In my last blog, I wrote about the threat posed by long-time ECT advocate Harold Sackeim and five colleagues, "The Cognitive Effects of Electroconvulsive Therapy in Community Settings," in the journal Neuropsychopharmacology in January, 2007 (32: 244-254). The most obvious and immediate one, which I have already discussed, is that while showing that bilateral ECT produces adverse cognitive effects, the study still leaves the door open to the administration of right unilateral ECT-- indeed, as I have shown, promoting its use was the authors' intention. But the more I think about it, the more problems I find with this article, which has been so tragically misinterpreted by the movement for the rights of mental patients. For instance, if one analyzes the conclusion, which has given ECT opponents such false optimism, "There seems to be little justification for the continued first-line use of bilateral ECT in the treatment of major depression," one can see that not only does it not rule out the use of right unilateral ECT as a first-line treatment for that illness, it also does not rule out the use of bilateral ECT as a "last resort" if other methods fail. And perhaps even more disturbingly, it says absolutely nothing about the use of ECT to treat other mental illnesses besides major depression.
This presents a danger to a wide range of people because of the way that mental illness is defined. After all, only a minority of people who are diagnosed as mentally ill have ever experienced a psychotic episode. And of those who have-- schizophrenics, manic-depressives (those suffering from what is today called bipolar disorder) and depressives-- many are quite sane most of the time. I recently received the fall, 2008 Journal of Mind Freedom, the leading American organization fighting for the rights of mental patients, and was dismayed as always to find the term "mad pride" all over it. Indeed, the letter from the executive director, David Oaks, entitled "Why Mad Pride?" uses the term throughout with no apparent recognition of the way it discredits everything he says. No one will or should believe someone who is psychotic-- that is to say, irrational-- and organizations like Mind Freedom do not have to persuade the public to do so in order to achieve their goals. For it is unequivocally evident that, whatever he might have experienced in the past, David Oaks has not been having psychotic episodes for the twenty years during which he has headed Mind Freedom, and he was not having one when he wrote this letter. Mind Freedom could not possibly have mounted an effective campaign for anything whatsoever while its members were in the grip of psychosis. There is no evidence of it anywhere on their website or in their publications. Why then do they indulge in the manifestations of self-loathing signified by the term, "Mad Pride"? An article in the New York Times says that "Just as gay rights activists reclaimed the word 'queer' as a badge of honor rather than a slur, these advocates proudly call themselves 'mad'." But this is not true: having lived for much of my life in San Francisco I know that "queer" remains a slur-- what homosexuals did was to find a new word-- "gay"-- to describe themselves. The self-abasement indicated by their adoption of the word "mad" to describe themselves makes members of the movement for the rights of mental patients ill-equiped to fight ECT.
The majority of people diagnosed as mentally ill have what psychiatrists term a "personality disorder". "Personality disorder" is defined by the APA as an "enduring pattern of inner experience and behavior which deviates markedly from the expectations of the culture of the individual who exhibits it." Nothing comes closer to an admission that to psychiatry, people who are simply different are considered for that fact to be mentally ill. Given that this is the official definition (see Wikipedia article on the subject), no psychiatrist could deny that the object of psychiatry is to punish and persecute social deviance and non-conformity. People diagnosed with a personality disorder are not psychotic, but many psychiatrists believe that personality disorders represent milder forms of the psychoses they resemble. In other words, someone with a minor depression could become a major or manic-depressive, and someone with a schizoid or schizotypal personality could become schizophrenic. I recently received an e-mail circular from Rene Talbot, who heads an organization for the rights of mental patients in Germany. He said that his country is on the verge of adopting a provision, fraudulently claiming to be derived from the UN Declaration on the Rights of Persons with Disabilities, which would allow its government to incarcerate an individual diagnosed as mentally ill if he is a danger to himself or others, or under additional circumstances which are not specified. It is easy to see where this provision came from: the equally fraudulent "War on Terror" being waged by the United States government. The aspiring totalitarians in our government have not only the unconstitutional Military Commissions Act to use against dissidents, they also have the category of mental illness, which has long been used to incarcerate people against their will. And of course the worst weapon in their arsenal of repression is ECT.
Although ECT is usually thought of as a treatment for depression, it is in fact also being used against people who are diagnosed-- whether rightly or wrongly-- as schizophrenic (and remember that those diagnosed with a milder personality disorder which resembles schizophrenia can easily be pushed into this category). The website of ect.org has an article based on a number of studies which concludes that "There is some evidence to support the use of ECT for those with schizophrenia for short-term relief of symptoms. Electroconvulsive therapy may be advocated as an adjunct to anti-psychotic medication for those with schizophrenia who show a limited response to medication alone but the evidence for this is not strong... evidence exists to suggest that combining antipsychotic drugs with ECT increases the rate and extent of clinical improvement, in the short term, in one out of every five or six people." (http://www.ect.org/resources/schizophrenia/html) In other words, for the sake of mere short-term improvement, and although the majority of patients show no improvement at all, psychiatrists are willing to take the tremendous risks involved in the administration of ECT, in combination with anti-psychotic drugs which are themselves dangerous. Of course, as I have said before, we need more studies of the effects of unilateral ECT to determine just how dangerous it is, but no form of ECT can be said to be free of risk and to prescribe it under such questionable conditions is truly playing God. Leonard Frank's History of Shock Treatment contains an alarming quotation from English psychiatrist Andrew Wyllie: "The introverted schizophrenic or melancholic may be likened to a walled city which has closed its gates and refuses to trade with the rest of the world. Methods of persuasion having failed to get the citizens to open the gates of 'Mansoul', the artillery of convulsion therapy is brought to bear upon the walls of autism." (p. 14) It seems appropriate that Wyllie was willing to play the role of Satan in the story from which the name 'Mansoul' was taken-- John Bunyan's Holy War.
Is there any circumstance under which the adminstration of ECT may be justified? I was greatly disturbed by another article in the Fall Mind Freedom Journal. It was taken from an address by Mary Van Pelt, entitled "May is Mental Health Awareness Month". In it she speaks of the job discrimination that she, as a highly-placed professional, experienced when it became known that she had been diagnosed with bipolar disorder. This is a legitimate topic for an organization devoted to the rights of mental patients, and would be all the more relevant if she had been falsely diagnosed with a psychotic illness, as many people are. Then she goes off on a very dangerous tangent: "When my career ended so did my need to keep silent about a condition which kills thousands every year... Suicide statistics are difficult to track due to the very nature of suicide. The act is surrounded by stigma. Depending upon the circumstances, suicide can be reported as death from natural causes. The National Strategy for Suicide Prevention estimates that between three and twenty per cent of persons diagnosed with bipolar disorder die each year by suicide. Because of my own experience, I find this statistic very easy to understand." (p.11) How on earth could Mind Freedom have failed to see that this woman is quite obviously working not for patients' rights but rather for organized psychiatry? After all, bipolar disorder and suicide are not political issues, they are personal ones. And a feigned concern over the possibity of suicide is the most common justification for the use of ECT-- one assumes from his conclusion that Sackeim would approve of even bilateral ECT for the suicidal patient. In directing her comments at the danger of suicide rather than psychiatric abuse, Ms. Van Pelt shows very clearly where her sympathy lies-- not with mental patients but with psychiatrists.
Why is her tactic so dangerous and insidious? First of all, because people falsely assume that every suicide is the result of mental illness. Obviously Van Pelt does, and it is people like herself who have stigmatized suicide. Suicide, which was accepted as a legitimate response to many situations by cultures such as the Roman and Japanese, can be a perfectly rational act. It makes good sense for someone diagnosed with an agonizing but incurable illness to want to commit suicide--so too the painter who is told that he is going blind or the pianist who must lose the use of his hands. Above all, one must be ready to die when one is fighting a tyrannical government. By refusing to be taken alive, one spares oneself the pain and indignity of being held captive by people who have no decency or compassion. As for those who are contemplating suicide simply because they are afflicted with a clinical depression, one is certainly justified in stopping them-- at least for awhile-- in the hope that they will change their mind. One may even be justified in forcing anti-depressant medications on them temporarily, in the expectation that their mood will improve. But if they show no improvement, is one justified in using ECT? Some people, being fully informed, prefer the spiritual death involved in ECT to either a continuation of their depression or physical death. Obviously Kitty Dukakis did. And that is their right, just as it is their right to commit suicide. But if a person has been prevented from committing suicide for months, given medication and compassion and is still suicidal, I would present them with the following choice: "There is a treatment which may end your depression, although it will probably have to be repeated again and again all your life. It has worse side-effects than any drug known to man, in that it damages your memory and will, if administered a sufficient number of times, ultimately destroy your sense of identity. Do you wish us to administer this treatment to you or would you still prefer to die?" If they opt for the latter course, it is our moral obligation to provide them with the most humane method available of taking their own lives.
There is in fact no justification for forcing any form of ECT on anyone. Doing so is equivalent to murder. As we have seen, the majority of mental patients are sane and, fully informed, know perfectly well what is good for themselves. Even with those minority who may be having a psychotic episode and are in danger of taking a life they would regret having taken if they were sane, it is not justifiable to force something so dangerous as ECT upon them. Their inability to make a rational decision makes the treatment by definition involuntary. Ironically, the only people who are capable of giving their consent to ECT are those who are sane. Yet ECT continues to be used not only against the insane and incapacitated but also against those who are merely "different". This is the most hideous threat which hangs over anyone who has been diagnosed with a mental illness, however mild, (and perhaps some who have not been, for there is evidence that it may be being used against suspects in the so-called "War on Terror"). Activists for the rights of mental patients are not making things any better by printing articles such as Van Pelt's and speaking of "mad pride." Why not define mental illness in terms which suit the patient rather than the psychiatrist? For instance, a person suffering from bipolar disorder may warn, "Don't kill my spirit in order to save my body." Someone suffering from one of the schizotypal illnesses may declare, "I am a militant loner-- invade my mental space and you'll be sorry!" (in other words, this 'Mansoul' has artillery which can fire back). Above all, we must forever bear in mind the immmortal words of John Stuart Mill:
"Even despotism does not produce its worst effects so long as individuality exists under it, and whatever crushes individuality is despotism, by whatever name it may be called, and whether it professes to be enforcing the will of God or the injunctions of men."
Sunday, October 26, 2008
Monday, October 6, 2008
BLINDSIDED: The Reality Behind Sackeim's Article
In military strategy, it is axiomatic that one must keep up with the technological sophistication of one's enemy. If he achieves a new breakthrough, then one must be prepared to meet it. The same holds true for political campaigns. If one is ignorant of or misinterprets an advance on the part of the enemy, the results may be disastrous. And that is exactly what has happened in the on-going war over ECT, or electroconvulsive treatment. The pro-ECT forces have recently staged a cunning coup which has caught the anti-ECT forces so off-guard that most are as yet unaware that they have been blindsided.
That coup is best represented by an article authored by long-time ECT proponent Harold Sackeim, along with five colleagues, "The Cognitive Effects of Electroconvulsive Therapy in Community Settings," which appeared in the January, 2007 issue of Neuropsychopharmacology (32, 244-254). Having tested 347 patients who have had ECT, the researchers find that adverse cognitive effects, above all retrograde amnesia, persist for at least six months following an acute treatment course. Since this article's appearance, anti-ECT forces have been crowing over what they interpret as a victory for their cause. The website of ect.org has long been carrying an article entitled "Electroconvulsive Therapy Causes Permanent Amnesia and Cognitive Defects, Prominent Researcher Admits." It quotes Linda Andre, head of the Committee for Truth in Psychiatry, as saying that the study is "a stunning reversal of a 25-year career." Dr. Peter Breggin, the maverick psychiatrist who has long opposed ECT and other questionable psychiatric practices asserts quite falsely that the article proves that "every form of ECT causes lasting memory and mental dysfunction." (http://huffingtonpost.com/dr-peter-breggin/disturbing-news-for-patie-b-44734.html) A recent press release from the Wellbeing Foundation in Ireland continues the praise, calling the article a public recantation of Sackeim's previous views, and concludes that Sackeim "now rejects, at the very least, the widespread use of ECT... This gamekeeper has turned poacher."
Unfortunately, Sackeim's article is exactly the opposite of what the anti-ECT lobby thinks it is. It is an effort to sell ECT-- the new kind of ECT which Sackeim favors-- not discourage its use. The article on the ect.org website asserts that Sackeim is a consultant to the ECT device manufacturer Mecta Corporation-- if this is true, then it should certainly have alerted anti-ECT forces to what is really going on. The electronics industry is progressing at a dizzying and sometimes quite maddening pace. As new technologies become available, corporations try to discredit older technologies so that they may sell the maximum number of new products. This has happened, for instance, in the replacement of LPs by CDs, VHS by DVD, and older types of computers by more sophisticated ones. In these cases the old technology, although perfectly usable, becomes increasingly difficult to obtain, thus forcing the consumer to buy more electronic gadgetry. And in the case of television, the transition is taking place by government fiat, although for reasons I cannot fathom there has been little protest against this blatant violation of free market principles. ECT device manufacturers like Mecta are part of the electronics industry, and as with computers or television manufacturers, they naturally want to push this new, "state-of-the-art" product in place of the old one. With respect to ECT, this means unilateral, in which the current is directed through only one side of the brain, as opposed to bilateral, in which the current is passed through both. The fact that bilateral ECT has been put "on the shelf" does not however mean that it is dead. We may yet witness a craze among psychiatrists for "retro" ECT accompanied by Billie Holiday singing All of Me-- to wit, "You took the best, why not take the rest?"
The explanation for Sackeim's article is not merely economic-- it is also professional-- that is to say, he is defending the professional group with which he identifies. Although Sackeim is a psychologist, his loyalty is to the medical model of mental illness which dominates psychiatry today, and the article in question does not contain the slightest indication that this has changed. Knowing that much of the public fears ECT, a psychotherapist is only too happy to be able to say, "We know that the old kind of ECT had unacceptable side-effects, but the new kind is different," and that is exactly the point of Sackeim's article. It's the same thing that happened when it became common to anaesthetize patients so that they did not appear to have the dramatic and frightening grand mal convulsion portrayed in One Flew Over the Cuckoo's Nest (of course they still had it-- ECT would not be ECT without a convulsion-- but they did not look as if they did). Sackeim wants to win the trust of prospective patients-- if not for himself then for his colleagues-- and he has excellent prospects for doing so, for he has won over his worst enemies. But is this trust warranted? Although his study concludes, "There appears to be little justification for the continued use of BL ECT in the treatment of major depression," with right unilateral ECT (RUL) it is a different matter: "Indeed, recent work suggests that high dosage RUL delivered with an ultrabrief stimulus maintains efficacy and results in minimal retrograde amnesia even in the period immediately following the ECT course." But what does "minimal" mean in practice? That one forgets only the last five years of one's relationship with one's spouse instead of forgetting him or her entirely? Surely it is necessary to do far more tests with RUL ECT before it can be considered safe. Yet Sackeim is not calling for any.
What Sackeim and his colleagues are trying to do was explained in an article in the New York Times,"The Quiet Comeback of Electroshock Therapy," by Daniel Goldman on August 2, 1990. The article quotes Sackeim as saying, "There's been a sea-change in our understanding of ECT in the past decade... Until about 10 years ago, patients were commonly given the maximal charge, with machines set at the upper limit... but patients vary greatly in the level of current at which they will have a seizure. On average, a woman needs about 80 per cent as much current as a man, and the older you are the more you need. You need less current if applied to only one side of the head instead of both." What Sackeim is arguing for is a more fine-tuned version of ECT, instead of the sledgehammer approach which prevailed in the past. It's sort of like first-strike nukes which are accurate enough to take out the enemy's defenses so that one can achieve victory in a single surprise attack rather than the old kind of nuke which destroyed weapons and people indiscriminately. It looks more humane but in fact may be more dangerous for that very reason. Unfortunately, the anti-ECT movement is still using a sledgehammer approach to fight the procedure, and taking no account of the new and more subtle strategy adopted by its opponents. For one thing, it does not keep up with developments in psychiatry-- most of its leaders would not give a psychiatrists the time of day, and seem never to have heard the maxim, "Know your enemy". Furthermore, as one can see from the writings of anti-ECT activists such as Peter Breggin and Leonard Frank, it is calling for a complete and total ban on ECT, voluntary or involuntary. This is bound to doom their cause in an era when people as articulate and intelligent as Kitty Dukakis and Dick Cavett have joined the pro-ECT bandwagon. And it is after all rather hypocritical to oppose ECT on the grounds that it is a violation of civil liberties while denying it to those who really want it.
This support for an all-out ban is associated with another error of monumental proportions, the overestimation of the damage done by ECT, which misses an essential point: ECT is dangerous precisely because it destroys memory while leaving other brain functions relatively intact. Exaggeration such as that found in the work of Breggin, who maintains that it can reduce people to a subhuman level, leaves the anti-ECT people open to the charge that survivors like Leonard Frank, who have become activists against it, are in fact the best advertisements for the procedure (Rael Jean Isaac and Virginia ARmat, Madness in the Streets, p. 209) But the limited and very specific nature of the damage done by ECT in fact makes it easier to sell: shock doctors would have a hard time if Michael now had to bottle-feed and diaper Kitty or Dick's brain had shrunk to the size of a chimpanzee's. Above all, it makes ECT the perfect tool for totalitarianism. The growing number of government officials who want to replace our free republic with a totalitarian state need confessed "traitors" and converts who appear to be of normal intelligence, maturity, and sanity. That is why the CIA showed so much interest in ECT for decades, although it has no conceivable value for the acquisition of intelligence, funding such unethical experiments as those of Ewen Cameron of the Allan Memorial Institute. President Bush's call for national mental health screening shows that psychiatrists are still viewed as the shock troops of the new fascism: capture a dissident, declare him mentally ill, and give him ECT treatments. When he emerges, docile and resigned though to all outward appearances still "normal", he will become a walking advertisement for totalitarianism. The anti-ECT forces do not seem to see how endangered their movement itself is. In 2006, the U.S. Congress and President Bush approved the Animal Enterprise Terrorism Act (AETA), labelling animal rights activists-- most of whom are non-violent to a fault-- as "ecoterrorists". How long will it be before activists opposed to ECT and other psychiatric abuses find themselves branded "psychoterrorists"?
George Orwell, whose 1984 contains what is perhaps the first depiction of ECT in literature, has his villain, O'Brien, say that "He who controls the past controls the future." And it is all too true. That is why the inability of the anti-ECT movment to mount an effective challenge to the pro-ECT lobby is so disheartening. The use of ECT is not on the decline: it is increasing, and is likely to do so to an even greater extent in the future due to articles such as Sackeim's. The organized opponents of ECT, who have deluded themselves into thinking that they are winning, are in fact losing, to a catastrophic extent. And their loss is everyone's loss. For what is at stake here is not just the rights of mental patients, it is political liberty itself.
That coup is best represented by an article authored by long-time ECT proponent Harold Sackeim, along with five colleagues, "The Cognitive Effects of Electroconvulsive Therapy in Community Settings," which appeared in the January, 2007 issue of Neuropsychopharmacology (32, 244-254). Having tested 347 patients who have had ECT, the researchers find that adverse cognitive effects, above all retrograde amnesia, persist for at least six months following an acute treatment course. Since this article's appearance, anti-ECT forces have been crowing over what they interpret as a victory for their cause. The website of ect.org has long been carrying an article entitled "Electroconvulsive Therapy Causes Permanent Amnesia and Cognitive Defects, Prominent Researcher Admits." It quotes Linda Andre, head of the Committee for Truth in Psychiatry, as saying that the study is "a stunning reversal of a 25-year career." Dr. Peter Breggin, the maverick psychiatrist who has long opposed ECT and other questionable psychiatric practices asserts quite falsely that the article proves that "every form of ECT causes lasting memory and mental dysfunction." (http://huffingtonpost.com/dr-peter-breggin/disturbing-news-for-patie-b-44734.html) A recent press release from the Wellbeing Foundation in Ireland continues the praise, calling the article a public recantation of Sackeim's previous views, and concludes that Sackeim "now rejects, at the very least, the widespread use of ECT... This gamekeeper has turned poacher."
Unfortunately, Sackeim's article is exactly the opposite of what the anti-ECT lobby thinks it is. It is an effort to sell ECT-- the new kind of ECT which Sackeim favors-- not discourage its use. The article on the ect.org website asserts that Sackeim is a consultant to the ECT device manufacturer Mecta Corporation-- if this is true, then it should certainly have alerted anti-ECT forces to what is really going on. The electronics industry is progressing at a dizzying and sometimes quite maddening pace. As new technologies become available, corporations try to discredit older technologies so that they may sell the maximum number of new products. This has happened, for instance, in the replacement of LPs by CDs, VHS by DVD, and older types of computers by more sophisticated ones. In these cases the old technology, although perfectly usable, becomes increasingly difficult to obtain, thus forcing the consumer to buy more electronic gadgetry. And in the case of television, the transition is taking place by government fiat, although for reasons I cannot fathom there has been little protest against this blatant violation of free market principles. ECT device manufacturers like Mecta are part of the electronics industry, and as with computers or television manufacturers, they naturally want to push this new, "state-of-the-art" product in place of the old one. With respect to ECT, this means unilateral, in which the current is directed through only one side of the brain, as opposed to bilateral, in which the current is passed through both. The fact that bilateral ECT has been put "on the shelf" does not however mean that it is dead. We may yet witness a craze among psychiatrists for "retro" ECT accompanied by Billie Holiday singing All of Me-- to wit, "You took the best, why not take the rest?"
The explanation for Sackeim's article is not merely economic-- it is also professional-- that is to say, he is defending the professional group with which he identifies. Although Sackeim is a psychologist, his loyalty is to the medical model of mental illness which dominates psychiatry today, and the article in question does not contain the slightest indication that this has changed. Knowing that much of the public fears ECT, a psychotherapist is only too happy to be able to say, "We know that the old kind of ECT had unacceptable side-effects, but the new kind is different," and that is exactly the point of Sackeim's article. It's the same thing that happened when it became common to anaesthetize patients so that they did not appear to have the dramatic and frightening grand mal convulsion portrayed in One Flew Over the Cuckoo's Nest (of course they still had it-- ECT would not be ECT without a convulsion-- but they did not look as if they did). Sackeim wants to win the trust of prospective patients-- if not for himself then for his colleagues-- and he has excellent prospects for doing so, for he has won over his worst enemies. But is this trust warranted? Although his study concludes, "There appears to be little justification for the continued use of BL ECT in the treatment of major depression," with right unilateral ECT (RUL) it is a different matter: "Indeed, recent work suggests that high dosage RUL delivered with an ultrabrief stimulus maintains efficacy and results in minimal retrograde amnesia even in the period immediately following the ECT course." But what does "minimal" mean in practice? That one forgets only the last five years of one's relationship with one's spouse instead of forgetting him or her entirely? Surely it is necessary to do far more tests with RUL ECT before it can be considered safe. Yet Sackeim is not calling for any.
What Sackeim and his colleagues are trying to do was explained in an article in the New York Times,"The Quiet Comeback of Electroshock Therapy," by Daniel Goldman on August 2, 1990. The article quotes Sackeim as saying, "There's been a sea-change in our understanding of ECT in the past decade... Until about 10 years ago, patients were commonly given the maximal charge, with machines set at the upper limit... but patients vary greatly in the level of current at which they will have a seizure. On average, a woman needs about 80 per cent as much current as a man, and the older you are the more you need. You need less current if applied to only one side of the head instead of both." What Sackeim is arguing for is a more fine-tuned version of ECT, instead of the sledgehammer approach which prevailed in the past. It's sort of like first-strike nukes which are accurate enough to take out the enemy's defenses so that one can achieve victory in a single surprise attack rather than the old kind of nuke which destroyed weapons and people indiscriminately. It looks more humane but in fact may be more dangerous for that very reason. Unfortunately, the anti-ECT movement is still using a sledgehammer approach to fight the procedure, and taking no account of the new and more subtle strategy adopted by its opponents. For one thing, it does not keep up with developments in psychiatry-- most of its leaders would not give a psychiatrists the time of day, and seem never to have heard the maxim, "Know your enemy". Furthermore, as one can see from the writings of anti-ECT activists such as Peter Breggin and Leonard Frank, it is calling for a complete and total ban on ECT, voluntary or involuntary. This is bound to doom their cause in an era when people as articulate and intelligent as Kitty Dukakis and Dick Cavett have joined the pro-ECT bandwagon. And it is after all rather hypocritical to oppose ECT on the grounds that it is a violation of civil liberties while denying it to those who really want it.
This support for an all-out ban is associated with another error of monumental proportions, the overestimation of the damage done by ECT, which misses an essential point: ECT is dangerous precisely because it destroys memory while leaving other brain functions relatively intact. Exaggeration such as that found in the work of Breggin, who maintains that it can reduce people to a subhuman level, leaves the anti-ECT people open to the charge that survivors like Leonard Frank, who have become activists against it, are in fact the best advertisements for the procedure (Rael Jean Isaac and Virginia ARmat, Madness in the Streets, p. 209) But the limited and very specific nature of the damage done by ECT in fact makes it easier to sell: shock doctors would have a hard time if Michael now had to bottle-feed and diaper Kitty or Dick's brain had shrunk to the size of a chimpanzee's. Above all, it makes ECT the perfect tool for totalitarianism. The growing number of government officials who want to replace our free republic with a totalitarian state need confessed "traitors" and converts who appear to be of normal intelligence, maturity, and sanity. That is why the CIA showed so much interest in ECT for decades, although it has no conceivable value for the acquisition of intelligence, funding such unethical experiments as those of Ewen Cameron of the Allan Memorial Institute. President Bush's call for national mental health screening shows that psychiatrists are still viewed as the shock troops of the new fascism: capture a dissident, declare him mentally ill, and give him ECT treatments. When he emerges, docile and resigned though to all outward appearances still "normal", he will become a walking advertisement for totalitarianism. The anti-ECT forces do not seem to see how endangered their movement itself is. In 2006, the U.S. Congress and President Bush approved the Animal Enterprise Terrorism Act (AETA), labelling animal rights activists-- most of whom are non-violent to a fault-- as "ecoterrorists". How long will it be before activists opposed to ECT and other psychiatric abuses find themselves branded "psychoterrorists"?
George Orwell, whose 1984 contains what is perhaps the first depiction of ECT in literature, has his villain, O'Brien, say that "He who controls the past controls the future." And it is all too true. That is why the inability of the anti-ECT movment to mount an effective challenge to the pro-ECT lobby is so disheartening. The use of ECT is not on the decline: it is increasing, and is likely to do so to an even greater extent in the future due to articles such as Sackeim's. The organized opponents of ECT, who have deluded themselves into thinking that they are winning, are in fact losing, to a catastrophic extent. And their loss is everyone's loss. For what is at stake here is not just the rights of mental patients, it is political liberty itself.
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