Psychiatry’s electric evolution A new shock therapy or the same old charges?

San Francisco Chronicle

Dec 24 2006

Telling a friend I was starting Kitty Dukakis’ new book sparked a disagreement. Was it rubbing alcohol she used to drink? Or vanilla extract? A happy debate: We were both right.

One might be tempted to say Dukakis self-medicated by treating her storied long-term depression with booze and pills. But she had plenty of help from some of the country’s leading doctors, who enabled decades of her addiction to amphetamines.

Dukakis’ book, “Shock: The Healing Power of Electroconvulsive Therapy,” alternates what folks in Alcoholics Anonymous call a “drunk-a-logue” — Dukakis’ finely honed tale of a life punctuated by overdoses, blackouts and trips to treatment centers — with journalist Larry Tye’s history of electroconvulsive therapy, “psychiatry’s most controversial treatment.”

The Dukakis shining through these struggles with depression is warm, funny, vulnerable and considerably more engaging than her uptight husband of 43 years, former Massachusetts governor and 1988 presidential contender Michael Dukakis. Her description of unraveling under the media klieg lights is downright courageous.

Let’s face it, when celebrities get together to divvy up diseases, neither mental illness nor alcoholism often gets a taker. Appreciating the depths of Dukakis’ despair is the key to understanding why she would seek out the treatment that became her salvation and even promote it, even though it stole significant slices of her memory.

“Electroconvulsive therapy has opened a new reality for me. … It has given me a sense of control, of hope,” she writes.

Shock’s authors are on a mission to rescue this therapy from stigma that haunts it to this day, even as psychiatry has embraced it as a mainstream therapy and some 100,000 patients are said to undergo it each year in the United States.

It was an Italian neurologist, Ugo Cerletti, who determined that electric shocks could be used to “tame” mental patients by causing convulsions. Cerletti first determined the amount of electricity needed to induce a seizure, but not kill, a pig or a dog in a series of experiments that would give a PETA member a lifetime of nightmares.

He first made the leap to a human in 1938 when he administered 110 volts to a 39-year-old man who had been found wandering a train station in Milan, muttering incomprehensibly.

In the early decades of the therapy’s use, electrical shocks were administered to fully conscious patients. They lost consciousness, experiencing seizures and muscle spasms so violent as to routinely break bones. Confusion and memory loss was a common side effect.

To understand how such a brutal treatment gained sway in the 1940s and ’50s, it is worth noting that competing treatments included lobotomy, as well as other means intended to induce shock or coma as a therapy, such as insulin or the drug Metrazol.

But there was arrogance and sloppiness in its use, too. Doctors tried electroshock therapy on patients as young as 2 and as old as 102, seldom following them adequately or conducting proper clinical research, making it difficult to sort out the long-term impacts. Treatment was often given over patients’ objections or with scant attention to informed consent. The therapy became popular for treating schizophrenia, although, under more rigorous scrutiny, it was later determined not to be helpful.

Some doctors shocked with abandon, resorting to electroshock therapy for indications as questionable and slippery as “antisocial behavior,” “maladjustment” and homosexuality.

The use of shock for punishment rather than therapy also undermined its future.

Such was the case for the therapy’s most famous patient, albeit a fictional one. Randall Patrick McMurphy was the bete noir of Nurse Ratched in Ken Kesey’s 1962 novel, “One Flew Over the Cuckoo’s Nest.” The gruesome electroshock McMurphy received in “Cuckoo’s Nest” left the impression that he had been shocked into submission, but it was actually a lobotomy that reduced him to the catatonia seen at the movie’s end.

For Dukakis and Tye, that was your grandfather’s electroshock therapy. They say today’s version is neither an abomination nor a “Clockwork Orange” instrument of social control, but rather an invaluable treatment all too often denied to poor people and people of color.

Today, electroshock therapy is reserved for a more discreet set of circumstances. Depression is the most common indication, especially where antidepressant drugs and psychotherapy have failed and when suicide is a risk or psychosis and catatonia are complicating factors. Now, shocks are briefer; administering them on only one side of the brain is thought to spare memory. The patients receive anesthesia and muscle relaxants, and don’t remember undergoing what is a much calmer looking procedure.

Of course, one might wonder why a book seeking to destigmatize the practice is entitled “Shock” when modern practitioners prefer the “electroconvulsive therapy” of the subtitle.

“We debated it. Ultimately we decided it is the term most people recognize and understand. It might help sell the book and reach people in need. Sometimes embracing a stigmatized term is a way of deflating it,” said Tye in a recent phone interview.

“Shock” chronicles how the Bay Area was the crucible for much of the political debate over electroconvulsive therapy, profiling some of its harshest foes, Ted Chabasinski and Leonard Frank. They remain implacable critics of the procedure, even in its modern guise, maintaining that psychiatrists still understate long-term side effects, driven at least in part by a profit motive.

The debate fueled by California “psychiatric survivors” peaked in 1982, when they succeeded in placing electroshock therapy on the ballot in Berkeley. Residents voted 2-to-1 to ban the procedure within city limits, but the measure was quickly overturned in court.

Chabasinski, 69, a Berkeley attorney, is the very definition of a psychiatric survivor. A line on his Web bio summarizes his mental health experiences: “Shocked, Inpatient, Outpatient, Forced Treatment, Raped, Restraints, Tortured, Solitary Confinement.” With his natural mother incarcerated, Chabasinski was in foster care from birth. “The doctors had decided I was mentally ill before I was even born; hereditary views of mental illness were very much the fashion,” he said in a recent interview.

Chabasinski received electroshock therapy from Dr. Lauretta Bender at New York City’s Bellevue hospital in one of the first experiments involving children. He was 6 years old and would spend the next few years in what amounted to psychiatric solitary confinement.

Frank, 74, a longtime Pacific Heights resident, edits successful books of quotations for Random House. Born in Brooklyn, he landed in San Francisco after college and an Army stint. He was happy to hang out in North Beach and in no particular hurry to find a job. Distressed by his beatnik “lifestyle,” his parents had him involuntarily committed to a psychiatric hospital where he received 50 insulin coma treatments and 35 electroshocks in 1962 and 1963.

The impact on Frank’s memory was “like wiping a wet eraser on a chalkboard,” he said. He no longer remembered that JFK had been elected. More troublesome yet was the ablation of much of his Wharton School college education. Finally released from the hospital, “I decided I would spend my life fighting this,” he recounted in a recent interview in which he shared excerpts from his online “electroshock quotationary.”

Although Chabasinski and Frank and their fellow psychiatric survivors were unsuccessful in banning electroshock therapy, they were able to persuade California legislators to pass some of the strictest laws in the country regulating the practice.

Before administering the treatment in California, a psychiatrist must assert that other options have been exhausted. A second opinion must be secured from a physician who doesn’t use electroshock, and the episode must be reported to state authorities. Although “Shock” laments the California regulations as reducing the procedure’s availability throughout the state, one local practitioner embraces them.

Dr. Robert Dolgoff practices psychiatry at Alta Bates Summit Medical Center in Berkeley and teaches at UCSF. Much of his practice consists of referrals for electroconvulsive therapy.

“We are proud of what we do; we help incredibly vulnerable people,” said Dolgoff. His busy office is in the basement, not to hide it but because “that is the space we got.” Not all of the patients referred to Dolgoff for the treatment end up receiving it because he believes it is truly a measure of last resort.

“All of our patients have tried at least two drug regimens before coming to us for ECT. But it is much more typical for them to have tried four, five or six different drugs and still be suffering,” Dolgoff said.

Dolgoff acknowledges that some patients will experience memory loss for some of the time surrounding the procedure; discussing this risk is a key part of the informed consent process. But do extremely depressed patients have the wherewithal to weigh all the factors? “That is where the second opinion is helpful,” Dolgoff said. California also requires a court order for the therapy to be administered against a patient’s will.

Dolgoff said he rarely receives referrals for court-ordered electroconvulsive treatment, but when he does there is a good reason. “You have to understand that by this point patients are dying because they are so depressed that they are basically unwilling or unable to eat. ECT offers the prospect of a much more rapid turnaround than antidepressant drugs.”

Comments (2)

Ruth JamesonOctober 7th, 2009 at 7:37 am

What I would like to know is if Psychiatrists are unsure of how ECT works why are they using it? And why don’t they admit that it damages people’s brain? If you electrocuted by lightening you’re immediately brought to casualty for life-saving treatment, yet ECT is delibrately giving people electric shocks — ie electricuting them. Where’s the sanity in that? Is it the same sanity that gave the OK for insulin shock therapy or labotomy which leaves the patient in a simpleton state so much so that even their own relatives cannot cope with their “bad behaviour” forced on them by past psychiatrists who commended thjis bazzare treatment. Like the founding father of American Psychiatry — Rush, it has always been a brutal form of medicine– a junk science. Since the days of the Tranquilizer chair where patients were forced to sit in that chair sensory deprived for hours on end while undergoing at the same time other forms of brutal treatment, psychiatry is still a cruel and inhumane practice, treating the mentally ill as if they’re nothing more than animals. Isolation, enforced injections, chains and manacles the list goes on. There is no known chemical that pinpoints depression, and there has never been a gene found for it. This line of theory is used so that psychiatry can look like a medical science when it really is junk science. To say that this has a genetic component and a chemical one is deliberately falsifying research for psychiatry’s own gains. To force people to swallow pills pour syrup down their throat and tie them to chairs (and yes this practice still goes on) is barbaric. The way to treat depression is through psychotherapy and the removal of toxic environments, because no psychotherapy treatment will work if there are toxic stressors still in place. ECT is BAD Science, it is shameful; and if psychiatry is so proud of this treatment why don’t they test it on themselves first before giving it to a marginalized group in society? I hope that the ani-psychiatry movements will one day successfully ban psychiatry globaly. Noone has the authoritive right to destroy people’s brain either chemically through medince or the use of a machine to electricute them giving them legalized brain damage. It doesn’t matter how modern the machines are — ECT is FRIED BRAINS for breakfast.

AlexanderJuly 16th, 2010 at 9:30 am

I was diagnosed with schizoaffective disorder and social anxiety disorder when I was seventeen. I have tried the drug “therapy” routine many times, always with the hope that the next drug cocktail would help me. In every case, the drugs caused serious side affects that were, in my subjective experience, far worse than the “disease.” Now I have reached a point where I will not turn to these madmen, psychiatrists, or anyone else in the mental health field for assistance of any kind. To me it is like a Jew asking a Nazi SS guard for “help” in a concentration camp: It is just asking for trouble of the worst kind. Unfortunately, the threat is always lingering that I will be forced into treatment at some point. My meager income could will be turned over to someone else to manage and to withhold as punishment for refusing “treatment.” It is beyond me how anyone could think that it is “help” to deprive a person of all his assets until he agrees to take mind-altering drugs, but I am sure the Inquisitors of the Inquisition thought that they were doing God a service by torturing their victims, too.

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