Doctors of Deception

Doctors of Deception: What They Don't Want You to Know about Shock Treatment

LINDA ANDRE
Copyright Date: 2009
Published by: Rutgers University Press
Pages: 376
https://www.jstor.org/stable/j.ctt5hhzpr
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    Doctors of Deception
    Book Description:

    Mechanisms and standards exist to safeguard the health and welfare of the patient, but for electroconvulsive therapy (ECT)-used to treat depression and other mental illnesses-such approval methods have failed. Prescribed to thousands over the years, public relations as opposed to medical trials have paved the way for this popular yet dangerous and controversial treatment option.Doctors of Deceptionis a revealing history of ECT (or shock therapy) in the United States, told here for the first time. Through the examination of court records, medical data, FDA reports, industry claims, her own experience as a patient of shock therapy, and the stories of others, Andre exposes tactics used by the industry to promote ECT as a responsible treatment when all the scientific evidence suggested otherwise.As early as the 1940s, scientific literature began reporting incidences of human and animal brain damage resulting from ECT. Despite practitioner modifications, deleterious effects on memory and cognition persisted. Rather than discontinue use of ECT, the $5-billion-per-year shock industry crafted a public relations campaign to improve ECT's image. During the 1970s and 1980s, psychiatry's PR efforts misled the government, the public, and the media into believing that ECT had made a comeback and was safe.Andre carefully intertwines stories of ECT survivors and activists with legal, ethical, and scientific arguments to address issues of patient rights and psychiatric treatment. Echoing current debates about the use of psychopharmaceutical interventions shown to have debilitating side-effects, she candidly presents ECT as a problematic therapy demanding greater scrutiny, tighter control, and full disclosure about its long-term cognitive effects.

    eISBN: 978-0-8135-4652-0
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Notes on Terminology
    (pp. xi-xiv)
  5. 1 The Trouble with Time
    (pp. 1-12)

    Imagine you wake up tomorrow with your past missing. Although you look and feel the way you always have, and although everyone around you acts as if nothing’s wrong, you slowly become aware that you don’t have the most vital information about who you are. You may not recognize your home or know where your bank accounts are or what you are supposed to do for a living. You can’t remember your wedding, or your college education. Every day you discover more about how much of your life is gone. You’re like a detective trying to find out about the...

  6. 2 Eugenic Conceptions I: TICKING TIME BOMBS
    (pp. 13-27)

    I’d lost my whole world and gained a psychiatric label. Now I was thrust into a world I hadn’t known existed, a kind of parallel universe. I was not prepared for what happened there. I didn’t feel like a mental patient, had no memory or experience of any psychiatric treatment or symptoms, and never went near a psychiatrist again; yet I had become someone who could be treated in ways that would be unthinkable—even illegal—for someone without a label.

    Whether in the schoolyard or the courtroom, calling someone crazy is the surest, fastest way of totally invalidating him...

  7. 3 Eugenic Conceptions II: USELESS EATERS
    (pp. 28-43)

    Within memory of those still alive today is a time when it was not only acceptable to speak of mental patients as worthless defectives and malignant growths, it was possible for those at the highest levels of society and within organized psychiatry to act on these beliefs.

    The eugenics movement—advocating segregation, forced sterilization, and even the killing of mental patients—blossomed in America in the early to mid-twentieth century, thanks to funding from men with household names like Kellogg and Eastman.¹ And the movement’s agenda was not carried out in secret, but was promoted by eminent scientists at some...

  8. 4 A Little Brain Pathology
    (pp. 44-66)

    If it were a drug or a medical device coming onto the market today, electroshock would have to be proven safe and effective in controlled trials, and would have to be cleared for use by the Food and Drug Administration (FDA). Because there were no such safeguards in effect in 1938, and because ECT’s inventors and promoters had never thought it necessary to carefully study large numbers of patients before selling their treatment to the world, each patient became, in effect, a guinea pig.

    This was a time before in vivo brain imaging was possible; the CAT scan, MRI, and...

  9. 5 Informed Consent and the Dawn of the Public Relations Era
    (pp. 67-85)

    The ECT industry entered the public relations era in 1972. At that point the industry committed itself to a strategy to which it has held fast ever since. It made the decision to actas ifECT had been proven safe and effective. In effect, its power and credibility would serve as collateral against the fact that a thorough and unbiased scientific investigation had never taken place, and against the word of innumerable ECT patients. As its numbers and influence grew over the decades, its collateral would be more than sufficient.

    The industry likes to point to the 1975 movie...

  10. 6 The American Psychiatric Association Task Force
    (pp. 86-106)

    In direct response to what it perceived as “challenges,” including real and imaginary legislative initiatives, organized psychiatry took action. In the fall of 1974, just as California passed its first ECT patients’ rights bill, the APA established the Task Force on ECT “to defend against the complaints that the treatments were dangerous and abused.”¹ It was so pleased with the way the task force strategy worked to forestall legislation in Massachusetts that it appointed the chair of that group, Fred Frankel, to head the national effort.

    The APA Board of Trustees selected the task force members. Five of the nine...

  11. 7 The Making of an American Activist
    (pp. 107-123)

    The American Psychiatric Association’s PR script does not allow for any criticism of electroshock. It is so overbroad in its denial of harm from contemporary ECT, and so committed to its denial, that it must dismiss all its critics as irrational. It does this effectively, without ever addressing any of their claims, by maligning their character, sanity, or motivation. This is usually accomplished by using one-word epithets, whether they apply to any particular critic or not. For example, those who challenge the use of ECT are said to be “antipsychiatry.” Scientologists. And in the case of former patients, crazy, hysterical,...

  12. 8 The ECT Industry Cows the Media
    (pp. 124-137)

    The campaign to sell psychiatry and its wares to the public began in earnest in August 1977, in specific response to theMadness and Medicineprogram. The newly elected president of the American Psychiatric Association, Jack Weinberg, sent out a letter to all its members that was also published inPsychiatric News.¹ It announced the beginning of the APA’s campaign to win over the media in the classic public relations manner: each member was asked to donate at least ten dollars to conduct a survey of public attitudes toward psychiatry. “APA cannot launch a truly effective campaign to improve the accuracy...

  13. 9 Long Strange Trip: ECT AT THE FOOD AND DRUG ADMINISTRATION
    (pp. 138-155)

    In the 1980s the ECT industry convinced the federal government that ECT was safewithout ever doing a single safety study. In place of clinical trials, it substituted a massive lobbying campaign to the Food and Drug Administration (FDA). The American Psychiatric Association, the National Institute of Mental Health, and doctors from the most prestigious hospitals and universities in America spoke as one to the agency, with a clear message:Do not test the ECT device for safety. And it worked. To this day, neither the FDA nor any manufacturer of an ECT device has ever conducted a study to...

  14. 10 The Committee for Truth in Psychiatry
    (pp. 156-169)

    Marilyn Rice had developed a core network of fellow survivors over the years, but she had never put together any kind of formal organization. “Organizing is definitely not my bag,” she was known to say, but by 1984 people were interested and the time was right. The work they were already doing at the FDA begged for a formal structure.

    Drawing on her own experience and that of so many others, Rice had already drafted a proposed informed consent statement for ECT, the first ever written by an ex-patient. The FDA had said back in 1979 that it could consider...

  15. 11 Anecdote or Evidence?
    (pp. 170-188)

    The APA was convinced that it needed to bolster its position with letters to the FDA from former patients who were satisfied with their treatment. It was aware of the letters pouring in from ex-patients reporting permanent memory loss and cognitive disability. In an effort to neutralize the effect of these reports, Richard Weiner begged for letters in support of ECT from expatients in the APA newspaperPsychiatric News(April 4, 1984), publicly admitting that the majority of letters received by the FDA were anti-reclassification.

    Many years later, as the battle between doctors and patients dragged on, he tried again....

  16. 12 Shaming Science
    (pp. 189-211)

    Medical science today is a practice far removed from the idealistic notions of helping patients or advancing scientific knowledge. Scientific research now requires institutional support and competitive funding. It’s a high-stakes, profit-driven enterprise where stakeholders with conflicting interests compete to influence and spin the results. Billions of dollars in industry profits, billions of dollars in future grant funding, and careers are riding on those results. Research findings showing no or negative effects of treatment serve none of these interests.

    Like the tobacco companies who promoted cigarettes despite mounting evidence that their product killed people, the ECT industry is in a...

  17. 13 The Lie That Won’t Die
    (pp. 212-230)

    For the most part, the general public doesn’t have the time or expertise to pore through original scientific research, or to investigate whether it has been biased by financial conflicts of interest. How, then, are we to tell good science from bad science, good advice on health matters from bad or biased advice? Whether we are deciding if we ought to avoid all fats in our diet, or if hormone replacement therapy is worth the risks, we make decisions based on what we see and hear in the media. But neither do the media look critically at what scientific research...

  18. 14 Erasing History
    (pp. 231-252)

    Besides the media, the public generally gets its opinions about shock and other treatments for mental illness from official sources, trusted authorities like the federal Center for Mental Health Services, the National Institute of Mental Health, the Surgeon General, and state departments of mental health. All of these have taken positions on ECT during the PR era. If you’ve heard or read anything of what these authorities say about ECT, it’s likely to have been dumbed down to the size of a sound bite reassuring you that shock is safe. Virtually no one reads the original reports, but even if...

  19. 15 The Triumph of Public Relations over Science
    (pp. 253-266)

    In its public relations campaign, the APA has successfully reshaped perception of the nature and risks of shock for a whole generation of doctors, patients, and the public. In doing so, it has subtly redefined the very meaning of words like “informed consent” and “competency” to its advantage. The result is that the ECT industry has found a foolproof way to get around the laws protecting patients’ rights to full disclosure and to refuse treatment. As well, it has been able to insulate itself from potential liability for damages. Patients today often have, in reality,fewerrights and less recourse...

  20. 16 Should ECT Be Banned? THE MORAL CONTEXT
    (pp. 267-286)

    It is impossible for anyone—doctors, patients, the public, the media—to discuss shock without speaking about it in moral terms. Questions such as, how much risk is justified for how much benefit? what should patients be told or not told? and whether forced shock can ever be justified—these are by their very nature moral questions, to be decided based on values and principles. At the same time they cannot be answered without the valid scientific evidence to answer other questions: Does ECT cause brain damage? How much permanent amnesia, how much permanent cognitive disability does it cause? For...

  21. 17 Where Do We Go from Here?
    (pp. 287-301)

    Despite the success of the public relations campaign, the battles over shock, primarily between doctors and patients, show no sign of subsiding. There are some subtle but hopeful signs that people who have experienced ECT and those who have the critical thinking skills to see through the industry propaganda may yet shift the balance in favor of truth and science.

    The saga of the ECT device at the FDA is not over, and there continues to be a role for ex-patients and the public to play in determining what happens next. The APA’s petition to reclassify the ECT device languished...

  22. Epilogue
    (pp. 302-305)

    Even in a book this long, so much has had to be left out. For this I apologize to those whose stories got told only in passing or not at all. I had difficult choices to make. Two of the most important stories left out were those of the citywide ban on shock in Berkeley, California, in 1982, and the period from 1991 to 1993 when shock was nearly banned in Texas. I chose to focus on Vermont instead of Texas because I had more primary source material available to me, and had been more directly involved in the legislative...

  23. Appendix: Letters from FDA Docket No. 82P-0316
    (pp. 306-315)
  24. Notes
    (pp. 316-348)
  25. Resources
    (pp. 349-350)
  26. Index
    (pp. 351-360)
  27. Back Matter
    (pp. 361-362)