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.