(1) Years after Janis' 1950 study, Marilyn Rice (see below) contacted Irving Janis, and n a personal telephone interview, Janis explained how, one year later, he had followed up his 1950 study (unpublished) and how its results appeared reliable.

(2) Only Squire, Slater, and Miller (1981, p. 95) have repeated the Janis prospective study. Even after two years, and even with reminder cues, 50% of the ECT recipients in this study could not recall specific autobiographical events spontaneously recalled before ECT. This does not preclude the possibility that autobiographical evens which could be "remembered" after two years, might simply have been re-learned rather than recalled.

(3) That Squire and Slater selected the permanent gap to be the smaller one may indicate bias. Also, after three years, the larger gaps originally reported may only have appeared reduced (e.g., to eight and 10.9 months). Squire and Slater's conclusion that 100% of their subjects suffered an ECT induced average eight month permanent gap in memory in unquestionably the most conservative conclusion one may draw from their data. In any case, both studies indicate that patients under-report rather than over-report treatment induced permanent memory loss.

(4) Larry Squire himself administered Marilyn Rice a battery of cognitive tests as part of a malpractice suit she brought, in which she charged that years of her memory were permanently erased by ECT (Squire was hired by her defense). In a personal interview with the author, she related that she passed all of Squire's tests easily and in fact, regarded them as absurd. Throughout her lifetime, Marilyn contended that eight shock treatments had eliminated, in addition to treasured personal memories, all the mathematical and cumulative knowledge of her twenty years with the Department of Commerce in Washington D.C., where she coordinated vital statistics and activities concerning the National Budget (Frank, 1978). In spite of her claims, the results of Squire's tests were successfully used in court to prove her memory "intact" and she lost her malpractice suit. Rice, who died in 1992, lobbied the Food and Drug Administration (FDA) and state legislatures to mandate warnings of permanent memory loss and brain damage. Her influence on state legislatures may have been demonstrated by the recent 1993 Texas legislation, S.B. 205, which mandates a fresh signature by the patient and a fresh discussion with the patient on the "possibility of permanent irrevocable memory loss" before each individual treatment (not series) (see Cameron, 1994).

(5) The APA apparently gathered most of its facts from the device manufacturers or those closely connected with the products; in turn, the FDA obtained most of its information from the APA (APA, 1990; FDA 1990).

(6) Fink's unsubstantiated statistic was brought to my attention by shock survivor Linda Andre, Director of Committee For Truth In Psychiatry.

(7) From the Americans Wilcox and Friedman, not the Italians Cerletti and Bini, produced the world's first ECT device. The experiment with reduced electrical current was repeated in France that same year (Delmas-Marsalet, 1942).

(8) In that sense, the Wilcox-Reiter ECT device should also be credited with being the first brief pulse device. (see below)

(9) Eventually, with the introduction of informed consent, all unmodified EST (without exception terrifying to recipients) was replaced with anesthetized EST. Fear associated even with modified EST continues to baffle practitioners today (Fox, 1993).

(10) One might argue that barbiturates prompted Liberson to enhance electrical components as seizure threshold increases with barbiturate use. While this might explain some increases in electrical parameters, it does not explain increased numbers of treatment nor does it explain the eventual abandonment of minimal stimulus devices both here and abroad. (see below)

(11) This initial increase in wave length was developed to induce unconsciousness in the patient through electricity rather than convulsion (Liberson, 1948, p. 30).

(12) Impastato had introduced several of the earlier Wilcox-Reiter models and was probably an undeclared paid consultant to Reiter.

(13) Two companies (Medcraft and Elcot) continue to manufacture the older Cerletti-Bini style SW devices, both more powerful than Cerletti and Bini's original SW device renowned for brain damage and memory loss (Impastato et al., 1957) and upon which Wilcox and Liberson attempted to improve. Cerletti and Bini's original device emitted a maximum 120 volts for a maximum of 0.5 seconds. Medcraft's "modern" SW device, unchanged since its 1953 model, the BS24 (now the BS 24 III) has a maximum potential of 170 volts and emits a current for up to one full second (Weiner, 1988, p. 56; Medcraft Corporation, 1984). Today's SW devices, as well as modern day BP devices, are EST devices.

(14) By charge is meant the cumulative amount of electricity which has flowed past a given point at the end of an electron transaction.

(15) Using a straight-forward mathematical formula, the power of the new brief pulse devices can be verified by calculating joules (or the more familiar watts as in a light bulb), the measure of actual energy emitted (voltage is potential energy or power). All four companies (e.g., MECTA, 1993, p. 13) do list their devices as 100 joule maximums in all 4 brochures, but the manufacturers' calculations are based on a typical resistance of 220 ohms (ohms are the measure of resistance, here, of the skull and brain, to current flow). However, the true maximum joules or watts for all modern day BP devices is much higher than the estimate reported by manufacturers. For SW devices, the formula is: joules = volts x current x duration, or joules = current squared x impedance x duration. For BP devices, the formula is: joules = volts x current x (hz x 2) x wave length x duration, or joules = current squared x impedance x (hz x 2) x wave length x duration. All four manufacturers utilize the latter in lieu of the former formulas, deriving the 100 joule maximums for their BP machines. Utilizing the former formulas, however, which give us non-theoretical amounts, we find that the Thymatron DG BP is capable of emitting 250 joules or watts of electricity; the MECTA SR/JR BP models, 256 joules; the Medcraft B-25 BP, 273 joules; and the Elcot device even more. Compare these energy emissions with the following typical analogy; the standard SW device can light up a 60 watt light bulb for up to one second. (Modern SW devices can light up a 100 watt light bulb for up to one second.) Modern BP devices can light up the same 60 watt light bulb for up to four seconds.

(16) Ex-lobbyist Diann'a Loper, who suffers from severe grand mal epilepsy as a result of EST, worked on the passage of S.B. 205 in Texas. Her neurologist John Friedberg called Diann'a's seizures the worst he had witnessed. Even so, I noted Diann'a never suffered extensive long-term memory loss as a result of her seizures, but she had side effects exactly like those described by the manufacturers - temporary confusion, headache, temporary memory loss, and sometimes permanent loss of an event immediately surrounding (within minutes - not months) the seizure. On the other hand, as a result of EST, Diann'a has memory loss spanning years, as well as permanent memory retention problems. (My own experience with EST, resulting in permanent loss of both my high school and college educations, parallels Diann'a's and many thousands like us (Cameron, 1991). Manufacturers typically describe the less egregious effects of epilepsy or convulsions when describing "side effects" of EST, characteristically ignoring the effects of the one factor not present in spontaneous seizures - the electricity. Diann'a (along with the author) is Director of World Association of Electroshock Survivors (WAES) which seeks to prohibit EST worldwide.

(17) This is best exemplified through unilateral ECT. Originally utilized by Wilcox and Friedman to induce the most minimal stimulus threshold seizures possible (Alexander, 1953, p. 62; Liberson, 1948, p. 32), unilateral ECT is used by modern manufacturers to induce the highest electrical dosages possible (Abrams and Swartz, 1988, pp. 28-29) in order to achieve efficacy.