Compassionate ECT, Electroconvulsive Therapy: A Review - HealthyPlace.com Depression Community

SHOCKED!

Video Review

Beyond Stigma: The Compassionate Application of Electro-Convulsive Therapy
by Linda Andre

The only reason shock treatment has gotten such an undeserved bad rap is because doctors who give it don't treat patients nice enough.

What's wrong with this statement? If you said nothing, I can think of some prime real estate in Brooklyn that's for sale real cheap.

Most people would probably say, "While I have no personal knowledge about shock treatment and haven't researched it myself, I am willing to take the word of a psychiatrist and member of the American Psychiatric Association, who must know what he's talking about. Besides he wouldn't have produced and marketed a tape with such nice music, and couldn't sell it for so much money, and wouldn't have a web site devoted to selling it, and wouldn't be so apparently sincere about it, if it were all a bunch of hooey."

Brooklyn Bridge for sale: $10.

Christian Hageseth might have gotten the idea for his new video, "Beyond Stigma: The Compassionate Application of Electro-Convulsive Therapy," from watching late-night TV. This is a nation of people who believe in credit-card psychics, he probably said to himself. If the suckers will pay for that, have I got a gimmick for them! In fact, the more unbelievable and outrageous it is, the more they'll love it! I know! I'll call it Compassionate ECT!

You might consider giving Chris points for originality, at least. Surely no one else has ever had the gall to try to market such a bizarre idea. But sadly, there are one or two precedents. In the 1970s, shock doctor HC Tien tried to change shock's name and reputation: he called his version ELT, or Electro-Love-Therapy. The "Love" was a form of shock so intense that patients, who were always women, frequently those not happy in their housewife and mother roles, forgot their entire identities and regressed to the point of having to be bottle-fed. They were then resocialized by Tien into their housewife and mother roles, and Tien and the husbands were pleased with the results. The women even took new names to distance their new docile personalities from their old troublesome ones.

At one time in the 80s, I believe there was also a shock machine company that advertised "A Machine with a Memory---and Compassion." Perhaps the machines sucked up and acquired the stolen memories of the patients they were attached to. No one explained how the machines came by compassion. Anyway, the compassion thing never caught on as a marketing slogan, until now.

It turns out that Chris has a different idea of what compassion is. But before we ask what he means, let's just look at the logical absurdities of his fundamental premise. You don't need a Ph.D. to do this. ECT is the application of electricity to the human brain to produce grand mal seizures. The brain is the brain (humans haven't changed much in the past 50 years), electricity is electricity, and what happens when they meet is governed by the laws of physics, not by what patients do in the waiting room, how reassuring the doctor is, what the patient is wearing, how many people are present when shock is done, or anything else Hageseth thinks can magically affect what shock is and does.

Since shock always causes permanent memory loss of weeks, months or years, and since that memory loss almost always includes the actual administration of the shocks, the patients will never remember any of those things anyway. Had they been misled by his recommended tricks to feel slightly less anxious before the shock, they won't know or care about this afterwards. We can't help asking: Who is Hageseth seeking to reassure, and, who is he seeking to benefit by making this video? It can't be his patients.

"The stigma of ECT didn't just happen," Hageseth claims. "It came about because of the way it was administered in the past."

Maybe, he suggests, getting ECT should be more of a happy occasion, like having a baby. He even says that psychiatry should take cues from obstetrics: set up special "suites" just for ECT, for instance. Most hospitals already do this. The logical problem for Hageseth's theory is that obstetrics, unlike psychiatry, did not get stigmatized for not having special suites, or for having 'small and crowded' rooms, or for not allowing family members to be present during procedures for which patients are unconscious. Nor did any other medical or surgical procedures, which, cosmetically at least, resemble shock---requiring surgical gowns, anesthesia, special rooms, and life-support equipment. Why aren't these procedures, and the professionals who give them, stigmatized because of "the way they are administered?" Might there just be something else that is different about psychiatry in general, and shock in particular?

There can't be, he insists. He protests too much. ECT suites are not enough, he says. We must do ECT with compassion.

What does he mean by compassion?

Turns out, something different from what the rest of us think it is. He's confused compassion with infantilism, a switch that speaks volumes about his opinion of his patients. The video not only tells us about, but demonstrates, Hageseth's brand of compassion.

First, it involves mural wallpaper. Hageseth papered his free-standing Colorado psychiatric clinic in photographic murals of forests and mountains. In fact, there's a little trompe l'oeil sequence in the video where you just see the forest scene until the view expands, and you see it's only wallpaper. The clue is that the scene is interrupted, fittingly, by electrical outlets that couldn't be papered over. Humans have an affinity for nature, Hageseth tells us very seriously, the difference between a real forest and a wallpaper forest in a psych clinic being minimal.

He's even put a picture of a bird on the ceiling of the room where the patients are anesthetized so they can have a more pleasant experience of losing consciousness just before shock. Watch out: if this catches on for tonsillectomies, they too might shed their stigma.

The next way Hageseth thought of to show his consideration for the patients whose brains he is about to burn is to offer them a choice in paper gowns: they can have their unconscious bodies covered in a pattern of brightly colored balloons, Bugs Bunny, or Tweety and Sylvester.

The video pointlessly has one of Hageseth's employees, a burly gray-bearded social worker named Al, "act" as a shock patient in order to demonstrate the gowns, the IV, the heart monitors, and so on. Al's acting style is strictly tongue in cheek, and he doesn't look too good in balloons. Perhaps he should have chosen Tweety.

To Al's credit, when Hageseth asks him if he can touch his wrists (wrist-touching being meant to signify "compassion"), Al doesn't smirk.

Later, an actual patient, a fifty-ish woman named Jan Law, is filmed just prior to, and in the process of, getting shocked.

"Tell us about the teddy bears," Hageseth encourages, and Jan explains how she used to be scared of shock until she began taking a stuffed bear in with her to the shock room. She then tells us that, after getting Hageseth's permission, she began passing out teddy bears to his other shock patients. She's also seen in a roomful of them queued up for shock, praying with and for them.

One who has been watching this video up to this point, who has never had shock or even heard of it, might reasonably be confused by the double message. If shock's so wonderful, (we celebrate it, call it "an honoring of the soul" and make commemorative videos of ourselves having it so we can watch it over and lover like a child's first steps) then why is everyone so scared? Why are they praying if there's no danger? Why must fifty year olds resort to clutching childhood toys?

The answer won't be found anywhere in the video; it is willfully, perhaps skillfully, but very maliciously, left out. There is no doubt that Christian Hageseth knows that shock causes permanent memory loss (always) and permanent cognitive damage (frequently) resulting in a net personal loss that can be life-crippling or life-ending. I know this because of my personal communications with him. We know it because he admits on the video that it happened to his own mother. Yet the video assures us that there is absolutely no danger in getting shock. For some reason, (cowardice, fear of lawsuits?) Hageseth enlists another psychiatrist from Colorado named Steven Dubovsky, whom he calls an expert, but who has no special qualifications, in a set-up "question and answer" session where Dubovsky mouths the party line of the American Psychiatric Association.

Viewers are not told that all the research he cites -- for example, the article claiming shock treatment improves rather than damages memory,, or the one which claims a woman who had over 1,000 shocks showed no brain damage on autopsy -- was done by members of the APA's small "Task Force" on shock. They are men who have made a career out of doing and/or promoting it and who either own or have lucrative financial deals with the companies that make the shock machines. These men invented and popularized the theory, cited by Dubovsky, that all the people who complain about shock do so because they are just crazy and are imagining memory loss where none exists.

Oh yes. did I mention that these guys also get fat fees like $6,000 a day for saying these things in court?

Dubovsky has obviously been well coached, and he's tricky. He sounds scientific and could convince -- intends to convince -- those who don't know what he's leaving out or lying about. He says "the only physical risk with ECT is the risk associated with brief general anesthesia. There's no increased risk for the ECT itself."

Funny, but people don't die of brief general anesthesia at the rate they die from ECT (approximately 1 in 200), and brief general anesthesia doesn't usually cause brain hemorrhaging, cardiac arrest, or forgetting things like your name or how to read. Later on, he says "any brain damage that you get is probably from not breathing during the treatment -- not the ECT itself." Then he corrects himself, using a semantic trick he's learned from the APA: "There is no credible evidence of credible damage to the brain."

I think he messed up and meant to say no credible evidence of objective damage to the brain. See how easy this is: you simply discount all the evidence that does exist which is unfavorable to ECT as not "credible" or "objective." They you're not really lying. Just to be safe, though, it's wise to cross your fingers behind your back while you say this.

Hageseth then brings out his obedient patient, Jan Law, and her husband and adult children. Jan wears a big red bow in her hair and begins every sentence with "Gosh!" Hageseth feeds her questions designed to elicit the answers he wants, mostly about how bad depression is. The family complains about what a bad housewife Jan was when she wasn't getting shocked.

"I had to make all the meals," the husband whines.

"I was pretty bitter because we all ended up doing a lot of the housework, a lot of chores. It was an embarrassment to me," says the daughter. they all laugh in relief that shock has made Jan a better housewife. It is eerily reminiscent of HC Tien and his bottle-sucking "Electro-Love" patients. Hageseth gives Jan "maintenance" shock, which means one shock every month or so. In maintenance, which has never been researched, the brain never has a chance to heal before being zapped again. The patient is essentially maintained in a constant state of organic brain syndrome. As anyone who's had shock knows, when you are organic, you will do or say anything. Most survivors have stories about things they can't remember doing and can't believe they did. It is during this time that patients may thank their doctors for saving their lives, or are easily persuaded to talk other patients into shock. Later, as the acute organic brain syndrome wears off, the person comes to realize the extent of her memory and cognitive losses and feels very differently about her treatment. It is fair to say that *anyone* interviewed during or right after shock, would feel well, even euphoric, as a result of brain damage and would say anything a doctor asked.

We then see Jan actually getting her maintenance shock, and the teddy bear is there from start to finish. She's wearing the same clothes as in the interview and it's not clear whether the interview was before or after. Her family watches and then is given the printout from her EEG as a souvenir. The last we see of her she's being supported by her husband as she walks to her car, a gray-haired woman with a red hair bow, still clutching a teddy bear.

If you are a shock survivor, or know one, it's enough to make you cry, or puke. The description I've given isn't sufficient to explain the effect the video has on survivors. When I first watched it, I screamed loud enough to scare my dog. Others who have seen it have laughed hysterically.

You actually have to see the video to experience how much worse it is than it sounds. There's a pompous pseudo-religiosity to the way it's presented, from the opening strains of Amazing Grace, to Hageseth's quotes from Buber, and his prodding Jan to say that shock improved her spiritual life, to the end where Amazing Grace comes back on while Hageseth, wearing fuzzy slippers, reads his own godawful poetry about suicide while a blazing log is superimposed over his face. You get the sense that his purpose is to elevate ECT from a treatment to a sacrament.

His high, whiny voice doesn't help. Throughout, he's so deadly serious he's like a cross between a Sunday morning televangelist and Mr. Rogers -- patronizing you while trying to sell you something. Come on kids, can you say "Scrambled brains are big money?"

Even this is not enough to explain why the video is not only so viscerally horrifying, but so morally reprehensible. The tape transcends silly self-promotion, even the commonplace deception-for-profit of other tapes. If it were just another commercial for shock, we'd sigh and deconstruct its lies. It would just be evil. Evil that pretends to be good becomes evil in a new and worse way. Something that truly is sacred has been vilified.

Like compassion. Hageseth wants to trademark it while turning it into its opposite. There is a true "honoring of the soul" (as Hageseth calls shock), and there is real compassion, and it has nothing to do with teddy bears, or wrist touching, or cartoon gowns. It involves allowing people to make their own decisions and control their own lives. The teddy bears are nothing but a gesture of contempt, a statement that Hageseth doesn't consider his patients adult enough to be trusted with truthful information about shock, or to make up their own minds about it. After all, if they were allowed to do this, they might make a decision the grown-ups (doctors) don't agree with. Like children, they must be protected for their own good by the adults who really know what's good for them. Perhaps Hageseth is a kind of marketing genius to make the connection between deceiving patients and infantilizing them. Perhaps he'll make a fortune welling these videos at $80 each. Like any crime, this video does leave the survivor or sophisticated viewer searching for a motive: Why did he do this? I don't think it's just money: I think it's simpler and more pathetic. Why else go into such detail about his mother, in the video and also on his web site? Chris was only five years old, a terrified little boy, when the doctors dragged his mommy off to the mental hospital and shocked her. When she returned, Hageseth tells us in his Mr. Rogers fashion, she didn't remember who he was. She had permanent memory loss and was bitter about it for the rest of her life. But like Tien's women, he says she did eventually function in the way she was expected to.

Now it's impossible to avoid the conclusion that the big Chris is shocking the hell out of his mother each time he presses the button. When he looms over Jan in the recovery room, is he hoping she will wake up, or hoping she won't? Either way, he is now the one in control of what most scared him.

Does Hageseth hate his mommy or love her? Oooh, that's getting into mental quicksand that Hageseth should not have tried to drag the general public into. It's not pretty. I don't know what Freud would say, but my take on it is that the video's the ultimate act of passive aggression towards his poor brain-damaged mother. Kind of like saying "I love you," while stabbing the knife into the back, getting back at her for not recognizing him when he was little and needed her. But no matter what he's symbolically doing to his mother with his "compassionate ECT" scheme, there should be no doubt that he knows exactly how much he's screwing other patients and their families. I imagine him and his crew doubled over laughing between takes, saying to each other, "I can't believe we're getting away with this! There's a sucker born every minute!"

He's laughing all the way to the bank.

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