Psychiatry's electric evolution A new shock therapy or the same old charges?

[Guest guest]

Psychiatry's electric evolution

A new shock therapy or the same old charges?

Jeff Stryker, Sunday, December 24, 2006

San Francisco Chronicle, “Insight” Section, B-1

Telling a friend I was starting Kitty Dukakis' new book sparked a disagreement.

Was it rubbing alcohol she used to drink? Or vanilla extract? A happy debate: We

were both right.

One might be tempted to say Dukakis self-medicated by treating her storied

long-term depression with booze and pills. But she had plenty of help from some

of the country's leading doctors, who enabled decades of her addiction to

amphetamines.

Dukakis' book, " Shock: The Healing Power of Electroconvulsive Therapy, "

alternates what folks in Alcoholics Anonymous call a " drunk-a-logue " -- Dukakis'

finely honed tale of a life punctuated by overdoses, blackouts and trips to

treatment centers -- with journalist Larry Tye's history of electroconvulsive

therapy, " psychiatry's most controversial treatment. "

The Dukakis shining through these struggles with depression is warm, funny,

vulnerable and considerably more engaging than her uptight husband of 43 years,

former Massachusetts governor and 1988 presidential contender Dukakis.

Her description of unraveling under the media klieg lights is downright

courageous.

Let's face it, when celebrities get together to divvy up diseases, neither

mental illness nor alcoholism often gets a taker. Appreciating the depths of

Dukakis' despair is the key to understanding why she would seek out the

treatment that became her salvation and even promote it, even though it stole

significant slices of her memory.

" Electroconvulsive therapy has opened a new reality for me. ... It has given me

a sense of control, of hope, " she writes.

Shock's authors are on a mission to rescue this therapy from stigma that haunts

it to this day, even as psychiatry has embraced it as a mainstream therapy and

some 100,000 patients are said to undergo it each year in the United States.

It was an Italian neurologist, Ugo Cerletti, who determined that electric shocks

could be used to " tame " mental patients by causing convulsions. Cerletti first

determined the amount of electricity needed to induce a seizure, but not kill, a

pig or a dog in a series of experiments that would give a PETA member a lifetime

of nightmares.

He first made the leap to a human in 1938 when he administered 110 volts to a

39-year-old man who had been found wandering a train station in Milan, muttering

incomprehensibly.

In the early decades of the therapy's use, electrical shocks were administered

to fully conscious patients. They lost consciousness, experiencing seizures and

muscle spasms so violent as to routinely break bones. Confusion and memory loss

was a common side effect.

To understand how such a brutal treatment gained sway in the 1940s and '50s, it

is worth noting that competing treatments included lobotomy, as well as other

means intended to induce shock or coma as a therapy, such as insulin or the drug

Metrazol.

But there was arrogance and sloppiness in its use, too. Doctors tried

electroshock therapy on patients as young as 2 and as old as 102, seldom

following them adequately or conducting proper clinical research, making it

difficult to sort out the long-term impacts. Treatment was often given over

patients' objections or with scant attention to informed consent. The therapy

became popular for treating schizophrenia, although, under more rigorous

scrutiny, it was later determined not to be helpful.

Some doctors shocked with abandon, resorting to electroshock therapy for

indications as questionable and slippery as " antisocial behavior, "

" maladjustment " and homosexuality.

The use of shock for punishment rather than therapy also undermined its future.

Such was the case for the therapy's most famous patient, albeit a fictional one.

Randall Mc was the bete noir of Nurse Ratched in Ken Kesey's 1962

novel, " One Flew Over the Cuckoo's Nest. " The gruesome electroshock Mc

received in " Cuckoo's Nest " left the impression that he had been shocked into

submission, but it was actually a lobotomy that reduced him to the catatonia

seen at the movie's end.

For Dukakis and Tye, that was your grandfather's electroshock therapy. They say

today's version is neither an abomination nor a " Clockwork Orange " instrument of

social control, but rather an invaluable treatment all too often denied to poor

people and people of color.

Today, electroshock therapy is reserved for a more discreet set of

circumstances. Depression is the most common indication, especially where

antidepressant drugs and psychotherapy have failed and when suicide is a risk or

psychosis and catatonia are complicating factors. Now, shocks are briefer;

administering them on only one side of the brain is thought to spare memory. The

patients receive anesthesia and muscle relaxants, and don't remember undergoing

what is a much calmer looking procedure.

Of course, one might wonder why a book seeking to destigmatize the practice is

entitled " Shock " when modern practitioners prefer the " electroconvulsive

therapy " of the subtitle.

" We debated it. Ultimately we decided it is the term most people recognize and

understand. It might help sell the book and reach people in need. Sometimes

embracing a stigmatized term is a way of deflating it, " said Tye in a recent

phone interview.

" Shock " chronicles how the Bay Area was the crucible for much of the political

debate over electroconvulsive therapy, profiling some of its harshest foes, Ted

Chabasinski and Leonard . They remain implacable critics of the procedure,

even in its modern guise, maintaining that psychiatrists still understate

long-term side effects, driven at least in part by a profit motive.

The debate fueled by California " psychiatric survivors " peaked in 1982, when

they succeeded in placing electroshock therapy on the ballot in Berkeley.

Residents voted 2-to-1 to ban the procedure within city limits, but the measure

was quickly overturned in court.

Chabasinski, 69, a Berkeley attorney, is the very definition of a psychiatric

survivor. A line on his Web bio summarizes his mental health experiences:

" Shocked, Inpatient, Outpatient, Forced Treatment, Raped, Restraints, Tortured,

Solitary Confinement. " With his natural mother incarcerated, Chabasinski was in

foster care from birth. " The doctors had decided I was mentally ill before I was

even born; hereditary views of mental illness were very much the fashion, " he

said in a recent interview.

Chabasinski received electroshock therapy from Dr. Lauretta Bender at New York

City's Bellevue hospital in one of the first experiments involving children. He

was 6 years old and would spend the next few years in what amounted to

psychiatric solitary confinement.

, 74, a longtime Pacific Heights resident, edits successful books of

quotations for Random House. Born in Brooklyn, he landed in San Francisco after

college and an Army stint. He was happy to hang out in North Beach and in no

particular hurry to find a job. Distressed by his beatnik " lifestyle, " his

parents had him involuntarily committed to a psychiatric hospital where he

received 50 insulin coma treatments and 35 electroshocks in 1962 and 1963.

The impact on 's memory was " like wiping a wet eraser on a chalkboard, " he

said. He no longer remembered that JFK had been elected. More troublesome yet

was the ablation of much of his Wharton School college education. Finally

released from the hospital, " I decided I would spend my life fighting this, " he

recounted in a recent interview in which he shared excerpts from his online

" electroshock quotationary. "

Although Chabasinski and and their fellow psychiatric survivors were

unsuccessful in banning electroshock therapy, they were able to persuade

California legislators to pass some of the strictest laws in the country

regulating the practice.

Before administering the treatment in California, a psychiatrist must assert

that other options have been exhausted. A second opinion must be secured from a

physician who doesn't use electroshock, and the episode must be reported to

state authorities. Although " Shock " laments the California regulations as

reducing the procedure's availability throughout the state, one local

practitioner embraces them.

Dr. Dolgoff practices psychiatry at Alta Bates Summit Medical Center in

Berkeley and teaches at UCSF. Much of his practice consists of referrals for

electroconvulsive therapy.

" We are proud of what we do; we help incredibly vulnerable people, " said

Dolgoff. His busy office is in the basement, not to hide it but because " that is

the space we got. " Not all of the patients referred to Dolgoff for the treatment

end up receiving it because he believes it is truly a measure of last resort.

" All of our patients have tried at least two drug regimens before coming to us

for ECT. But it is much more typical for them to have tried four, five or six

different drugs and still be suffering, " Dolgoff said.

Dolgoff acknowledges that some patients will experience memory loss for some of

the time surrounding the procedure; discussing this risk is a key part of the

informed consent process. But do extremely depressed patients have the

wherewithal to weigh all the factors? " That is where the second opinion is

helpful, " Dolgoff said. California also requires a court order for the therapy

to be administered against a patient's will.

Dolgoff said he rarely receives referrals for court-ordered electroconvulsive

treatment, but when he does there is a good reason. " You have to understand that

by this point patients are dying because they are so depressed that they are

basically unwilling or unable to eat. ECT offers the prospect of a much more

rapid turnaround than antidepressant drugs. "

Jeff Stryker is a San Francisco writer who specializes in medical ethics.

Contact us at insight@....

[Guest guest]

Thank you, . I have seen so many people have electroshock and it

HASN'T worked at all. One woman I know said that it was as if the contents

of her brain had been picked up shaken around, and then left to settle.

Didn't help her- she was worse than before, awfully confused, unable to

remember basic things- all of that stuff. It was horrible to watch another

human being go through a procedure that clearly damaged her brain. She went

from being someone who would sometimes smile to having a desperate, hunted

look on her face, that was also coupled with a terrible vagueness. It was

very sad.

Ultimately I feel that it should be the patient's decision whether of not he

or she undergoes electroshock. If they don't want it, we shouldn't force

them. If they are desperate enough to try it, then maybe there is a reason

for them to have it. I think that electroshock is vastly abused but that it

works in a minority of cases. I am totally against pscyhiatric drugs for

most people, too- I feel that they may work in a minority of cases as well,

and in this regard it is important to remember that schizophrenia, for

example, is said to be twelve or thirteen different diseases, manifesting

similarly in people but requiring completely different treatments and

attention.

On 12/28/06, P Cockrell <11.5qp@...> wrote:

>

> zap zone:

> http://www.nationalgridus.com/non_html/shared_zapzone.pdf

>

> ----------------------------------------------------------

>

> Safety Tips:

>

> Overhead power lines are not insulated, and carry enough energy to cause

> serious injury or even death. Regard all wires as live.

>

> Keep yourself, your co-workers, friends, family and vehicles at least 10

> feet

> away from electric lines and equipment.

>

> Stay alert. Keep ladders at least 10 feet away from power lines when

> carrying, moving, and raising them.

>

> Keep away from wires when working with tools, pipe, lumber or siding -

> all of which can conduct electricity.

>

> Make sure the area is clear of wires before working near trees or shrubs.

>

> Never attach or tie anything off to power lines or electrical equipment.

>

> (from: Massachusetts Electric Safety)

> http://www.nationalgridus.com/masselectric/safety_electric.asp

>

> and & Kitty Dukakis are family members of:

> " Families For Depression Awareness "

> http://www.familyaware.org/aboutus/board.php

>

> Dear Mr. President Dukakis ... you need more voltage.

>

>