Letters to the editor

Shock and Disbelief

"Shock and Disbelief," by Daniel Smith (February Atlantic), incorrectly characterizes those who urge caution on electroconvulsive therapy as falling into one of three groups: "a handful of former ECT patients, some dissenting psychiatrists, and the Church of Scientology." Smith may be surprised to learn that a number of established organizations in the mental-health field also believe that a high degree of caution is warranted. For example, the official policy statement of the National Mental Health Association, America's oldest and largest nonprofit organization addressing all aspects of mental health and mental illness, includes the recommendation "that ECT be presented as an alternative with extreme caution, only after all other treatment approaches, such as medication and psychotherapy, have either failed or have been seriously and thoroughly evaluated and rejected."

Although many people have been helped by ECT, it is a mistake to discount the compelling stories of those who have suffered severe and permanent disability in its wake. Although they may represent a minority of recipients, there is no way to know in advance who will experience similar deficits, as even proponents admit. As a result, ECT should remain a treatment of last resort, and the choice to use it must be a truly informed decision, made competently and without coercion.

Michael M. Faenza
National Mental Health Association
Alexandria, Va.

In 1960, when I was seventeen, electroshock therapy literally saved my life. After three months in a private psychiatric institution I was sent home, where, in spite of changes in medication and increased doctor visits, I simply could not cope, and found temporary relief by way of an overdose that rendered me unconscious but near death.

Back at the institution, my doctor started me on higher doses of medication in hopes of breaking the grip of this suicidal depression, but sustainable relief came only after my doctor administered ten electroshock treatments over the course of three weeks. I was no longer agitated or anxious. The depression that almost took my life finally became manageable after more than a year of struggle. Eventually it would dissipate, leaving me to finish my schooling, marry, raise two children, and enjoy a successful career.

Did I suffer a loss of memory? Of course. A little or a lot? Doesn't matter. Was it a fair tradeoff? Unquestionably. If needed, would I undergo such therapy again, or encourage others to? Without hesitation.

Cathy McCulloch
New Milford, Conn.

I read "Shock and Disbelief" with great hope, thinking that surely Daniel Smith would have unearthed some scientific evidence that ECT benefits patients. There were the usual anecdotes and testimonials, as can be found for any therapy throughout the history of medicine. But not a word about randomized studies or other means of determining the actual efficacy of ECT as compared with no treatment or with any other form of treatment for depression. Is ECT just a high-voltage placebo effect?

Thomas A. Preston, M.D.
Professor of Medicine
University of Washington
Seattle, Wash.

The one and only mission of the Committee for Truth in Psychiatry is to advocate truthful informed consent to ECT. We take no position on any other issue, including whether or not ECT should be banned. We do not make the claims that are attributed to us in "Shock and Disbelief." Our work does not include the activities Smith describes, such as instigating lawsuits.

The article portrays us as a bunch of crazies who oppose ECT for no reason other than that we are irrational anti-ECT, anti-psychiatry fanatics. To do this, Smith has to omit the most-important material facts: that all of our members had ECT, that we all have permanent memory loss, and that none of us were told of this possibility when we gave our consent. He also had to omit any mention of the actual work we do—for instance, we were instrumental in getting the Food and Drug Administration, which regulates ECT machines, to acknowledge that ECT's adverse effects include brain damage and memory loss, and we have worked to keep the ECT device in the FDA's highest-risk category, Class III, where it stands today.

Smith also had to invert the truth to make his speculations about my current mental health. I am not mentally ill. I haven't had a symptom or a diagnosis, seen a shrink, or taken a single psych pill in more than sixteen years. Nor have I ever in my life been committed or "recommitted" to a mental hospital.

When Smith writes, "Andre, Sackeim says, has shown him her medical records; he says that she may have experienced a similar breakdown" (to that which left a nameless mental patient allegedly unable to hold a job at a fast-food restaurant), he leads the reader to the conclusions that I showed Harold Sackeim my medical records and that these records, apparently psychiatric records, show that I am disabled by mental illness. Both conclusions are false.

The truth is this: the only personal record I ever showed Sackeim, many years after shock, was the neuropsychological report attributing my brain damage to ECT. Smith knew what this report said—he reports its finding that my IQ dropped dramatically after ECT. He simply left out its further finding that the loss was due to ECT. Smith suggests, inferentially, that I am one of only a very few ECT survivors who have suffered loss of intelligence and devastating permanent amnesia. Hundreds of such cases are documented in the FDA files and medical journals.

On what basis does Smith assure his readers that electroshock is "safe"? He cites no evidence, not a single safety study. Has he reviewed the research of the past sixty years, and is he qualified to discredit the human and animal evidence for brain damage? Has he conducted his own studies? Has he reviewed all forty volumes of the FDA files, as I have? His quoted experts Max Fink, Sackeim, and Charles Kellner have never done safety studies. As for effectiveness, Smith either doesn't know or chose not to mention that even the industry concedes that ECT has no benefit that lasts for more than four weeks.

Linda Andre
New York, N.Y.

Daniel Smith replies:

Linda Andre correctly notes that the Committee for Truth in Psychiatry is devoted to advocating for informed consent. Nothing in the section of my article concerning CTIP states that CTIP's mission is to abolish electroconvulsive therapy or that the organization files lawsuits. At the outset of the article I observed that a number of activist groups, taken collectively, were engaged in a whole range of activities (making a public case against ECT, agitating politically for curbs on ECT, instituting lawsuits), and Andre may have taken this to mean that every group is engaged in all the activities. CTIP's declared mission is to lobby for improved informed consent, a commitment that arises out of its belief that ECT "'works' by damaging the brain" and that this information is withheld from patients by psychiatrists. That all members of CTIP have experienced ECT is clearly stated in the article.

The article neither states nor implies that Andre is now mentally ill. As for the chronology of Andre's past hospitalizations, the paragraph was read to her word for word; she made one small correction, which was incorporated in the printed text. In my interview with her Andre reported that she was given ECT at New York Hospital's Payne Whitney Psychiatric Clinic in 1984, and that she had been "locked up" and "treated against [her] will."

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