Committee For Truth In Psychiatry Informed Consent Statemement Patients Often Aren't Informed of Full Danger Quick Results Often Fade Just As Fast For Patients, Treatment Value Varies How Shock Therapy Works Doctor's Financial Stake In Shock Therapy
The Committee for Truth in Psychiatry, or CTIP, is a national organization of over 500 former electric shock patients. None of us was truthfully informed about the nature or consequences of this treatment before consenting to it, and we have pooled our experience-gained knowledge to provide truthful information about it for future psychiatric patients.
Over the years, many individual recipients of "electroconvulsive therapy" (ECT) (shock treatment) have related their personal experiences, verbally or in writing, emphasizing whatever aspects were most important in each one's special circumstances. What the CTIP has done as a group is to highlight and emphasize the common demoninators in the shock experience. Accordingly, though our members differ widely in the details of their own stories, including how they got into ECT and how much good or (more often) harm it did them, we can agree on the most certain effects of ECT and that future patients should be informed of them before they give their consent to it.
FDA had classified the ECT device or shock machine in the highest risk class of medical devices, Class III, which classification earmarked ECT for a safety investigation; and the American Psychiatric Association (APA) had subsequently petitioned FDA to reclassify the device to Class II, which action would constitute recognizing ECT as a safe treatment without an investigation. The FDA was preparing to grant the APA's petition when the CTIP came in to oppose reclassification and to press for an investigation. We were confident that an impartial scientific investigation would confirm in physical terms what is apparent from ECT's emotional and memory effects: that it is inherently brain damaging.
Throughout the rest of the 1980s, the CTIP both enlarged its shock patient membership and also became the central contact for other individuals and organizations who urged an FDA investigation of shock treatment, including all fifty of the state Protection and Advocacy agencies.
Expansion of the CTIP was based on its informed consent statement. Any former shock patient who endorses it is a member. Membership imposes no duties or dues, but every endorsement stregthens the patient voice. And since we were bound together by agreement on the fundamental of the shock experience, we could operate without elected officers. Any member who chose to be active could speak, write, or deal with the FDA in the name of all.
With only such an informal kind of organization, we managed for six years to forestall action toward reclassification. Ultimately, however, the FDA bent to the stronger pressure from the psychiatrists and published in the Federal Register of September 5, 1990 a "proposal to reclassify" the ECT device to Class II. Since then, the classification (and investigation) have been "on hold", with no reclassification or investigation having yet taken place.
Regardless of when or in what direction the FDA may move, the CTIP is continuing to work for truthfully informed consent. The problem we alone address is that patients throughout the country are routinely misinformed and misled as to the results to be expected from shock treatment. At the same time, regulatory actions concerning ECT are under way in various state and local governments, instigated in some cases by ex-patients and in some cases by the electroshock industry. In any of these arenas, the opportunity exists for CTIP members to step forward and push for a requirement for truthful information, for they speak with the authority and credibility of a concerted voice of experience---a voice which grows stronger with the addition of each new member.
If you have had ECT, and if you would like to help protect future patients from consent by deception, we hope you will add the weight of your endorsement to our proposed informed consent statement. Both electronic and snail-mail versions of the statement and membership form are available. If you have questions, please call or write the CTIP Director, Linda Andre, at 13 St. Marks Place, New York, NY 10003, phone 212 473-4786.
We would like to see the federal government, through the FDA, or states through their Offices of Mental Health, adopt this statement.
What ECT does is to produce profound emotional relaxation. The patient sleeps and eats well and her or his body has an opportunity for rest and repair. When the relaxing effect wears off, which is in a few days or weeks, the patient may remain well or she may relapse.
The essence of a grand mal epileptic seizure is the intensely rapid "firing" of every brain cell. In a natural seizure this activity of the brain causes the body to thrash about wildly, but when a seizure is induced in ECT the movements of the body are largely suppressed by a drug. In either case, if a complete grand mal seizure is occurring in the brain, the person is unconscious.
An ECT treatment is usually given in the morning before breakfast. First the patient receives an injection to reduce secretions in the mouth. Then she is taken to the treatment room, where she is given a general anesthetic through a vein in the arm. This takes effect quickly and is followed by another drug through the same needle, this being the one that suppresses muscle movement. The anesthetic is not necessary for the shock treatment as such, for the shock would produce unconsciousness, but it is given to spare the patient the feeling of becoming paralyzed. Next, two electrodes are applied to the head and a current passed briefly between them. (Most commonly, the electrodes are on the temples and the shock is about 140 volts for half a second, but these particulars may vary.) The brain seizure that is triggered by the shock lasts about a minute.
Throughout the treatment procedure the patient does not experience pain or discomfort, but she awakens soon afterward in a state of confusion. When the confusion subsides, she can resume her daily routine. Headache, mild muscle soreness, or nausea sometimes occur, but these usually respond to simple medication.
Treatments are usually given three times a week, and a typical course of ECT consists of from six to ten treatments.
During a course of treatment the patient experiences a cumulative eradication of memory, which begins with recent events and learning and thoughts (including worries), and gradually extends to the distant past. Once the course is ended, memory gradually returns in the opposite time order until, in about a month, the patient has regained the main outlines of her personal history and also knowledge and skills acquired early in life. After this length of time there is little further automatic return of memory, although a good deal more has become strong enough that it can later be revived by reminders or efforts at relearning.
The extent of the permanent memory loss varies with the number of treatments, age of patient, placement of electrodes, and other factors, but the pattern of loss is the same for all patients. The loss is total or near total for the period of the ECT course and tapers back over previous years with smoothly diminishing severity and no precise cut-off point. The patient's remaining memory appears "spotty" in that the smooth amnesic blanket has merely dimmed some memories but submerged others, depending upon their original relative clarity.
In addition to this erasure of pre-shock memory, which is certain to occur, there may also be a permanent adverse effect upon memory function after the shocking. That is, the patient's memory for new experiences and new learning may fade rapidly.
Some patients do not mind their memory changes and seldom have occasion to notice them. At the opposite extreme are persons whose work or way of life is made impossible by them. In between are persons who gradually adjust to various degrees of handicap.
Aside from adverse effects on memory, ECT contains also, like other major medical and surgical procedures, some element of ordinary risk. Fatalities are very rare, but there is a slight possibility that a stroke or heart attack could occur during a treatment. There is also the possibility that a particular individual may experience one or more untoward after-effects in addition to the expected deleterious effect on memory.
If you have had ECT and would like to add the authority of your experience to our efforts to obtain informed consent, please fill out and submit the electronic version or the snail-mail version of our CTIP Support Form.
