Anti-ECT protesters are wrong and dangerous
Posted May 15, 2015
The following post was co-written by Dominic A. Sisti, PhD, Director, The Scattergood Program for Applied Ethics of Behavioral Health Care, University of Pennsylvania.
Is electroconvulsive therapy (ECT) controversial? Google certainly thinks so: a search for those two terms together resulted in over 100,000 hits, and that number is bound to increase as the “World Wide Protest of Electroshock” approaches on May 16.Organized by self-identified electroconvulsive therapy (ECT) “survivors” Ted Chabasinski and Debra Schwartzkopff, this effort currently includes 30 events scheduled in several countries, including the United States, Canada, England, Argentina, and Chile. But as those web entries pile up, it’s important to ask: why, exactly, is ECT so controversial? And to what degree should that controversy, periodically whipped up by anti-ECT advocates, be permitted to drive public policy regulating the accessibility of a therapy that is currently helping an estimated 200,000 Americans?
There is no doubt that ECT has a checkered history. It was overused, particularly before the introduction of anti-depressants in the 1950s, and it was involved in truly inhumane medical experiments on brainwashing and gay conversion. But this reflects more on the doctors running these protocols than ECT itself: virtually anything can kill you if you take too much of it, including water. The only question that should matter to patients considering this treatment or bureaucrats charged with regulating it is whether ECT, when properly administered for indicated conditions, is safe and effective.
Science has answered this question, but you wouldn’t know it from reading through the propaganda currently being disseminated by the “World Wide Protest of Electroshock” organizers. These include several brochures, posters, and links to YouTube videos that all condemn ECT – and not one scientific study is cited in any of these materials.
Peter Breggin, in his video, refers viewers to his website, ectresources.org, and his list of “More than 125 Scientific Articles” that support his claim that ECT is “brain damage.” But this list is dominated by newspaper articles, letters to the editor, personal experiences and opinion pieces. Twenty-four citations date to 1960 or earlier, and fifteen have nothing whatsoever to do with ECT, focusing rather on effects to the brain from stroke or traumatic brain injury. There are exactly three articles on the entire list that address the question of whether ECT is effective; these are review articles summarizing the psychiatric literature comparing ECT to a control condition known as “sham” ECT, in which patients believe they are getting ECT, and are actually put under general anesthesia, but receive no electrical stimulus. Anti-ECT advocates like these studies because they generally show that, while patients getting real ECT initially improve much more than those in the control group, “No study demonstrated a significant difference between real and placebo (sham) ECT at one month post-treatment,” as Colin Ross reported in 2006. But this is a meaningless argument: the effects of ECT are transient, and typically must be maintained with periodic ECT or medication. Damning ECT for this reason is like dismissing dialysis because a patient went into kidney failure a month after treatment.
In another video, Nancy Rubenstein informs viewers of the call for more research that emerged from the last FDA hearing on the regulation of ECT devices, in January 2011. “That research has never taken place,” she proclaims. A simple pubmed search, however, reveals almost 1500 studies that have been published since then – articles in peer-reviewed journals that not only confirm ECT’s safe and effective treatment of classic indications such as depression, bipolar disorder and schizophrenia, but also suggest it may be able to ameliorate the devastating symptoms of autism, Alzheimer’s disease and Parkinson’s disease. Incidentally, no studies have found that ECT causes “loss of personality” or makes patients “docile and submissive,” as Breggin claims. Much research has examined the side effects of ECT: the most frequently reported are headache and nausea, but short-term memory loss is not uncommon. Six months after ECT, the cognitive functioning of the vast majority of patients is either back to baseline, or, in many cases, improved.
That FDA hearing was puzzling, in retrospect. It’s unclear why the government should be soliciting personal testimony, either negative or positive, when it has a wealth of empirical evidence to consider (in this case, over 10,000 studies altogether). Anecdotes are obviously useful in the absence of such a record – for example, parental reports of the resolution of their children’s intractable seizures with medical marijuana has driven new research – but that isn’t the case with ECT. Perhaps the FDA felt it was preserving the democratic process by inviting public opinion, but science is decidedly not democratic. Which is why, on May 16, as anti-ECT groups exercise their right to protest, it is incumbent on us all to focus on the science, which has been and always will be our best champion in the fight against disease. A few advocates calling for blanket bans on ECT based on anecdote or personal experience, gruesome movie depictions or gross misinformation disseminated by anti-psychiatry machines like the Church of Scientology risk denying many more people a potentially beneficial treatment.