CIA brainwashing victims seek Canada court action

Monsters and Critics

Americas Features
CIA brainwashing victims seek Canada court action
By James Stairs
Jan 19, 2007

Montreal – In a case that sounds like science fiction, a Montreal court is deciding whether a class action lawsuit can be brought against the Canadian government on behalf of more than 250 psychiatric patients who were unwittingly subjected to radical experiments in the 1950s.

The so-called MK-ULTRA tests were part of a secret mind-control programme funded by the US Central Intelligence Agency (CIA) and the Canadian government in the 1950s.

The Cold-War-era experiments, carried out by a Scottish doctor in Montreal, included forced isolation, induced-comas, electro-shock therapy and the use of hallucinogenic drugs, including LSD and paralysis-inducing narcotics.

Lawyers for Janine Huard, a 78-year-old great-grandmother, told a Montreal court last week that their client suffered for years as a result of Dr. Ewan Cameron’s experiments at the Allan Memorial Institute, a psychiatric hospital based at Montreal’s McGill University.

The experiments were part of a controversial secret CIA programme, aimed at uncovering techniques of mind control and led by Cameron, who died in 1967.

MK-ULTRA was launched by the CIA in 1953 and headed by the American chemist Sidney Gottleib. It reportedly funded projects both at home and abroad, including the Montreal study, and hoped to be able to find ways to extract information from prisoners and influence foreign leaders through brainwashing.

The project was brought under scrutiny in 1974 when newspaper reporters uncovered that MK-ULTRA had drugged unwitting subjects in the US with hallucinogens and secretly observed their actions. The project had been disbanded a year earlier and all record of its activities were destroyed.

Cameron’s research specifically revolved around ‘psychic driving’ – a potential cure, he believed, for depression and dementia that involved erasing patients memories and then building them back up again.

Huard said that she first came under the care of Cameron, a former president of the World Psychiatric Association, when she consulted him in 1951 regarding a case of postpartum depression after the birth of the second of her four children. She was in his care another two times up to 1962.

The court heard that Huard and hundreds of others were test subjects for Cameron’s ‘de-patterning’ experiments, which included the repeated playing of recorded messages while patients lay in a drug-induced semi-comatose state.

Huard said that she underwent electro-shock treatments and was administered dozens of unknown pills a day, keeping her semi- conscious.

‘She never knew that she was being subjected to these experiments or that she was being used by Dr. Cameron and his staff as a guinea pig,’ Alan Stein, Huard’s lawyer told the court.

The aftermath of the tests, she said, left her unable to function normally, afflicted by memory loss, depression and by migraine headaches.

‘I came out of there so sick that my mother had to live with me for ten years,’ she told reporters. ‘I couldn’t take care of my children any more.’

The CIA paid Huard and several others 67,000 US dollars each as part of a 1988 class action settlement.

In 1994, the Canadian government compensated 77 of the most severely incapacitated former patients 100,000 US dollars each for damage they suffered from the programme.

Huard and 252 others were denied compensation at the time, since the long-term affects of the testing were not deemed serious enough to warrant payment.

In 2004, a court overturned one of the decisions and awarded 100,000 Canadian dollars (85,259 US dollars) to Gail Kastner, a former patient who had undergone severe electro-shock therapy to treat her depression in 1953 at the hospital but whose claim had been previously deemed ineligible.

This decision, Huard’s lawyers argued, opens the door for the current class-action request.

Lawyers for the government did not dispute Huard’s claims but argued that the tests happened too long ago for her to make another attempt at compensation.

‘They demolished me,’ Huard told reporters as she entered the court. ‘They gave me terrible drugs, electroshocks, and made me stay in a bed with a mask over my face listening to recordings for hours a day. I was afraid.’

No timetable has been given regarding a decision from the court.

Professional accounts of electroconvulsive therapy: A discourse analysis

Peter Stevens a, , and David J. Harper b,

aOxleas NHS Trust, Dartford, Kent, UK
bUniversity of East London, UK

Available online 8 January 2007.

Abstract
Electroconvulsive therapy (ECT) is a socially contested psychiatric intervention. However, the accounts of professionals involved in its use have rarely been systematically investigated. This study aimed to examine the accounts of clinicians who have used ECT on a routine basis. Eight health professionals (psychiatrists, anaesthetists and psychiatric nurses from a major city in the United Kingdom) with experience of ECT administration were interviewed about the procedure. Discourse analysis was used to interpret the interview transcripts. Interviewees appeared to draw on a repertoire, which constructed ECT recipients as severely ill. This was used to support claims which had the effect of: defining who should receive ECT; warranting the use of urgent physical psychiatric treatments; reformulating distress in biological terms; and discounting the therapeutic value of alternative, non-physical interventions. The interviewees managed concerns about ECT in a variety of ways, for example by: rendering it as a medical procedure with concomitant risks and benefits; downplaying a lack of clarity over its evidence base; and undermining the legitimacy of criticisms. Implications of these findings are discussed.

Keywords: Discourse analysis; Electroconvulsive therapy; Debates; Persuasive communication; UK

Article Outline
Introduction
The unconscious motives of professionals: psychoanalytic research
From motives to attitudes, belief and knowledge: cognitive research
From motives, knowledge and attitudes to accounts: the contribution of a discursive approach
Method
Participants
Interviews
Initial reading and coding
Results
The biomedicalˆmedical repertoire
The Œsevere end‚ rhetorical device
Who is appropriate for ECT?
ECT as Œlife-saving‚
Locating the focus of concern at the biological level
Exclusion of non-physical interventions
Managing concern about ECT
Acknowledging grounds for concern: weighing up risks and benefits
Rendering ECT as a medical procedure
Downplaying debate: the evidence is becoming clearer
Managing criticism of ECT: who has rights to speak?
Discussion
Implications
Researchers
Mental health professionals
Service users
Appendix A. Appendix
A.1. Transcription notation
References

Introduction
Electroconvulsive therapy (ECT) remains one of the most widely used but contested and debated interventions in psychiatry. Advocates argue that the procedure is safe, effective and often life-saving (e.g., Abrams, 1997; Fink, 1979) whilst critics argue that it is ineffective and has the potential to cause psychological and neurological harm (e.g., Breggin, 1993; Friedberg, 1977; Johnstone (2000) and Johnstone (2003); Read, 2004).

However, there are two neglected areas in the research literature. The first is the relative lack of interest in the experiences of ECT recipients. Recently, researchers, including those with direct personal experience of receiving ECT have tried to redress this imbalance (Johnstone, 1999; Rose, Wykes, Leese, Bindman, & Fleischmann, 2003; Rose, Fleischmann, & Wykes, 2004), and there is a need for further investigation in this area.

A second neglected area is the empirical investigation of the accounts of those involved in ECT administration. The two most popular investigatory paradigms here have been psychoanalytic and cognitive. We will briefly review studies from these two paradigms, arguing that these studies are both theoretically and methodologically limited, before making the case for the contribution of a discursive approach.

The unconscious motives of professionals: psychoanalytic research
In the two decades following the introduction of ECT in the late 1930s, a variety of theories emerged to explain how Œshock treatments‚ worked and affected patients˜Gordon (1948), for example, reviews 50 of these. Less frequently, theorists examined the way ECT affected the professionals involved in its administration (e.g., Abse & Ewing, 1956; Fenichel, 1945; Wayne, 1955). Both were characterised by a psychoanalytic approach.

Abse and Ewing (1956) analysed Œoff guard‚ statements made by psychiatrists who were experienced in administering Œshock treatments‚. They suggested that such accounts were characterised by themes of hostility and punishment. For example, Œlet’s see if a few shocks will knock him out of it‚; Œwhy don‚t you put him on the assembly line‚; and the description of ECT as Œa mental spanking‚ (all p. 37). The authors suggested that Œthe very nature of the treatment itself can produce the attitudes described‚ (p. 38).

In a more recent example, Levenson and Willett (1982) reported observing Œsplitting‚ (divided clinical opinions), and disruption to the Œtherapeutic alliance‚ (rapport and empathy) in a multidisciplinary team involved in the care of two patients who received ECT. They concluded that ECT was an upsetting procedure because it Œoften produces rapid improvement in patients who had previously not responded to treatment‚ (p. 298) and the staff team experienced the therapeutic success as Œimplying devaluation of their own therapeutic skills‚ (p. 302).

However, this paradigm suffers from a number of limitations. For example, these studies have tended to be based on anecdotal reports rather than a more systematic gathering of material. Moreover, the reported comments are open to a number of competing explanations. Since psychoanalytic interpretations rely for their plausibility on inferred constructs which lie, as it were, within the person’s unconscious and thus cannot be demonstrated in the texts, they remain largely speculative.

From motives to attitudes, belief and knowledge: cognitive research
The second dominant approach in this area is cognitive, with questionnaires as the primary methodology. There have been a number of questionnaire-based studies investigating the attitudes and knowledge of professionals who are involved with ECT (e.g., Finch, Sobin, Carmody, deWitt, & Shiwach, 1999; Janicak, Mask, Trimakas, & Gibbons, 1985; Kalayam & Steinhart, 1981; Lutchman, Stevens, Bashir, & Orrell, 2001). Janicak et al. (1985) compared the knowledge and attitudes of psychiatrists, nurses, psychologists and social workers in relation to ECT. They reported that a positive attitude towards ECT in professional groups was correlated with increased knowledge about the procedure, and they concluded that educating staff about the facts of ECT would increase its utilisation in conditions where they suggested it should be the treatment of choice. Lutchman et al. (2001) used a similar design and drew similar conclusions finding differences in attitudes and knowledge across different disciplines, with psychiatrists being the most positive about ECT and psychologists the least.

However, as Diana Rose and her colleagues (Rose, Fleischmann, & Wykes (2004) and Rose, Wykes, Leese, Bindman, & Fleischmann (2003)) have argued in relation to investigations of ECT recipients‚ experiences, questionnaire-based methods limit and reduce the responses available to participants (see also Rosier, 1974). As a result, the possibility that factors other than knowledge might correspond with attitudes towards ECT has remained unexplored. More importantly, perhaps, this paradigm is methodologically and conceptually limited as a result of its assumptions about what constitutes Œknowledge‚ and Œattitudes‚ which are, again, inferred constructs thought to lie within the individual’s head.

A more fundamental problem with this approach is the way in which knowledge about ECT is presented as uncontested fact when the reality is much more complicated. Both the Janicak et al. (1985) and Lutchman et al. (2001) studies asked participants whether they agreed or disagreed with statements about the procedure. Despite being presented as Œfactually correct‚ or Œfactually incorrect‚ each statement could be interpreted in different ways and their facticity has been disputed in the literature. For example, the first statement from Janicak et al. (1985)˜Œthe therapeutic effect of ECT is related to the induction of a seizure in the brain‚˜is both supported (West, 1981) and contradicted by research demonstrating the effectiveness of placebo ECT (see Medical Research Council, 1965).

Similar assumptions have been made about Œattitudes‚ towards ECT. Janicak et al.’s (1985) participants were asked whether they would have ECT themselves if they were Œsuffering from varying degrees of depression‚ (p. 263). These responses were then regarded as demonstrating positive or negative attitudes toward the procedure. However, as with most attitude research there are fundamental epistemological difficulties with the notion that responses to lists of statements are unproblematically transformed into inferred mental constructs like beliefs or attitudes or unproblematically linked with conduct. Discursive psychologists like Potter and Wetherell (1987) dispute the idea that completing an attitude questionnaire represents a neutral and transparent transfer of an internal cognitive state to a mark on a page. Instead, they argue that people construct what they say in order to serve a range of functions (though not necessarily intentionally) and that this can be seen in intra- and inter-participant response variation. Thus the meaning of a psychiatrist agreeing with the statement that they would undergo the procedure if they were depressed (as 76.6% of Janicak et al.’s participants did) is not straightforward. For example, such agreement might enable participants to counter the potential charge of ethical inconsistency which might accompany disagreement with the statement. Moreover, the statement is abstracted from a context: there might conceivably be situations where these participants would be less likely to agree to have ECT.

From motives, knowledge and attitudes to accounts: the contribution of a discursive approach
Variation, disagreement and contradiction are usually rigorously controlled for in traditional cognitive research but at the cost of focusing on attitudes shorn of their context and this may tell us little about situated Œattitudes‚. In contrast, such variation is a topic of analytic importance for discourse analysts. For example, Harper (1999), in his study of professional and service user accounts of psychiatric medication, reported that a variety of explanations could be used in order to account for events such as the apparent failure of medication. Moreover, these explanations could be seen as having a variety of rhetorical effects˜in other words, they served a persuasive function, though this was not necessarily seen as an intentional action on the part of speakers. For example, when speakers claimed that medication had not worked because of the chronicity of the service user’s Œillness‚, this emphasised the permanence and severity of biological symptoms and shifted responsibility for treatment failure away from the medication and on to the illness.

Discourse analysis (DA) has been used to explore the accounts of health professionals in relation to a number of topics (Griffiths & Hughes, 2000; Parker, Georgaca, Harper, McLaughlin, & Stowell-Smith, 1995; Soyland, 1995). Because of its focus on the inherent variability of accounts, it is particularly useful in understanding how contested issues are constructed by participants. For example, Horton-Salway (2002) has shown how general practitioner’s discussions about ME (myalgic encephalomyelitis or CFS) are often concerned with the management of blame for the condition. Boyle (2002) and Boyle (2004) has suggested that professionals‚ use of rhetorical resources can make some ways of talking about a topic like schizophrenia seem more reasonable than others. In his study of talk about medication, for example, Harper (1999) argued that one of the effects of such talk was to serve certain institutional interests. For example, accounting for medication failure as due to the chronicity of illness could be seen to serve the interests of the Œpsychopharmaceutical complex‚ (Breggin, 1993) because questions about the efficacy of medication were deflected when such responses were deployed.

Johnstone and Frith (2005) have recently used DA to examine Freeman and Kendall’s (1980) study of ECT recipients‚ experiences and attitudes. They describe how patients are rhetorically constructed in this article in a number of ways, for example as passive and compliant or as hostile and unreasonable. They note that one of the effects of such constructions is to Œpreserve the view of ECT as a benign and beneficial procedure, and to validate both psychiatrists and psychiatry in the continued use of this treatment‚ (p. 200).

DA thus provides a novel perspective on the accounts of professionals. However, the kind of accounts presented in published research articles are highly systematised and organised and are likely to differ from those found in more informal settings. The aim of the present study, therefore, was to conduct an empirical qualitative investigation of accounts of the administration of ECT by those who administer it in the more informal context setting of a semi-structured interview.

Method
Eight clinicians involved in administering ECT were interviewed about it by the first author. The interview transcripts were interpreted using DA, which draws on a broadly social constructionist epistemology. Here we will briefly note key discourse analytic concepts on which we drew in the present study. Following Wetherell’s (1998) suggestion, we have drawn on both discursive psychology and Foucauldian discourse analytic traditions (Willig, 2001).

In discursive psychology, the systematic ways of talking about a topic generally found in conversations are termed interpretative repertoires. Edwards and Potter (1992) have described a number of ways in which speakers use rhetorical devices which have the effect of making what they are saying appear factual˜an example is the empiricist forms of accounting found in journal articles, where the agency of the scientist is minimised and agency is implicitly located in the objects of research. Such devices are often deployed when there is some disagreement about the facts and when the speaker has a stake in the outcome.

The analysis also drew on positioning theory (Davies & Harré, 1990), which attempts to re-conceptualise static and essentialist notions like role and identity. It assumes that when people speak they implicitly position themselves and others in relation to the topic under discussion. For example, in a conversation between a doctor and a patient, the doctor is implicitly assumed to have expertise about topics like illness, diagnosis and so on, whilst the patient is implicitly assumed to have expertise about topics like their health concerns. Parker (1997) notes that all positions carry Œcertain rights to speak and specifications for what may be spoken‚ (p. 291). Thus there are certain things which can and cannot be said from particular positions and within particular interpretative repertoires.

Discourse analysts try to avoid the ascription of intentionality to participants‚ accounts. In other words, it is not assumed that participants strategically design their talk in order to have certain effects. Parker (1992) comments that Œpeople make discourse, but not in discursive conditions of their choosing‚ (p. 32). One significant context-marker for the present study is that the participants were being interviewed by a psychologist who, by virtue of his discipline (see Lutchman et al., 2001), might be thought to have a different position to them on ECT, and this may well have influenced the results. Walkup (1994) has argued, for example, that such situations may well lead to Œquite self-conscious attention to legitimation themes‚ (p. 149). The reader needs to take this into account in judging the quality of the analysis.

Participants
All the interviews took place in a major city in the United Kingdom. The interviewees represented the cross-professional involvement in ECT administration, including pre- and post-procedure care (psychiatric nurses), prescription and delivery of the treatment (psychiatrists) and the administration of anaesthetic and muscle relaxant (anaesthetists). The research aim was to identify which positions and repertoires were culturally available to the speakers˜in other words to see what range of things could be said about ECT by professionals. Since discourse analysts are critical of abstract notions like Œattitude‚ and Œview‚, the aim was not to represent participants‚ views nor to compare views within the sample.

We considered that eight participants would produce a reasonable range of possible repertoires and positions, and this is consistent with previous DA research. A purposive sampling strategy was followed in that a range of disciplines were interviewed: four psychiatrists, two psychiatric in-patient nurses, and two anaesthetists. More psychiatrists were interviewed since ECT is primarily a psychiatric intervention.

Potential participants were identified and recruited through liaison with departments of anaesthetics or old age psychiatry˜the latter departments prescribe a substantial portion of the total number of ECT administrations in the UK (Pippard & Ellam, 1981). All were sent a standard invitation letter followed by a telephone call. The first eight professionals invited to take part agreed to do so.

The small number of participants increases the risk that they will be identified and so, in order to protect confidentiality, we will present demographic information for the group as a whole and not for individuals. Four men and four women were interviewed. Three participants were aged in their 30s, three in their 40s and two in their 50s. Five of the six medical professionals were consultants and one was a senior registrar. The two nurse participants had considerable involvement with ECT. All but one participant was involved with ECT administration at the time of the interviews.

Interviews
Potter and Hepburn (2005) have cautioned against what they see as the inappropriate and over-use of interview methods in DA studies. It is certainly true that interviews create particular kinds of interaction, and they should not be seen as a proxy for more Œnaturally occurring‚ kinds of conversations. However, it seemed that interviews were an appropriate source of data here because the study was interested in how professionals constructed accounts about ECT, for example how they might provide justifications for a contested intervention.

Interviews took place at a time and place of participants‚ choosing, usually at their workplace. The aims of the investigation were explained, anonymity was guaranteed and consent to both audio-taping the interviews and publishing extracts was obtained. A semi-structured interview schedule was followed, covering the participants‚ experiences of ECT and issues that had been debated within the literature. Appropriate ethical permission had previously been granted from a University Ethics Committee and interviews were conducted in 2001.

Initial reading and coding
Following Wood and Kroger’s (2000) guidelines, all the transcripts were read through in their entirety while a separate list of recurring or interesting categories and features were noted and eventually categorised. Extracts seen as related to each category were copied and pasted into correspondingly named computer topic files. Once printed, these became the material for analysis.

Results
Discourse analysts see their interpretation of such texts as only one of a number of possible readings and not the definitive one (Willig, 2001). Our reading of the interview transcripts indicated that different interpretative repertoires and rhetorical devices were drawn on by the interviewees, suggesting that a range of such features were culturally available to them. During the reading, the subject of interest was talk about ECT and, increasingly, as the analysis progressed, about those to whom it was administered. Although a range of features were identified, because of limitations of space, our analysis is structured by a focus on the Œbiomedicalˆmedical‚ interpretative repertoire and the Œsevere end‚ rhetorical device. We will also discuss how interviewees managed concerns about ECT. We will also draw on some of the psychiatric literature in order to place the interview material in context.

Transcription notation is described in the Appendix A. The code underneath each extract refers to the participant (e.g., Dr. A), their discipline (e.g., consultant psychiatrist) and the line numbers of the interview transcript from which the extract derives (e.g., lines 20ˆ22).

The biomedicalˆmedical repertoire
Throughout the interviews, it was common for ECT recipients to be described with diagnostic medical language, which typically referred to their behaviour and the consequences of that behaviour. For example, asked who was most likely to receive ECT, Dr. A responded Œpatients with severe depression who may be in a depressive stupor˜that means that they‚re sort of bed-bound, immobile, not eating not drinking‚ (Dr. A, consultant psychiatrist: lines 54ˆ55). Such lists of behaviour were described elsewhere as Œclear biological features‚ (Dr. E, consultant psychiatrist: lines 753ˆ754) or Œprominent physical symptoms‚ (Dr. B, senior psychiatric registrar: line 117).

A variant of the biomedicalˆmedical conceptualisation of patient behaviour and psychiatric interventions were accounts framed in electro-chemical terms. These are also to be found in some of the professional literature, for example, Œrepeated treatments [of ECT] alter chemical messages in the brain and bring them back to normal‚ (Royal College of Psychiatrists, 1995, p. 104).

The biomedicalˆmedical repertoire was often accompanied by a rhetorical device which focused on the chronicity and severity of problems.

The Œsevere end‚ rhetorical device
In the following extract the characteristics of those who are seen as most likely to be appropriate for treatment with ECT are discussed. Dr. A is discussing the occasions when ECT might be used to save life:

Dr. A: They‚re sort of bed bound, immobile, not eating, not drinking, er at risk of developing um major medical problems such as deep vein thrombosis, pulmonary embolic complications, which will kill them.

Interviewer: Right. Is that as a result of er (.)

Dr. A: Depression. Because they‚re severely depressed, they‚re in a depressive stupor. It’s defined as stuporous, literally.

(Dr. A, consultant psychiatrist: lines 54ˆ60)

Who is appropriate for ECT?
One feature of the extract is the way in which Dr. A constructs those patients who are seen as appropriate for ECT. They are Œbed bound, immobile, not eating, not drinking‚˜and located at what another interviewee described as Œthe severe end‚ of the clinical spectrum (Dr. E, consultant psychiatrist: line 56). Examples of the use of the Œsevere end‚ device can also be found in the professional literature:

It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with: severe depressive illness; catatonia; a prolonged or severe manic episode.

(National Institute for Clinical Excellence, 2003, p. 1)

ECT as Œlife-saving‚
A formulation of ECT recipients as Œsevere‚ appeared to warrant the use of ECT on occasions when the person was viewed as at risk of dying either because of their attempts to actively kill themselves or because they were not eating or drinking. Both these kinds of behaviour were seen as symptoms of depression with failure to eat or drink viewed more seriously if the person was older, thereby potentially increasing the risk of physical health complications. The claim that ECT was life-saving was common across the interviews, regardless of participants‚ professional orientation. One effect of the Œlife-saving‚ repertoire was to sanction the use of ECT under conditions of compulsory psychiatric treatment (i.e., without requiring recipients‚ consent). This was termed Œemergency ECT‚ by participants. The grounds for such treatment are highly contested: both Johnstone (2003) and Read (2004) argue that there are no studies to support the claims of advocates for Œemergency ECT‚. Read comments that ECT Œdoes not prevent suicide and for a small number may precipitate it‚ (2004, p. 95).

Locating the focus of concern at the biological level
Another feature of interest in Dr. A’s extract is that there appears to be a causal chain in the location of the cause of problems. Causal agency initially appears to be located in physical health problems but these are then framed as caused by the patients‚ self-destructive behaviour, which in turn is seen as caused by depression. Ultimately, these biological signs and symptoms are presented as the threat to life. One effect of using technical descriptions (Œpulmonary embolic complications‚) is to construct the patient as both the cause of, and passive victim of, biological processes.

A second effect of constructing the problem at the biomedicalˆmedical level, rather than, say the psychological, or societal, is that it then becomes difficult to argue for alternative, especially non-biomedical, explanations and interventions. ECT was thus constructed not only as a reasonable intervention, but also an obvious one because it was viewed as fast-working and effective. One effect of this was that non-physical interventions were often discounted.

Exclusion of non-physical interventions
In the following extract, a participant describes the importance of early treatment when service users are extremely Œill‚:

Dr. E: ∑ if you delay effective treatment, you often have a tougher fight to fight.

(Dr. E, consultant psychiatrist: lines 789ˆ709)

In this extract Œtreatment‚ is implicitly seen as synonymous with ECT and the notion of time is foregrounded. It is implied that the use of other interventions would mean delaying the use of ECT, which is constructed as an Œeffective treatment‚. Elsewhere in the interviews the term Œtreatment‚ was seen as synonymous with pharmaceutical interventions. The ECT fact sheet for patients published by the UK’s Royal College of Psychiatrists (1995) states, Œthe alternative [to ECT] is drug therapy which also has risks and complications‚ (p. 104). Non-physical interventions such as psychotherapy or increased social support are absenced in these accounts, and one effect of this is to preclude them from being offered as alternative interventions. Arscott (1999) points out, Œit is likely to be difficult for a patient to refuse treatment with ECT if they believe that this is their only chance of cure‚ (p. 106).

Managing concern about ECT
All of the interviewees recognised that there was public concern about ECT and that it was seen as controversial, and they managed this in a number of ways. They acknowledged grounds for concern but framed ECT within a risks and benefits calculus similar to other medical procedures, sometimes accompanying this with claims that the evidential basis was becoming clearer. The interviewees acknowledged criticisms of ECT but in some of their accounts, more rights to speak were accorded to service user critics who had undergone it.

Dr. E: And I‚m actually quite scrupulous about g-, giving the pros and cons I, I, I very often clear with people, I really think this is the treatment you should be having, but I‚m also very clear ab-, that many people don‚t agree with this treatment, it’s still regarded as controversial, there are some things you probably will experience which you will not like. You probably will find your memory’s adversely affected. Er there are, you know, having an anaesthetic is at, at some level a risk, oh, the figure that’s quoted in the College of Psychiatrists Handbook is three deaths per one hundred thousand anaesthetics.

(Dr. E, consultant psychiatrist: lines 193ˆ202)

Acknowledging grounds for concern: weighing up risks and benefits
One way in which concern about ECT was managed was by drawing on a notion of informed consent. In this extract Dr. E notes how ECT recipients are presented with Œthe pros and cons‚. He includes some of the key concerns that critics of ECT have raised: that many disagree with it; that memory problems may occur; and that the administration of the anaesthetic itself is a risk. However, at the same time Dr. E says that he states ŒI really think this is the treatment you should be having‚. Also, the risk from the anaesthetic is slightly downplayed by noting that it is a risk Œat some level‚, although it was the risk seen as raising the most concern. This informed consent account is commonly encountered in discussions about medical procedures like major surgery, and so one effect of employing such a risk and benefits calculus is that ECT was seen as similar to other medical procedures.

Rendering ECT as a medical procedure
Within the interviews, ECT was often discussed through analogies with effects or processes associated with general medical procedures, and this also had an effect of managing concern about ECT. If ECT can be seen as a medical procedure with concomitant risks and benefits, then its particularly controversial status within the popular imagination (e.g., from films like One Flew over the Cuckoo’s Nest) can be minimised. Differences between the work of psychiatrists administering ECT and that of their medical colleagues carrying out surgery are de-emphasised and the procedure is presented as reasonable˜as Johnstone and Frith (2005) put it, ECT is thus presented as a Œbenign and beneficial procedure‚ (p. 200). Pilgrim and Rogers (1993) have argued that linking the content of psychiatric procedures with those of other medical procedures is one way of increasing the institutional alignment between psychiatry and general medicine˜an enterprise which Baruch and Treacher (1978) have suggested began in the 1960s when psychiatrists shifted their site of operation from separate institutions to district general hospitals. Equating the physical processes involved in psychiatric treatment with those involved in general medical treatment allows the status of the problem to be more easily conceptualised as biomedicalˆmedical. Moreover, Bracken and Thomas (2001) note that attempts to assert the equivalence of psychiatric and medical illness ignore the power of psychiatrists to use psychiatric treatments coercively. They remark, Œpatients and the public know that a diagnosis of diabetes, unlike one of schizophrenia cannot result in their being forcibly detained in hospital‚ (p. 725) and note, Œit is hard to imagine the emergence of Œanti-paediatrics‚ or Œcritical anaesthetics‚ movements‚ (Bracken & Thomas, 2001, p. 724).

Downplaying debate: the evidence is becoming clearer
A common theme in many psychiatric accounts of contested treatments is that the grounds for debate are lessening with increased research (see, for example Clare, 1976). This was evidenced in the interview material. In the transcript just before the next extract, Dr. B had noted that patient concerns about the lack of knowledge about how ECT works was understandable.

Dr. B: If the case for ECT was (.) crystal clear, that it does definitely work, then that wouldn‚t happen. (.) But as it happens, the case is not crystal clear, but I think it’s clearing up.

(Dr. B, senior psychiatric registrar: lines 447ˆ449)

Here Dr. B acknowledges that the case for ECT is Œnot crystal clear‚. Left at this point, Dr. B could potentially be challenged on why he continues to prescribe ECT. However, he then goes on to claim that it is Œclearing up‚. This could be seen as a form of Œrhetorical inoculation‚ (Sorenson, 1991) where a speaker deflects anticipated criticism.

In addition to these ways in which ECT recipients‚ concerns were managed within the interviews, the interviewees also drew on a range of other responses to direct challenges from ECT critics including groups of patients who have received ECT.

Managing criticism of ECT: who has rights to speak?
In the following extract, a participant discusses the confusion which they suggest can be experienced by patients and relatives regarding the behaviour of service users after they have received ECT. Dr. B is discussing the case of a patient who had Œlost her memory of her holidays‚ (line 89):

Dr. B: ECT is given to people who are very ill. And it’s very easy for relatives and patients (.) to (.) mix the two, sort of to (.) blame (.) ECT, the ECT for things that are to do with the illness.

(Dr. B, senior psychiatric registrar: lines 93ˆ95)

Here Dr. B suggests that behaviour could be viewed both as the direct result of ECT or, instead, Œto do with the illness‚. In claiming that it is due to the latter, Dr. B draws on the Œsevere end‚ device by describing those receiving ECT as Œvery ill‚. If this statement was made by a non-professional, it might be seen simply as an assertion. However, discourse analysts note that the force of a statement comes not only from its content but who makes it. Edwards and Potter (1992) describe the Œcategory entitlement‚ device which refers to the way in which the veracity of a report can be warranted by the entitlement of a speaker in a particular category to know certain things or have certain skills. Dr. B’s professional status confers rights to speak about what might constitute both unwanted effects of ECT and symptoms of illness. Others, like the relatives and patients mentioned here are positioned as less informed about the medical understanding of emotional distress and the effects of treatment. Thus it becomes possible to construct them as less authorised to make such judgements. One effect of this is to undermine the legitimacy of criticisms made by non-experts and especially recipients of ECT and their relatives. Johnstone and Frith (2005) have noted similar strategies at work in their DA of Freeman and Kendall’s (1980) article.

Of course, service users can attempt to claim certain kinds of category entitlements. As recipients of ECT they might understandably argue that they had expertise in understanding the effects of ECT. Indeed, such arguments have enabled users‚ experiences of ECT to gain a foothold in research conducted by ECT recipients themselves (Rose, Fleischmann, & Wykes (2004) and Rose, Wykes, Leese, Bindman, & Fleischmann (2003)). However, in the next extract, we see how attempts to gain such rights to speak can be challenged:

Interviewer: What, and when you talk about er (.) lay views of depression, many people underestimate how profoundly depressed people can be, what, what is the lay view of depression do you think? What is the standard view?

Dr. F: Well, I, it could be people who don‚t feel like going to work, who don‚t feel like going out, who don‚t feel like getting out of bed in the morning (.) er and they‚re a bit low (.) er it’s really, they stop socialising. I don‚t think people realise that depression is also, you stop eating, (.) that you‚ve stopped having baths, that you don‚t have a bath for three months and they find you at home. You know, that’s what they don‚t realise. You know, because as I said, most people have felt a bit low, but they don‚t really realise that depression is a serious illness. I don‚t know if you‚re a patient. Did, did you talk to the patient groups?

Interviewer: Well I‚ve read some of their literature.

Dr. F: I don‚t know, do they really know how bad these people are (.) those, those who are against ECT? (.) Do they ever come across, them, do they ever see how bad they are, do they/

Interviewer: /Do you mean people in the anti-ECT groups?

Dr. F: That’s right, do they really see them? You see it’s so easy for them to say when they get better Œoh ECT is a cruel treatment‚, but do they remember how bad they were to start with? Do they really know how severely ill?

(Dr. F, consultant anaesthetist: lines 342ˆ364).

Dr. F’s account here follows a similar trajectory to that of the previous extract from Dr. B in that lay views of depression are challenged: Œthey don‚t really realise that depression is a serious illness‚. In this extract, the Œsevere end‚ device is drawn on by describing Œhow bad‚ and how Œseverely ill‚ patients can be before they have ECT. However, Dr. F goes on to use a similar formulation to challenge the legitimacy of accounts of Œpatient groups‚. These critical accounts are implicitly challenged for being selective or lacking in objectivity in some way: Œdo they really see them?‚

There is an interesting shift in this extract, from describing individuals who are against ECT, but who have not Œcome across‚ those who receive it, to describing those who have received it (Œpatient groups‚), but who are Œbetter‚ and might have forgotten Œhow bad they were to start with‚. This account appears to challenge the legitimacy of the criticisms of both groups by drawing on the implied category entitlement of Œdoctor‚, which is set against the category entitlement of Œpatient‚. Thus, the knowledge and claims of ECT recipients who have experienced adverse effects are positioned as secondary to the knowledge and claims of the professionals who administer the procedure. These service users are positioned as poorly informed and forgetful. However, those who are critical of the procedure, but who have not been recipients, are implicitly positioned as even less authorised to criticise ECT. Elsewhere this is put more explicitly:

Nurse A: And especially if the person is really anti-ECT and had ECT then I haven‚t got too much of a problem. (.) It’s the ones that haven‚t had ECT that are against it that I‚ve got a bit of a problem with.

(Nurse A, Psychiatric Nurse: lines 364ˆ367)

By singling out those who are critical but who Œhaven‚t had ECT‚, Nurse A’s account appears to imply a hierarchy of authority to speak about ECT with those who have received ECT seen as having more rights to speak than those who have not. However, as we have seen, even those service users who have received ECT can still have the validity of their views challenged.

Discussion
We have presented a reading of professionals‚ accounts of ECT in which interviewees appeared to draw on a repertoire which constructed ECT recipients as severely ill. This was used to support claims which: circumscribed who should receive ECT; warranted the use of urgent physical psychiatric treatments; reformulated distress in biological terms; and discounted the therapeutic value of alternative, non-physical treatments. The interviewees managed concerns about ECT by: rendering it as a medical procedure with concomitant risks and benefits; downplaying a lack of clarity over its evidence base; and undermining the legitimacy of criticisms.

The use of the Œsevere end‚ rhetorical device is interesting in the light of evidence that the strongest predictor of ECT prescription is gender and age, rather than severity of illness: women and those aged over 65 (again, predominantly women for demographic reasons) are most likely to receive ECT (Read, 2004; Salford Community Health Council, 1998). Moreover, the viewing of memory problems as resulting from depression rather than ECT seems a little dated˜the consensus view from a range of studies does appear to demonstrate a range of cognitive problems following ECT administration (McElhiney et al., 1995; Neylan et al., 2001; Robertson & Pryor, 2006).

In interviewees‚ accounts, the agency of psychiatrists in prescribing ECT was downplayed with the decision portrayed as flowing from factors relating to the severity of illness. However, this does not account for the variability of ECT prescription over time, in different regions and also between psychiatrists. For example, the study of ECT prescription in Salford and Greater Manchester (Salford Community Health Council, 1998) detailed wide variations both between individual psychiatrists and over time. In his analysis of discourse concerning paranoid delusions, Harper (1994) reported that professionals used empiricist forms of accounting to explain how they reached diagnoses but he noted that they drew on a more contingent and subjective form of accounting to explain variations in diagnoses between professionals. This could be explored in further research focused on professionals‚ accounts.

Implications
There are epistemological challenges associated with applying findings from discourse analytic research (Willig, 1999). However, some discourse analysts explicitly seek to promote Œsubversive discursive practices and spaces of resistance‚ (Willig, 1999, p. 12). Here we will suggest some implications consistent with our analysis for different interest groups in mental health: researchers, professionals and service users.

Researchers
DA can provide a useful way both of examining some of the assumptions implicit in professional accounts and of detailing their effects. This can be most useful in relation to topics like mental health where conceptualisations are contested. Future research could explore whether the strategies employed here can be seen in other accounts both of ECT and of other psychiatric interventions. However, there is also a need for further research into the experiences of the recipients of psychiatric interventions, including studies conducted by service user researchers.

Mental health professionals
It may be possible to draw on some of the insights of studies like this to develop training packages to help mental health professionals become aware of the ways in which particular rhetorical resources may foreclose the offering of choices about interventions, like ECT, to service users. Such training could be aimed not only at psychiatrists, but also other health professionals (e.g., psychiatric nurses and social workers, psychologists and anaesthetists, etc.).

It is important to note that ECT recipients, like other users of mental health services, are not a homogeneous group of individuals (see Campbell, 1999). For example, some (e.g., ECT Anonymous, 1999a) have called for ECT to be banned, whilst others (e.g., Perkins, 1994) have made a case for its benefits. Service users could be provided with specific information about the type of accounts which they might expect prescribing clinicians to draw on during discussions about ECT. Robertson and Pryor (2006) have provided a useful format for discussing the benefits and risks associated with ECT with mental health service users. Informing service users about the ways in which health professionals can use language to construct ECT as Œordinary‚ or Œurgent‚, and patients as Œseverely ill‚ for example, could allow them to recognise that this is only one possible way of understanding their situation. Simply knowing that other accounts are available could empower service users to ask more questions about ECT and alternative treatments.

Service users
Service users could also develop training packages˜similar to assertiveness training˜in managing psychiatric interviews by role-playing possible responses. Such training would need to be accessible and to acknowledge both the emotional distress experienced by potential ECT recipients and the difficulties associated with challenging professional power. An example of what such training might look like can be seen in the ECT Anonymous (1999b) factsheet which pre-empts a list of questions and suggests possible responses with the suggestion that Œthere are simple answers to all these queries, even ones with technical terms. If there is a deep reluctance to answer these questions you should suspect the likely quality of your treatment‚ (p. 1).

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Appendix A.
A.1. Transcription notation
Noticeable pauses of less than one second were indicated by a full stop in brackets (.) while pauses of between 1 and 3 s are indicated by the word Œpause‚. A slash (/) indicates interruption and triangular brackets (< and >) indicate incidental contributions that were made by speakers during the other speaker’s turn. Transcripts were punctuated to facilitate reading. Identifying details were changed to preserve the anonymity of participants.

Corresponding author. Tel.: +44 1322 297151; fax

Electroconvulsive Therapy Causes Permanent Amnesia and Cognitive Deficits

ect.org note: This article is appearing in numerous publications and websites, so to avoid repeating the same information again and again, an ongoing list of publications will be posted below.

———–

Forbes
Electroconvulsive Therapy Causes Permanent Amnesia and Cognitive Deficits, Prominent Researcher Admits
12.21.06, 3:38 PM ET

NEW YORK, Dec. 21 /PRNewswire-USNewswire/ — In a stunning reversal, an article in the journal Neuropsychopharmacology in January 2007 by prominent researcher Harold Sackeim of Columbia University reveals that electroconvulsive therapy (ECT) causes permanent amnesia and permanent deficits in cognitive abilities, which affect individuals’ ability to function.

“[T]his study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings,” the study notes.

For the past 25 years, ECT patients were told by Sackeim, the nation’s top ECT researcher, that the controversial treatment doesn’t cause permanent amnesia and, in fact, improves memory and increases intelligence. Psychologist Sackeim also taught a generation of ECT practitioners that permanent amnesia from ECT is so rare that it could not be studied. He asserted that most people who said the treatment erased years of memory were mentally ill and thus not credible.

The National Institute of Mental Health (NIMH) estimates that more than 3 million people have received ECT over the past generation. “Those patients who reported permanent adverse effects on cognition have now had their experiences validated,” said Linda Andre, head of the Committee for Truth in Psychiatry, a national organization of ECT recipients.

Since the mid-1980s, Sackeim worked as a consultant to the ECT device manufacturer Mecta Corp. He never revealed his financial interest in ECT to NIMH, as required by federal law, and, until 2002, did not reveal it to New York officials as required by state law. Neuropsychopharmacology has endured negative publicity over its failure to disclose financial conflicts of journal authors, resulting in the editor’s resignation and a promise to disclose such conflicts in the future; yet there is no disclosure of Sackeim’s long-term relationship with Mecta, nor did Sackeim disclose his financial conflict when his NIMH grant was renewed to 2009 at approximately $500,000 per year.

The six-month study followed about 250 patients in New York City hospitals, an unusually large number; most ECT studies are based on 20 to 30 patients. Sackeim’s previously published studies were short term, making it impossible to assess long-term effects. “However, in other contexts over the years — court depositions, communications with mental health officials, and grant protocols — Sackeim has claimed to follow up patients for as long as five years. This raises serious questions as to how long he has actually known of the existence and prevalence of permanent amnesia and why it wasn’t revealed until now,” Andre said.

Besides finding that ECT routinely causes substantial and permanent amnesia, the study contradicts Sackeim’s oft-published statements that ECT increases intelligence and that patients who report permanent adverse effects are mentally ill.

“The study is a stunning self-repudiation of a 25-year career,” Andre said.

———————————————————-

Other publications that have picked up the story:

Dec 22 2006:

Forbes
Medical News Today
Brietbart
Dallas News
Kron.com
MedicalDevices.org
TXCN.com – Healthcare & Hospitals
WFAA
Philadelphia Weekly
Genetic Engineering News
Pharma-Lexicon

Electroconvulsive Therapy Causes Permanent Amnesia And Cognitive Deficits, Prominent Researcher Admits

Electroconvulsive Therapy Causes Permanent Amnesia And Cognitive Deficits, Prominent Researcher Admits

Medical News Today
Dec 22 2006

In a stunning reversal, an article in the journal Neuropsychopharmacology in January 2007 by prominent researcher Harold Sackeim of Columbia University reveals that electroconvulsive therapy (ECT) causes permanent amnesia and permanent deficits in cognitive abilities, which affect individuals’ ability to function.

“This study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings,” the study notes.

For the past 25 years, ECT patients were told by Sackeim, the nation’s top ECT researcher, that the controversial treatment doesn’t cause permanent amnesia and, in fact, improves memory and increases intelligence. Psychologist Sackeim also taught a generation of ECT practitioners that permanent amnesia from ECT is so rare that it could not be studied. He asserted that most people who said the treatment erased years of memory were mentally ill and thus not credible.

The National Institute of Mental Health (NIMH) estimates that more than 3 million people have received ECT over the past generation. “Those patients who reported permanent adverse effects on cognition have now had their experiences validated,” said Linda Andre, head of the Committee for Truth in Psychiatry, a national organization of ECT recipients.

Since the mid-1980s, Sackeim worked as a consultant to the ECT device manufacturer Mecta Corp. He never revealed his financial interest in ECT to NIMH, as required by federal law, and, until 2002, did not reveal it to New York officials as required by state law. Neuropsychopharmacology has endured negative publicity over its failure to disclose financial conflicts of journal authors, resulting in the editor’s resignation and a promise to disclose such conflicts in the future; yet there is no disclosure of Sackeim’s long-term relationship with Mecta, nor did Sackeim disclose his financial conflict when his NIMH grant was renewed to 2009 at approximately $500,000 per year.

The six-month study followed about 250 patients in New York City hospitals, an unusually large number; most ECT studies are based on 20 to 30 patients. Sackeim’s previously published studies were short term, making it impossible to assess long-term effects. “However, in other contexts over the years — court depositions, communications with mental health officials, and grant protocols — Sackeim has claimed to follow up patients for as long as five years. This raises serious questions as to how long he has actually known of the existence and prevalence of permanent amnesia and why it wasn’t revealed until now,” Andre said.

Besides finding that ECT routinely causes substantial and permanent amnesia, the study contradicts Sackeim’s oft-published statements that ECT increases intelligence and that patients who report permanent adverse effects are mentally ill.

“The study is a stunning self-repudiation of a 25-year career,” Andre said.

New Zealand: First Report of Director of Mental Health

29 November 2006
Scoop Independent News

First Annual Report of the Office of the Director of Mental Health released
The first annual report by the Office of the Director of Mental Health has been released today by the Ministry of Health.

The publication provides a record of the work the office does and reports on some of the activities of District Inspectors of Mental Health and the Mental Health Review Tribunal. It is part of the office’s accountability to the sector and will be of significant interest to many people, including mental health service users and their families, those who work in the sector, and advocacy groups. It will also contribute to improved standards of care and treatment for people with a mental illness.

“We are proud of this work and believe it is an enormous achievement. The report reflects the importance we place on transparency and accountability to the sector and the wider public. We hope to build on this information in subsequent reports and include trend data,” says Dr David Chaplow, Director of Mental Health and Chief Advisor Mental Health.

The report is divided into three sections. The first section looks at how the office operates and the legislation it is guided by. The second section describes the work carried out by the office in 2005 and the third section provides information on the use of the Mental Health (Compulsory Assessment and Treatment) Act 1992, electroconvulsive therapy treatments and deaths of people subject to the Act. An appendix provides historical background on compulsory treatment in New Zealand.

For the first time raw data on the use of compulsory treatment is being published. It shows marked variations between district health boards.The data has not been analysed and the differences could be due to a range of reasons, such as the differences in the nature of their populations, service coverage or clinical practice.

Information on the numbers and outcomes of Special and Restricted-Patient’s leave and change of legal status applications considered by the Health Minister are also included.

“We have not captured all the data we would like, for example statistics on the use of force, serious adverse incidents and seclusion are not included because the earlier data is not reliable enough,” Dr Chaplow says.

” However, District Health Boards now have more robust reporting procedures in place and as a result we expect to be able to include trend data in future annual reports.”

The report also includes research looking at the outcomes for Special Patients found not guilty of a crime, by reason of insanity, over the last three decades. The work followed an indication by the Law Commission that it intended to review section 23 of the Crimes Act 1961, which relates to insanity.

“Our research found that following discharge in to the community, people acquitted on the grounds of insanity are reconvicted of violent crimes at a very low rate, although readmission to hospital is more common,” Dr Chaplow says.

During 2005 there were 23 deaths recorded for people subject to the Mental Health (Compulsory Assessment and Treatment) Act 1992, of which six were suspected suicides.

Full report

Continuation ECT as Good, or Poor, as Drug Therapy for Preventing Depression Relapse

Dec 6 2006
Reuters Health Information
NEW YORK (Reuters Health) Dec 06 – Electroconvulsive therapy (ECT) is comparable to pharmacologic treatment in preventing relapse of depression, but both approaches have limited efficacy, investigators report in the December Archives of General Psychiatry.
While electroconvulsive therapy is extremely effective for acute treatment of major depression, ECT is also being used as continuation or maintenance treatment (C-ECT) to prevent relapse. However, there are few data to support such use, note Dr. Charles H. Kellner and colleagues at five different academic clinical centers.
Dr. Kellner, from the UMDNJ New Jersey Medical School in Newark, and members of the CORE group (Consortium for Research in ECT) conducted a two-phase trial with 531 patients with primary major depressive disorder.
The first phase involved a course of bilateral ECT delivered three times per week for all the subjects until their illness went into remission. Participants who maintained remission at 1 week were then randomly assigned in the second phase to continuation ECT or a combination of nortriptyline and lithium.
ECT was administered weekly for 4 weeks, every other week for 8 weeks, and monthly for 2 months.
Relapse rates were 37.1% for C-ECT and 31.6% for medication treatment. In the two arms, 46.1% and 46.3% remained in remission, respectively, while 16.8% and 22.1% dropped out.
Subjects in both groups who remained in remission showed similarly improved cognitive abilities during the course of the trial, as assessed by the modified MMSE.
“An important interpretation of these data is that relapse or treatment discontinuation rates after successful ECT remain unacceptably high with standard treatment regimens,” Dr. Kellner and his team write, although they acknowledge that both types of treatment were “modestly effective in preventing depressive relapse.”
However, they caution that failure to detect significant differences between groups “cannot be taken to mean that the outcomes in the two groups are equal.” Instead, their advice is to decide treatment options “based on judgments about tolerability for the individual patient and patient preference.”
They hope that further research will turn up biomarkers to predict which patients will respond better to one or the other treatment. They also suggest that better remission rates might be achieved by combining C-ECT and medication therapy.
Arch Gen Psychiatry 2006;63:1337-1344.

Season of Suppers

Meals on Wheels Association of America (MOWAA) and Banfield, The Pet Hospital have teamed up to provide meals for pets this holiday season. The campaign is called Season of Suppers.

After discovering that countless senior recipients of Meals On Wheels were feeding their food to their pets, MOWAA created We All Love Our Pets (WALOP), a new initiative that seeks to unite Meals On Wheels programs across the country that are providing pet food.

It’s EASY to donate! Go to any Banfield or Meals on Wheels office and drop off your donation, either pet food or monetary. I shop at PetSmart, and there’s a Banfield inside. They’ve made it easy – there’s a box right there, and I bought extra food – dog and cat – and dropped it in. I plan to continue….it’s easy and every little bit helps a dog or cat and owner. Your food donation stays in your own county, for area MOW recipients.

I’m a believer in the power of pets to help people emotionally and health-wise. Health professionals are beginning to realize the power of pets as well, and are bringing pets into nursing homes and hospital rooms to visit. IT HELPS!

What a FABULOUS program this is. My thanks go out to MOWAA and Banfield for their efforts, and I ask that you give as much as you possibly can. Even one can or box of food will help feed a pet.

Bringing pets and people together – and finding ways to help – has always been a “pet” cause of mine. It helps the individual who gets unconditional love, and it saves another life of a dog or cat that otherwise might not find a home. It’s a win-win for all!

Meals on Wheels provides hot meals for elderly and persons with disabilities. I have a special fondness for them because as my grandmother became older, she found it hard to cook a healthy meal. Meals on Wheels brought her healthy, hot meals. What’s more, my grandmother, a farm woman, always loved her pets. Cats especially. She was lucky enough to be able to afford food for her cats, but many are not so blessed.

So while you’re out doing your errands and holiday shopping, stop by your local Banfield and drop off a donation of food or money! It’s a Season of Suppers and you can help. Thank you for your generosity!

Visit Banfield, The Pet Hospital
Visit Meals on Wheels

——

Who are those pets in the banner pictures?

The elderly woman and dog picture comes from MOWAA. The rest of the pets are mine. The dog is Sharik, who passed away several years ago. (Sharik means little ball in Russian, and Sharik is the most common dog name in Russian. But I named her after the hero of my favorite book, Heart of a Dog by Bulgakov.) She was a golden retriever/chow mix whose mother was a stray that found shelter in my uncle’s barn. I hope to see her again at the Rainbow Bridge one day. I miss her terribly.

The black cat is Dmitri, who died one year ago. I got him as a kitten from the vet, who had some babies who needed homes. He was 16 when he died and lived a generous life. He never met a person, dog or cat he didn’t like. He had the ability to turn every dog he met into a friend. I credit that gift to Sharik, who raised him from a kitten. They had a very special relationship. I miss him so much, and so does Jack.

Jack is the gray cat and he came from Seattle. He’s the Internet cat and loved by so many around the world. His owner, Catharine, was dying of breast cancer. She had adopted him from a Seattle shelter, where he’d been in a feral colony. She worried that he would be dumped when she died, so she reached out to people in a cat health discussion group to find Jack a home. Long, wonderful story of Netizen generosity short – Jack made his way to me on the pet bus. You can read Jack and Dmitri’s love story here.

He and Dmitri had some beautiful years together and became joined at the hip. When Dmitri died, Jack became so grief stricken and horribly depressed. Two weeks later, I went to PetSmart for food and they were having an adoption day.

I’ve always felt that Dmitri was there guiding me that day, telling me to bring that deaf little girl home. And I did. That’s the white cat, Jasmine. She’s special with her disability, but we’ve learned some sign language and she brought Jack out of his despair. She did the same for me, and she’s a funny little cat. She likes to dunk her toy mice in the toilet and drown them. She also likes to “hide” in paper bags and attack everyone. We all (including Jack) pretend to be surprised. She doesn’t know that she makes a lot of noise in her bag, so she hides, then jumps out and boxes feet. She squeals with joy and runs back into her bag.

Nobody wanted Jasmine because she had a disability, but that made her special.

So please, please give what you can to this wonderful program. And you can find a list of other pet charities that I support on my links page.

Thanks for reading! And thanks for giving.

Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression

Archives of General Psychiatry
Dec 2006

A Multisite Study From the Consortium for Research in Electroconvulsive Therapy (CORE)

Charles H. Kellner, MD; Rebecca G. Knapp, PhD; Georgios Petrides, MD; Teresa A. Rummans, MD; Mustafa M. Husain, MD; Keith Rasmussen, MD; Martina Mueller, PhD; Hilary J. Bernstein, DHA; Kevin O’Connor, MD; Glenn Smith, PhD; Melanie Biggs, PhD; Samuel H. Bailine, MD; Chitra Malur, MD; Eunsil Yim, MS; Shawn McClintock, MS; Shirlene Sampson, MD; Max Fink, MD

Arch Gen Psychiatry. 2006;63:1337-1344.

Background  Although electroconvulsive therapy (ECT) has been shown to be extremely effective for the acute treatment of major depression, it has never been systematically assessed as a strategy for relapse prevention.

Objective  To evaluate the comparative efficacy of continuation ECT (C-ECT) and the combination of lithium carbonate plus nortriptyline hydrochloride (C-Pharm) in the prevention of depressive relapse.

Design  Multisite, randomized, parallel design, 6-month trial performed from 1997 to 2004.

Setting  Five academic medical centers and their outpatient psychiatry clinics.

Patients  Two hundred one patients with Structured Clinical Interview for DSM-IV–diagnosed unipolar depression who had remitted with a course of bilateral ECT.

Interventions  Random assignment to 2 treatment groups receiving either C-ECT (10 treatments) or C-Pharm for 6 months.

Main Outcome Measure  Relapse of depression, compared between the C-ECT and C-Pharm groups.

Results  In the C-ECT group, 37.1% experienced disease relapse, 46.1% continued to have disease remission at the study end, and 16.8% dropped out of the study. In the C-Pharm group, 31.6% experienced disease relapse, 46.3% continued to have disease remission, and 22.1% dropped out of the study. Both Kaplan-Meier and Cox proportional hazards regression analyses indicated no statistically significant differences in overall survival curves and time to relapse for the groups. Mean ± SD time to relapse for the C-ECT group was 9.1 ± 7.0 weeks compared with 6.7 ± 4.6 weeks for the C-Pharm group (P = .13). Both groups had relapse proportions significantly lower than a historical placebo control from a similarly designed study.

Conclusions  Both C-ECT and C-Pharm were shown to be superior to a historical placebo control, but both had limited efficacy, with more than half of patients either experiencing disease relapse or dropping out of the study. Even more effective strategies for relapse prevention in mood disorders are urgently needed.

Author Affiliations: Department of Psychiatry, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark (Drs Kellner, Petrides, and O’Connor); Departments of Psychiatry and Behavioral Sciences (Dr Kellner) and Biostatistics, Bioinformatics, and Epidemiology (Drs Knapp and Mueller and Mss Bernstein and Yim), Medical University of South Carolina, Charleston; Department of Psychiatry, The Zucker Hillside Hospital, North Shore–Long Island Health System, Glen Oaks, NY (Drs Petrides, Bailine, Malur, and Fink); Department of Psychiatry and Psychology, Mayo Foundation, Rochester, Minn (Drs Rummans, Rasmussen, Smith, and Sampson); and Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas (Drs Husain and Biggs and Mr McClintock).

Harold Sackeim reverses position in upcoming study

by Linda Andre
Director, CTIP

The Cognitive Effects of Electroconvulsive Therapy in Community Settings

NIMH-funded research study published in the January 2007 issue of Neuropsychopharmacology

Author and primary investigator: Harold Sackeim

Funding: NIMH grants

#35636, Affective and Cognitive Consequences of ECT, funded since 1981 for a total of approximately ten million dollars so far (grant has been renewed through 2009)

#59069, ECT Practices in Community Settings—Evaluating Outcomes, funded since 1999 for a total of approximately 3.5 million dollars so far

Summary: After 25 years and millions of dollars of federal funding to research the adverse cognitive effects of ECT—25 years in which not one single longterm followup study was ever published—self-proclaimed “world expert” on ECT Harold Sackeim has now reversed his position, admitting that ECT routinely causes permanent memory loss and deficits in cognitive abilities. His new study—the first to be published in which he followed patients as long as six months, and one of his only studies to use controls—validates a generation of patient reports of permanent iatrogenic disability, and disproves Sackeim’s previously published claims that these reports were simply symptoms of mental illness. Other findings: there is no evidence that ECT increases intelligence, as Sackeim has previously claimed; and women are much more likely than men to experience severe permanent amnesia.

Significance: Harold Sackeim has been called the Pope of ECT, and for good reason. He’s published more on ECT than anyone in the world, has received more money to research it than anyone in the world, and is the author of the American Psychiatric Association’s patient information statement and consent forms, which are used by most hospitals in America. Through his writing, teaching, testimony—and positions on peer review, editorial, and funding boards, including NIMH grant review panels—he has more influence on what the profession and the public believe about ECT than anyone in the world. What Harold says goes.

Conclusion: This study could have been done at any point in the past 25 years. If it had, a generation of patients could have been warned of the likelihood of permanent significant memory and cognitive deficits before, instead of finding out after, ECT. In fact, there is evidence—from Harold’s own statements—that over the years he has in fact conducted studies following up ECT patients for a long as five years…but never published the results. Why not? Why did it take 25 years and over ten million dollars to validate what patients have been saying all along? In other words: What did Harold know, when did he know it, and why wasn’t it revealed?

Quotable quote from the study: This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.

For a detailed critique, see below.

For the past 25 years, patients who received electroconvulsive therapy (ECT) have been told by the nation’s top ECT doctor that the controversial treatment doesn’t cause permanent amnesia or cognitive deficits and, in fact, improves memory and increases intelligence. Psychologist Harold Sackeim of Columbia University also taught a generation of ECT practitioners around the world that permanent amnesia is so rare it could never be studied. Sackeim was the popularizer if not originator of the position that former patients who said the treatment erased memory were simply mentally ill and thus not credible.

His newest and perhaps last ECT research study disproves his tenaciously held claims about the treatment’s harmlessness. It is, in effect a stunning self-repudiation of a 25-year research career…one in which he accepted federal research money with one hand and consulting fees from shock machine companies with the other.

See, for instance, the key finding:

This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.

Similarly, from the abstract:

Despite ongoing controversy, there has never been a large scale, prospective study of the cognitive effects of electroconvulsive therapy

Sounds like the research team is congratulating itself for being “the first,” as if they’d made a discovery before anyone else, doesn’t it? You might think that…if you didn’t know that Sackeim has held the only available NIMH research grant to study ECT’s adverse effects, titled “Affective and Cognitive Consequences of ECT,” continuously since 1981…and if you didn’t know what Sackeim promised the federal government in his original application for grant funding:

“The major objective of the proposed research is to examine the effects of bilateral and right unilateral electroconvulsive therapy on affective and cognitive functioning. The consequences of the two treatment modes will be studied in regard to neuropsychological functions that have previously not been studied…Drug-free inpatients presenting major unipolar depressive disorder will be tested before, during and after treatment and a matched normal control group will be tested at comparably spaced times.”

Instead of doing this, however, he used his grant money largely to compare different types of ECT to each other, not to examine the effects of ECT; and only less than a handful of his 200+ published studies used normal controls, an absolute necessity to isolate the effects of ECT.

Why did it take 25 years to conduct one large, long-term controlled follow-up study? And in the absence on this research, why did Harold so confidently assure professionals, patients, legislators, and the public that ECT was safe?

A closer look at the study shows us that, in fact, Harold and his team are still not being honest with us, still not revealing all they know. They tried their damnedest not to find out what ECT really does…but failed. Here they reveal only the minimum information they had to concede after using every trick in the book to bias their research in favor of not finding negative effects of ECT.

What tricks did they use here?

1) The assumption that ECT does not cause permanent amnesia and cognitive deficits was built into the design of the study. How so? The study allowed subjects who’d had ECT before, as recently as two months prior, to be counted as the “before ECT” patients–meaning before this course of ECT. It assumed that any effects of ECT resolve within two months. 43% of the subjects had had prior ECT, so that at least half of the data involved comparing the effects of ECT to the effects of more ECT–not isolating the effects of ECT.

2) The outcome measures used to measure amnesia and cognitive function are irrelevant and inadequate to measure the known effects of ECT. Yet even deliberately using measures that would result in underestimating deficits, these deficits were still found to be profound and persistent!

For a critique of the tests used by Sackeim, see Robertson and Pryor’s article, Memory and cognitive effects of ECT: informing and assessing patients, in Advances in Psychiatric Treatment (2006), vol. 12, p. 228-238. For example, the Mini Mental Status exam used by Sackeim is a test that screens for dementia, the grossest and most glaring form of cognitive disability, and is useless for detecting the kinds of deficits caused by ECT.

Sackeim uses a memory test he invented himself, the Autobiographical Memory Inventory. This test is unpublished, not publicly available, not validated, and is not used except by ECT advocates. Robertson and Pryor note that the majority of questions are not relevant to the types of information forgotten by ECT survivors, nor can the test detect amnesia beyond a one-year period. A string of references in Sackeim’s new article attempt to provide support for the claim that the AMI “has shown strong reliability and validity as a measure of retrograde amnesia.” Not only do they not show this, but all the referenced articles were written by Sackeim himself!

3) Patient IQs were estimated pre-ECT using a method that underestimates intellectual ability especially with much higher than average IQs; no attempt was made to ascertain actual IQ. No one looked at these patients’ IQs post-shock to see what happened to them; why not?

Sackeim et al. conclude, based on inaccurate assumptions and no data from these or any other patients, that “Individuals with greater premorbid abilities can better compensate for the impact of ECT on cognitive functions” (references claiming to support this point have nothing to do with ECT but are articles about an unproven theory of “cognitive reserve”).

Even if the researchers didn’t choose to seek out survivors of ECT who once had very high IQs, or to respond to the many survivors of formerly superior IQs who have contacted them, there is a substantial record of accounts by persons who had extremely high or genius IQs who have spoken and written publicly of the devastating effects of having those IQs lowered by ECT (Jonathan Cott, Linda Andre, Anne Donahue, and Marilyn Rice are four such individuals.) None of these accounts suggests that people with “greater premorbid abilities” have an easier time after ECT; in fact, they strongly suggest the opposite.

In addition to these tricks, the researchers used one of the most reliable methods of biasing results: concealing data.

1) “A substantial number of secondary cognitive measures” are said to have been administered along with the named tests, yet the researchers nowhere reveal what they were and what the results were.

2) The names of the seven facilities in the New York City metropolitan area are not revealed. While this isn’t necessary for evaluating the results of the study, it means the facilities with the worst outcomes can’t be held publicly accountable, nor can the millions of city residents protect themselves from the worst offenders.

3) The results of the cognitive tests on the 24 control subjects are not revealed, nor is how they compared to the people who had ECT.

It’s a very big deal for the Sackeim team to use matched normal controls; in 25 years and hundreds of studies they have not done so. Normal controls are essential to ethical and valid research. This article states that “The comparison sample completed the same neuropsychological battery at time points corresponding to the assessment period in patients.” But you search in vain to find out how the controls did on the five named tests of memory and cognitive functioning and the unnamed “secondary measures”, and how they compared to the ECT patients immediately and six months after ECT. It’s not in the text, and it’s not in the tables. So why have the controls take the tests at all, if you’re not going to reveal the results?

Only one thing is revealed: The normal controls did much better than the bilateral ECT patients on the (flawed) measure of amnesia:

“The average decrement in AMI-SF scores in patients treated exclusively with BL ECT was 3.4 and 2.8 times the amount of forgetting seen in the healthy comparison groups at the post-ECT and 6-month time periods, respectively, suggesting that the deficits were substantial.”

4) Sackeim does not reveal—has never revealed in hundreds of published articles—his financial ties to the shock machine companies Mecta and Somatics. Yet in sworn testimony, Sackeim admits he has worked for Mecta for at least twenty years. He designs their shock machines for them. Not only is disclosure required by journals such as Neuropsychopharmacology (ironically, the subject of a recent scandal in which authors and even the journal’s editor did not reveal their ties to another company which has hired Sackeim, Cyberonics), it is also required by state law (because Sackeim is an employee of New York State) and federal law (because Sackeim accepts NIMH money).
Sackeim flaunts these laws by not disclosing the money he makes from the shock machine manufacturers.

This article is a damning critique of work done over 25 years (and at the expense of millions of taxpayer dollars) by this very team of researchers.

If you know that Sackeim’s been funded for decades to do this research and chose not to do it, the following statements read very differently than the researchers intended. Instead of self-congratulation, they read as condemnation.

“Empirical information about ECT’s long-term effects derives mainly from small sample studies conducted in research settings, with follow-up intervals limited to two months or less…These studies could not adequately assess the severity and persistence of long-term deficits.”

The use of small samples and short-term follow-up characterizes all of Sackeim’s work until now, and was their choice, deliberately made so as not to know (officially) about “the severity and persistence of long-term deficits.” These researchers single-handedly had the wherewithal to address these belatedly-acknowledged flaws in their own research at any time since 1981.

“We conducted the first large-scale, prospective study of cognitive outcomes following ECT.”

Why the first study only after 25 years? What of the generation of patients—two and a half million people according to their own estimate—who have received shock in those years without knowing the long-term consequences?

“Severity of depressive symptoms showed little relationship with the cognitive measures. At the post-ECT time point, none of the 11 measures were related to concurrent HRSD scores. Findings were also negative for 8 of the 11 measures at the six-month follow-up.”

Translation: patients aren’t just imagining or lying about their cognitive and memory deficits because they’re crazy. Yet in many published articles written on the NIMH dime, and over and over in public testimony and in court, that is exactly what Sackeim and Prudic have claimed. And they have influenced countless others to believe it.

DAMNING FINDING #1: amnesia is substantial and permanent

“The average decrement in AMI-SF scores in patients treated exclusively with BL ECT was 3.4 and 2.8 times the amount of forgetting seen in the healthy comparison groups at the post-ECT and 6-month time periods, respectively, suggesting that the deficits were substantial.”

“At the six-month time point, there continued to be a significant relationship between the number of BL ECT treatments and the extent of retrograde amnesia.”

“Greater amnesia for autobiographical events was significantly correlated with the number of ECT treatments received 6 months earlier.”

DAMNING FINDING #2: cognitive deficits are substantial and permanent

“Compared to baseline performance, at the postECT time point the total patient sample showed deficits in the mMMS, sensitivity of the CPT, delayed recall of the BSRT, delayed reproduction on the CFT…” (All are measures of memory and cognitive ability).

“This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.”

DAMNING FINDING #3: ECT permanently affects reaction time

“Although psychomotor function is of practical importance with respect to driving and other motor activities, the impact of ECT on this domain has rarely been examined…”

(Once again: Whose fault is that?)

“The fact that relative reaction time deficits were observed at the 6-month follow-up indicates a persistent change in the speed of information processing, motor initiation, or response levels…The findings here raise the concern that this form of stimulation has deleterious long-term effects of elemental aspects of motor performance or information processing.”

DAMNING FINDING #4: Bilateral ECT is no good

“For decades, BL ECT represented the gold standard with respect to ECT efficacy…A majority (of US ECT practitioners) administer mainly or exclusively BL ECT…
There appears to be little justification for the continued first-line use of BL ECT in the treatment of major depression.”

(More than 90% of the ECT given in the U.S., and at least as high a proportion in other countries, is bilateral.)

DAMNING FINDING #5 They lied when they wrote in the APA consent form that ECT improves your memory

What this team has said in numerous published articles—and what Sackeim wrote into the American Psychiatric Association guidelines on ECT, the “bible” used by all rank and file shock doctors—that ECT improves memory and intelligence, is not true.

“It is noteworthy that most cognitive parameters were substantially improved at 6-month follow-up relative to pre-ECT baseline, presumably because of the negative impact of the depressed state on baseline performance…It cannot be concluded, however, that the extent of improvement in any group returned to premorbid levels.”

DAMNING FINDING #6: A much greater percentage of women than men are damaged by ECT than men: 81% vs. 18%.

“There was a gender difference, with a greater preponderance of women (81.6%) compared to men (18.4%) in the persistent deficit group.”

No doubt Sackeim and his handlers will try to “spin” this study as a scientific breakthrough, and hold him up as a reformer and patient advocate. Nothing could be farther from the truth.

Where is the apology to the generation of people who were lied to, who will never regain their memories and their cognitive abilities?

Full study

Psychiatrist defends electric shock treatment in NSW

ABC News (Australia)
Nov 18 2006

The chief psychiatrist in New South Wales has defended the use of electric shock therapy in the state’s hospitals.

Government figures show the use of electric shock therapy has doubled in NSW in the past decade and more than a dozen children under the age of 14 have been given the treatment.

But Associate Professor John Basson says the perceived increase is not accurate because records of electric shock therapy were not reliable a decade ago and did not reflect the true number of cases.

He says there is no recorded cases of children receiving the treatment in the past two years, but his colleagues would not support a ban on the practice.

“Across the board they wouldn’t wish to lose it as a possible treatment in very, very rare and unusual cases where the life of the child was put at risk,” he said.

“This would be a treatment of extremely last resort.

“Recently we’ve been very much more scrupulous and that plays a part.

“You’ve got to be careful that we’re not comparing apples with oranges. We’ve got to compare apples with apples and we are now in a situation where we can compare.

“I don’t see that sort of increase that would cause us concern or would cause us to question.”

Australia: Use of electric shock therapy has doubled in decade

By Clare Masters

November 18, 2006
The Daily Telegraph

CONTROVERSIAL electric shock treatment is making a comeback in NSW hospitals, with new figures showing the use has doubled in the past 10 years, including on schoolchildren.

Federal Government statistics show the use of Electro Convulsive Therapy (ECT) – electric shock delivered to the brain – has risen in the state from 2093 in 1994-1995 to 5291 in 2005-2006.

The Medicare statistics recorded 16 cases in the five to 14 age bracket.

The figures come as the Western Australian Government bans ECT for children under the age of 12, but the NSW Government has ruled out prohibiting the treatment for children.

“NSW Health is not aware of any child under 12 years having received ECT in the public hospital system in recent years,” a spokeswoman said.

The Royal Australian and New Zealand College of Psychiatrists Dr Phil Brock said the college did not recommend the use of ECT on children due to their developing brains.

Sydney University’s Professor of Child and Adolescent Psychiatry Garry Walter said he was unaware of any cases in NSW relating to very young children but said it was possible in 15 year olds.

“It is rare but when it is used it can be lifesaving – its use is most common in young people with severe mood disorders,” he said.

Notorious for its barbaric use in Sydney’s Chelmsford Private Psychiatric Hospital, shut down nearly 30 years ago, ECT is increasingly used across the country – up from 9034 in 1994-1995 to 18,083 in 2005-2006.

Although doctors are still mystified as to how the therapy works, it is used to treat mental disorders such as depression and psychosis.

Adverse reports of ECT include memory loss, spontaneous seizures and headaches and modern treatment involves administering, under anaesthetic, a series of electric shocks to the brain at intervals over a few weeks.

Reports on Australian mental health support website depression.com.au record one person claiming the treatment was “humane” and “changed my life”.

Another 54-year-old male said he suffered short-term memory loss and headaches and a 43-year-old male reported forgetting his phone number.

“I will never voluntarily have ECT again,” he wrote.

Jane Pauley suit against NYT says paper duped her into being drug stooge

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

Patients decide which treatments they would allow

Pact gives mentally ill options
Patients decide which treatments they would allow

October 16, 2006

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.

Good for three years

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

Fears for dozens of patients given electric shock therapy against their will

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.”

That darned Spikol!

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/