[NYAPRS Enews] ABC: ECT Controversies Capture National, NYS Attention

[Harvey Rosenthal]

NYAPRS Note: Always controversial, electroshock is back in the news both
nationally and here in New York.

In the wake of a recently unsuccessful court challenge by a NYS
psychiatric center inpatient who had sought  to bar another round of
electroshock, questions have been raised once more about the use of
court ordered ECT at NYS psychiatric facilities. The patient, who is an
elderly Spanish speaking Dominican woman, had also renewed her claim
about not receiving adequately linguistically competent treatment as an
appropriate alternative to ECT (NYS operates Spanish speaking state
inpatient units).

NYAPRS has focused our efforts in this area towards working for greater
state oversight and stronger informed patient consent procedures.
Accordingly, we also acted to support of the aforementioned woman's
challenge ('Simone D').  We also wonder whether OMH facilities or
physicians are using different clinical protocols: only a few seem to
favor the use of court ordered ECT while most do not use it.

In an environment of informed patient choice and complete knowledge
about potential risks and benefits and with all appropriate governmental
oversight, it's important to reiterate, we fully support individuals'
decision to avail themselves of ECT.

Several years ago, OMH launched new efforts in both of these areas.
Yesterday, at a meeting of the OMH Recipients Advisory Committee, OMH
released some updated results from the stepped up oversight, including a
finding that 52 of 147 qualified inpatient settings (35%) provide ECT.
OMH overseers have directed some of these facilities to step up their
efforts to ensure more clarity around pre-ECT evaluations, to improve
their promotion of patient rights to have a 3rd party present and the
availability of consent forms in the patient's primary language and the
need to have a clearer process to evaluate ECT risks and benefits to
individual patients. 

It was also made clear that an individual's right to self determination
is a 'paramount' consideration and that an individual's preferences to
not have ECT as represented in their advance directive will be respected
and supported by law. To receive OMH-funded trainings on both advance
directives (and the Medicaid Buy-In), contact the NYAPRS Training
Collective via our Deputy Director Mat Mathai at mathewm at nyaprs.org. 

-------------------

 

Electroshock Therapy Gets a Makeover

Despite Changes, ECT Still Stirs Controversy

By SIBILE MORENCY   ABC News   July 20, 2007

 

Amy, a New York resident, had her first electroshock treatment at the
age of 72 and despite the stigma that electroshock is a brutal, outdated
procedure for treating psychiatric health, she said it's been a miracle
for her. 

 

And it's probably more common than most people believe. 

 

"I started 10 years ago when I was very depressed. I was diagnosed as
bipolar. I took medicine -- Prozac, a whole slew of them -- but they
didn't help," she said. "Then a psychiatrist told one of my friends that
I should have ECT. My friends told me to get ECT. It was the only
solution, I couldn't go on the way I was. After ECT, everyone told me it
was a miracle." 

 

Amy, who asked that her last name not be used, is now 82 and continues
to receive electroshock therapy regularly. 

 

Although she admits that after each procedure she has a headache and her
memory is temporarily "a little bit off," she insists that ECT has been
a success for her. 

 

"I know there's a lot of negative. I think it's a rather painless
procedure. It's wonderful," she said. "If medicine doesn't work, then
yes, I would recommend it to someone else." 

 

The New Face of ECT

Since its terrifying depiction in the movie "One Flew Over the Cuckoo's
Nest," electroshock, or electroconvulsive therapy (ECT) has changed
dramatically. According to doctors who use it, the administration of the
anesthetic, changes in the type of electricity used and the way seizures
are triggered have transformed the procedure, making it safer and more
effective. 

 

The latest clinically available form of ECT, called ultrabrief pulse
unilateral, uses a briefer stimulus that lasts for .25 to .3
milliseconds, according to Dr. Sarah Lisanby at the New York State
Psychiatric Institute. The difference in the type of electricity used
allows doctors to induce seizures with lower amounts of electricity then
was previously possible. 

 

"It does away with lifelong memory loss," said Dr. Harold Sackheim, a
leading proponent of ECT and chief of the department of biological
psychiatry at the New York State Psychiatric Institute. "If there is any
memory loss, it's markedly reduced." 

 

ECT Not Uncommon

Although there are no national reporting requirements for the number of
procedures performed, experts estimate that approximately 100,000
patients a year in the United States and several million worldwide
receive ECT. According to Dr. Mustafa Husain, the director of the
Geriatric Psychiatry Training Program at the University of Texas
Southwestern Medical Center, the newer version of ECT is becoming the
standard in practice, particularly at academic medical centers and
clinics due to its relatively low amount of adverse effects on the
brain. 

 

"We started the new ECT almost a year ago. All of our equipment is now
ultrabrief pulse," he said. 

 

Critics Call ECT Russian Roulette

Despite support from many well-respected physicians, ECT is still
controversial. Critics view the procedure as a dangerous game of Russian
roulette that should be banned. 

 

"You hear from people who succeed. You don't hear from people who lost
wedding or childbirth memories," said David Oaks, director of
MindFreeedom, a nonprofit organization focused on human rights campaigns
in mental health. 

 

Dr. Peter Breggin, founder of the International Center for the Study of
Psychiatry and Psychology, is a staunch opponent of the practice. 

 

"If you were in your kitchen, touched your stove and got a convulsion,
you would be in the hospital. It would be treated as an emergency. You
might even be given anti-seizure medication to ensure that you do not
get another convulsion," Breggin said. "Psychiatry is the only place
where you damage the brain and call it a cure." 

 

Because unilateral ECT is a shock to the nondominant, nonverbal side of
the brain, controls a person's intuition, creativity and emotions,
Breggin said patients may have a harder time explaining the side effects
they might experience. 

 

"So people when damaged on the nonverbal side can't tell you about it.
It's a ruse," Breggin insisted. "Ultrabrief pulse unilateral is still
damaging the brain, but it's less obvious. It cures by creating a
delirium in which the patient is incapable of normal human emotion." 

 

John Breeding, an Austin, Texas, psychologist, is alarmed by the state
of the industry. 

 

"The shock industry is the Enron of mental health. If they're honest,
and you ask them, 'How does shock work,' they'll say they don't really
know," Breeding said. 

 

Oaks agreed. 

 

"They look at a problem as physical -- drug, drug, drug, drug, drug --
then they'll try shock. The system is so oriented toward this medical
model approach. Relapse rate is enormous, so what's their answer?
Maintenance shock," he said. "What has happened in the industry is that
research has discounted people's memories." 

 

ECT experts recognize the controversial history of the procedure and
acknowledge the stigma attached to it. 

 

"The stigma affects providers and patients. The treatment is perceived
by the public as brutal," Sackheim said. "Undoubtedly people don't
receive the treatment, because they're afraid of it. In some cases it's
quite tragic because they may not live." 

 

ECT proponents hope that the newer form of ECT will encourage more
people to seek the procedure to cure their depression. 

 

"Finding ways to make ECT safer, beneficial, lowers barriers to
accessing the efficacy of this procedure," said Dr. Lisanby. 

 

Still Searching for a Cure

Doctors who use ECT are the first to admit that the complete cure for
severe depression still eludes them. 

 

"ECT can be rapidly effective in treating [depression] but always needs
maintenance treatment to maintain effects," Lisanby said. 

 

Don Weitz, co-founder of the Coalition Against Psychiatric Assault, a
group that opposes the use of ECT, said that the American public is in
the dark about its use as a treatment. 

 

"Most people think it no longer exists. When I meet people in the
street, they say, 'You're kidding!' And it's increasingly for elderly
women," Weitz said. "Two-thirds of people who get ECT are women. This is
not a treatment. It always causes brain damage and it targets women." 

 

http://abcnews.go.com/print?id=3397685 

 

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