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The Electrical Abuse of Women: Does Anyone Care?

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Photo by Bjoertvedt | CC BY 2.0

Many Americans are unaware that electroconvulsive therapy (ECT)—more commonly known as electroshock—continues to be widely utilized by U.S. psychiatry. In the current issue of the journal Ethical Human Psychology and Psychiatry, psychologist John Read and co-author Chelsea Arnold note, “The archetypal ECT recipient remains, as it has for decades, a distressed woman more than 50 years old.”

In a comprehensive review of research on ECT, Read and Arnold report that there is “no evidence that ECT is more effective than placebo for depression reduction or suicide prevention.” They conclude, “Given the well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.”

This begs the question of why this brain-damaging electrical abuse of predominantly middle-aged women, unlike the sexual abuse of younger women and girls, is not today addressed by most high-profile feminists. One renowned feminist who did speak out against ECT was Kate Millett (author of the 1990 book Loony Bin Trip), but she died in September 2017 after receiving little attention in recent years. There continues to be women such as psychologist Bonnie Burstow (author of the 2006 article “Electroshock as a Form of Violence Against Women”) who do see ECT as a hugely important issue for women, but Burstow is renowned only among ex-patient “psychiatric survivor” activists and dissident mental health professionals.

Today, many self-identified feminists, like most other Americans, apparently have uncritically accepted the American Psychiatric Association’s proclamation that “extensive research has found ECT to be highly effective for the relief of major depression”—a promulgation that has no scientific basis. In recent years, psychiatry’s assertions have been uncritically accepted, perhaps because the APA has quite effectively marketed the idea that questioning psychiatry is like challenging evolution, global warming, and science itself.

The reality is that the APA and mainstream psychiatry has, for quite some time, disregarded science, specifically the standard scientific methodology by which treatments such as ECT are evaluated. Standard scientific methodology requires a placebo-control group, without which it cannot be determined as to whether the treatment itself or mere patient expectations result in positive outcomes. Psychiatry has long abandoned studying ECT utilizing a placebo-control, no doubt because in the past such methodology showed ECT to be ineffective.

Prior to 1986, there were 10 placebo-controlled experiments done on ECT use on depressed patients. The placebo utilized in these studies was a simulated ECT (SECT) in which the general anesthetic is applied but the actual electricity is withheld. Read and Arnold report that none of these studies showed ECT effectiveness beyond the end of treatment.

Among these 10 placebo-controlled studies, 6 reported immediate benefits for a minority of ECT recipients (perceived as benefits sometimes only by psychiatrists and not by other raters), and 4 studies reported there were no immediate differences between ECT and SECT. Most importantly, none of the 10 studies reported any differences in effectiveness between ECT and SECT beyond treatment. Only 4 studies followed participants beyond the end of treatment, and none of these studies found differences between ECT and SECT subjects.

It is troubling that since 1985 there have been no placebo-controlled studies examining whether ECT has any benefits for depression beyond the treatment period. In that last 1985 study, researchers found no differences in effectiveness between ECT and SECT groups at either 1 month or 3 months after treatment. While there have been studies done on ECT for depression since 1985, none have been placebo-controlled, so they do not allow for scientific conclusions on effectiveness. (Recent ECT studies have commonly looked at predictors of ECT responses, including examining procedural differences in ECT delivery.)

While psychiatry quotes studies stating a high percentage of patients improved with ECT, lacking a placebo-control, these studies are scientifically meaningless. A significant number of patients with depression will report improving with any kind of treatment. Much of the effectiveness of any depression treatment has to do with faith, belief, and expectations. That is why it is critical to compare a treatment to a placebo so that it can be teased out what part of improvement had to with the treatment itself vs. faith, belief, and expectations. In a similar vein, one can find many patient testimonials for ECT, as one finds testimonials for any treatment; but in science these testimonials are referred to as anecdotal, and mean only that a person believed a treatment worked for them, not that the treatment has been proven to be scientifically effective.

Psychiatry is well aware of ECT’s negative public image, so today the administration of ECT is not as painful to observe. Patients are administered an anesthetic and given oxygen along with a muscle relaxant drug to prevent fractures. However, the goal of ECT is to create a seizure, and these ECT “procedural improvements” raise the seizure threshold, thereby necessitating a higher and longer electrical charge, potentially resulting in even greater brain damage. The standard “electrical dosage” is from 100 to 190 volts but can rise to 450 volts. Thus, while ECT no longer appears quite as torturous to observers as it appeared prior to these procedure changes, ECT’s effects on the brain are as—or more—damaging than ever.

Even ECT advocates such as the APA recognize ECT’s adverse effects on memory, but the APA tends to minimize the extent of this damage. However, in 2007, the journal Neuropsychopharmacology reported a large-scale study on the cognitive effects (immediately and six months later) of currently used ECT techniques. The researchers found that modern ECT techniques produce “pronounced slowing of reaction time” and “marked and persistent retrograde amnesia” (the inability to recall events before the onset of amnesia) that continue six months after treatment.

Just how widespread is ECT treatment? In 2009, the Journal of Psychiatric Practice reported, “approximately 100,000 people in the United States and over 1,000,000 worldwide receive ECT.” However, this is only an estimate. Not all U.S. states require ECT reporting, but Texas does require it and documented earlier this year: “In fiscal year 2016, 22 of the 25 facilities in Texas with registered ECT equipment performed treatments and provided the required patient reports to the state. There was a 1.1 percent increase in the number of treatments in fiscal year 2016 compared to 2015.” Texas reports 2,675 “aggregate quarterly reports of patients who received ECT” (if patients received ECT in multiple quarters over the course of the year, they may have been counted more than once). There is wide variation of ECT use within the United States, as the journal Brain and Behavior reported in 2012 that, among the Medicare population in the United States, ECT treatments were twice as common in urban areas as in rural areas, and ECT was more common in the Northeast than the West.

“Women are subjected to electroshock 2 to 3 times as often as men,” notes Bonnie Burstow. There is no controversy that women are far likelier to receive ECT treatment than men. The 2016 Texas report noted females received 68% of the ECT treatments. While men too are treated with ECT, similar to the statistics on sexual abuse, men receive ECT at a much lower rate. With respect to age, Texas reported that 61% of those who received ECT were 45 years and older (age within gender was not broken down in the Texas report).

Psychiatrist commonly recommend ECT to severely depressed patients after various antidepressants fail to improve symptoms. Psychiatry increasingly focuses on symptoms and not causes of our malaise, and so it often fails to address obvious sources of depression such as loss, unhealed traumas, and other overwhelming pains. The Interactional Nature of Depression (1999), edited by psychologists Thomas Joiner and James Coyne, documents hundreds of studies on the interpersonal nature of depression; in one study of unhappily married women who were diagnosed with depression, 60 percent of them believed their unhappy marriage was the primary cause of their depression. It is often an unhappy marriage or isolation and loneliness that fuels depression, but it is easier and more lucrative to offer ECT after antidepressants fail than to make all therapeutic efforts at ameliorating the source of depression.

ECT patients do routinely sign consents to treatment, so how can ECT be considered abuse? The reality is that most consents are not truly informed consents in which patients are made aware of the truth about risks and benefits. Moreover, when we are depressed, even if risks are stated, our capacity to question and resist authority is highly diminished. While psychiatry refuses to acknowledge that vulnerable people can comply with abuse by powerful authorities such as themselves, Louis C.K. ultimately did recognize this reality about sexual abuse:

“At the time, I said to myself that what I did was O.K. because I never showed a woman my dick without asking first, which is also true. But what I learned later in life, too late, is that when you have power over another person, asking them to look at your dick isn’t a question. It’s a predicament for them. The power I had over these women is that they admired me. And I wielded that power irresponsibly.”

The damage of sexual abuse is caused by the trauma of violence as well as, for many victims, the shame over not having resisted it. Some self-identified psychiatric survivors have shame over giving psychiatry permission to show them its ECT dick. The wound of shame can heal with love. However, neither love nor anything else can heal the brain damage caused by ECT.

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Bruce E. Levine,  a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect.  He is the author of Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite (Chelsea Green Publishing, 2011). His website is www.brucelevine.net

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