In a 7/2 decision, the New York Court of Appeals has turned down Simone D., who had sued not to be put through electroshock again. (She’s had electroshock done to her over 200 times in her life).
According to the majority opinion,
At a hearing held on the petition, Dr. Ella Brodsky, a licensed psychiatrist and the person who administers the ECT at Creedmoor, testified that the appellant suffers from a “major depressive disorder, severe, with chronic features” and was incapable of making decisions regarding her own treatment. In fact, Dr. Brodsky asserted that during a meeting to discuss treatment, at which the appellant, her Spanish-speaking attorney, Dr. Brodsky, and the treatment team were present, the appellant refused to respond or even make eye contact.
Gee, the patient refused to talk or make eye contact during a meeting with the doctor who conducts torture on her. What could possibly account for that? Hmmmn….
A few points:
1) Electroshock, or ECT, Has No Proven Benefits.
The majority’s opinion relies heavily on Dr. Brodsky’s belief that electroshock is an effective treatment for Simone D. But the evidence that electroshock ((Including “ECT” or “electroconvulsive treatment,” which seems to bear approximately the same relationship to “electroshock” that “intelligent design” bears to “creationism.”)) has any beneficial effects is practically nonexistent.
For instance, Bonnie Burstow, an academic and psychotherapist, writing in the journal Canadian Woman Studies, reports: ((Burstow, Bonnie. “Understanding And Ending ECT: A Feminist Imperative.” In Canadian Woman Studies, aka Les Cahiers De La Femme, vol. 25 (1,2), p. 115-122. (.pdf link.) ))
While minimizing the damage done, ECT ((“ECT” stands for “electroconvulsive treatment,” a form of electroshock.)) promoters defend the use of ECT on the basis of its alleged effectiveness in alleviating depression and preventing suicide. And yet electroshock has no such special efficacy. In a rigorous double blind study, Lambourne and Gill found that a month after shock and simulated shock, shocked patients had not improved more than nonshocked. They concluded that shock does not produce a superior therapeutic effect and that its alleged effectiveness is due to placebo. Correspondingly, all the research on electroshock and suicide—for example, Black and Winokur—tell the same story: ECT has no effect on the suicide rate.
From a review of literature published in The International Journal of Risk And Safety In Medicine: ((I’ve edited out endnotes and citation details from this passage. Citation: Breggin, Peter (1998). “Electroshock: scientific, ethical, and political issues.” In The International Journal of Risk And Safety In Medicine, vol. 11, p 5-40. (.pdf Link.) ))
Crow and Johnstone, in a review of controlled studies of ECT efficacy, found that both ECT and sham ECT ((“Sham ECT” refers to faking ECT treatment but not actually shocking the patient. It’s the equivalent of treating patients with a sugar pill rather than a drug.)) were associated with “substantial improvements” and that there was little or no difference between the two. […]
At the Consensus Conference on ECT, critics and advocates of ECT debated the issue of efficacy. The advocates were unable to come forth with a single controlled study showing that ECT had a positive effect beyond 4 weeks. Many studies showed no effect, and in the positive studies, the improvements were not dramatic…. The Consensus Conference panel stated in its report that ECT had no documented positive effect beyond 4 weeks. […]
ECT is frequently justified as treatment of last resort in cases at high risk for suicide. […] Despite the claims of advocates, research uniformly shows that ECT has no beneficial effect on the suicide rate. […]
Some patients do feel “helped” by ECT. Often they have been so damaged that they cannot judge their own condition. They suffer from iatrogenic denial and helplessness. But should a treatment be banned when some people believe they are helped by it? In fact, it is commonplace in medicine and psychiatry to withdraw from use treatments and devices that have caused serious harm to a small percentage of people, even though they may have helped a very large percentage. The risk of serious injury to a few outweighs helping many.
In the case of ECT, a large percentage of people are being harmed, and there is very little evidence that many are being helped.
And of course, Simone D. doesn’t perceive herself as being helped by ECT at all.
So the first thing to understand about this decision is that it’s based on a false premise. The court’s assumption that ECT “works” and is beneficial, which formed the basis for their decision, does not have any empirical support in controlled scientific studies.
What has been proven beyond reasonable doubt is that ECT causes permanent damage to the brain. So Simone D. is being forced to have treatment that she finds painful and unhelpful, and which will permanently damage her brain.
What ECT brings to my mind this review of the book Madhouse — about Henry Cotton, administrator of a New Jersey asylum, who for decades forcibly removed teeth and other body parts from unwilling patients “for their own good,” and was much admired for this practice.
I don’t doubt that Dr. Brodsky believes she is doing good. But medicine, and in particular doctors at asylums, have a long history of doing grave harms to their patients in the name of helping them, based more on ideology than on evidence.
2. Most Electroshock patients are elderly women.
Multiple studies have shown that between two-thirds and three-quarters of patients given electroshock treatment — regardless of the diagnosis — are older women. From the activist website endofshock.com:
Why is it that women are disproportionately represented as electroshock patients?
1) This is a legacy of patriarchy, where women continue to be coerced, overtly or subtly into psychiatric treatment.
2) This is also a legacy of sexism, where “’masculine“ stoicism is valued and feminine” qualities such as emotional expression are classified as psychopathological. It is also related to sexism in that social and economic inequality is still a big factor in our society, and understandable stress reactions, sadness and confusion are interpreted as “symptoms of mental illness.”
3) Women, compared to men, are expected to be passive, and they may be punished or silenced for speaking out and complaining. When a woman is being considered for electroshock, one should ask, “What is important that she not remember and tell about?” Or “What is it that the others do not want to hear or look at?” Often it is abuse, always it is difficult or disruptive conduct that makes others feel uncomfortable or threatened.
4) Women are on average more open to getting help than men. In our psychiatric system, it is assumed that human problems and crises are due to biologically or genetically based “mental illnesses.” The primary treatment is psychotropic drugs, so women reaching for help get drugs, these drugs often do not help or actually worsen their situation; hence, the backup treatment of electroshock is brought into play.
5) Elderly women often cannot handle psychotropic drugs because of aging and infirmity, so are considered prime candidates for electroshock.
6) Women of perimenopausal may be experiencing depressive symptoms due to undiagnosed hormonal or endocrine changes.
Of course, the minority of patients who are young, male or both are equally important; electroshock therapy should be banned for all patients, period. But that doesn’t mean that we should ignore that this form of torture is practiced disproportionately against older women.
I expected that ECT would also be primarily used against lower-class and non-white women. However, according to Bonnie Burstow’s essay, “the primary target is middle-class white women.” ((From Burstow, page 120: “Whenever a relatively new area is taken up, it is easy to assume that the identical structural dynamics that apply to other issues apply to this one. Indeed, I have heard feminists who know little about ECT claim that working class women and women of colour are in greater jeopardy of electroshock. As demonstrated in Breggin (1997) and numerous other sources, the reality is markedly different. The primary target is middleclass white women. While is it important to start theorizing why this is the case and theorize it with an antiracist and anti-capitalist awareness, it is essential that we educate with this reality in mind.”))
3. Simone G. is a native Spanish speaker, but has not been offered substantial therapy in Spanish.
ECT shouldn’t be used at all, in my opinion; but even ECT defenders agree that if ECT is used, it should be a last resort. But — as the dissenting opinion by Judge Crane noted — treatment by a Spanish-speaking therapist was tried “for only a few weeks.” Simone G., through her lawyer, has requested that same-language therapy be resumed as an alternative to ECT, but this request has been refused.
Alison Hymes (whose mental disability rights blog is really great), writing in comments at the Mental Disability Law Blog, sums it up:
So they’ve caused her brain damage, documented in her record, tried psychotherapy with someone who speaks her language for only a few weeks, and they call this treatment? She doesn’t speak English but has no Spanish speaking MH staff, you think that might impact her mental health????
This is state sanctioned torture and brain damage. I thought NY was doing better than this a few years back. We need a stronger advocacy system in NY, that’s clear, and more rights for patients in treatment over objection hearings.
4. Who you can write.
Reclusive Leftist has the contact information for four New York politicians who should be emailed, faxed, called or emailed asking them to intervene on Simone G’s behalf.
(It’s via R.L. that I learned of Simone G’s case. She heard it in turn via Writhe Safely, which is annoyingly anti-feminist which I think is unfair to feminists (the post blames feminists for not knowing about an issue that has received zero media coverage; I think it would make more sense to blame the media) but I can totally understand why she’s pissed off, even though I think her anger is aimed a bit in the wrong direction. The Mental Feminist also has a post up.)
(Edited a bit to try and fix my phasing in the link to Writhe Safely. For the record, I don’t think she’s an anti-feminist at all. She seems like a cool person; I just disagree with how she wrote one post.)
Barry, thanks for picking this up. This is an excellent post you put together.
I just do want to say that Robin at WritheSafely is not anti-feminist; she’s frustrated. She’s been a feminist since olden times, like me, and I think her frustration is long-standing on the disjunct between feminism and psychiatric abuse.
Violet, I’d take it further, and say that there is a big disjunction between feminists and people who deal with any types of disability related issues. Certainly, mental health related disabilities are just one more example of this.
[Comment removed by author, who skimmed the post too quickly and skipped a whole section. Oops.]
I’m glad you’re covering this (really, I am), but I strenuously object to your characterization of Writhe Safely as “annoyingly anti-feminist (apparently feminists should be blamed for not knowing about an issue that has received zero media coverage).” True, its author cares more about actual women than about allegiance to ideologies, but that doesn’t make her “anti-feminist.” Taking feminism, and feminists, to task for ignoring issues as critical to women as electroshock is not “anti-feminist” – it’s in the interests of feminism. (Would you criticize as “anti-feminist” a blog author who takes feminists and feminism to task for inaction/ignorance on other specific civil rights violations? Or would you just say, damn, I had no idea, and proceed with educating yourself and spreading the word?)
[Blatant attempt to restart a many-months-dead flamewar over “Ampgate” deleted by Amp. If you don’t know what “Ampgate” is, you can read about it here — which is also the appropriate place to post comments about Ampgate, if you want to. –Amp]
Although I agree that this particular woman has been treated improperly, I have to question these statements about ECT in general. I think it’s telling that the only psychiatrist cited here as being opposed to ECT is Peter Breggin, hardly a credible source (see here for a response to Breggin’s writings about ADHD, although I couldn’t find anything about his writings on ECT specifically). For a more balanced review, I suggest this article. Referring to the procedure as “torture” is not supported by any evidence, and trivializes actual torture — ECT is usually voluntary, and doesn’t cause pain because it is performed under anaesthesia. Its side-effect profile is no worse than that of many non-controversial procedures.
I also suggest reading the comments to the Feministing post about this case, many of which deal with public perceptions of ECT.
Victoria and Violet, in response to your comments, I’ve edited the post. I didn’t intend to say that she herself is an anti-feminist, just that I thought the criticism in that particular, single post was unfair to feminists.
Yeah, it’s certainly not like after I read her post, I spent the next few hours researching the issue and writing a long post on it for my own blog, with exactly the attitude you describe here. (Rolleyes)
Kevin,
Wow, that’s as solid an example of an ad hom argument as I’ve ever seen.
An argument isn’t good or bad because of the person who makes it. I think ad homs are particularly bad arguments when the main thing the person you’re attacking does is cite studies by other people. To discredit the particular arguments I quoted, I think you need to show that his citations were either to illegitimate sources, or inaccurately described, or so badly done that they should be ignored.
(You might also have noticed that Breggin wasn’t my only source of info.)
One question, because I don’t have time to research it: is ECT supposed to be effective beyond 4 weeks? If it’s (supposed to be) used mostly for high suicide risk, it seems like effect within 4 weeks would be most important.
Barry, I didn’t say that you did not, in fact, educate yourself about this issue and proceed with spreading the word. Clearly, you did that, and well. What I had a problem with is that in the course of doing that, you found it necessary to pass judgment on the feminism of the (female) feminist disability rights activist whose work was an original source for your own explorations, from your ethically compromised (the material you edited out of my comment) position of male privilege. No, I didn’t carefully wrap my criticism in praise to make you feel better about it, but I don’t do that, any more than I start flamewars. (Hell, I’m not even blogging these days, and would not have come out of my silence as a commenter had it not been for the affront to Robin.)
I didn’t weigh in here on “Ampgate” as you’re calling it at the time because I didn’t want to give it any energy. If, instead, you materially benefited from racism (as you have from sexism) and then publicly castigated the anti-racist credentials of a person of color (while writing in an authoritative tone about an issue said person of color had originally developed) I’d have confronted you about that, too, and not on some old thread, but right there.
Victoria, the way to avoid replaying the entire debacle is to avoid replaying the entire debacle. I think you’ve made your point, and unless Ampersand disagrees, I think it would be good for this thread to be about ECT now, not Amp.
—Myca
I couldn’t possibly be in more agreement. I’m quite done with what I needed to say.
I just skimmed through the post/comments at Writhe, but I must say I generally agree with her. She is angry and frustrated and wrote a post out of anger and frustration. I don’t think it’s misdirected anger. I’m angry with feminists because mental health and general disability rights are LARGELY ignored, swept aside or given a token post every now and again. Disability rights and feminism would benefit greatly from working together… it makes me angry that disabled women’s voices are hushed or ignored as much as (if not more than) women of color feminist voices. You don’t blame WOC feminists for being pissed when that happens, you shouldn’t blame a woman frustrated with the lack of disability rights perspective in feminism.
**I don’t think you are particularly ableist, nor is your blog (though it basically only gets token posts now and again – which to some extent is expected given that you can’t cover everything), but the feminist movement in general has a LONG way to go.
Amp,
An argument isn’t good or bad because of the person who makes it.
However, people with bias have a tendency to present dishonest and/or one sided arguments. pointing out someone’s bias is standard in science and is a crucial aspect of accurate scientific disclosure. It has a big link to their perceived trustworthiness.
I skimmed through a variety of papers by that author. I noted that–accurately–she cited a variety of papers supporting her position. However, she doesn’t appear to have cited many contrary position papers. A quick scan of the (long) position-on-ECT paper from the American Psychological Association suggests that there are other data that she neither addressed or did a good job acknowledging. That makes me less likely to believe her scientific conclusions, and more likely to believe that she is promoting a political position.
Not that I’m a great fan of ECT, but I think you are mischaracterizing a valid protest as an ad hom.
Kate,
I hear what you’re saying… at the same time, I suspect there’s a fair overlap between feminits bloggers and people who have experienced mental health treatment. So I think the issue of representation of that particular facet of disability is a bit complicated.
I really love Ginmar’s posts about her experiences with PTSD. She talks about her treatment, which is appalling, and she also discusses her personal experiences in a visceral and moving way. It’s also given her a lot of perspective on the ways in which people treat craziness and the concept of craziness, which she describes in her usual pithy fashion.
An appalling story – my heart goes out to this woman.
But, alas, a seemingly-inevitable inevitable outcome of combining the power of the state with the power of the medical establishment, and applying it to society’s least powerful members. It happens all over; we only hear about a few cases that manage to come to the attention of people not beholden to the system.
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Harold Sackheim, the chief promoter of ECT in the U.S. for many years, himself finally came out and admitted that ECT causes memory loss and brain damage this year. I don’t know any legitimate or reputable psychologist or psychiatrist who will say that memory loss and brain damage are substantial risks with ECT nor any who will say that it works long term without being done repeatedly, thus increasing the risk of cognitive impairment.
As chair of my local hospital’s human rights committee, I took a tour of our ECT suite locally and listened to the psychiatrist who was in charge at that time. He was pro-ECT and yet spoke of the risks of cognitive impairment and the need to regularly screen maintenance ECT patients for it.
ECT was suggested to me by one doctor years ago, not my primary psychiatrist but someone in a program I was attending. My regular psychiatrist, not a non-traditional psychiatrist by any means, quickly vetoed the idea because, wait for it, I was too intelligent and I would be risking my intelligence. What does that tell you?
We have a Spanish speaking man in our local state hospital who like this woman has not been given any Spanish speaking caregivers. He has been living in seclusion, which they call an “alternative living arrangement” for a decade or more, for several of those years he was in restraints 24/7. It is far too easy for MH professionals to make someone into even more of a non-person than most psychiatric patients when that person can’t communicate with them.
This is about power over and control. It is not about helping anyone. In a previous case in N.Y. state, a young man in the same situation won his legal case. The ECT stopped and not long after he was released from the state hospital, doing much better. He was from Haiti and had been an activist in his home country.
Virginia is going towards making it even easier to force all kinds of psychiatric treatment on folks who are no danger to themselves nor others and even folks with dementia/Alzheimers are being considered by a member of my taskforce as ripe for forced treatment. For activists who don’t fit the norm or who don’t have a lawyer on speed dial, this is a good time to think about the risk of easier forced treatment by our government on all of us.
Appreciate you posting this. Regardless where one stands on ECT we can pretty much agree that forcing it on Simone D over her pleas and objections is unacceptable. The onslaught of emails might make a difference, thanks to all for sending them.
I don’t completely agree with this post. Specifically, there is evidence from randomized controlled trials that ECT can be effective in major depression.
That having been said, I seriously doubt that it is the right treatment for this woman. First, and most obvious, she doesn’t want it done and doesn’t feel she’s ever benefited from it. Second, she seems to have (from what I can tell from the information given) several characteristics associated with resistance to ECT so there is reason to believe that she is not a good candidate for it. Finally, she’s had it 200 times already. That is a more than adequate trial. It didn’t work, move on to something else. Talk therapy in her native language, for example, which hasn’t been given a decent trial yet.
There is a possibility that we’re completely wrong on this. Maybe in the past, after a couple of courses of ECT she’s happy and dancing and she only feels like they have never helped now because of her current depression. I doubt it, but suppose for the moment it were true. She is still getting inadequate care. As noted in the second link on this page, ECT is effective acutely, but the effects tend to wane with time. Therefore, it should really only be used in conjunction with other more long term effective therapy, i.e. psychotherapy. She has clearly not gotten this and therefore, is getting inadequate care, regardless of the justification or lack thereof of using ECT. She needs someone who can help her understand the reasons for her depression and find ways of getting out of the depressive thinking when it starts, not just someone who will give her ECT or feed her prozac when it gets too severe.
Then there is the follow up question: What should or can be done for this woman and other people with resistant depression? I have the feeling that if the letter writing campaign succeeds and the order to give ECT reversed, her doctors will shrug and abandon her to sit in a corner in a fetal position all day long, maybe stopping in to feed her through an NG tube when she stops eating altogether and basically giving up on her altogether.
I say this not to discourage people from writing but to suggest that they include some positive suggestions as talking points, ie pointing out that she hasn’t had an adequate course of psychotherapy in her native language and that a thorough review of her medication history may reveal pharmecotherapy options not yet explored, etc.
Dianne, the study you cite says that at follow-up at 12 weeks, there was no difference between the group who received actual ECT and those who received sham ECT, this is hardly proof that it is effective.
We don’t know that being locked up in a state hospital without anyone who speaks her language is not the real cause of this woman’s psychological problems. She has no one to speak to, why should she speak? She is efffectively being subjected to stimulus deprivation which has bad psychological effects on everyone. Being released from this snake pit may cure her “depression” as it did for the young man who fought maintenance ECT from Haiti and won and was released shortly thereafter.
Total institutions are depressing in and of themselves. Read Ayslums by Goffman, still apt and timely despite its age. The real problem is the idea that these places are ever helpful to anyone.
Alison, I don’t have to read about institutions like that, I’ve seen institutions like that first hand. Yes, psych wards are depressing. Yet most patients, if properly treated, do feel better even with the depressing surroundings, get released, and return to their lives. People who don’t get treated rarely do, even with the most pleasant and stimulating of surroundings. People with really severe, untreated (or inadequately treated) depression can actually get bed sores and contractures because they don’t move simply because their brains are so depressed that movement feels futile and like too much of an effort. Depression is a serious problem, not simply a matter of “oh, she just needs a more cheerful setting and she’ll be fine.”
The point of my second post is this: I don’t think that ECT will help this woman in the short or long term, but suppose it did work for her–suppose after a couple of treatments she felt much better. They’re still not treating her right because they have no long term follow up plan to prevent her from becoming depressed again or to help her deal with it when she does. ECT is not a long term treatment. It is, at best, a way to (sorry, I can’t seem to help myself from using this phrasing) jolt people out of a severe depression. If it is not followed by psychotherapy, drug therapy, or both, the depression will recur–as it did in her case. So she is clearly not getting good treatment even if they are right on the ECT issue. (Which I seriously doubt.)
Seen or been a patient in? There’s a huge difference.
I’m not sure where you are getting your information from, but people with severe depression do get better in better surroundings, smaller treatment facilities, caring psychotherapists, not available in practically any state hospitals, in their own homes with good intensive services and supports, and sometimes just on their own over time. I have had severe depression off and on most of my life, hospitals have made it worse in every case so I gave up on them long ago. A caring and skilled psychologist has changed my life and this is not because I was “never that bad in the first place” if that’s your next guess. I have been the person who could barely move, I was lucky to have supports in place that kept me alive while I recovered. Everyone should have the opportunity to recover in their own or their family’s home or if not possible a small treatment facility rather than a total institution. People with depression deserve no less respect and dignity than people with heart disease or kidney disease.
I’m not going to keep this up, I am not a fan of conflict.
Everyone should have the opportunity to recover in their own or their family’s home or if not possible a small treatment facility rather than a total institution. People with depression deserve no less respect and dignity than people with heart disease or kidney disease.
I agree with you. Everyone should have the opportunity to be treated in an optimal setting. But not everyone does. Remember the Reagan era deinstitutionalization crisis? It was declared (I think) unconstitutional (and expensive) to institutionalize people long term. So they were deinstitutionalized. I’m sure that helped some of them, but most simply ended up on the street without help and unable to care for themselves. Simply saying that living in an institution is bad (which it is) and closing the institutions is not enough: there need to be supports in place so that the formerly institutionalized can get the help they need or they will end up in a worse situation than before.
I almost didn’t read your comment because it was becoming overly personal for me, but I’m glad I did because I see now that you’re coming from a very different place than where I thought you were coming from. So here’s the anecdote that leads me to get upset when I think that people are blowing off depression as not a real disease: One of my great aunts fell into a deep depression after her husband and child were killed in an auto accident. Her family took her in and tried to help her, but they had no real idea how and she simply got worse as time went on. Eventually she starved to death not because she committed suicide by fasting but simply because she could not come out of her depression enough to be able to eat. I don’t know if modern psychiatry could have saved her or if she simply would have ended up sitting in a back ward instead of on the back porch for the rest of her life, but I know that just having a family that cared wasn’t enough.
The problem (or a problem) is that many people don’t seem to understand that depression is a real disease, much like kidney or heart disease. It is a real disease and untreated has a death rate of about 20%. But it isn’t treated the same as any other disease. Even good health insurance plans usually cover 23 psychiatric visits a year–and usually only half the cost of the visit. But psychotherapy requires a minimum of weekly visits to be effective. So poor people tend not to get it. Life insurance policies don’t cover suicide, because, I suppose, it is the “fault” of the deceased that they died so why pay their beneficiaries?
Ok, I’m ranting and you know all this at least as well as I do. I’m sorry that I misunderstood your position.
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