The late Marilyn Rice, founder of the Committee for Truth in Psychiatry, an organization of approximately 500 former ECT recipients was forced to give up her career as a government economist after ECT wiped out her knowledge of economics.

Lawrence says that ECT wiped out a year and a half of memories before she received ECT, and eight months of memories after her shock treatment. She believes it's important to look at ECT from every angle, and offers both perspectives on her Web site. Still, she is not convinced ECT is an effective treatment for depression, but only offers a brief respite.

Glass' editorial does not warn that ECT may cause heart damage or even death.

Last year's controversial U.S. Surgeon General's Mental Health: A Report of the Surgeon General, endorsed the use of ECT, but warned, "However, a recent history of myocardial infarct, irregular cardiac rhythm, or other heart conditions suggests the need for caution due to the risks of general anesthesia and the brief rise in heart rate, blood pressure, and the load on the heart that accompany ECT administration."

"In a large retrospective study of 3,288 patients getting ECT in Monroe County, New York, ECT recipients were found to have an increased death rate from all causes," reports Moira Dolan, MD, in The Effects of Electroconvulsive Therapy, a review of scientific literature on the subject.

She also reports, "The first three years of mandated recording of death within 14 days of ECT in the state of Texas yielded reports of 21 deaths," according to a 1996 report filed by Don Gilbert, Commissioner, Texas Department of Mental Health and Mental Retardation. "Eleven of these were cardiovascular, including massive heart attacks and strokes, three were respiratory, and six were suicides..."

"In this issue of The Journal, Sackeim et al report the results of a multicenter, randomized controlled trial that addressed the important clinical problem of preventing relapse following a course of ECT," Glass writes.

"He fails to mention that in the JAMA study, patients were given an electrical charge so high (double the maximal output) that special machines had to be manufactured, and that this kind of charge is allowed only in research, not in contemporary US practice," counters Lawrence. "Even with that doubled dose, the response rate was dismal. Out of the 290 persons who completed a full ECT series at this high electrical rate, 24 weeks later only 28 were considered to be `in remission' from depression."

Informed Consent

"In his editorial, Dr. Glass does add that some ECT recipients have reported `devastating cognitive consequences' and says that this should be `acknowledged in the informed consent process,'" adds Rogers. "Unfortunately, he does not note that the opportunity for truly informed consent rarely exists now, since many hospitals base their informed consent information on sources such as the American Psychiatric Association fact sheet, which whitewashes the risks of ECT."

In 1998, the U.S. Department of Health and Human Services released the Electroconvulsive Therapy Background Paper prepared by Research-Able, Inc., a Vienna, Virginia, contractor for the Center for Mental Health Services (CMHS). This report indicated that some 43 states regulated the administration of ECT. Nevertheless, its authors concluded that despite state laws regulating the practice of ECT, "physicians and facilities comply neither with the letter nor the spirit of the laws, nor with professional guidelines." The Wisconsin Coalition for Advocacy, for example, reviewed records and conducted in-depth interviews at a psychiatric hospital in Madison, and uncovered...

• coercion to obtain patients' consent;
• failure to honor the requests of people who refused treatment;
• failure to provide patients with sufficient information about the procedure to allow them to make an informed decision; and
• absence of consent to treat people who were mentally unable to give consent.

"The American Psychiatric Association's own consent form doesn't even mention the high relapse rate, and mentions memory loss and cognitive damage as something rare and nearly freakish," adds Lawrence.

Has the abuse and overuse of ECT has declined over the years?

"One only has to look in the courtrooms of New York and spend an hour talking with Paul Henri Thomas, a man who has received as many as 70 forced electroshocks and is fighting against 40 more," asserts Lawrence.

"Or visit the courtrooms in Michigan, where it is against state law to give involuntary ECT to a person who does not have a guardian; yet in the last year, two hospitals and two judges have ignored state law and done it anyway. And you might talk to prominent [British] psychiatrist Dr. Carl Littlejohns, who is a proponent of ECT. Last year he criticized the American practice of ECT saying it was not standardized at all, and called it `most unsettling.' Or talk to the thousands of ECT survivors who say they have devastating, permanent damage and were lied to about the longevity of ECT on depression," advises Lawrence.

The National Mental Health Consumers' Self-Help Clearinghouse's policy is that potential ECT recipients have a right to be educated about the benefits and dangers of the controversial procedure before they make up their minds about it.

The Financial Factor

Many ECT proponents including some cited by Glass do not disclose they may have a financial conflict. For example, he cites Richard D. Weiner, MD, Ph.D., who heads Duke University Medical Center's Electroconvulsive Therapy Service and the APA task force on ECT which petitioned the Food and Drug Administration to lower its classification of ECT machines in 1982.

"As a paid 'consultant' to shock machine companies, Weiner designs virtually all of the shock machines in the United States," asserted Linda Andre, head of the New York City-based Committee for Truth in Psychiatry in 1999. "He admits getting money from shock machine companies but says it's deposited in his `research' account."