My Turn: ECT Editorial Casts Shadow on Author and JAMA's Credibility

Written by Leye Jeannette Chrzanowski

Tuesday, March 20, 2001
by Leye Jeannette Chrzanowski
Copyright © The Disability News Service, Inc.

Is Electroconvulsive therapy (ECT) now safe and effective as indicated in a March 14, 2001, editorial published in the Journal of the American Medical Association (JAMA)? The author, JAMA's Deputy Editor Richard Glass, MD, asserts ECT is effective, safe, and no longer abused, and thus time to bring ECT out of the shadows. Glass fails to sway ECT critics. They are incensed that JAMA would publish such a questionable report, and remain unconvinced ECT is the harmless panacea he describes. Critics assert Glass's editorial makes erroneous assumptions, excludes important information, and ignores people who have experienced adverse effects after receiving ECT. They conclude ECT remains ineffective, abused and unsafe.

What is ECT?

According to the National Institutes of Mental Health (NIMH), ECT, sometimes more commonly referred to as shock treatment, involves producing a seizure in the brain of a patient under general anesthesia by applying electrical stimulation to the brain through electrodes placed on the scalp. According to NIMH, "Repeated treatments are necessary to achieve the most complete antidepressant response." People of all ages receive ECT -- even young children.

The Effects

ECT has been known to cause epilepsy, brain damage, memory loss, stroke, heart attacks and even death.

Glass asserts ECT earned a bad reputation in the mid-20th Century, when shock treatments were abused and overused. He also blames the movie One Flew Over the Cuckoo's Nest for contributing to an "erroneous view of ECT as a punitive, painful, and assaultive procedure used by authorities to control inconvenient creativity."

"That reputation was enhanced by the immediate adverse effects of bitten tongues and even fractured bones and teeth caused by the induction of generalized seizures, and the painful effects of electroshocks administered without anesthesia when they did not successfully induce a seizure with loss of consciousness," he writes.

"Richard Glass makes some very erroneous assumptions in this editorial, and it leaves me wondering if he really knows ECT research at all," says freelance journalist Juli Lawrence, MA, BS, BA, who received ECT in July 1994 for severe depression. Lawrence also operates an Internet Web site http://www.ect.org , which contains a vast amount of ECT information. She accumulated the articles and journal entries -- both pro and con -- after spending years researching ECT.

"He lists a few reasons that ECT is controversial, but ignores what every ECT researcher tends to ignore -- patient feedback. That has been the modus operandi of the entire ECT industry from the beginning, although it seems to be currently in vogue to say, `Well, yes, we admit ECT was misused in the past, but it's fixed today,'" adds Lawrence.

"It is disturbing that such a respected source as the Journal of the American Medical Association sees fit to describe ECT as `an effective and safe treatment,' given the fact that a significant number of people have been permanently disabled by it," says Joseph A. Rogers, executive director of the National Mental Health Consumers' Self-Help Clearinghouse in Philadelphia.

To bolster his opinion, Glass relies on the most recent task force report by the American Psychiatric Association (APA) committee on electroconvulsive therapy. First published in 1990, the 2001 edition of The Practice of ECT: Recommendations for Treatment, Training, and Privileging concludes ECT is a safe and effective treatment for severe major depression. Glass writes the committee noted that after receiving ECT, people may experience "a variable but usually brief period of disorientation," or some retrograde amnesia immediately after the ECT seizure is induced, which usually decreases with time. Glass adds that some people may experience a persistent loss of memory of events that happened directly before and after they received the ECT. Anterograde amnesia, forgetting learned information, may also occur during and following ECT, but is resolved in a few weeks, according to Glass.

"Importantly, there is no objective evidence that ECT has any long-term effect on the capacity to learn and retain new information," writes Glass.

"The APA fact sheet claims that ECT is `no more dangerous than minor surgery under general anesthesia, and may at times be less dangerous than treatment with antidepressant medications,'" adds Rogers. He asserts APA wrongly refers to ECT as "a safe, practically painless procedure" and brain damage a "myth." Rogers says APA minimizes memory problems. "Research to the contrary is ignored," he asserts.

If APA considers brain damage a myth, then it ignores the results of its own task force survey. Some 41 percent of psychiatrist responded, "Yes", and only 26 percent said, "No," when asked, "Is it likely that ECT produces slight or subtle brain damage?"

"As a neurologist and electroencephalographer, I have seen many patients after ECT, and I have no doubt that ECT produces effects identical to those of a head injury," wrote Sydney Samant, MD, in Clinical Psychiatry News, March 1983. Samant concluded that ECT "in effect may be defined as a controlled type of brain damage produced by electrical means."

In the American Journal of Psychiatry, September 1977, John M. Friedberg, MD, writes, "The potency of ECT as an amnestic exceeds that of severe closed head injury with coma. His report, "Shock Treatment, Brain Damage, and Memory Loss: A Neurological Perspective," concluded, "It is surpassed only by prolonged deficiency of thiamine pyrophosphate, bilateral temporal lobectomy, and the accelerated dementias, such as Alzheimer's."

"One reason psychiatrists are unaware that ECT is causing memory loss is that they do not test for it," wrote Peter Sterling, MD, in a January 2000 letter to the editor of Nature. Sterling who works in the department of neuroscience, at University of Pennsylvania, wrote, "Memory loss could be monitored by questioning patients before ECT about early events in their lives and then re-questioning them following each series of ECT. When this was done 50 years ago, memory losses were marked and prolonged. However, no effort has been made since to routinely perform this simple test."