Shock Therapy...IT'S BACK - Instances of Involuntary Electroshock

Written by SANDRA G. BOODMAN The Washington Post

Instances of involuntary electroshock

At the same time, there is concern that the elderly are particularly vulnerable to inappropriate or dangerous treatments.

Last year the Illinois Appellate Court ruled that ECT was too risky and not in the best interests of Lucille Austwick, an 82-year-old nursing home patient who suffers from dementia and chronic depression.

The state's highest court reversed the decision of a lower court in Chicago that had ordered Austwick, a retired telephone operator, to undergo as many as 12 ECT treatments at Rush-Presbyterian-St. Luke's Hospital against her will. Austwick, who has no family, had previously been declared incompetent by a court.

In a strongly worded opinion the judges detailed contradictions in the testimony of Austwick's psychiatrist, who said he had sought a court order "because medication therapy would take a long time [and] he felt it would be better to get [the patient] out of here [the hospital] rather than stay here and spend time and money."

In Wisconsin, the state agency that protects the rights of the mentally ill last year issued a report detailing nine cases in which patients at St. Mary's Hospital in Madison received ECT against their will or without proper informed consent.

All but one of the patients was over 60 and female. Two were coerced into having ECT, the report by the Wisconsin Coalition on Advocacy stated. In another case the hospital threatened to get a court order to administer shock over a spouse's objections, investigators said.

The agency concluded that "medical and nursing practices surrounding ECT at St. Mary's psychiatric unit may not consistently reflect the minimum standards required by state law and relevant professional standards."

Hospital officials denied that St. Mary's had violated patients' rights. They noted that regulatory officials had not taken any action. The hospital made changes in its ECT consent documents, but not as a result of the commission's report, officials said.

Discovered in 1938, Electroshock Has Fluctuated in Popularity

Even its most ardent defenders agree that ECT arouses primitive fears: of being struck by lightning, of Dr. Frankenstein's experiments, of electrocution and the electric chair.

"ECT is something that just because of its nature doesn't look good," said Richard D. Weiner, chairman of the American Psychiatric Association's 1990 task force on ECT and an associate professor of psychiatry at Duke University Medical Center. "You're talking about putting electricity on top of somebody's head."

"ECT is a bizarre treatment," agreed Harold A. Sackeim, chief of the ECT service at New York's Columbia-Presbyterian Hospital. "In terms of its surface features, it has a horrific aspect to it."

For thousands of years, the notion of using electricity to treat illness has held a fascination for doctors. In 47 A.D. Roman healers applied electric eels to the heads of headache sufferers. In the 1920s and '30s American and European psychiatrists began treating some mental illnesses by inducing epileptic-like convulsions through massive doses of insulin and other drugs. They discovered that some patients showed dramatic, albeit temporary, improvement.

ECT was discovered somewhat by accident in 1938 after an Italian psychiatrist adapted a pair of tongs used to stun hogs before slaughter and applied them to the temples of a 39-year-old engineer from Milan, shocking him out of a delirious state in which h e spoke only gibberish.

By the 1940s insulin coma and electric shock treatments were widely used in American mental hospitals, especially the overcrowded public institutions that housed as many as 8,000 patients and as few as 10 doctors.

Historical accounts are replete with examples of shock used to subdue and punish patients, sometimes under the guise of treatment. Particularly troublesome patients received hundreds of shocks, often several in a single day.

"ECT stands practically alone among the medical/surgical interventions in that misuse was not the goal of curing but of controlling the patients for the benefits of the hospital staff," medical historian David J. Rothman of Columbia University told an NIH consensus conference in 1985. "Whatever the misuse of penicillin or coronary artery bypass grafts, the issue of staff convenience was not nearly as prominent as with ECT."

The invention of Thorazine and other antipsychotic drugs led to a decline in the use of ECT. So did published accounts of abusive treatment. The most famous was "One Flew Over the Cuckoo's Nest," Ken Kesey's 1962 novel based on his experiences in an Oregon state mental hospital, which in 1975 was made into a movie starring Jack Nicholson.

By the mid-1970s ECT had fallen into disrepute. Psychiatrists increasingly turned to drugs, which were cheaper and easier to administer and aroused less opposition. In addition, a series of landmark cases involving the abuses of shock therapy helped form the basis for patients' rights and informed consent legislation.

The late 1980s marked a resurgence in the use of ECT, and in recent years ECT opponents in a few states have tried to restrict or ban the treatment. In 1993 the Church of Scientology, which opposes psychiatric treatment, and several groups of anti-ECT activists helped persuade Texas lawmakers to bar ECT for children under 16 and to require hospitals to report deaths within 14 days of treatment.

Last year a bill to ban ECT was the subject of a two-day public hearing before a Texas legislative committee that heard testimony from 58 witnesses. That bill died in committee but its sponsors predict it will be resurrected next year when the legislature reconvenes.