What Yudofsky is really saying, I believe, is that SHOCK TREATMENT IS NOW EASIER FOR THE PSYCHIATRIST TO WATCH. In truth the electricity coursing through the brain is no less damaging now than it was forty years ago. In fact, the sedating drugs now given prior to the shock require the doctor to use somewhat higher doses of electricity, since it takes more current to produce a brain seizure.

The electric current injures the brain's tissue, causing mental confusion. The medical developments described above, in other words, have done nothing to change how shock treatment "works": the patient is so dazed and confused that he or she forgets many important things. For a few weeks, emotional problems are driven from the mind, but they are not solved or alleviated in any way. Neurologist Sidney Sament has described what happens.

I have seen many patients after ECT, and I have no doubt that ECT produces effects identical to those of a head injury. After multiple sessions of ECT, a patient has symptoms identical to those of a retired, punch-drunk boxer. After one session of ECT the symptoms are the same as those of a concussion (including retrograde and anterograde amnesia). After a few sessions of ECT the symptoms are those of moderate cerebral contusion, and further enthusiastic use of ECT may result in the patient functioning at a subhuman level. Electro- convulsive therapy in effect may be defined as a controlled type of brain damage produced by electrical means. No doubt some psychiatric symptoms are eliminated ... but this is at the expense of the brain damage, which may have varying effects of patients' lives, depending on their age, personality and the number of ECT treatments. In all cases the ECT "response" is due to the concussion-type or more serious, effects of ECT. The patient "forgets" his symptoms because the brain damage destroys memory traces in the brain, and the patient has to pay for this by a reduction in mental capacity of varying degree ... a patient "responding" to ECT and even becoming asymptomatic and "easier to manage" is not necessarily healthy or cured but may be functioning at a low mental level, and his potential for full human function may be seriously impaired. The causes of the patient's depression - marital or interpersonal stress, financial pressures, problems of aging - are untouched by ECT. The patient's CONCERN over these problems is temporarily blotted out, but soon (usually after a few weeks or a month) the brain recovers enough for the person to remember his or her problems. Now the patient has an additional reason to feel low: Memory for past events and ability to retain new information are impaired. The brain injury leaves residual damage that may be permanent.

There is disagreement among researchers on the likelihood of permanent damage. This is because the "tests" used in psychiatry and psychology are strictly subjective and open to interpretation. Proponents of ECT readily admit the treatment's immediate impact on memory and learning but deny that this is long lasting. They say that the common complaints of ECT recipients, even those made years later, are a result of their mental disorders, not the result of treatment.

I am unable to dismiss these complaints so easily, since many ECT recipients describe what clinical medicine teaches us to expect from a brain injury. Brain injuries, particularly those involving the areas that ECT selects (temporal lobes and the underlying structures), may cause permanent memory loss for events in the past (retrograde amnesia).

Memory of the months immediately before and after the injury is especially vulnerable. Brain injuries may also cause permanent deficiencies in retention of new information (anterograde amnesia). It is this learning disability that is particularly upsetting for recipients. I have talked with many ECT recipients: Some of them have no complaints of permanent deficiencies, but most do.

If psychiatrists who use ECT deny the possibility of permanent injury, among themselves and to the public, they are hardly likely to mention the possibility to patients asked to consent to the treatment. Instead, patients are told that confusion and memory impairment last just a few weeks. Merely this lack of accurate information on which the patient may decide whether the risks or treatment are worth the potential benefits makes suspect the apparent consent of most ECT recipients. Equally important is the legal and ethical requirement that the consent be truly free. But is free consent possible on a psychiatric ward, where patients (even those who appear to be voluntary), may not leave unless the psychiatrist agrees? True voluntary status is rather uncommon on a mental ward. Finally, one last factor makes these dilemmas of consent even more troublesome. Once the patient has received the first or second of the ten or twelve treatments planned, he or she is so confused that any resistance to the treatment has been wiped out. Even if the patient had the physical capacity to fight back, he or she has lost the desire to do so.

Shock treatment is now enjoying a renaissance because of psychiatry's strong promotion of medical rather than psychological treatment methods. Whereas twenty years ago it was considered an embarrassment to psychiatry, every other instance, past and present, in which physical intrusion becomes a "Treatment" simply by official pronouncement, ECT is not said to correct brain abnormality. Some have likened it to "recharging our batteries." Others, hoping to sound more scientific, have said it "stimulates the deeper survival centers of the brain."

Shock treatment thus follows in the path of earlier treatment, like bleeding or lobotomy, now discarded by psychiatry. But there is no sign yet that ECT is about to be relegated to the past. A treatment favored by psychiatry will be used regardless of the cost of the patient and regardless of the patient's wishes.

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Dr. Coleman then goes on in the next section of his book to discuss the "Operation Mind Control: Missing the Point". It begins with:

When clear-cut examples of mental patient abuse come to light, we often overlook the most basic reason: the patient's powerlessness to refuse an unwanted treatment.

Now by not also copying this section, I am far from saying that "Forced Treatment" is not of primary importance. I am simply saying that if you want to read his book, do so. It is a resource that every P&A lawyer and all activists in the field should have ready access to.

When I was working at Delaware State Hospital the reason ECT was seen as successful was due to the fact that it felt to the patients just like they were being killed. Freud had argued in his later years that there was a drive for DEATH in human beings and this he referred to as Thanatos. The explanation for ECT was therefore that by letting the patient "safely" experience the "controlled" death of a seizure, his death drive was being satisfied and he could safely return to life.

Well some of you who are confirmed Freudians may think this sounds logical. I don't. For me the best advertisement is the Video, SHOCK TREATMENT put out by Twentieth Century Fox. Yes it is a sequel to the ROCKY HORROR PICTURE SHOW and many of the same stars are featured in this presentation of the macabre adventures of Dentonvale Psychiatric emporium where craziness is certainly not limited to the patients.

next: Medical Journal Under the Microscope