ECT Anonymous - Research Information - May 1999 - Does ECT Works in Depression_

Written by Juli Lawrence

If ECT works in depression, let us remember it 'works' even better to modify behaviour - and change the personality:

"Their [i.e. electric shock therapy and leucotomy] main interest to us...is their physical interference with personality... lectric-shock therapy...alters the personality...." (W. Grey Walter, 'The Living Brain, 1961, pp. 82 and 197)

"...the best clinical results are often obtained when the patient is shocked into amentia [i.e. mental deficiency]... "Moderate improvement" means that the patient shows conduct improvement and a general lessening of...symptoms." (Abraham Myerson, 'Further Experience with Electric-Shock Therapy in Mental Disease,' New England. J. Med., 1942)

"Neurosurgery and electroshock are clearly the most controversial and dramatic of mind-control methods and, because of this, warnings were raised within the agency about these methods. In 1952 a C.I.A. document said that "the severity of the treatment, possibility of injury and permanent damage to the subject and the highly experienced personnel required rule these techniques out for the moment."" ('Private Institutions Used in C.I.A. Effort to Control Behaviour,' New York Times, August 2, 1997)

Despite standard denials of any lasting harmful effects, researchers are nonetheless exploring listening tests, in low-key but determined efforts to find the definitive test for cognitive dysfunction from ECT.

"...most studies have either indicated that residual neuropsychological impairment follows ECT, or they have yielded mixed or inconclusive data concerning protracted deficits after ECT. ...It has been found that in dichotic perception tasks [tasks divided into two strongly contrasted groups or classes] normal individuals usually exhibit right-ear superiority in the detection of verbal material and left-ear superiority in the detection of non-verbal material. Trauma to the brain in the vicinity of the temporal lobe in the right hemisphere has been found to result in deficits in the perception of material presented to the left ear." ('Dichotic Perception and Memory following Electroconvulsive Treatment for Depression,' Williams, Iacono, Remick and Greenwood, Brit. J. Psychiat. (1990))

The nature of the covert attempts to discover a test for ECT impairment is particularly striking, since:

"The main result of dominant temporal lobectomy in human patients is to produce a defect of verbal learning, especially of verbal material presented through the auditory modality. It is contended...that there may be a close resemblance between the side effects of various forms of temporal lobectomy and those of the corresponding kinds of ECT. ... The results at the time of the three month follow-up demonstrated that verbal learning impairment was still evident in the patients who had received dominant hemisphere ECT." (James Inglis, 'Shock, Surgery and Cerebral Asymmetry,' Brit. J. Psychiat. (1970), 117)

Which brings us to that old chestnut - memory loss following ECT:

"In the early days of shock therapy, changes in memory were believed to be important to the therapeutic process, and memory impairment was encouraged by allowing the patient to remain apneic and cyanotic until normal breathing occurred after each seizure." (Max Fink, 'Myths of Shock Therapy,' Am. J. Psychiat., 1977)

"...it seems clear that we do not yet know with sufficient precision the frequency of the significant persistent memory loss that does apparently rarely follow ECT, and we do not know anything about patient characteristics (e.g. age, sex, type of lateralization of brain functions) that may increase its likelihood. Many more studies...are needed." (Culver, Ferrell and Green, 'ECT and Special Problems of Informed Consent,' Am J. Psychiat 137:5, 1980)

"Does the sharing of such information [about the risk with ECT of permanent memory loss] constitute a risk in itself? It is hard to imagine that any patient who has been fully informed of the possibility of permanent, near-total memory loss would consent to such a procedure." (Carl Salzman, 'ECT and Ethical Psychiatry,' Am. J. Psychiat., 1977)

Near-total memory loss - surely not? Oh yes - sometimes deliberately createdMemory in man "is the bastion of his being. Without memory, there is no personal identity." The psychiatrist who declared this in the course of the 37th Maudsley Lecture (who just happens to be the same doctor who administered ECT calculatedly to 'de-pattern' so-called schizophrenics of their personality), went on to state:

"In the electro-shock procedure, we have a means of producing graduated amnesia, and it is of interest to note that there is a proportional relationship between the number of electroshocks given within a period of time and the extent of the amnesias. It is quite possible, for instance, to produce a long-lasting, probably permanent, amnesia by setting the number of electroshock treatments to be given within a predetermined period." Ewen Cameron, 'The Process of Remembering,' Brit. J. Psychiat. (1963), 109)

There is no mystery concerning how ECT achieves the memory impairment complained of (i.e. an amnesic disorder), accompanied by reduced ability to learn and retain new material. It does so through a local effect on limited brain areas, especially the particularly sensitive structures of the temporal lobes, which include the hippocampus:

"...intervention in certain areas of the temporal lobes has been shown to produce automatism with associated amnesia... it has been found that '...the area of the temporal lobe in which epileptic discharge might produce automatism was the peri-amygdaloid area and the hippocampal zone....' Recent reviews...have strongly suggested that in many human disorders in which learning dysfunction appears as a significant element there is often also to be found evidence to indict malfunctioning of the temporal lobes and their adjacent structures, particularly the hippocampal region. ... The areas most likely to be affected by ECT lie within the temporal lobes and the most probable result of their disturbance is some form of amnesic disorder. The psychological evidence points to close similarities between the behavioural effects of shock and surgery. Both kinds of interference on the dominant side of the brain produce defects of verbal learning; on the non-dominant side they produce defects of non-verbal learning. These parallels imply a pressing need for the systematic study of other modes of ECT that would interfere as little as possible with the normal activity of those parts of the human brain that are essential for adequate learning and memory function." (James Inglis, 'Shock, Surgery and Cerebral Asymmetry,' Brit. J. Psychiat. (1970), 117)