Local patients report radically different effects from electroshock therapy

"IT HAPPENED almost overnight," Dr. Paul Rosenbaum said, recalling the onset of the first stream of bleak days back in 1989.

They began when, out of the blue, he lost his ability to speak. Try as he might, he could hardly get words to flow out of his mouth, and when they did, they were garbled and unintelligible. A stroke, doctors said.

Rosenbaum, seeing his dental practice doomed, fell under the full-body grip of a depression that chained him to his bed, where he'd lie for days on end wondering if living was worth the trouble.

"I was frightened and became emotionally unstable," the West Hempstead man recalled. "It was a living death."

After months of unsuccessful treatments with drugs, Rosenbaum, now 76, joined tens of thousands of people who put their hopes in what may be the most controversial psychiatric treatment in use today: electroconvulsive therapy.

ECT, or electroshock, has seen a brisk resurgence in recent years, nationally and on Long Island, with more doctors recommending it to treat depression, as well as psychosis and catatonia. At least 100,000 people undergo it each year in the United States, up from about 34,000 in 1980, according to the National Institute of Mental Health.

Electroshock so alters people's existence that patients often divide their lives into pre- and post-electroshock blocks.

Sometimes the change is for better, sometimes for worse.

ECT helped Rosenbaum - who even repeated the treatment when he relapsed into depression years later. "I consider myself an example of success for ECT," he said, "especially for those for whom medication is not viable."

But electroshock "ruined my life," primarily by destroying her memory, said Carol Steinhauser of North Babylon. She said ECT was forced upon her in 1992. "It took me a year to relearn how to read and write," said Steinhauser, 54, an avid reader who first noticed the harmful effects of her 36 ECT treatments one day when she tried to read Newsday. The words made no sense.

"I didn't remember one word to the next," she said. An occupational therapist helped her relearn how to read, but "I wanted to finish college and I felt like I couldn't because I couldn't remember anything. It destroyed my dreams."

The personal stories of Rosenbaum, Steinhauser and other local electroshock patients serve as reminders that behind the controversy over ECT are real people struggling to deal with real illnesses at what may be the most difficult points of their lives.

Supporters such as Rosenbaum say recent refinements make it a kinder, gentler treatment that allows people to lead productive lives.

But other former patients, who lambaste ECT, describe themselves as "survivors." Some doctors, including psychiatrists, deplore it as "barbaric," saying it causes brain damage, evidenced by memory loss and other side effects.

Electroshock has been used often on Long Island, where several hospitals perform the procedure and train physicians in its use. SUNY Stony Brook and Long Island Jewish Medical Center's Hillside Hospital have extensive programs, due in large part to the presence at both of Dr. Max Fink, a psychiatrist who is perhaps ECT's most avid proponent nationally.

Fink, who declined to be interviewed for this story, addresses ECT's bad reputation in his 1999 book, "Electroshock: Restoring the Mind."

"Electroshock is an effective and safe treatment for those with severe mental illness," he wrote. "Electroshock has undergone fundamental changes since its introduction 65 years ago. It is no longer the bone-breaking, memory-modifying, fearsome treatment pictured in films."

ECT, which is performed in hospitals, is most often used when psychotherapy and medication either fail or when the drugs are dangerous to the patient.

Despite its long use, electroshock is still an enigma; no one really knows how or why it works for some people.

Some critics compare the procedure, in which electricity is passed through the brain via electrodes, creating a grand mal seizure, to slapping the side of a TV set to fix the reception.

Sometimes the blow produces a clear picture, but often only for a short time, and with varying degrees of damage, if any, to the set.

Relapses of the patient's illness occur in about half of all cases. And some former patients report an inability to recall special moments, such as Christmas holidays; in the worst cases, massive chunks of childhood vanish.

As critical voices rise in volume, the widening debate over ECT has spilled into the state legislature, which is considering several bills to regulate its use.

State Assemb. Martin Luster (D-Trumansburg) wants to begin requiring that providers report their use of ECT and to create an advisory group to review standards and outline the legal issues involved, including patient consent.

Right now, several psychiatric patients in Long Island hospitals are resisting doctors' recommendations that they receive electroshock.

The case of Paul Henri Thomas, 50, a Pilgrim Psychiatric Center patient who over the past two years has undergone the procedure 60 times - against his will all but three times - is the most notable example wending its way through the courts.

Luster's office said that court applications to administer electroshock without a patient's consent jumped 73 percent from 1999 to 2000, from 56 to 97, many of those applications filed by Pilgrim.