February 16, 2012

The Stealth ECT Psychiatrist in Psychiatric Reform

By Dr. Peter Breggin

When I was a freshman in college leading the Harvard Mental Hospital Volunteer Program, I found myself with free access to the state mental hospital in which we volunteered, and I got to see shock treatment. Electroshock patients were brought into the shock room led by burly aids and strapped down on the shock table.

Before the shock, the patients were sometimes depressed, sometimes extremely anxious, frequently terrified, and on occasion physically resistant. They were individual people with feelings and willpower. After being held down and driven into a seizure by a jolt of electricity, they always came out the same — confused, disoriented, and helpless, like victims of head injury, and always they became docile and manageable. The most “difficult patient” was always easily led away to languish on the ward. Concussive-like head injury, especially involving electrical trauma to our frontal lobes, makes us all alike in our vulnerability.

As I described in Toxic Psychiatry, I asked one of the psychiatrists how shocking the patients could possibly be helping them and he replied, “Shock kills bad brain cells.”

At the age of 18, witnessing this barbarity helped transform me into a psychiatric reformer.

Soon after I became a psychiatrist, I discovered that lobotomy was making a comeback. It was the early 1970s and I took four years out of my life to carry on a successful international campaign to stop lobotomy. It was my baptism into the maelstrom of psychiatric reform. I knew that lobotomy and shock (now called electroconvulsive therapy or ECT) were nearly one in the same — both assaults on the highest centers of the brain, one with scalpels and hot electrodes, the other with searing jolts of electricity.

Eventually, I took on ECT, and my first published medical book became the first and still the only medical book critical of ECT, Electroshock: Its Brain Disabling Effects (1979). The basic science in that book would be updated over the years.

In the early stages of my reform work in the 1970s, I discovered how and why these treatments had always gone unchallenged within the profession. There is a secret psychiatric code: You do your thing, and I’ll do mine, and we’ll never criticize each other. And so at the annual meetings of the American Psychiatric Association, the lobotomists would have their own sessions together, the shock doctors theirs, the drug docs theirs, the psychoanalysts theirs, the family therapists theirs, and so on…

I broke the rule in 1972 and went to a meeting of lobotomists and shock doctors. All I had to do was sit in the audience. One lobotomist and shocker stood up and called me psychiatric names. That was Leo Alexander, perhaps the nation’s leading proponent of shock at that time. As documented in The Conscience of Psychiatry, another threatened me with death, stating that my reform work was depriving some of his incarcerated patients of the benefits of lobotomy and that several of them wanted to kill me when they got out of jail. He added with mock affection, “And Peter, the danger is real.”

The shockers and lobotomists at this American Psychiatric Association meeting became so out-of-control in their rage at my presence that Leo Alexander’s remarks would lead me to sue him for libel and slander. Fortunately, his outbursts were captured on my SONY tape recorder and I won a large enough settlement to continue funding my reform work.

Those of us in psychiatric reform are now being asked to behave like the American Psychiatric Association and its tens of thousands of members. We are being asked to welcome into our midst a man who is probably the leading proponent of shock in the world today. This stealth psychiatrist is David Healy.

David Healy is a psychiatrist working in Wales who first became well-known in 1997 — three years after my wife and I published the bestseller, Talking Back to Prozac — as a newbie critic of antidepressants. It was refreshing at that time to have a dyed-in-wool biological psychiatrist take on Prozac, Zoloft, and Paxil, and he made a contribution to research and to informing the public and the professions of the dangers. But he presented himself as something new and unique without drawing on the work already published and his books were critical of those of us in the reform movement.

Even after Healy was critical of me in his books, we invited him to speak in 2004 at the annual conference of the reform organization I founded, and I specifically asked one attendee not to embarrass him in public when he was speaking. I wanted a “big tent” for psychiatric reform. Healy took the opportunity to interview me for a “historical” book he was writing about ECT and I explained some of the critical scientific literature that he would later leave out or dismiss in his ECT book. At the time, I had no idea that Healy’s real underlying commitment was to shock treatment — so much so that it explained why the biological psychiatrist was criticizing antidepressants. David Healy wanted to justify the need for shock treatment.

Then in 2007 Healy published one of the few books in recent years to unabashedly promote shock treatment: Shock Treatment: A History of Convulsive Therapy in Mental Illness (written with Edward Shorer, a Canadian defender of ECT). Healy’s acknowledgement begins, “This book owes a special debt to Max Fink … “ The book even has a photo titled “ECT ‘Victory Party,’” featuring Fink and an array of the world’s most notorious advocates of shock celebrating the founding of their own pro-shock journal. Until the publication of Healy’s book, Fink was the world’s best known advocate of ECT — a man whose testimony in deposition and trial until very recently prevented any patients from winning malpractice suits against shock doctors. The book clearly establishes Healy as heir to the throne of the aging Max Fink as the new face of ECT.

Healy’s book states, “the charge of brain damage from ECT is an urban myth” (p. 3) and “Therapeutic convulsions induced by electricity, by contrast [to epilepsy], do not harm the brain and can save lives” (p. 9). His statement, “ECT really does work in illnesses where drugs fail” (p. 7), directly connects to his work in criticizing drugs.

In the next year, 2008, Healy wrote a more informal article in which he summarized his views. Dr. Healy said about brain damage, “ECT rarely, if ever, causes clear clinical evidence of brain damage and has not been shown to do so in animal studies.” About memory destruction, he said, “critics have found it difficult to demonstrate memory or other cognitive problems that endure beyond three months.” About the effectiveness of ECT, Dr. Healy declared with no uncertainty, “ECT is the most effective treatment for severe depressive disorder.”

Healy was selling ECT as a replacement for antidepressants. There was no mention of human service, caring approaches, such as psychotherapy or family therapy, or even of exercise which has also proven as effective as or more effective than antidepressants. He also failed to mention that placebo has proven as effective as or more effective than both antidepressants and ECT — without producing any brain damage.

One psychiatric reformer recently defended Dr. Healy by declaring, in effect, “Dr. Healy gives informed consent to his patients and they make the choice for ECT.” But if Healy tells his patients the same things that he writes in his books and articles about ECT — that it’s nearly harmless and very effective — have his patients been adequately informed of risks and benefits associated with the treatment?

Another leading psychiatric reformer has been traveling the world giving joint seminars with Dr. Healy, who talks about the hazards of antidepressants, apparently without mentioning his underlying devotion to shock treatment, which until this blog has been ignored by the psychiatric reform movement. Three out of four endorsers on the back cover of his newest book, Pharmageddon, are highly-respected authors and researchers with major contributions to psychiatric reform.

This is not the place to discuss the vast evidence documenting that ECT causes severe memory dysfunction, generalized cognitive deficits, and brain damage, including brain hemorrhages and cell death in multiple animal studies. Most people know intuitively that shocking people can’t be good for them. Many people know someone who was permanently transformed into a damaged human being by shock. There are organizations of shock survivors within the psychiatric reform movement devoted to abolishing ECT. Besides, the damaging effects of ECT have been documented for decades. Here the issues are simpler: Should those of us devoted to psychiatric reform continue to support such a “big tent” that it begins to look like the American Psychiatric Association? This failure to confront shock doctors and lobotomists is precisely what has allowed these treatments to survive despite their obvious barbarity.

Some of Dr. Healy’s defenders have pointed out that he has lent comfort and even legal support to families who have lost loved ones to suicide caused by antidepressants. I hope he continues this good work. But the fact that he has simultaneously taken on himself the mantle of the leading promoter of shock treatment in the world raises issues about his inclusion in the psychiatric reform movement and especially about the silence that, until now, has led psychiatric reformers to ignore his dark side. I’ve never thought in terms of litmus tests, but if we were to have one litmus test for inclusion in psychiatric reform, it might be this: “Thou shalt not shock and lobotomize people.”

Remember the haunting moral question we must always ask ourselves about one or another atrocity, in this case, “Where was I when they came for the shock patients?”

Originally published on The Huffington Post