Lately doctors have been taking special pains to spell out the risks that patients face. "I tell all my patients that they are going to have memory loss," Sackeim says. "In the vast, vast majority of patients that will be limited to a few months surrounding the course of treatment. There will not be a blank slate. But there will be gaps in memory. And the vast majority of patients say that's a small price to pay for getting well. It's not really a big deal to them. But I also tell them that in very rare instances it can be more extensive, and that no one can tell for certain who is going to experience that and who is not."
It has taken some time for a full disclosure to seep into the official literature. The report published this year by the APA Committee on ECT contains that organization's first substantial discussion of the possibility of serious memory problems.
A Doctor's Complaint
There was a moment at the 1985 NIH conference, Peter Breggin recalls, when patients who had had positive experiences with ECT were asked to step up to the lectern and tell about their illness and recovery. Breggin, who is the director of the International Center for the Study of Psychiatry and Psychology, in Bethesda, Maryland, had already delivered a lecture titled "Neuro-pathology and Cognitive Dysfunction From ECT," and he listened intently as the patients spoke. Afterward one of them pressed a note into his hand, thanking him for speaking out about the side effects of ECT. "This was one of the pro-ECT people," Breggin told me when we spoke recently. "They were up there to tell people that ECT works, and here this person was thanking me for providing a dissenting opinion."
For Breggin, the experience epitomized ECT's ability to reduce patients to docility—to the point where they are willing to praise a treatment they feel has done them harm. In his view, ECT is a purposeful assault on the brain. He has been publicizing this opinion since 1979, when his first book, Electroshock: Its Brain-Disabling Effects, was published. Since then Breggin, a psychiatrist by training, has made a career out of attacking psychiatry and its methods. He has written several books arguing against the use of medication to treat mental illness, and he claims to be responsible for quashing the resurgence of lobotomy. His most recent efforts have been directed at establishing a link between antidepressants and the Columbine massacre. When Breggin discusses psychiatry, it is in the brusque manner of an aggressive debater.
Though Breggin has waged many campaigns, he has attacked ECT particularly vehemently, arguing that it causes "severe brain dysfunction" and that it creates in patients profound feelings of apathy or delirium. Psychiatrists welcome either outcome, he told me, because they can note with satisfaction on their charts that the patient is "complaining less" or has "an elevated mood." In this way, he says, psychiatrists fool themselves into believing that they are helping a patient when they are really doing harm. In his book Toxic Psychiatry (1991), Breggin wrote,
If a woman received an accidental shock in her kitchen, perhaps from touching her forehead against a short-circuited refrigerator, and fell to the floor convulsing, she'd be rushed to the local ER and treated as an acute medical emergency. If she awoke the way a shock patient does—dazed, confused, disoriented, and suffering from a headache, stiff neck, and nausea—she'd be hospitalized for careful observation and probably put on anticonvulsants for months to prevent another convulsion. But on a psychiatric ward she'd be told she was doing fine and "not to worry," while the electrical closed-head injury was inflicted again and again.
Breggin first encountered ECT in the 1950s, when, as an undergraduate at Harvard, he volunteered at a state psychiatric hospital. He was horrified, he recalls, at the conditions on the hospital's "back wards." Schizophrenic patients were left mumbling and rocking back and forth, without any human contact. They were led, zombie-like, to be treated with insulin coma or ECT. Breggin believed that if the patients were exposed to a more empathic environment, and one that provided for their basic needs, they would get better, so he persuaded the hospital administration to start a program of "love and care." He contends that plain old kindness worked. Later, as a resident in psychiatry and a teaching fellow at Harvard Medical School, Breggin observed firsthand the trend in psychiatry away from psychotherapy and toward physiological treatment, and he found it very disturbing.