There was at this time no FDA, no physician adverse effect reporting system, no psychiatric survivor led civil rights movement, no informed consent requirements. In short, there was no one but the ECT investigator him/herself to announce that ECT had failed and that EST was producing the desired effects. It remained only for the investigator to report that there was no possibility of administering EST without the damaging effects, as both the damage and the "therapeutic" effect appeared to be the result of suprathreshold dosages of electricity. But neither Wilcox, Friedman, nor Reiter made any such announcement. Rather than challenge colleagues who were damaging the brains of thousands of persons yearly, Wilcox and Reiter, after voicing half-hidden resentment through Impastato's announcement and publication (Impastato et al., 1957) against those who failed to use the safer unidirectional minimal current ECT devices, then allowed Impastato and colleagues to introduce the newest Wilcox-Reiter machine, the Molac II, a Cerletti-Bini style SW AC device, capable of administering convulsions many times over seizure threshold. This was, in effect, the first deliberately designed Wilcox-Reiter EST apparatus.

The Molac II was announced as having a superior feature over "old" Cerletti-Bini style machines, a millisecond of high voltage current (around 190 volts) in order to render the person unconscious before delivering two to three seconds of AC current at around 100 initial volts. Ironically, Impastato and colleagues, just before the announcement of the new Molac II, had railed against the side effects of the "classic Cerletti-Bini EST machine," attributing them to "excessive current used" (Impastato et al., 1957, p. 381). There was no reason to believe the current intensity of the new device was any lower and whereas the original Cerletti-Bini machine could administer current up to five tenths of a second, the new Molac II had no timer at all. The recommended duration of each treatment was between two and three seconds, but this was left completely up to the doctor's discretion. The black button could be held down indefinitely!

After designing the least dangerous machine in history, Wilcox and Reiter had now designed the most dangerous EST machine in history, completely discarding their minimal dosage, adequate convulsion precept of ECT. Ironically, the Impastato et al. (1957) paper ended by claiming that Molac II recipients tested on the "Proteus Maze" did no worse than those who had been treated with previous minimal dosage machines, a contradiction of everything Wilcox, Friedman and Reiter stood for and had maintained for the previous 17 years. since December, 1956, there have been no ECT devices produced in America. The same experiment ended similarly in Europe (see footnote 7).

The Case for Consumer Misinformation

In 1976, due to the actions of a California group of psychiatric survivors, Network Against Psychiatric Assault (NAPA), the psychiatric survivor movement scored a major victory (Hudson, 1978, p. 146). NAPA had attained for the state of California the first semblance of informed consent for EST in the United States (perhaps the first semblance of informed consent anywhere for persons labeled "mentally ill"). At least 30 other states enacted similar rule changes within the next few years. Psychiatrists in state institutions had to begin asking patients if they wanted EST. In these institutions, where EST had been predominantly administered up to this time, shock was, for a period at least, largely abandoned. At about this time too, shock devices came under the scrutiny of the FDA. It was time for the shock industry to take a different approach.

Also in 1976, psychiatrist Paul Blachley helped launch an attempt to make shock respectable again in America. A major part of a campaign to alter and improve the now very negative image of shock came in the form of "new and improved" EST devices, specifically the resurgence of Liberson's BP machine. Blachley's new company, Monitored Electro Convulsive Therapy Apparatus (MECTA), was soon followed by Somatics, Elcot and Medcraft in producing the "safer wave form," or BP ECT, devices. (13) With these newer devices, hospitals began, as standard procedure, to anaesthetize patients, the great majority of whom were now private hospital patients with insurance.

A recent New York Times article lauded the "modern" brief pulse models as "improved," and having modifications "like reduced doses of electricity" (Foderaro, 1993, p. A16). Recently, the television show 48 Hours featured psychiatrist Charles Kellner of the Medical University of South Carolina, who regularly administers electric shock. Kellner stated: "Well, it's such a different treatment now that there's almost no comparison...It really is a different treatment now...Having the seizure is the therapeutic part of ECT; probably about one fifth of the electricity that was used in the old days..." Such claims are false or misleading: the new BP devices are neither lower stimulus nor lower current devices than the older, or even the newer, SW models.

All other electrical components being equal, simple unmitigated BP (systematic interruptions of SW current) does in fact lead to reduced electrical dosages. However, aware that convulsions alone, induced by simple BP, are ineffective, manufacturers of modern BP devices amplify all other electrical components in order to compensate for the interruptions. Therefore, modern "souped up" BP apparatuses re-equal the cumulative electrical charges of the Cerletti-Bini style SW in every respect. For instance, 100 percent power of standard SW will emit the same 500 millicoulombs of electrical charge as 100 percent power of a modern BP machine such as Somatic's Thymatron DG. While one would expect reduced charges with BP, in fact, the old standard SW, i.e. Medcraft's 1950 model, emits slightly less charge than the modern day BP Thymatron DG. This would not be possible without electrical compensation of BP devices.

This compensation is accomplished in the following ways:

(a) The frequency is increased. Frequency is the number of pulses of electricity per second flowing past a given point. Although sine waves are "wider" than brief pulses, they are emitted at a constant rate of 120 per second. In comparison, modern BP devices can emit up to 180 pulses per second of electricity (e.g., MECTA's SR-2 and JR-2), or up to 200 pulses (Elcot's MF-1000).

(b) The current is increased. Current can be defined as electron flow per second and is measured in amperes or milliamperes (mA). The old SW devices deliver between 500 and 600 mA of current. The new BP Thymatron DG by Somatics delivers 900 mA constant current, the MECTA SR/JR devices, 800 mA, and the Medcraft B-25 BP up to 1000 mA or one full ampere.

(c) Duration is increased. Duration is the amount of time the current flows through the brain. Maximum duration of modern BP machines is four to six times the maximum duration of the older SW models.

(d) Wave lengths can be increased in most modern BP devices. The Elcot MF-1000, for instance, has adjustable brief pulses from a typical on msec up to an atypical two msec. A standard SW is 8.33 msec.

(e) Alternating current is used. In spite of the fact that both Liberson and Wilcox utilized DC successfully to induce adequate grand mal convulsions, modern BP devices utilize AC.