Various objective tests have been used to determine whether memory loss occurs following ECT, including standard IQ. tests, the Benton test, the. Paired Associates test, and tests devised specifically for assessing memory following ECT (e.g., Bender, 1947; Brunschweig, et al., 1971; Dornbush, et al, 1971; Squire and Chace, 1975). Most of the tests require the patient to learn and remember new material of very simple kinds. For example, can a patient memorize a list of words, numbers or faces and recall them after an hour, a day or a few weeks? Others test recognition of remote events that are not intimately connected with the patients' lives, for example, recognition of the names of old television programs (Squire and Chace, 1975). One of these reports shows that patients have more difficulty recalling their own past than in learning new material and that amnesias recover more slowly than do the processes required for new learning (Brunschweig, et al., 1971). Until recently, such tests revealed very little impairment, and it was common to conclude that patient reports of memory loss are nothing more than complaints associated with their illness or merely an underestimation of their true memory abilities (Squire and Chace, 1975). No study, however, has tried to document this hypothesis, and several solid studies reporting substantial memory losses find no association between the degree of memory loss and the patient's emotional health. Teuber, et al., (1976) studied 34 patients who had been subjected to cingulotomy (brain surgery) for relief of their mental illness. Many of these patients had been subjected to ECT prior to their surgery. On a battery of nine standardized psychological tests, significant deficits were found correlated not with the surgery but rather with the patients' history of ECT.

"We found that individuals whose prior treatments had included ECT were inferior to normal control subjects and to patients who had been spared ECT, and this inferiority was apparent on the following measures: verbal and nonverbal fluency, delayed alternation performance, tactual maze learning, continuous recognition of verbal and nonverbal material, delayed recall of a complex drawing, recognition of faces and houses, and identification of famous public figures. In some cases, the degree of deficit was related to the number of ECT received, patients who had been given more than 50 ECT being significantly worse than those who had sustained fewer than 50." (Teuber, et al., 1976, P. 76).

This study is one of the most thorough applications of objective tests to ECT patients; one would like to see it repeated on patients who had not also sustained surgical brain damage. Yet, it does not tell us what individual patients knew about themselves before and after their ECT. This question received a clear answer in the early 1950s.

The Janis Studies

One series of studies, those of Dr. Irving Janis of Yale University, stands out in the scientific literature on the effects of ECT on memory for the past (Janis, 1950a; Janis, 1950b; Janis and Astrachan, 1951). Janis, unlike most investigators, studied patients before as well as after ECT and could, therefore, determine whether individual patients showed changes. He studied patients not merely for a few days or weeks following ECT but for up to 3+ months. Janis did not primarily use artificially devised tests but actually asked patients about the details of their lives, covering the following topics: 1) school history, 2) job history, 3) history of the mental disorder, 4) sexual and marital relationships, 5) family relationships, 6) childhood experiences, 7) miscellaneous, e.g., details of the layout and furnishing of the home, 8) outstanding life experiences, e.g., personal failures and troubles, best and worst experiences of one's life, etc. In these interviews he pressed patients for minute detail. For example, he asked the name, location, years of attendance for each school; reasons for transferring or leaving; names of teachers; subjects failed and reasons for failure; difficulties with school authorities; description of the graduation ceremony on the last day of school. In this way he built up a rich account of personal memories so that he could compare the amount of detail that was supplied following ECT.

The Janis studies were carefully controlled. For patients who were to receive ECT, there was another group who matched the shock patients in age, education, type and degree of illness, and form of psychotherapy. These control patients were interviewed in the same detailed way as the shock patients, both initially and at the same later intervals. In this way Janis could be certain that any losses in memory he might find would be due to the ECT and not to the course of the illness or some other unidentified factor. At the end of the study, Janis asked both the shock and the control patients to state what they thought the purpose of the interviews was. Their replies indicated that none of them suspected that the purpose was to test their memory. They could not have been "faking" responses to determine the outcome of the study because they did not suspect that a study was underway.

The shock patients in this study received standard treatment (60 cycle, AC., 3 times/week). The number of shocks was relatively modest, between 8-27, with an average of 17. No differences were noted between patients who received different numbers of shocks.

The results of Dr. Janis' study are, in my opinion, conclusive proof that serious losses of personal memories are caused by ECT and that the losses persist. Here is an example of what he found. First, a 38 year old woman before ECT:

Case E. -- A 38 year old female schizophrenic (borderline or mixed); 10 electroshocks.

Before ECT. (Q. How did your illness begin?)... .About four years ago, right after I lost my child ... I took thyroid then which caused palpitations. I didn't know , At the time, that that caused it. I felt terrified by them. It was a real panic, as if I were on railroad tracks with a train coming. I was trying to be very brave about the death of my baby, going to work in the hospital where it died, collecting legal papers on it, and so forth, trying to be the super-woman. Then I had the palpitations; a friend told me I should get psychiatric help. I saw my family doctor and he sent for a neurologist. I spent the night at my doctor's office and then I went to the H Sanitarium for a week. I was hopeful of getting all better. They didn't feel I was really ill. After that, I began analysis. (Janis, 1950a.)

Note that a single question elicits a long account that is rich in detail. Information flows without prompting by the interviewer. Here is the same woman 3 1/2 weeks after a series of 10 shocks.

Three and One-Half Weeks after ECT.

Q.Did you take some medication after the loss of your child? A.I don't remember. Q.Thyroid? A.I think so. Q.What reaction did you have to it? A.I don't know. Q.During that period did you have any special symptom -which disturbed you: A.I felt depressed. Q.Anything else? A.l don't recall. Q.Did you have palpitations? A.I vaguely remember having palpitations now that you mention it. Q.How did you feel about them at the time? A.I don't recall how I felt. Q.How did you feel at the moment when you had the palpitations? A. Probably not too well. Q.Did you ever go to a sanitarium? A.Yes, I remember going to one. Q.What was the name of it? A.I don't recall the name. Q.What were the circumstances that led to your going there? A.I don't remember why I went or what happened, I remember being there though. Q.How long were you there? A.I don't remember. I don't think it was for very long. I really can't reconstruct that-whole period. (Janis, 1950a, pp. 369-370.)