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San Diego doctors, patients debate electroconvulsive therapy

Shock

  • “The Shock Shop. Mr. McMurphy, is jargon for the EST machine, the Electro Shock Therapy. A device that might be said to do the work of the sleeping pill, the electric chair, and the torture rack. It’s a clever little procedure, simple, quick, nearly painless it happens so fast, but no one ever wants another one. Ever.”
  • One Flew Over the Cuckoo’s Nest

She refused to grant them permission to give her son electroshock. The hospital sought out her husband—he hadn’t seen the boy in five years-, got him to sign the papers, and went ahead with the treatments.

A community health counselor recently saw a young woman who’d been in and out of psychiatric wards for eleven years without ever receiving anything vaguely resembling therapy or counseling. She had been treated exclusively with drugs and electroshock.

“That’s common practice,” says Vic DiMeo, family counselor at University Hospital. “First they drug you into insensibility, then they shock the affect out of you. It’s common knowledge that at some hospitals they give shock to any patient they consider a pest. There’s a private hospital in the area where they line them up like peanuts for ECT. It’s a racket.”

If a controversial new California law is not completely emasculated by proposed amendments, electroshock devices may eventually take their place alongside the trepan, the dunking stool, and the stake, in the Museum of Curious Curios of the Past.

The law, sponsored by Assemblyman John Vasconcellos, a Santa Clara Democrat, would make it mandatory for a psychiatrist to attempt all other therapies before resorting to electroshock and would require, in most cases, both the informed consent of the patient and the agreement of a panel of three psychiatrists or neurosurgeons that electroconvulsive therapy (ECT) is “critically needed for the welfare of the patient.” Doctors would have to explain all the risks of shock treatments and would be forbidden under any circumstances to perform lobotomy and similar brain-destructive operations without the patient’s informed consent.

The law asserts that any physician who violates the ECT and psychosurgery requirement “shall be subject to a civil penalty of not more than $10,000 for each violation and revocation of license, or both.”

Presently tied up in litigation, the law is being amended to overcome the objections of outraged psychiatrists.

Pushed by the Network Against Psychiatric Assault (NAPA), a group of former mental patients, mental health workers and maverick doctors, the law was hardly on the books when doctors Gary Aden and M. Brent Campbell of Mesa Vista Hospital persuaded Superior Court Judge Charles Froelich to issue a temporary restraining order. The doctors challenged the law’s constitutionality and claimed that it infringes on their right to treat their patients without government interference.

A group of psychiatrists led by Dr. Aden and Dr. Leonard Cammer of New York have organized the American Society for Electrotherapy in an attempt to muster professional support to fight the California law and others like it. The group is headquartered in San Diego.

The present bill which is before the state senate would require only one other psychiatrist’s agreement that shock is necessary, and then only for involuntarily committed patients. The penalty for violation would be reduced to $5,000.

The new law “has tied it all up in red tape,” according to Ralph Witcraft of San Diego Mental Health Services. “To my knowledge, shock treatments have come to a halt in San Diego.”

The controversy of electroconvulsive therapy, more commonly known as electroshock, is not a new one. It has been brewing ever since the technique was introduced in 1938 by Ugo Cerletti, professor of psychiatry at the University of Rome. Having observed hogs being shocked in a slaughterhouse. Dr. Cerletti decided to try it on humans. His first subject, a vagrant sent to him by the police, is recorded by Dr. Cerletti to have cried out before his second jolt, “Not another one! It’s deadly!” After that, even Cerletti is reported to have had grave doubts about its continued use.

Critics claim that electroshock, a technique that involves jolting the brain with an elec-' trie current and producing a grand mat seizure similar to the ones experienced by epileptics, causes disorientation, unwanted behavioral changes, memory loss, intellectual impairment, brain damage, and even death. They claim that it is often administered as punishment rather' than as therapy, that it is a dangerous and terrifying procedure, and that, although it is of great economic benefit to psychiatrists, it is of only questionable therapeutic value.

In a letter to Assemblyman Vasconcellos, San Diego doctors Thomas Rusk and Randolph Read note that, “It is no secret that psychiatrists who heavily use ECT . . . frequently have incomes in excess of $100,000 to $200,000 per year.”

The orthodox psychiatric community, on the other hand, regards ECT as a highly useful but commonly misunderstood “treatment modality.” For psychotic and acute suicidal depression, as well as for certain forms of schizophrenia, it is considered “treatment of choice.” They claim there is no evidence that electroshock damages the brain, and they insist that the memory of ECT patients is only temporarily impaired.

Dr. Larry Squires of UCSD has recently published the results of an experiment purporting to demonstrate what psychiatrists have long maintained— that electroconvulsive therapy patients substantially recover their memories shortly after treatment has ended. Dr. Squires is quoted as saying that he can find “no complaint against the use of ECT.”

Apparently, however, Dr. Squires’ experimental subjects don’t agree with him. He reports that 65% of the ones who underwent bilateral ECT — the most common form of electroshock— continue to complain of memory impairment.

One ex-patient who received shock treatments twenty years ago in Agnew and Camarillo State Hospitals disagrees with Dr. Squires, and insists that many of his early memories are gone for good.

Eli is 39 now, a guitar-strumming poet with a blond beard, one earring, and a mellow, subterranean laugh. He talks about his experiences in a restrained, contemplative voice. He has been in and out of correctional institutions since his youth. The word “outcast” is tattooed over his heart.

When he was 18, Eli was busted for auto theft and sent to Agnew State Hospital. Like McMurphy, Ken Kesey’s protagonist in One Flew Over the Cuckoo’s Nest, he figured he was beating the rap. But at Agnew he got into one too many fights. They gave him electroshock.-He says his folks were tricked into giving their consent; they signed a paper that gave the hospital permission to perform whatever treatment they thought necessary. He was given twenty-eight treatments.

“My childhood is all gone. I can’t remember back in my childhood and feel things. You know how you remember back in your childhood and feel things—well I can’t do any of that. I’m just stuck out here like a Buddha with no past experiences. It dusted my past.”

He is silent for a moment. Coughs into his fist. Filtered through the blood-red curtains of his O.B. apartment, the afternoon light throws an orange glow across the room. There are incidents of his youth that he knows happened only because he was told they happened. Other incidents he remembers only in part.

“Sure, I can remember the pictures, but I can’t remember the experience, how it felt to be a child. That’s what the poem is. I can’t write any poems about my childhood because I don’t have that.”

Eli’s concern for the loss of his past is not unusual among ECT recipients. In 1971, Ernest Hemingway complained bitterly that his memory had been destroyed by electroshock treatments and that he was ruined as a writer. A month after undergoing a second series of treatments Hemingway killed himself.

Dr. Thaddeus Kostrubala, a psychiatrist with Mercy Hospital, says that “ECT can be a lifesaver,” but adds that it has not always been administered judiciously in the past. “Where you’re dealing with the memory you’re involved with an extraordinarily complex subject. You’re dealing with an area that borders on the metaphysical.”

A writer himself—his first book, about the joys of running, will be published by Lippincott in the fall—, Dr. Kostrubala admits that Hemingway’s suicide affected him deeply. He questions the use of ECT for conditions that are less than critical. “Who’s to say that depression and even some degree of disorientation aren’t normal human responses. Maybe they’re even useful. Maybe they can lead to periods of creativity. ’

If Hemingway’s suicide was to some degree a result of his treatments, others have been suspected of killing themselves from the sheer terror of impending shock treatment.

Dr. Leonard Cammer, co-chairman of the American Society for Electrotherapy, and an outspoken advocate of ECT, is the author of a popular book. Up From Depression, which gives the following advice for dealing with a relative’s pretreatment fear:

“Skirt away from the subject of treatment. If your relative brings it up, change it as gradually as possible. Or you might say, ‘Why discuss it now? Let’s see how you feel when you have to go.’ Thereafter mention it only once, on the day of the treatment and as close to the appointment time as possible. ” Just the thing to set the depressed mind at rest.

When Eli recalls his shock experiences twenty years ago it sends a shiver up his back. “On shock day it goes on till one, two o’clock in the afternoon. I can remember standing in that room bullshitting to keep your mind off the fear. Then they call your name and you put your shoes outside the door. There are four or five nurses and the doctor. He’s dressed in black. And Big Nurse — you know like in the Cuckoo’s Nest – the big read-headed nurse. Always got one of them, man.

“They wrap this sheet around you. They spread-eagle you on the floor, strap you down.Then they shock you. It’s like a dark curtain comes over your eyes. There’s no pain, just fear. The fear is real. It’s like going to the electric chair or gas chamber.

“When you wake up your body stiffens and goes into an arch and then it starts bucking. You start spitting out the sides of your mouth. Like spasms. You wet your pants. Lot of people shit in their pants. Lot of people vomit. All kinds of involuntary things happen to you. Every muscle in your body goes through this terrible thing— this convulsion.”

Dr. John Friedberg, the leading medical advocate of the new California statute, claims in a recent article in Psychology Today that, “The death rate from ECT runs about 1 per 1000 patients, with one-fifth of these deaths directly due to brain damage.”

Dr. Friedberg, NAPA and the Church of Scientology, one of the few national organizations that has actively opposed electroshock, claim that the medical malpractice insurance rates are appreciably higher for psychiatrists who use the treatment.

Dr. Kostrubala believes that when properly administered, ECT therapy is relatively safe but notes that metrazol and insulin shock therapy were discontinued because “they killed too many people.”

Under both the new bill and the law as it now stands, patients who are “incapable” of giving informed consent are at the mercy of the courts, the hospitals and the “conservators” who are appointed to act in their behalf, according to Allen Snyder, a San Diego attorney with Legal Aid. Mr. Snyder claims that the conservators often represent the hospitals more than they do the patients.

Furthermore, he points out, hospital administrators can deny patients their rights—including the right to refuse electroshock – under certain conditions. A patient’s right can be denied, for example, if granting it would “be dangerous for the patient.” A recent proposal by the Council of Local Health Directors would substitute for “dangerous” the word “detrimental,” a term eloquently characterized by the San Diego Mental Health Director as “a weasel word.”. The counsel for the State Department of Mental Health rejected the proposal, but the fact that it was suggested in the first place gives some indication that doctors and hospital administrators will not take the curtailment of their powers without a struggle.

The Vasconcellos Law is not an isolated assault on psychiatric authority, but the latest of a number of recent statutes attacking a variety of psychiatric practices. Behavior modification, operant conditioning, aversive therapy and other forms of “behavioral engineering” have also been coming under the judicial and legislative gun.

As for electroshock, it might be the beginning of the end.

“The empirical results of electric shock therapy are impressive,” writes James Hamilton, M.D. “Today hundreds of thousands of people are leading normal, productive lives, thanks to electric shock therapy.”

“Miss Huey began to talk in a low, soothing voice, smoothing the salve on my temples and fitting the small electric buttons on either side of my head. ‘You’ll be perfectly all right, you won’t feel a thing, just bite down. And she set something on my tongue and in panic I bit down, and darkness wiped me out like chalk on a blackboard,’’ wrote Sylvia Plath in The Bell Jar.

“I can’t say how much I lost because I don’t know what was there,” a Mr. Jerome Ford wrote in a statement for NAPA.

“What you have to keep in mind,” says Dr. Thaddeus Kostrubala, “is that electroshock is treatment, not therapy. Therapy comes from a Greek word meaning service. You treat wood.

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