Why is ECT so controversial?
I believe the old adage, 'where there's smoke, there's fire.' There are reasons that ECT is so controversial.
Since the beginning of ECT use, patients have complained of lingering side effects, including memory loss, and loss of certain abilities (which varies from person to person). These complaints have remained quite consistent during the nearly 70 years since it was introduced as a medical treatment. (1)
Since that time, the ECT industry has repudiated the complaints of ECT patients. Instead of trying to listen to the patients and find a solution to the problems, the industry has been on the attack, attempting to discredit those who speak out. They have taken a wide range of people and categorized them into one group of people: antipsychiatry and Scientologists. If that doesn't deflect the attention away from those speaking out, they tell the public and media that they are too mentally ill to understand what's going on. (2-4)
Consider the words of Dr. Richard Abrams, who produces a patient brochure to accompany his Thymatron machine:
"Just as with other medical treatments, from appendectomy to penicillin, ECT was used excessively in the past, mostly in large, understaffed mental hospitals in the 1940s. The drama of mental illness has also been exploited by fictional movies such as "The Snake Pit" that included stark and exaggerated portrayals of ECT to emphasize a story. More recently, quasi-religious groups have received media attention for unsubstantiated claims that all medical approaches to psychiatric illness are undesirable." (5)
This statement does not address the deeper reasons for the controversy.
Certainly appendectomy and the use of penicillin are not controversial. Consider the use of chemotherapy. This is an intrusive treatment with horrific side effects for some. Yet you do not see protesters in front of cancer centers, or working in congress to stop it from being used with force.
Cancer patients are very aware - and told upfront - what the results may be with chemotherapy. ECT patients are not.
Instead, the industry bristles at any criticism, and points to a badly-designed study that concluded the majority of patients were happy with their ECT treatment. They do not mention that nearly half of the original participants either dropped out after treatment, or refused to participate. (6)
Abrams admits that "doctors who give ECT have shown remarkably little interest in their patients' views of the procedure and its effects on them" but goes on to say that the ECT activist movement is made up of a "loose coalition of ex-patients, civil libertarians, religious cultists, consumer advocates and medical opportunists, a consortium virtually unopposed by any equivalent pro-ECT patient advocacy groups." (5)
Even consumer advocates, who represent the psychiatric consumer point of view, are mentioned with distaste in the above passage. It is clear that even today, those who practice ECT want mental patients to remain in their place.
Harold Sackeim, Ph.D., admits that the industry has refused to acknowledge consumer/survivor complaints. He goes on to say that Dr. Abrams is defensive, and this has caused Abrams and the ECT industry to continually ignore complaints. (7)
This is, unfortunately, typical of today's lack of understanding by the industry towards those it says it wants to help: a complete misunderstanding (or refusal to understand) of the issues that ECT activists and patients believe are important. The industry points to how bad it was in the past - the abuse of ECT and that doctors did not care about patient views - while continuing the same pattern today. Sadly, nothing has changed.
Whether ECT practitioners secretly know the truth, but keep their heads in the sand, or whether they truly believe what they say is not known. It is possible that they honestly believe things have changed, and that patients are happy. In a study of patient attitudes in 1996, an unsurprising finding was that when patients complain about the results of their ECT, the doctors disregard their complaints.
The unexpected finding of that study was that the patients tend to move on to new doctors, or leave psychiatric treatment altogether, leaving the doctors completely uninformed of the truth. The doctors believe that the treatment was a success because the patient never returns. The patient, on the other hand, feels entirely different, even humiliated. (8)
This study, while small and certainly not without methodological flaws, does validate that a terrible communication breakdown exists.
Dr. Abrams, on the other hand, says that the majority of patients are satisfied, and you don't hear from them because they're busy getting on with their lives and "prefer not to be reminded of their illness or its treatment."
ECT critics would strongly disagree with this view, saying that those patients are NOT silent, that they continually contact the activists, some even becoming activists. Critics would also add that many of these patients Abrams and colleagues believe are getting on with their lives have simply given up and feel too damaged to speak publicly.
The issues surrounding ECT are complex and not easily put into black and white. Activists want reform and accountability and have been demanding that for decades.
The answer from the ECT industry has not changed since the beginning. They continue to say "These people just want ECT banned, they're crazy, or they're Scientologists."
The controversy surrounding ECT is real and it is valid. But until the industry begins to look within and confront their absolute fear of criticism (7), the controversy will continue.
1. Andre L, Lawrence J: Beyond "anecdotal" evidence: The contribution of ECT survivors to research on the permanent effects of ECT on memory, memory ability and cognition, in NIMH 2002, 2002.
2. Fink M: Impact of the antipsychiatry movement on the revival of electroconvulsive therapy in the United States. Psychiatr Clin North Am. 1991; 14(4):793-801.
3. David J. Rissmiller DO, Rissmiller JH: Evolution of the Antipsychiatry Movement Into Mental Health Consumerism. Psychiatric Services 2006; 57:863-866
4. Lebensohn Z: The history of electroconvulsive therapy in the United States and its place in American psychiatry: a personal memoir. Compr Psychiatry 1999; 40(3):173-81.
5. Schwartz C, Abrams R: Somatics Patient Brochure. 1994
6. Goodman J, Krahn L: Patient satisfaction with electroconvulsive therapy. Mayo Clin Proc 1999; 74(10):967-71.
7. Deposition Harold Sackeim: Mecta Lawsuit Case #01069713. March 2004.
8. Lawrence J: Voices From Within. www.ect.org 1996.
Updated August 12, 2006