rodriguez-Ryland thinks about suicide every day - sometimes constantly.

And if not for the 175 times she’s had medically administered electric shocks sent through her brain, she says her unyielding depression would have killed her by now.

“It’s like going outside in the sunlight, you know, colors look brighter, people seem friendlier,” she said of the electroconvulsive therapy, also called ECT or shock therapy, she’s chosen to receive. “I just feel like I wanna go out and do everything. And this is after just a few hours before, feeling like I wanted to kill myself. I mean, that’s quite a radical transition.”

The controversial treatment - mostly used to dull intractable cases of severe and prolonged depression when drugs and therapy fail - appears to be making a comeback from its stigmatized past.

In Oklahoma City, Dr. Shreekumar Vinekar, a professor of psychiatry and behavioral science at the University of Oklahoma College of Medicine, said he now administers the treatment to about twice the number of patients he did 10 years ago - up from about 250 treatments per year to an estimated 500 now.

National and Oklahoma statistics on the treatment are not collected. But Dr. Charles H. Kellner, chairman of the department of psychiatry at the New Jersey Medical School-UMDNJ, a leader in the field, said ECT use is “definitely increasing. It’s going up several percent a year, definitely. I don’t think there’s much question about that.”

Some say the treatment has become destigmatized. Others say patients are simply more aware that it’s an option.

The increase comes in spite of risks, including memory loss.

But for those with depression like Rodriguez-Ryland’s that doesn’t respond to anti-depression medications, or doesn’t respond quickly enough to avoid crisis, psychiatrists have long backed keeping ECT available.

They say modifications have made the treatment a safe and effective option - worth the risks.

How it works
Exactly how ECT works is not understood, but its power is thought to be in the seizures it induces.

Patients are wired to two electrodes placed on their forehead. While under general anesthesia, a series of shocks, lasting usually no more than 6 seconds each, are pumped into the brain. This induces seizures, which are thought to reboot or reset brain chemistry.

Patients are given muscle relaxers before ECT treatments, otherwise they would convulse and maybe get injured.

The procedure takes 10 to 15 minutes.

Rodriguez-Ryland said the first time she underwent ECT she felt terrified, miserable, hopeless. Since then, she has come to know her doctor and anesthesiologists and looks forward to ECT.

She only can receive up to three treatments per week. She goes back for one any time she feels like she can’t go on living otherwise.

Memory loss
Rodriguez-Ryland and others experience memory loss, which they link, at least in part, to their shock treatments.

Rodriguez-Ryland parks in the same, empty section of the Wal-Mart parking lot every time she goes, so she’ll remember where her car is. She uses visual markers to put places she might otherwise forget in a memorable context.

She says doctors have told her severe depression causes her memory loss, not the shocks. But she thinks it may be both. Her memory returns, and it’s a risk she’s willing to take for the benefits.

She said she has tried to kill herself about 30 times. The first attempt was at age 10. She says ECT saved her life.

Tina Boyle says a series of ECT treatments ruined hers.

After shock therapy, she lost almost all recollection of her family. She used stacks of photo albums to refresh her memory but says she will never be the same. “I feel like I’m short-circuiting,” she said.

She and her family members say the memory loss started after her shock therapy. Her children quit their jobs to take care of her for a time. She stays in her south Oklahoma City apartment most all the time, for fear she’ll forget how to get home.

Boyle’s memory loss may not be related to her shock therapy. She has other mental health conditions.

Her psychiatrist declined to comment on her case, despite Boyle’s willingness to sign legal release forms necessary for him to do so. Medical records from 2002 provided by Boyle show she received ECT treatment.

Future
Rodriguez-Ryland hopes more people become aware of shock therapy so that they can discuss the option with their psychiatrists.

She is still very depressed.

But she has enrolled in graduate school at OU, with the hopes of writing a book about her experiences with ECT.

4 Responses »

Sep. 28, 2006
The State

The body electric
What’s more shocking — that electroconvulsive therapy is still around, or that some doctors and patients say it really works?
By LINDA H. LAMB

It’s a humid, overcast morning when Marcia Hudson heads to the hospital for a treatment most people would be surprised to know still exists.

Reclining on a gurney with white cloths tucked around her, she will be rolled into a bright room at Palmetto Health Baptist. She will chat with the doctors and nurses attending her. She will be sedated and have electrodes attached near her temples.

When she’s asleep, a doctor will press a button and for a fraction of a second, an electrical stimulus will pass into her brain.

Yes, electroconvulsive therapy or ECT — formerly known as electroshock — does still exist. About 100,000 patients will have these treatments in the United States this year, including more than 385 in South Carolina.

If you’re already picturing a horror movie, or “One Flew Over the Cuckoo’s Nest,” you might be surprised to know Hudson calls ECT “a blessing” that helped her conquer crippling depression when nothing else worked.

“I was feeling hopeless, totally hopeless,” said Hudson, 62, of Laurens County.

While struggling in the aftermath of her stepson’s suicide, she became immobilized by sadness and anxiety.

“I just could not function,” she said. “I felt numb, I couldn’t think, couldn’t put one foot ahead of another.”

The antidepressant medications that help many people were not helping her, and she felt that talk therapy was a dead end. That’s why she sought out ECT early this year. Despite some resulting problems with her short-term memory, she credits the treatments with helping her feel balanced and creative again.

“I think it’s an option that people don’t know about,” she said.

STILL CONTROVERSIAL

Doctors who use ECT say that for some people — especially older patients who are severely depressed — it’s an option that can save lives. They say the treatments have changed significantly over the years thanks to improved techniques, smaller jolts of electricity and the use of anesthesia and muscle-relaxing medications.

There’s even a new celebrity testimonial to the benefits of ECT: Kitty Dukakis, wife of the former Democratic presidential candidate, has written a book about how ECT saved her from decades of depression (“Shock: The healing power of electroconvulsive therapy”).

But that doesn’t mean the subject is no longer controversial.

Juli Lawrence, 46, says ECT did not cure the depression she developed while dealing with job troubles and a difficult divorce. Worst of all, she said she’s still trying to cope with cognitive problems following the treatments, which she had in 1994.

“The one thing that really stands out is that some of my math abilities have disappeared,” she said. “Math has always been something I loved and I was exceptional at.”

Now she can’t balance her checkbook, said Lawrence, who lives on Long Island, N.Y., and operates a Web site critical of ECT (www.ect.org).

Another former ECT patient, Andy Behrman, was bemused to find himself an ECT poster boy after writing a 1999 New York Times essay about how it helped him regain control of a life ravaged by bipolar illness. When he wrote a verbally hyperactive book about his experiences, he titled it “Electroboy: A Memoir of Mania.”

Behrman credits ECT with breaking his manic cycle. He’d been living in fast-forward, hopping planes from his Manhattan home to London or Tokyo on a whim, spending money like crazy and eventually getting into legal trouble. Now, at 44, he lives in Los Angeles and is happily working on a movie based on his book.

Electroconvulsive therapy “was a last resort for me — 37 medications had failed me,” he said. But his 19 ECT treatments caused confusion and memory lapses he found frightening and humiliating.

“Electroboy” said he doubts he would have ECT again.

“I don’t know any patient who hasn’t suffered from some pretty serious confusion and memory loss,” he said.

NOT THE FIRST OPTION

On the other hand, who wants to cherish memories of being paralyzed in dark depression, or being obsessed with thoughts of suicide? Up to 15 percent of seriously depressed people end up killing themselves, according to the National Institutes of Health.

Some patients say brief periods of confusion, even memory gaps that persist for years, are a worthwhile tradeoff for the ability to go back to living their lives.

“The people who are selected for ECT today are those who are significantly, suicidally depressed,” said Dr. Kenneth Huggins, a psychiatrist who administers treatments for Hudson and others at Palmetto Health Baptist.

“We don’t take a person who is depressed and give them ECT to start with,” he said.

Typically, Huggins said, doctors will try various medications and therapies for patients who are sad, anxious or depressed. ECT might be considered if patients seem perilously close to suicide, have a serious reaction to medication, or are so ravaged by depression that they cannot take care of themselves.

“ECT has saved my life a few times in the last three years,” said Kathleen Kain, 48, of Columbia.

“Psychiatric medications are great, but my body can’t tolerate them because I get severe side effects,” she said.

Kain, trained as an engineering scientist, has struggled with bipolar illness for years and currently is on disability. She said she has attempted suicide half a dozen times. She thinks “horror stories” about ECT keep patients from trying it.

Another Columbia woman, who asked that her name not be used, fears she would be stigmatized in her government job if people knew she had had electroconvulsive therapy. But the treatments jolted her out of two decades of depression, she said.

“About four years ago, I just kind of lost it,” she said. “I called my doctor and said, ‘Get me a room at the hospital; I’m on my way.’

“After 10 days in the hospital, I came home and I sat on the couch for two and a half months. I just stared at the TV. I didn’t go anyplace but the doctor. I withdrew.”

She had tried medications, group therapy and psychoanalysis. Finally, she agreed to try ECT. Now she is back at work, coping with some short-term memory loss by making notes to herself.

“I did that before, but I do it more now,” she said with a laugh.

“The fatigue is gone; (I) can think … it’s like all of a sudden, a light went on.”

‘CUCKOO’S NEST’

Huggins, who teaches a course on electroconvulsive therapy at the University of South Carolina School of Medicine, said ECT was developed in the 1930s.

Doctors had observed that when epileptics had seizures, or when people had fever-related seizures, depression symptoms often improved. They tried triggering seizures with electric current for a similar effect.

“Your brain is an electrical organ in delicate balance,” Huggins said, adding that it’s not clear why ECT may help depressed patients. He thinks the best theory is that the stimulus triggers release of brain chemical that functions as a powerful antidepressant.

According to the 1999 Surgeon General’s Report on Mental Health, no controlled study has shown any other treatment to be superior to ECT for depression. However, it fell out of favor for several reasons, Huggins said.

One is that before psychiatric drugs, ECT was tried for all kinds of mental disorders — and in most cases, it didn’t help.

Also, patients suffered serious memory loss and brutal seizures. Some patients convulsed so violently that they broke bones, Huggins said.

Actor Jack Nicholson in the Oscar-winning, 1975 “Cuckoo’s Nest” grimaces painfully during an electroshock treatment.

“He did a great job. That is exactly the way it looked, back in the ’50s,” Huggins said.

View the film carefully and you’ll notice Nicholson’s character is affected little by his ECT. But at the end of the movie, he’s had a surgical procedure called a lobotomy that leaves him completely senseless. Interestingly, people remember that horrifying image and associate it with ECT.

“That was probably one of the most influential movies in the history of psychiatry,” said Dr. Milton J. Foust Jr. of the Medical University of South Carolina.

Besides the two Palmetto Health hospitals in Columbia, MUSC in Charleston is the only other place in the state where ECT is administered.

Foust said negative media portrayals of ECT run counter to his observations at MUSC, especially of gravely depressed, older patients. “Those kind of patients respond exquisitely well to ECT,” often showing great improvement after only a few treatments, he said.

The brief pulse of electrical current is as little as one-third as powerful as what was used decades ago. With the use of anesthesia and muscle relaxants, the only sign of a seizure might be a slightly twitching hand or toe and the printout of an EEG (electroencephalogram, which measures brain activity).

Resulting memory loss “typically is not going to have any serious effect on the person’s ability to function,” said Foust, an assistant professor of psychiatry.

The National Institute of Mental Health says lasting memory problems are less troublesome than in the past, but advises patients to weigh the benefits and risks carefully before having ECT.

Patients usually receive eight to 12 treatments, two or three a week. Initially some receive the treatments while hospitalized. Hudson and Kain receive outpatient “maintenance” treatments.

More than 100 patients receive ECT in Charleston each year, about 225 a year at Palmetto Health Baptist and 60 at Palmetto Health Richland.

DECLINE AND COMEBACK

Use of ECT declined with the emergence of anti-psychotic drugs and antidepressants in the 1950s. According to medical journals, the treatment has made a bit of a comeback in recent years. But positive accounts of ECT have been controversial, such as Martha Manning’s 1994 book “Undercurrents: A therapist’s reckoning with her own depression.”

“Nobody bats an eye when electricity is delivered to a stalled heart … But try talking about the same thing with the brain, and it’s no miracle,” Manning wrote. “Suddenly, words like torture and mind control populate the descriptions.”

Some experts believe other forms of brain stimulation will replace ECT to treat the 15-20 percent of depressed people who do not respond to medications and psychotherapy.

Proto, the magazine of Harvard University-connected Massachusetts General Hospital, recently touted “less shocking alternatives” of vagus nerve stimulation, transcranial magnetic stimulation and deep brain stimulation. It proclaimed cheerily that these treatments are “sure signs that electroconvulsive therapy has flown the cuckoo’s nest.”

But Dr. Mark George, a renowned brain researcher at MUSC, noted that two of those techniques involve surgery and none of them are widely available. Though very promising, they are not appropriate for an emergency in which a depressed person is not eating or is suicidal, he said.

George said research is being done at MUSC and elsewhere to try to bypass or limit the cognitive problems of ECT — for example, to deliver energy inducing a seizure without passing through the part of the brain that affects memory.

“I don’t think ECT will ever fall into disuse, not in the next 10 to 15 years, for sure,” George said.

“ECT, with all its problems, is still a lifesaver.”

Reach Lamb at (803) 771-8454.

ABOUT ECT

Electroconvulsive therapy, or ECT, formerly was called electroshock or shock treatment.

• For most patients, medications for mental illness are more likely to be used than ECT.

• Studies show ECT can be highly effective for severe depression, some psychotic states and mania.

• A brief pulse of electric current passed through one or two electrodes causes a generalized brain seizure.

• Possible risks from ECT include confusion, memory loss, headache, hypotension (a type of low blood pressure), rapid heartbeat and allergic reaction to anesthesia.

• Cost of a typical course of ECT (eight to 12 treatments) is about $10,000 to $17,000, usually covered by insurance.

• To view a video presentation of one woman’s experience with ECT, visit www.mayoclinic.com/health/electroconvulsivetherapy/MH00022.

SOURCES: Surgeon General’s report, National Institutes of Health

7 Responses »