Shocking Treatment

Electroconvulsive therapy is enjoying a comeback, and though practitioners claim it’s now safe and effective, others insist it still causes permanent damage

BY TOM LYONS
Eye Magazine
October 2000

It is 8:15am, and the Electroconvulsive Therapy (ECT) room at the Queen Street Mental Health Centre is open for business. A man in his 40s sits in the waiting area. In a few minutes he will be injected with an anesthetic, a sedative and a muscle relaxant. Oxygen will be administered while the relaxant partially paralyzes his lungs. Two electrodes will be attached to his skull, delivering a brief electric current that will induce a grand mal seizure lasting 20 to 90 seconds. After 10 minutes or so he will awaken in a state of confusion and be wheeled back to his ward.

Theoretically, this treatment, which typically consists of six to 12 convulsions spaced out at a rate of three per week, provides a brief cure (up to a month) for severe depression.

Dr. Barry Martin, head of the ECT service at the newly amalgamated Centre for Addiction and Mental Health — which includes the Queen Street Mental Health Centre, the Clarke Institute of Psychiatry, the Addiction Research Foundation and the Donwood Institute — says ECT is necessary to treat intractable mental illnesses like severe depression, especially when there is a risk of suicide, and insists that improvements in ECT practice have reduced the dangers associated with early shock treatments.

“When it is administered according to contemporary standards of psychiatric and anesthesia practice, it is an extremely safe and effective procedure,” he says. “It’s been in widespread clinical use since the late 1930s. There have been improvements in the procedure that have made it much more safe and acceptable to patients by reducing some of the side effects and risks of physical injury.

“The other thing to keep in mind is that it is the most effective antidepressant available — it helps a large proportion of patients who are not responsive to antidepressant medications.”

But some people who have received ECT since it was “modified” with anesthetic, sedatives, oxygen and muscle relaxants are not so sure. Keith Welch, head of the Queen Street Patients’ Council, received 53 electroshock treatments for severe depression in the mid-’70s, and says they permanently damaged his memory and erased two years of his life. After waking up in a panic after his 53rd session, he’d had enough.

“I grabbed the doctor and said, ‘You give me one more treatment, you’re going to have to give me the electric chair, because I’ll kill you,’” he says.

Still, Welch says his memory losses are minor compared to those of other patients. “One can’t remember his mother or father, or whether he’s got a sister. He didn’t know how many treatments he received.

“Most lose memory, sometimes for a short period, sometimes for a long period,” he adds. “What makes me mad is that each treatment kills brain cells. And how’s that going to help the patient? Some people have been there for 30, 40 years. They could never get ‘em functioning outside anymore.”

For the time being, however, it is doctors’ rather than patients’ advocates’ views that prevail. Although anti-ECT protests, legal challenges, a Toronto Board of Health moratorium, a provincial review committee and intensive media coverage led to a dramatic reduction in the number of ECT treatments given in Ontario in the ’80s, the numbers are climbing steadily back upward. In 1986-87, there were 10,362 per year, down from 39,501 in 1973-74. In 1993-94, however, the number had risen to 11,360, and by 1997-98 it was 16,028. Nationally, the use of ECT has doubled in the past decade.

But has ECT fundamentally changed? Anti-ECT doctors like John Friedberg, Peter Stirling, Peter Breggin and Robert Morgan point out that the modifications touted as new were actually introduced in the 1940s and had become routine by the ’60s, and that despite the modifications, numerous studies indicate the persistence of long-term memory loss.

Moreover, opponents argue that while anesthesia and muscle relaxants reduce the risk of bone fractures during the convulsion, they do not change the essential nature of ECT itself, which is, simply, the passage of an electrical current — typically 100 to 150 volts — through the brain. It is for this reason that ECT opponents argue that the numerous studies from the ’40s and ’50s that found evidence of ECT-produced amnesia and brain damage are still relevant.

In fact, ECT opponents argue that contemporary modified shock treatments are often more dangerous than those of the past, because more powerful electrical currents must be used to overcome the seizure thresholds in patients who have been anesthetized and sedated.

Similarly, the use of “milder” forms of ECT, like low-voltage non-dominant “unilateral” ECT (given to the right, non-verbal hemisphere of the brain) produce such “inadequate” seizures that the procedure often has to be repeated or replaced with regular bilateral ECT.

Dissenting doctors have had little need to convince patients that ECT can cause permanent memory deficits. “I lost four years of my education,” estimates Mel Starkman, 58, a former history teacher who received 38 shock treatments for depression in North York’s Branson Hospital between 1966 and 1968. “And I’ve had to read books over again.”

Wendy Funk, 42, a former law student and social worker in Alberta, says that after receiving 43 shock treatments for depression in 1989-91, she lost the memory of virtually her entire life prior to the treatments. “After 14 months, I couldn’t speak or walk,” she says. “I managed to say thank you, and they figured I was cured.”

Upon her release, Funk had to be reintroduced to her husband and children. Ten years later, her memories have not returned, and she has launched a lawsuit against the Alberta government and the doctor who treated her.

Wayne Lax, 60, a retired taxi driver in Kenora, Ont., received over 80 shock treatments for alcoholism and depression between 1967 and 1992. Lax says he has virtually no recall of those 25 years, which he has since been trying to reconstruct from hospital files, photographs and the recollections of friends, family and other ex-patients.

“I thought I was in hospital 12 times, and it ended up that I had 108 admissions. I can’t remember half my life because of electroshock,” says Lax, who, like Funk, is suing his doctor.

Juli Lawrence, 39, a health writer in St. Louis, estimates she lost two years of her memory after a series of ECTs in 1994. “I’m lucky I didn’t lose my childhood,” says Lawrence, who went on to create , a website that disseminates information on electroshock.

Even the supposedly harmless unilateral ECTs evidently produce memory impairment, albeit of a different type — for visual and spatial rather than verbal data. A 25-year-old Toronto woman says she lost her sense of place after receiving eight unilateral and one bilateral ECT treatment earlier this year.

“I had memorized the TTC stations from Finch all the way around,” she says. “When I got out of the hospital, I had no memory. I had to look at the map. Slowly, it started coming back, but there is some stuff I don’t remember still.”

Although the complaints of patients and anti-ECT doctors are dismissed by ECT advocates, they have been given more credence by mainstream health bodies. The U.S. Food and Drug Administration recently announced that ECT may cause brain damage and permanent memory loss. And last year, the American Psychiatric Association — which has vigorously supported ECT — upgraded its 1990 guess that only a “very small” percentage of ECT patients suffer permanent memory loss to the more generally accepted estimate that “many” do.

ECT practitioners insist that such reports are rare, however, and that there is no need to warn patients about permanent memory loss. “I don’t believe that’s true, so I don’t say that,” explains Dr. Joel Jefferies, a staff psychiatrist at the Clarke, who adds that many of the patients who complain about memory losses may be suffering from memory impairment caused by age, depression or medication.

Yet anti-ECT doctors note that many of the studies that found evidence of ECT-produced amnesia were controlled for such factors. The patients themselves likewise believe that complete annihilation of memory produced by ECT is readily distinguishable from the side effects of drugs.

“There is some medication that’ll make you lose your memory,” says Welch. “But the shock treatment does the biggest damage.”

Martin contends that since ECT is useful in treating people with severe depression who are at risk of suicide, its benefits outweigh its risks. But there is no proof that ECT reduces the incidence of suicide, as Martin concedes, just as there is no proof that it cures depression by correcting a chemical imbalance in the brain, a point Martin likewise grants.

Why, then, is ECT still in use? One reason is that it’s a product of the very era its advocates try to distance themselves from: the dark ages of lobotomies and insulin shock. Invented in 1938 in a slaughterhouse in fascist Italy, ECT was never subjected to the safety trials that any new drug or treatment has to undergo today. Rather, it was “grandfathered” into use. When the FDA tried to reclassify shock machines in 1979 to make them subject to safety testing, the ECT lobby protested, touching off a 20-year battle, with the FDA caught in the middle.

As for why ECT use has been increasing, shock opponents say the answer is simple: money. A 1996 Washington Post article exposed the fact that the leading ECT expert in the States, Richard Abrams, owns one of the country’s two shock-machine companies — Somatics, Inc. — a detail he had failed to mention in his textbook and journal articles. And ECT opponents point out that virtually all pro-ECT research is written by psychiatrists who make a substantial living from providing it. A 1996 article in Psychiatric Times actually advised psychiatrists to take up a lucrative ECT practice to overcome the threat to their income posed by the new “managed care” companies. More tellingly, a study in Texas — one of the few states with strict ECT reporting laws — found that ECT use jumped almost 400 per cent between 64- and 65-year-old women, the only plausible explanation being that the 65-year-olds are eligible for Medicare.

Canada, of course, has universal health insurance, but the patterns of use here have nonetheless closely followed profit-driven trends in the States. Here, as in America, the typical ECT recipient is an elderly woman suffering from “geriatric depression.”

Asked about the trend, Dr. Martin says: “ECT is extremely effective for those severe affective disorders which occur in the elderly patient. Paradoxically, a course of ECT may be more easily tolerated than a course of antidepressant medication.”

But ECT opponents, like medical writer and ex-shock recipient Leonard Frank, argue that psychiatrists “are underestimating the dangers of using ECT on the elderly.”

Frank cites Impastato’s 1957 study of 254 ECT-related deaths, which found that “the death rate among elderly persons [was] five times higher than the overall death rate,” and adds that later studies also found high rates of heart complications and death among elderly ECT patients.

Indeed, ECT opponents claim elderly women are being targeted precisely because they are fragile and unlikely to resist. But there is no guarantee that even the most determined protests will bring about change. “It’s hard for activists to have any long-lasting effect, because this is a procedure the medical establishment wants to keep,” says Dr. Bonnie Burstow, co-founder of the now-disbanded Coalition to Stop Electroshock Treatment, which staged over 40 protests in Toronto throughout the ’80s.

Still, Welch says the Patients’ Council is planning another demonstration against ECT — the first in Toronto in a decade — because they fear that if they say nothing, its use will increase even more rapidly.

“Sometimes you’re sitting in the [patients'] mall, and you see people going through on a wheelchair, right out of it,” says Welch. “And you know they’re coming back from shock treatments. How can anybody do that to another person? I’ve thrown that up at the nurses. ‘Well, it’s doing some good,’ they say. ‘Can you prove it?’ ‘No.’ I said, ‘Then don’t do it.’”

Comments (3)

brendaJune 1st, 2010 at 1:54 pm

After about 6 treatments on both sides of my head nearly 15 years ago in bc I have still not gotten my short term memory back, and have lost some former memories my family tell me. I have retained memories I hoped to erase, that had triggered my depression.
[I was not yet 50].

CurtisMay 23rd, 2011 at 11:35 am

So can ect make make you forget things perminitly sorry can’t spell well but can u actully forget things for a long time by having ect I was just woundring an also say you wanna do it can you go to any hospital to have it done?

Lilian RalphDecember 9th, 2015 at 6:32 pm

I am receiving ECT treatment for 2.5 years
And experience severe memory loss, short
And longterm . I want to quit but my psychiatrist
Refuses. I asked to change from every two weeks to every three weeks. I asked my med to be reduced but
They refuse and state my depression will get worse.
Any one has advise?

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