Note I hat the woman has many gaps in her recall and needs specific prompting by the interviewer. Sometimes she recalls facts when prompted ("now that you mention it ...."). Dr. Janis gives several additional detailed examples and summarizes as follows:

...the examples fail to convey the extensiveness and variety of personal experiences subject to amnesia in each individual case. Every one of the 19 patients included in the study showed at least several instances of amnesia and in many cases there were from ten to twenty life experiences which the patient could not recall . (Janis, 1950a.)

In contrast, the control patients were able to reproduce practically all the material they had given in the initial interview, and they recalled it so readily that the examiner rarely needed to resort to raising questions giving specific cues so often required by the ECT patients. In fact, most of the control patients improved between the tests, as one would have expected because of the stimulation of "reliving" old events (Janis and Astrachan, 1951). Janis discovered amnesias in patients diverse in personality type and intellectual status, in patients with different types of mental disorders, in patients who improved psychologically, and in those who did not improve. These amnesias were in some instances for emotionally upsetting material, e.g., related to the illness, but in other instances were for emotionally "neutral" material as well. Furthermore, Janis notes, "many patients were distressed about their failure to recall past experiences and frequently made definite efforts to secure information about the events for which they were amnesic". He says, "The patients usually expressed little conviction about the occurrence of such experiences and were unable to reconstruct the details beyond what they had been told about it." (Janis, 1950a, P. 376). Janis notes that there was no tendency for patients to "protect" their amnesias since they sometimes actively sought for cues to help them remember. Therefore, even strong motivation to remember did not help.

A later study employing a somewhat different set of questions revealed "gross amnesic gaps" such as total failures to recall a particular job. Again, there were also more subtle amnesias such as failure to recall details of a specific event. Janis found, in addition to the gross gaps and subtle losses, a slowness and a great effort in recalling details. In some cases, details returned, but only with great effort and with the help of cues provided by the examine, (Janis and Astrachan, 1951). In his published papers, Janis reports following half of the shocked patients for 2 1/2 - 3 1/2 months after the end of ECT. He found that in each case most of the instances of amnesia persisted. Janis continued to follow six of these patients for a full year and found that the amnesias persisted (Janis, 1976).

The Janis studies employed the most sensitive method of any in the literature and the one that most directly addresses the concern of the patients, the loss of their own memories of their pasts. It would seem to me incumbent upon any researcher who fails to find memory loss using an artificially devised test to explain the Janis results. The simplest explanation at present is that the artificial tests are not as sensitive. No author so far has mounted serious criticism of the Janis studies, nor has anyone repeated them. The Janis results fit well with the evidence cited earlier that ECT causes organic brain damage. Overall, the evidence convinces me that ECT is far from benign. If, for others, doubts remain as to whether ECT impairs human memory, the first step toward settling the issue should be a careful and thorough repetition of the Janis studies.

OVERALL CONCLUSIONS

1. Convulsions caused by electrical shocks to the brain are accompanied by alterations within the brain. Many of the brain's natural protections are broken down. Mentioned in particular are the massive rise in blood pressure, the breakdown of cerebral auto regulation of blood flow, and the breakdown of the blood-brain barrier.

2. Such changes can lead to alterations in brain chemistry and physiology. The change most easily measured in humans is the alteration of the EEG toward a form that is commonly recognized as pathological.

3. Such changes are also associated in many studies with gross pathology such as brain swelling (edema) and particularly brain hemorrhages which lead to the irreversible death of neurons.

4. Such changes are also associated with persisting, probably permanent amnesias for life events and experiences.

5. Such amnesias may only be detected when patients are questioned in detail about their life histories before and following the administration of shocks.

6. At all levels, from changes in blood pressure to losses in memory, there is extreme variability. Losses can, however, be catastrophic after only a few shocks. In general, the younger and healthier the animal or person, the less permanent damage may result.

7. Such losses of memory can and do occur without any necessary changes in overall intelligence as measured by a psychological test and without any other detectable neurological abnormalities. This finding is common not only with ECT but in brain damage accompanying other kinds of insult such as trauma or toxicity.

Dr. Sterling's view on Whether ECT Damage Is Easy To Find

more on: Memory Loss From ECT | ECT and Brain Damage

next: An Introduction to Neuropsychological Assessment