In his book, *The Reign of Error*, Dr. Lee Coleman, M.D. offers an explanation of psychiatric oppression that IMHO has never been surpassed. This book was written in 1984 and still marks the high water mark in many respects because it combines legal as well as medical issues. On page 116 the following dissertation begins:

Shock Treatment: As Damaging as Ever

Shock treatment started in 1933, with insulin being used to drop the patient's blood sugar low enough to cause a coma and sometimes a convulsion. This was the idea of Manfred Sakel, who had been treating his private patients at the Lichterfelder sanitarium, near Berlin, in this manner for several years. Sakel's reasoning was the following:

My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells ... a reduction in the energy spending of the cell, that is in invoking a minor or greater hibernation in it, by blocking the cell off with insulin will force it to conserve functional energy and store it to be available for the re-enforcement of the cell.

In just a few years after Sakel published his new method insulin shock treatment was being used on thousands of the world's mental patients. Today it is rarely used.

Laszlo von Meduna had a different theory, one he developed during the early 1930's while working at the Interacademic Brain Research Institute in Budapest. Meduna used a chemical (Metrazol), rather than the hormone insulin, to produce the convulsions. Like insulin, Metrazol was given by intravenous injection. Before the patient started to convulse, he or she experienced a horrible period of panic and impending doom, lasting up to a minute. It was not a popular treatment.

Ugo Cerletti, professor of neuropsychiatry at the University of Rome, conceived the method by which shock treatment is given today - electric shock. Cerletti accepted the idea that convulsions were good for schizophrenics and in 1938 started using electric shock to produce the convulsions. Electric shock treatment quickly replaced insulin and Metrazol as the favorite form of shock treatment, and became the most effective method of controlling troublesome asylum inmates.

Today between one hundred thousand and two hundred thousand Americans receive Electroconvulsive treatment (ECT) each year. About 120 volts, the amount in ordinary house current, is applied to the brain for about a half-second. A course of treatment usually lasts two to three weeks, with shocks given perhaps ten to fifteen times. Some doctors give several shocks at a time, one right after the other. Many patients have received over the years several courses of treatment, and some patients are even "maintained" on shock treatments indefinitely. Many people believe that shock therapy is no longer dangerous. This is because psychiatry proudly proclaims that shock treatment today is administered differently from earlier practices.

I first witnessed shock treatment in 1963, when I visited the Illinois State Hospital at Manteno with three other University of Chicago medical students. After being shown around several of the wards, we were taken to observe patients receive "shock." Expecting to enter a treatment room with two or three patients waiting outside, we instead found ourselves inside a cavernous ward. About two dozen patients, lying on their backs and strapped to treatment tables, were lined up from one end of the room to the other. Most were women.

The treating psychiatrist greeted us and got to work. I had the impression, by the way the doctor readied her equipment, that administering shock treatment was routine. As the other patients watched, she rubbed conducting paste on the temples of the first patient, a woman who appeared to be in her forties. She passively accepted the rubber mouthpiece placed in her mouth, as though she had done this many times. We were told the mouthpiece was to prevent cuts during the seizure.

The doctor pressed a button on the small box she had been adjusting and the convulsion began. The woman went rigid and then began to convulse rhythmically. Her face became a ghastly blue as her convulsing muscles prevented her from breathing. It seemed like a long time before she started to breathe again, but it was probably only a few seconds. She made grunting and snorting sounds, as saliva mixed with a little blood, frothed at the corners of her mouth. Once it was clear that she would continue to breathe, perhaps thirty seconds to a minute after the shock had been given, the doctor went to the next patient. Most of the patients seemed prepared to accept the treatment without complaint, and a few told the doctor they were doing better and could skip a treatment today. Such pleas went unheeded.

We watched two or three more treatments, as the doctor made her way down the line of carts. We were told this was a typical day; Shock was given between ten and eleven o'clock each morning. We then moved on to other sights and sounds of the hospital.

Today fewer patients are given ECT. The practice is no longer common in state mental hospitals, but is still used widely in private mental hospitals. Psychiatrists who currently administer shock therapy claim it is a lifesaving treatment for those who are severely depressed and possibly suicidal. Furthermore, they insist that ECT no longer deserves its ugly reputation, because there have been several new medical developments in how the treatment is administered.

Today's patient is first injected with a barbiturate; thus the person is unconscious before the electric shock is administered. Second, he or (usually) she is given a nerve blocking agent (succinylcholine), which paralyzes the muscles of the body. As a result, the outward muscular convulsion is greatly reduced. In the past, patients sometimes suffered bone fractures or dislocations from muscular convulsions. Third, oxygen is given to the patient, to compensate for the patient's inability to breathe; thus the patient does not become cyanotic (blue).

Proponents of ECT claim these developments make shock treatment safe and effective. Psychiatrist Stuart Yudofsky of the New York State Psychiatric Institute for example, has said, "The only way you physically know a seizure is taking place is that sometimes you see a finger wiggling slightly."

What Yudofsky is really saying, I believe, is that SHOCK TREATMENT IS NOW EASIER FOR THE PSYCHIATRIST TO WATCH. In truth the electricity coursing through the brain is no less damaging now than it was forty years ago. In fact, the sedating drugs now given prior to the shock require the doctor to use somewhat higher doses of electricity, since it takes more current to produce a brain seizure.

The electric current injures the brain's tissue, causing mental confusion. The medical developments described above, in other words, have done nothing to change how shock treatment "works": the patient is so dazed and confused that he or she forgets many important things. For a few weeks, emotional problems are driven from the mind, but they are not solved or alleviated in any way. Neurologist Sidney Sament has described what happens.

I have seen many patients after ECT, and I have no doubt that ECT produces effects identical to those of a head injury. After multiple sessions of ECT, a patient has symptoms identical to those of a retired, punch-drunk boxer. After one session of ECT the symptoms are the same as those of a concussion (including retrograde and anterograde amnesia). After a few sessions of ECT the symptoms are those of moderate cerebral contusion, and further enthusiastic use of ECT may result in the patient functioning at a subhuman level. Electro- convulsive therapy in effect may be defined as a controlled type of brain damage produced by electrical means. No doubt some psychiatric symptoms are eliminated ... but this is at the expense of the brain damage, which may have varying effects of patients' lives, depending on their age, personality and the number of ECT treatments. In all cases the ECT "response" is due to the concussion-type or more serious, effects of ECT. The patient "forgets" his symptoms because the brain damage destroys memory traces in the brain, and the patient has to pay for this by a reduction in mental capacity of varying degree ... a patient "responding" to ECT and even becoming asymptomatic and "easier to manage" is not necessarily healthy or cured but may be functioning at a low mental level, and his potential for full human function may be seriously impaired. The causes of the patient's depression - marital or interpersonal stress, financial pressures, problems of aging - are untouched by ECT. The patient's CONCERN over these problems is temporarily blotted out, but soon (usually after a few weeks or a month) the brain recovers enough for the person to remember his or her problems. Now the patient has an additional reason to feel low: Memory for past events and ability to retain new information are impaired. The brain injury leaves residual damage that may be permanent.

There is disagreement among researchers on the likelihood of permanent damage. This is because the "tests" used in psychiatry and psychology are strictly subjective and open to interpretation. Proponents of ECT readily admit the treatment's immediate impact on memory and learning but deny that this is long lasting. They say that the common complaints of ECT recipients, even those made years later, are a result of their mental disorders, not the result of treatment.

I am unable to dismiss these complaints so easily, since many ECT recipients describe what clinical medicine teaches us to expect from a brain injury. Brain injuries, particularly those involving the areas that ECT selects (temporal lobes and the underlying structures), may cause permanent memory loss for events in the past (retrograde amnesia).

Memory of the months immediately before and after the injury is especially vulnerable. Brain injuries may also cause permanent deficiencies in retention of new information (anterograde amnesia). It is this learning disability that is particularly upsetting for recipients. I have talked with many ECT recipients: Some of them have no complaints of permanent deficiencies, but most do.

If psychiatrists who use ECT deny the possibility of permanent injury, among themselves and to the public, they are hardly likely to mention the possibility to patients asked to consent to the treatment. Instead, patients are told that confusion and memory impairment last just a few weeks. Merely this lack of accurate information on which the patient may decide whether the risks or treatment are worth the potential benefits makes suspect the apparent consent of most ECT recipients. Equally important is the legal and ethical requirement that the consent be truly free. But is free consent possible on a psychiatric ward, where patients (even those who appear to be voluntary), may not leave unless the psychiatrist agrees? True voluntary status is rather uncommon on a mental ward. Finally, one last factor makes these dilemmas of consent even more troublesome. Once the patient has received the first or second of the ten or twelve treatments planned, he or she is so confused that any resistance to the treatment has been wiped out. Even if the patient had the physical capacity to fight back, he or she has lost the desire to do so.

Shock treatment is now enjoying a renaissance because of psychiatry's strong promotion of medical rather than psychological treatment methods. Whereas twenty years ago it was considered an embarrassment to psychiatry, every other instance, past and present, in which physical intrusion becomes a "Treatment" simply by official pronouncement, ECT is not said to correct brain abnormality. Some have likened it to "recharging our batteries." Others, hoping to sound more scientific, have said it "stimulates the deeper survival centers of the brain."

Shock treatment thus follows in the path of earlier treatment, like bleeding or lobotomy, now discarded by psychiatry. But there is no sign yet that ECT is about to be relegated to the past. A treatment favored by psychiatry will be used regardless of the cost of the patient and regardless of the patient's wishes.

Dr. Coleman then goes on in the next section of his book to discuss the "Operation Mind Control: Missing the Point". It begins with:

When clear-cut examples of mental patient abuse come to light, we often overlook the most basic reason: the patient's powerlessness to refuse an unwanted treatment.

Now by not also copying this section, I am far from saying that "Forced Treatment" is not of primary importance. I am simply saying that if you want to read his book, do so. It is a resource that every P&A lawyer and all activists in the field should have ready access to.

When I was working at Delaware State Hospital the reason ECT was seen as successful was due to the fact that it felt to the patients just like they were being killed. Freud had argued in his later years that there was a drive for DEATH in human beings and this he referred to as Thanatos. The explanation for ECT was therefore that by letting the patient "safely" experience the "controlled" death of a seizure, his death drive was being satisfied and he could safely return to life.

Well some of you who are confirmed Freudians may think this sounds logical. I don't. For me the best advertisement is the Video, SHOCK TREATMENT put out by Twentieth Century Fox. Yes it is a sequel to the ROCKY HORROR PICTURE SHOW and many of the same stars are featured in this presentation of the macabre adventures of Dentonvale Psychiatric emporium where craziness is certainly not limited to the patients.