“Let’s Not Go Overboard About ECT”

By Peter Breggin, MD

This post was first published on Mad in America on March 3, 2019 and can be accessed here.

In an internet email discussion among a large group of supposedly enlightened mental health professionals, few came forward to outright condemn or ban ECT. One participant responded to my comments with, “It worries me how this debate gets so polarized. I appreciate Peter’s opposition to ECT. But that doesn’t mean ECT has not ‘helped people’ even though it might be a placebo effect.” Another declared it was “fashionable” to criticize ECT, but all treatments had their pros and cons. Most seemed to agree that “it sometimes works.”

This refusal to say or to accept something polarizing is a hallmark of most so-called reformers in the field of mental health. What about lobotomy—most of which my 1970s campaign stopped? What about insulin coma therapy? The spinning chair? What about freezing baths? What about the bleeding and purgatives? What about all the other atrocities committed by psychiatry on helpless “patients”? Should we never have simply said, “Stop!”?

Some Things Are Worth Polarizing Over

We know enough about the damage caused by ECT to conclude that it would be unethical even to experiment on people (and perhaps even on animals) in search of that person who supposedly might benefit. I was once asked to add my guidance as a consult to a study of ECT in a foreign country in order to make sure the damaging effects were revealed by the measurements. It would have been like participating in a study of beating children and adults to make sure the perpetrators properly cataloged all the harms. The only possible ethical guidance, I decided, was to urge an end to the experiment and to refuse to participate.

Refusing to take a rock-solid stand against atrocities results in violent people and institutions getting away with things like ECT and lobotomy, and severe spankings or beatings of children, for that matter. Like psychiatrists who refuse to reject ECT for children or adults, many educators once defended “corporal punishment” as a benefit to some children when used judiciously. Mealy-mouthing like this prevents the abolition of these abuses and empowers those who wish to shock, lobotomize or beat children and adults, if only “when necessary.”

What Do We Mean that ECT “Sometimes Works”?  

Perhaps ECT “works” about as often as a severe beating inflicted on a child. Anecdotes tell us nothing because even if it were true that some people were supposedly helped by ECT, even as a placebo effect, we have no way to separate out the potential rare ECT victim who seems helped from the thousands more we know are harmed. The same would be true if we looked at beating children, which many parents to this day still swear by. Some adults believe their childhood beatings made them into better adults, a conclusion they too often then inflict on their own children as well.

Who is making the judgment that ECT works? It is almost always the doctors who prefer a stone face to a sad or angry one. It is also those nurses who prefer a more compliant patient who never “complains.” Sometimes it is an oppressive family member who prefers a more docile husband, wife or child, or a misguided loved one who mistakes passivity and lack of verbalized complaints for an improvement.

Most ECT patients, especially those who are “helped,” are too harmed to evaluate or to fully understand what has happened to them. As I describe in comparing some similar effects of psychiatric-drug neurotoxicity and ECT-induced brain damage, frontal lobe dysfunction diminishes finely tuned faculties such as self-insight or self-awareness. In addition, these victims may be saying they were helped in order to avoid being subjected to more of the same, much as children in violent homes and inmates in mental hospitals will act grateful for what they are getting, in order to avoid further harm. Indeed, patients teach each other to go along with everything in the mental hospital so that they can get out quicker and more safely.

Protecting the Feelings of People Who Don’t Know They Are Harmed?

What about the sensibilities of people who think they have been helped by ECT? I frequently am consulted by people who feel they have been injured by ECT or drugs. I’ve even seen people who have been injured by psychosurgery. All these people are almost always more harmed than they realize, and yet when I talk with them in a caring and honest manner about these harms, they feel relieved and deeply grateful. At long last, after so many professionals minimizing or denying the damage done to them, they feel understood and they feel confirmed. They feel better knowing what’s been done to them and having a doctor empathically share their loss, sadness and outrage. What I describe in The Heart of Being Helpful as a “healing presence” requires a combination of being honest, respectful and caring.

After discussing the harms with the victim and hopefully with sympathetic family members, I can then share with them another truth—that we human beings have such great psychological and spiritual resources that we can learn to live good lives despite the harm done to our mental functioning. Sometimes we can build much better lives—sometimes better than ever before—by learning to live as responsibly and as lovingly as possible. But how much better it would have been to have avoided the physical and emotional trauma of ECT and instead to have been helped in building a good life by the first professionals from whom we sought help.

The Woman Who Gave a Testimonial for ECT

At a large government-funded ECT conference where I was the sole expert on harm from treatment, a woman testified on the podium that ECT helped her. She looked very sad as she talked. Afterward, at the official press conference, she gently squeezed my arm as she passed by me and pressed a scribbled note into my pocket. Her note read, “Dr. Breggin, thank you for speaking out.” Even this woman, who professed in public that ECT helped her, was secretly grateful for my saying outright that it hurts people and should be stopped.

Peter Breggin, MDhttp://www.breggin.com
The Breggin Blog: The Conscience of Psychiatry: Dr. Breggin has been called “The Conscience of Psychiatry” for his decades of successful efforts to reform the field. He criticizes psychiatric drugs and ECT, and promotes more caring, empathic and effective therapies. His newest book is Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions.