A Shocking Discovery (Part Three)

Continue from Part Two

In the last years of his life, Ernest Hemingway became increasingly despondent due to chronic pain, alcoholism, health problems, and his failing literary career. By 1960, he underwent a series of ECT sessions to treat his depression and paranoia (of course the FBI had been watching him ever since he left Cuba so there may have been reasons for the paranoia). While the ECT was meant to control his depression, it actually seemed to make things worse. In addition to his other problems, Hemingway began experiencing serious memory loss as well. Talking about his ECT sessions, he said that "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient." Following his first suicide attempt in 1961, Hemingway received further ECT treatments before finally succeeding in killing himself on July 2 in that same year. While a clear link between Hemingway's ECT use and his suicide can't be established, his tragic experience has made him a poster child for the anti-ECT movement.

The counterculture movement that took shook psychiatry in the late 1960s and early 1970s was driven by a renewed activism by former psychiatric patients rebelling against the perceived authoritarian culture in psychiatric hospitals. Hemingway, Silvia Plath (who committed suicide in 1963), and other writers who wrote movingly of their experiences with ECT helped shape the popular perception. Combined with the writings of Thomas Szasz, R.D. Laing, Michel Foucault, and Erving Goffmann, psychiatrists came to be seen as increasingly sinister figures who used ECT and other treatments to modify unwanted behaviours rather than treating disease.

Ken Kesey's 1962 book One Flew Over the Cuckoo's Nest and its 1975 movie version helped shape public awareness of ECT and it was during that same period that a massive revolution in how psychiatric patients were treated got underway. With newer and better medications came a rapid deinstititutionalization of psychiatric patients Mass closing of psychiatric hospitals and the dumping of patients into communities that were often ill-equipped to handle them made the need for better treatment options all the more acute.

Questions concerning the appropriateness of ECT use and accusations of involuntary treatment spurred the rise of antipsychiatry groups and and patient's rights organizations began to challenge psychiatric hospitals in court. Neurologists also began questioning the potential role of ECT in causing brain damage in patients. John Friedburg published Shock Treatment Is Not Good For Your Brain in 1976 in which he stated that ECT produced amnesia through selective brain damage.

As former patients such as Mark Vonnegut and Leonard Frank came forward with their own negative experiences with ECT and the public awareness of its dangers grew, more and more patients came to refuse it altogether. Anti-psychiatry groups such as the Network Against Psychiatric Assault (founded in 1973), the Committee for Truth in Psychiatry (founded in 1984) and the Church of Scientology began to agitate against ECT use (especially on involuntary patients). ECT became increasingly rare, especially since psychiatrists using it found themselves receiving sharp rises in their professional liability insurance premiums as a result.

Given that not all cases of depression and bipolar disorder responded to medication, ECT continued to have a role in treatment however. My own graduate mentor, Norman Endler, credited ECT with helping him recover from serious bipolar disorder and even wrote a book on his experiences, Holiday of Darkness. Other former psychiatric patients including Kitty Dukakis, Thomas Eagleson, and Andy Behrman have come forward with their own positive experiences although they tend not to be as well-publicized as the negative accounts.

I won't try to do justice to the hundreds of pro- and anti-ECT research studies that have been carried out over the past four decades. Government and non-government organizations including the National Institute of Mental Health (NIMH) and the American Psychiatric Association have released reports confirming the value of ECT in certain circumstances as well as imposed more stringent guidelines concerning informed consent and training of ECT staff. It was in 1985 when Max Fink, a protege of Lothar Kalinowsky launched the Journal of ECT which remains the primary publication of its type and helped restore some of ECT's lost credibility.

The political debate over ECT use has become increasingly polarized over time with harsh denunciations on both sides. Even a brief Web search can turn up numerous anti-ECT sites that denounce the treatment and its providers. Attempts at a reasoned debate on ECT use have a tendency to degenerate into anti-psychiatry arguments. And there we stand at present.

Ironically, ECT may well be moving into a new direction altogether. The use of deep brain stimulation procedures to treat depression by implanting electrodes to stimulate the subcalossal cingulate region of the brain has been found to relieve treatment-resistant depression with few of the negative side effects associated with ECT or anti-depressant medication. Whether this new form of electrical stimulation will replace its predecessor, only time will tell.

Comments

[Alison Hymes]

Another way to look at this is that psychiatrists and other mental health professionals have a tendency to label anyone who is critical of aspects of psychiatry as "anti-psychiatry" rather than listen to the criticism or refute it with evidence. When other oppressed minorities have spoken out about practices in medicine that hurt them, they have not been labelled "anti-medicine". We will not get beyond a degenerated debate until all sides take responsibility and that includes not putting the "anti-psychiatry" label on folks who actually use the psychiatric system but are critical of many of its practices. To get respect you have to show respect usually in our culture.

[Mike]

Deep transcranial magnetic stimulation is a way to non-invasively stimulate almost any brain area selectively without the need for surgery like deep brain stimulation.
http://brainstimulant.blogspot.com/2008/02/deep-transcranial-magnetic-stimulation.html
http://brainstimulant.blogspot.com/2008/04/uses-of-deep-tms.html

[Romeo Vitelli]

A reasoned debate on the pros and cons of psychiatry is fine but the abuse and name-calling that seems to arise is not. I tend to reserve the "anti-psychiatry" label for the "psychiatry is torture" activists. There are extremists in both camps and they're the ones who are stifling real debate.

[Alison Hymes]

I can't disagree with that. Some folks say all psychotropics are bad for all people for example and don't mind trying to force their opinion on folks who have chosen to use one or more psychotropics after making an informed choice with their doctor. And then we have a few psychiatrists who publically label anyone who wants to preserve basic human rights for psychiatric patients such as freedom from assault or rape "disgruntled patients" or Scientologists.

Too bad the middle gets lost in the screaming but I notice in the U.S. at least that happens on many issues.

[Shaheen Lakhan]

Thanks for submitting this post to our blog carnival. We just published the 38th edition of Brain Blogging and your article was featured!

Thank you.

Sincerely,
Shaheen

[Lisa]

It was a brilliant cure but we lost the patient." Following his first suicide attempt in 1961, Hemingway received further ECT treatments before finally succeeding in killing himself on July 2 in that same year. While a clear link between Hemingway's ECT use and his suicide can't be established, his tragic experience has made him a poster child for the anti-ECT movement.

[Friends and Families of Psychiatric Survivors]

I don't know who wrote this, or what this website is even about, but the article above --- "A Shocking Discovery" --- is inaccurate and untrue.

First, electroshock is not rare.

Second, there is no "new form of electrical stimulation". It's just electroshock, repackaged.

Third, time has already told.