We are gathered today at the end of the "Decade of the Brain," a massive propaganda war on the most basic distinctions between mind and brain, mental illness and physical disease.
Most people today are conditioned to ask where in the brain mental illness exists, not whether a metaphor can be said to "exist" like a chunk of amygdala or hippocampus.
Most people have swallowed a daily diet of absurdities so long they've lost their gag reflex. Just this week a panel of government mental health experts was convened to determine how a Cuban father and son should be re-united while other experts argued over whether John Hinckley is really cured or just in remission from the invisible illness that drove him to shoot President Reagan.
Dr. Thomas Szasz, of course, is the great exception. I am honored to speak at his 80th birthday celebration. He has been a major influence in my life.
Twenty five years ago, after reading the "Myth of Mental Illness" and meeting the man who wrote it, I corrected the course of my medical career from psychiatry to neurology just in the nick of time.
Not long afterward, as a neurology resident, I read an article by Dr. Szasz, "From the Slaughterhouse to the Madhouse," an account of the origins of electroshock treatment and I was off again, researching and publishing "Shock Treatment Is Not Good For Your Brain" in 1975.
I argued then and still believe that electroshock therapy epitomizes the fraud, the force and the fear that empowers the therapeutic state of America. I regret to report that the use of electroshock is probably more widespread today, its acceptance greater and the electroshock machines more powerful than a quarter century ago.
In December of 1999, David Satcher, M.D., Ph.D. Surgeon General of the United States Public Health Service issued his first-ever report on mental health in the United States. In it, he gives the coveted stamp of approval - "safe and effective" - to electroshock.
At the same time a new book appeared by Dr. Max Fink, for many years the leading advocate of the treatment. It is called "Electroshock: Restoring the Mind", and I have chosen it to be the focus of my talk today.
The author, currently a Professor Emeritus of Psychiatry and Neurology at State University of New York at Stony Brook, was born in Vienna in 1923. He spent World War II in medical school in New York City and first saw electroshock used at Bellevue where Lauretta Bender of Bender-Gestalt fame was shocking children as young as 34 and one half months.
In 1947 Dr. Fink began his career as a medical officer administering electroshock to returning GI's at Fort Knox Station and over the next fifty years he has shocked thousands of people, published hundreds of articles, several books, founded a journal and filmed a videotape all about shock. He has been making myths as fast as Dr. Szasz debunks them and his latest book caps a lifework of deception.
Max Fink, M.D.
The very first sentence of the preface states the author's premise as a conclusion and is never examined again. The second sentence, in my view, goes to the heart of the matter: "Electroshock is an effective and safe treatment for those with severe mental illness. Yet many consider it so dangerous that they fear it as much as they fear the disease."
Illogically lumping categories he asserts: "psychosis can leave scars on the brain, the mind and behavior." Since "no one with a mental disorder escapes alterations to memory" the priorities are clear: what's a little brain damage and memory loss, the risk of a permanent seizure disorder or even death compared to the unspeakable horror of mental illness?
Dr. Fink claims that "for the elderly, the systemically ill, and pregnant women, electroshock is a safer treatment for mental illnesses than any alternative."
I am convinced that psychiatry will never willingly relinquish electroshock because the very real existence of the practice lends gravity and authenticity to the imaginary mental maladies it purports to treat. Like torture, it works and is useful. If Dr. Fink and electroshock didn't exist, they'd have to be invented.
From 1952 through 1958 Dr. Fink ran the experimental psychiatry ward at Hillside Hospital in Queens, New York where he oversaw electroshock and insulin coma, a particularly brutal precursor which Fink now characterizes as "brain altering, ineffective and long discarded."
Around the time Dr. Szasz was writing "The Myth," Dr. Fink, with the help of government grants, was studying the effects of electroshock on the electroencephalogram. In a series of short reports he repeatedly discovered that electroshock causes marked brain wave slowing which correlates with improvement of the mental illness as determined by psychiatrists and family. There is no indication of how the patients felt about the treatment and its effects.
His latest published research reports success in using electroshock to treat head banging in the mentally retarded. He considers head banging to be a movement disorder discussed in the same chapter with Parkinson's disease, catatonia, neuroleptic malignant syndrome and intractable seizures, all of which respond to electroshock. He admits that this "broad applicability" can be "confusing to clinicians who are accustomed to assigning certain prescriptions to certain diseases." I contend this is the whole point: some books are written to communicate and clarify - Dr. Fink writes to confuse.
Let us now briefly examine what he has to say about fatalities, memory loss and especially consent.
Dr. Fink is dismissive of the danger. He writes "Neither patients nor treatment team members have ever been electrocuted during ECT."
To be sure, I've never seen the precise word "electrocution" in the electroshock literature but there are accounts beyond reckoning of death - death by cardiac arrest and rupture; death from fatal arrhythmia, terminal seizures, intracerebral hemorrhages and post-treatment suicides. No electrocutions perhaps, but stand back from the gurney, he warns, just in case.
What is the death rate from electroshock? Dr. Fink claims it's safer than childbirth. In a 1993 study in the American Journal of Geriatric Psychiatry, titled "Electroconvulsive Therapy for Major Depression in the Oldest Old," the authors reported on 65 patients 80 years of age and older hospitalized for major depression. The patients were divided into two groups. One group of 37 patients was treated with ECT, the remaining 28 with anti-depressants. After one year one patient or 4% among the 28 in the medicated group was dead; after one year 10 patients among the 37 patients in the ECT group - a staggering 27% - were dead.
Commenting on this article, Dr. Fink blames the excess deaths among the shock subjects on their poor medical condition and on "cumbersome and risky techniques such as caffeine augmentation (which Dr. Fink himself helped invent) or double stimulation" or ineffective convulsions due to under-powered machines.
In 1995 the State of Texas, required hospitals to report deaths occurring within two weeks of electroshock, reported that 8 persons out of 1700 died for a death rate of approximately 1 in 200. Dr. Fink writes that 7 of the 8 deaths were "unrelated to ECT" but doesn't say how he knows.
Nevertheless, the death rate of approximately 1 in 200 among the elderly is consistent with that found in reports going back to the 1950's.
What about memory? On page one of his book Fink alleges that electroshock is "no longer memory-modifying" thanks to "fundamental changes" such as anesthesia, oxygenation and muscle relaxation, all of which, he informs the assiduous reader who makes it to page 93, were "routine measures" by the mid 1950's.
His sample consent form is designed more to protect the doctor than the patient with a loophole clause: "in most patients memory difficulty is gone in four weeks but rarely problems remain for months or even years."
The truth is that the best studies have documented some permanent loss of autobiographical material with every series of electroshock.
Dr. Fink came closest to the real truth in 1978 when he wrote: "The principle complications of electroshock therapy are deaths, brain damage, memory impairment and spontaneous seizures. These complications are similar to those seen after head trauma, with which EST has been compared."
It stands to reason that death and amnesia from electroshock haven't really changed. The electroshock machine probably puts out more energy than ever though still not enough to please some.
Dr. Fink, for one, repeatedly laments the impotence of American shock machines that he claims, without substantiation, are restricted by onerous government regulations to an energy output of 100 joules or five times the brain's natural threshold for convulsing. According to him, this is wholly inadequate for treating older patients whose brains are tougher to kindle. Only "robust" convulsions will do.
The Surgeon General, for his part, promotes the notion that electroshock is new and improved: "A therapeutic seizure may be induced with as little as one-third the electrical power as with the older method." Maybe or maybe not.
The physics of electricity can be employed to mystify but hard facts are facts: 100 joules of energy, whether brief pulse, square wave, sine wave, AC or DC equals the energy it takes to light up a 100 watt bulb for one second or drop a 73 pound weight one foot.
The whole point of an electroshock machine is to trigger a convulsion and a convulsion is an animal's last-ditch agonal response to a wide variety of brain insults of sufficient severity be it fever, anoxia, blunt trauma, chemical poisons or electrical energy. A safe electroshock machine is a contradiction in terms.
Willful physical injury without consent is assault and battery. The Surgeon General reassures us that "although many people have fears related to stories of forced ECT in the past, the use of this modality on an involuntary basis today is uncommon."
Those of us who are closer to the ground know that in a psychiatric setting, where involuntary commitment is always an option, freely given consent is a fiction. Every psychiatric in-patient knows or quickly learns that they are only two signatures from imprisonment without crime or trial.
Dr. Fink's concept of consent is very elastic. He illustrates with the case history of a certain Mr. Burr who "listened carefully, read the consent form and declared he would not sign it."
After being administered 12 electroshocks anyway, Mr. Burr was "no longer sure that his wife was unfaithful" but he managed to remind Dr. Fink, during a "friendly exchange" as he was leaving the hospital, that he'd never signed a consent form.
By relating this anecdote Dr. Fink takes control of the language so that "acquiescence to treatment" equates with consent to treatment. Which is a good thing for Dr. Fink because written consent, especially from the resistive patient, can be very time consuming or impossible to obtain.
I have treated hundreds of seizure patients over the years and not one ever volunteered that he or she felt better after a convulsion. Yet Dr. Fink takes efficacy for granted. Calling electroshock "magical" and "uniformly effective" for delusional depression he refers the reader by footnotes to his prior writing on the subject, 37 times.
Instead he assumes electroshock works and devotes an entire chapter to mis-directing the reader's attention to the question of how it works. Noting that over 100 different compounds are "squeezed out" into the spinal fluid during electroshock, he concocted a glandular theory many years ago and he's sticking to it.
I have a theory too and it's the same as the father of American Psychiatry, Benjamin Rush, suggested in 1812:
"Terror acts powerfully upon the body, through the medium of the mind, and should be employed in the cure of madness…fear accompanied with pain and a sense of shame has sometimes cured this disease."
Irrational terror is the secret to the power behind the myth of mental illness and it is to the everlasting credit of Dr. Thomas Szasz that he has set so many free from enslavement to a vast system of false ideas.
In making his case against the commitment of the mentally ill, Dr. Szasz wrote, in1993 in "Law, Liberty and Psychiatry":
"There is the violence - indeed the brutality - and also the completely unproved efficacy" of electroshock and the other standard somatic treatments in psychiatry.
Thank you.
