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By ERICA GOODE
New York Times
A preliminary draft of the U.S. Surgeon General's Report on Mental Health, not yet released to the public, has touched off an uproar among some consumer advocates, who say it gives too rosy and uncritical a picture of electroshock therapy.
In the draft, electroconvulsive therapy, or ECT, is characterized as "a safe and effective treatment for depression." It says the treatment can be "recommended for select groups of patients with severe depression, particularly to those with associated active suicidal ideation, psychosis or catatonia." Pages containing this assessment were released by the National Mental Health Consumers' Self-Help Clearinghouse, which is based in Philadelphia.
Joseph A. Rogers, executive director of the group, said the draft did not sufficiently describe problems associated with the treatment. "The idea that the surgeon general is going to unqualifiedly say that ECT is safe and effective really concerns us," Rogers said. "You wouldn't say that so unqualifiedly even about aspirin."
Damon Thompson, a spokesman for the office of the surgeon general, said the draft was still "undergoing a rigorous review and revision process," and that the version Rogers referred to was not final.
He said Rogers was one of 150 people, including researchers, mental health consumers, and other experts, who had been asked to comment on parts of the draft.
"We follow a scientifically recognized procedure of peer review, and part of that peer review is an expectation of confidentiality from people whom we ask to comment," Thompson said. He said Rogers never submitted written comments on the draft to the surgeon general's office.
But Rogers said in an interview that he had communicated his objections about the draft by telephone to government officials involved with the report. He said he was led to believe that the section would not be changed, and he decided to make the matter public, through the Internet. More than 100 people, alerted by Rogers, have sent angry e-mail to the surgeon general's office, he said. "We think there's a lot of reasons for people to be cautious in seeking and receiving ECT," Rogers said.
The surgeon general's report, like earlier reports on smoking, nutrition, and other health topics, is intended to present a comprehensive review of the state of knowledge on mental health, including an assessment of "leading edge" scientific research and treatment. The report is scheduled for release in December.
The draft describes problems associated with electroshock therapy in the early years of its use, before anesthesia was routinely given to patients, and notes that "these now antiquated practices contributed to the negative portrayal of ECT in the popular media."
The use of the therapy declined until the 1980s, the draft continues, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression." Of patients who received ECT, the draft notes, 50 percent to 70 percent improve.
The draft also notes that electroshock often causes "confusion" after each treatment and can result in memory loss for "the period immediately surrounding the treatment itself." But reports of permanent memory loss from the shocks, the draft said, were ''anecdotal."
But Rogers and others argue that there are more serious risks associated with the treatment, that its benefits are short-term, and that it is at times used in a coercive manner.
Laura Van Tosh, an independent consultant on mental health issues in Washington who also identifies herself as a consumer of psychiatric services, said she was asked to review the draft's section on electroshock, and agreed that the section did not indicate the extent of the controversy over the treatment.
But she added that "I think there's every opportunity for consumers to speak out on the report and on this section."
"I have a great deal of respect for the people who contributed to the report and the editors of the report for developing a document like this for the public," Ms. Van Tosh said. "I do know people who ECT has benefited, and I feel that this is a matter of choice and preference."