Timothy Kneeland and Carol A.B. Warren's Pushbutton Psychiatry: A Cultural History of Electroshock in America, is a useful source whose value is disguised by the ideology they authors impose on their subject. In focusing on patriarchy and sexism they are harping on the irrelevant, for ECT is not a gender issue. That is quite obvious from the fact that the most famous (although hardly the best) negative depiction of ECT, Ken Kesey's One Flew Over the Cuckoo's Nest, is emphatically sexist. And perhaps the most eminent victim of ECT, Ernest Hemingway, was a "macho man" who would not please most feminists. To judge by the CIA's decades of experiments with the procedure, including experiments in the field during the Vietnam War, it is likely that the most pitiable victims of ECT today are terrorist suspects, all of whom are men who adhere to beliefs of which no feminist could approve. Finally, as I know from personal experience, it is perfectly possible for a divorced woman to be the head of a household and to decide of her own volition, without any influence from men, to place her child in a mental hospital where he or she may be forced to endure ECT, drugging with neuroleptics, or other horrors. When women were decidedly second-class citizens, they were more often the victims of ECT because as with any type of abuse, it is the most helpless who are the most victimized. Today, when women have achieved an equal place with men, they are more likely to be victimizers, like for instance Kitty Dukakis whom I wrote about in my last blog, and Joan Prudic, M.D., a co-author of Harold Sackeim's now-famous article promoting unilateral ECT, who teaches a course in that subject at The New York State Psychiatric Institute. This should not surprise us, because there is no fundamental difference between males and females, and no reason why women should not be attracted to power and wealth as much as men-- ECT is an issue upon which some will take a stand from moral courage and others will use to further their own self-interest, regardless of whether they are male or female.
Under the spell of their obsession with gender, the authors waste many pages discussing the quasi-erotic and quackish use of electricity and "animal magnetism" in eighteenth and nineteenth century medical performances (and performances they were, in many cases before an audience) involving male doctors and female patients. Thus they miss the opportunity to discuss a much more relevant use of electricity in so-called "therapy". The practice of aversive conditioning derived from the theories of psychologist B.F. Skinner often makes use of painful electric shocks. Although these are not directed at the brain and therefore do not cause the massive physical damage that ECT does, they can cause psychological trauma when inflicted upon the helpless, such as children at the Judge Rotenberg School for Autistic Children. More importantly, they are similar to ECT in that they are in actuality punishment masquerading as therapy. Indeed, the closest relative of the ECT machine today is the Graduated Electronic Decelerator (GED) developed by Mathew Israel, director of the aforementioned school. The reader would do well to simply skip the first two chapters of this book entirely and read only chapters 3 through 5, which follow ECT from its birth in fascist Italy and enthusiastic reception in the what those countries which we used to call the "Western democracies", through its challenge by the social reform movements of the nineteen-sixties and seventies, to the ultimate and tragic triumph of ECT in the era of incipient totalitarianism, 1981 to the present day.
There are three excellent contributions which the authors make in these chapters. First, they discuss the struggle between the psychodynamic and somatic, or biological approach to mental illness. They establish quite accurately, although it rather undercuts their thesis of ECT as being an expression of patriarchy, that the psychodynamic model is the traditional one, the somatic a brazen usurper of recent vintage. Freud and his followers, whatever their defects (and some, such as Adler and Jung, were relatively free from the sexism which marred Freud's thinking), put the emphasis upon understanding the patient through prolonged discourse. Genuine psychotherapy is a time-consuming and expensive process, which does not appeal to the technocrats of today, obsessed as they are with the search for a "quick fix". But the their substitutes-- whether chemical or electrical-- not only do profound damage to the patient, they do not cure them. Even Kitty Dukakis admits that she has to go back to have more ECT treatments every few months, when her symptoms re-appear. So in a sense, ECT is like an addictive drug, and far more damaging to the user than cocaine or heroin. Similarly, people who are given neuroleptics are subject to the inner tortures of tardive dyskinisea or akathisia (a bit like delirium tremens) when they attempt to withdraw from them, even after a short period of time, with the result that they end up "hooked". The psychodynamic approach to mental illness may or may not cure it-- it is hard to say, for human beings are complex and any approach which takes account of these complexities is not easily subjected to statistical analysis. But the somatic approach is demonstrably a dismal failure. Indeed, psychiatrists who use it do not even claim that they are aiming to cure the patient, generally describing the individual upon whom they have inflicted their techniques as "in remission", implying that they are not and never will be "cured", but will have to come back again and again to pay for ever more expensive and damaging treatments. They are the legal equivalent of drug pushers. And what Kneeland and Warren fail to point out is that the place where the somatic concept of mental illness triumphed first and most completely, to the point of becoming official dogma, is the Soviet Union. Is there not something inherently totalitarian in an approach which had such appeal to the doctors working under Stalin?
The second contribution the authors make is in tracing the history of the legal battles over ECT, especially in California, where they raged most fiercely, probably because the juxtapositioning of some of the most wealthy electronics firms in Silicon Valley next to some of the most enlightened politically progressive communities in the nation in San Francisco and Berkeley. The attempts to restrict ECT in Berkeley and California at large which were made in the nineteen-seventies gave rise to a powerful backlash, led by the Association for Convulsive Therapy (ACT), which has completely eliminated free debate over the issue from the American Psychiatric Association and the psychiatric profession at large. Acceptance of the efficacy of some form of ECT is now required dogma for the aspiring psychiatrist and he or she can no more challenge it than a Soviet doctor could have challenged the questionable tenets which underlay Soviet medicine. But the most important factor in the triumph of ECT seems to have been money. Indeed, greed looms obscenely large in Kneeland and Warren's account. Contrary to Dukakis' assertion that there are only "two small companies manufacturing ECT devices, and they lack the means to do studies of it", there appear to be five major corporations-- Somatics, MECTA, Medcraft, Hittman and Eliot. These companies played a major role in the rehabilitation of ECT after its decline in the seventies, lobbying the FDA not to force them to pre-market test their machines because doing so would increase their costs by more than three million dollars (pp. 88-89). Thus a decision which could adversely affect the lives of millions of potential patients was made purely on the basis of the economic well-being of the corporations which manufactured the devices.
The ties between the "shock doctors" and the companies which make the machines they use and the videos to sell them to the consumer are close: MECTA was the invention of Dr. Paul Blachly, one of the founders of ACT; ECT proponents Drs. Richard Abrams and Conrad Swartz began Somatics in 1985; and Richard Abrams, who wrote the leading text on ECT, derives more than fifty per cent of his income from that company (pp. 91-92). Max Fink, the leading proponent of ECT in America today, shock proponents Harold Sackeim and Richard Weiner all contributed to the making of $350 videos to advertise ECT: Fink received $18,000 for his work and an 8% royalty on the them. One critic of of this overlap of professional and economic interest remarked that the APA Task force on ECT ought to be called "The Manufacturers Task force on ECT" (pp. 91-92). Here one must note the profits to be made from both private and taxpayer supported insurance: one study showed that 65-year-olds receive 360 per cent more shock therapy than 64-year-olds in Texas. The difference? Medicare pays for the latter. (p. 93). Reductions in the length of hospital stays reimbursed by private insurance during the 1980s set time limits on trials of psychoactive drugs (and even more so on traditional psychotherapy, which has always been undersupported by insurance). "Cynical observers noted that the advent of Diagnostic Related Groups (DRGs) for hosptial reimbursement may make ECT more cost-effective than drugs, for it works [sic] 30 to 40 times faster." (p. 93-- of course this means in practice that the patient gets the "high" associated with brain damage much faster than he would if given drugs). Thus insurance companies do not have to pay so much for the procedure, while shock is "very advantageous economically to hospitals". p. 83) Psychiatrists' fees are anywhere from $125 to $250 for the 5- 15 minute procedure; a study published in 1998 found that Medicare paid $97.73 and Medicaid $36 for psychiatrists attending ECT, the anaesthesiologist's fee fanged drom $75 to $160, while the nurse and treatment room added another $500 per treatment." (p. 92) Given the profitability of ECT, it is not surprising that the number of recipients in California doubled between 1994 and 2004, from 2,356 to 4,553.
How then to explain the hypocritical argument, made by many spokesmen for ECT, that it is a "benefit" denied by an unjust society to the poor? (p. 86) To understand this one must recognize that human beings are motivated by the quest for power and prestige as well as profit. And power and prestige can be collective. The struggle to replace the psychodynamic concept of mental illness with a soomatic one emanated from the struggle of psychiatry to gain equality with other medical specialties, and avoid sarcastic comments such as, "We are dissecting a cadaver-- would you be so kind to come and show us the location of the id?" (quoted in Don Gillmor, I Swear by Apollo) To maintain their own self-esteem, psychiatrists had to compete, to come up with results which could be quantified, which presents great difficulty for those who take a humane and compassionate approach to their patients. The increasing public perception of psychiatrists as "scientific" professionals swelled their own pride as it damaged their patients. And of course nothing could compare to the thrill of having the power to destroy a person's identity and rebuild it according to one's own wishes. Faced with the imperatives of modern technological society, traditional psychotherapy was to go the way of the U.S. Constitution and traditional concepts of freedom and dignity, dismissed as a mere relic of an irrelevant past. What was done by government fiat in the Communist countries was done by general agreement in the Western nations. Reading of the tragic acceleration of the rate of administration of ECT, one cannot help but be struck by the harm done by Ken Kesey's One Flew Over the Cuckoo's Nest. The real dangers of ECT are long-term. By emphasizing only the sight of the grand mal convulsion produced by ECT on an unanaesthetized patient, Kesey created a prejudice which was easily overcome by the slick advertising of ECT manufacturers (who were often one and the same as the doctors who administered the treatment). Those of us who formed our opinions of ECT long before we read Kesey's book or saw the film find it maddening to hear people say "Well it's not like that any longer," as if this had any relevance to the debate.
When I think of the ascendancy of the ECT lobby today, I am reminded of a Japanese Noh play, entitled The Valley Rite. I will not go into the entire historical background, which concerns the struggle between the native religion Shintoism and the imported one Buddhism, except to say that the play takes as its starting point an ancient belief that sick people pollute holy places and must not be allowed into them and then exaggerates this in order to make a point. In the play, a young boy, Matsuwaka, accompanies his religious master on a pilgrimage to a holy mountain. On the way, the boy is taken ill. Learning of this, his master says, "Hush! You mustn't say such a thing on this pilgimage. You are only tired because you are not accustomed to traveling. All you need is a good rest." But the leader of the pilgrimage finds out the truth, and says, "The boy is seriously ill. You must inform [his master] that it is our duty to hurl the boy into the valley, as our rule requires." Accordingly the boy is killed (Donald Keene, Editor, 20 Plays of the No Theatre, pp. 323-4). The mentally ill or troubled person is in exactly the same situation today. My advice to them is to find a good friend. If one is agitated, a psychiarist can be of use only if one does not place too much trust in him and knows what to ask for. If one is agitated, demand a minor tranquilizer-- the Benzodiazpepines (such as Valium and Ativan) are the most unjustly maligned of all psychiatric medications and so mild and harmless that in my opinion they should be sold over the counter. If you take an anti-depressant you are getting into heavier stuff-- it may help to pull you out of a depression but it has very bad side effects and should not be taken for long. But the major tranquilizers or neuroleptics will maim you for life and should be avoided. So too, it goes without saying, should ECT. Above all, for God's sake, don't tell anyone that you are severely depressed! Tragically, the "cry for help" does not stimulate compassion any longer but rather the desire to exploit in order to enhance the psychiatrist's own power, prestige and income. I you threaten or attempt to commit suicide, what the psychiatric profession will do to you will make you wish you had.
Thursday, November 20, 2008
Saturday, November 1, 2008
SUICIDE, NOBLE AND IGNOBLE
Voluntary euthanasia or assisted suicide was the first political issue I ever cared deeply about (the right to abortion being the second). I was ten or eleven when I saw the 1962 film The Interns, in which an aspiring doctor, played as I recall by Cliff Robertson, ends the life of a man with a terminal and painful illness, who wants to die. For this he is deprived of his internship. I can still recall turning to my mother and asking, "Mommy, why are they mad at him? He didn't do anything wrong." I could not understand-- it seemed so unjust. Fifty-seven years later, the incomprehension and indignation remain as strong as ever. My rage at the opponents of voluntary euthanasia is increased by the way that proponents of the spiritual murder called ECT or electroconvulsive treatment use the threat of that a patient may commit suicide as an argument. But suicide is not always the rash impulse of a disordered mind. It can be an admirable act of courage. Indeed, such suicides have a long and venerable history throughout the world.
At the beginning of the fourth century BCE, the first prominent individualist in history, Socrates, was accused of "corrupting the morals" of Athenian youth by his argumentative debates, and sentenced to death by drinking hemlock. As he held the honorable status of Athenian citizen, he was however allowed the opportunity to escape into exile. In Plato's Crito, Socrates is depicted giving his reasons for accepting the death sentence-- that someone who has enjoyed the benefits of living under a government of law must abide by it even when the sentence is unjust, because the injustice was the error of men, not the law. This has become the foundation of our own tradition of civil disobedience, or non-violent protest. Althugh civil disobedience only makes sense in a government under law, which our nation is fast ceasing to be, for the person still fortunate enough to live in a democracy, the argument would be unanswerable and Socrates' choice of death was surely a well-considered and noble one.
Similarly, the founding of the Roman Republic was inspired by a suicide, that of Lucretia, who in the sixth century B.C. was raped by the son of the Tarquin king of Rome. According to Livy, Lucius Junius Brutus, her kinsman, grabbed the dagger from her breast and and declared war on the Tarquins. After assassinating the king, he had the Romans swear an oath that they should never again allow themselves to be ruled by kings. His descendent Marcus Junius Brutus, who is immortalized by Shakespeare as the "noblest Roman of them all", was in fact far less noble, because after the assassination he refused to sign a statement declaring Caesar to have been a tyrant in order to keep the office he had been awarded by Caesar as urban praetor. Between this and the servility of the general population, who loved Caesar for providing them with "bread and circuses", the Roman Republic was doomed. But some good men lived on. The letters of Pliny the Younger reveal the high regard in which people who committed suicide for noble reasons were held. While Pliny recognized and regretted that some people committed suicide purely on upon impulse, he praises those take their lives for good reason, as, for instance, and incurable and painful illness. His greatest hero in this regard is Arria, wife of Caecina Paetus.
When Lucius Arruntius Camillus Scribonianus led a rebellion against the Emperor Claudius in 42 CE with the intention of restoring the Republic, Caecina Paetus joined him. Scribonius was killed and Paetus was taken to Rome as a prisoner for conspiring with him. Arria attacked the wife of the leader of the rebellion for giving evidence to the prosecution, crying, "Am I to listen to you, who could go on living after Scribonius died in your arms?" After Paetus was ordered to commit suicide for his rebellion, Arria determined to join him. This should not be viewed as an expression of guilt or shame for their part in the rebellion, as Shakespeare depicts the conspirators in the assassination of Julius Caesar as feeling when they committed suicide-- rather it was an act akin to Socrates decision to drink the hemlock. When Arria's friends and relatives begged her not to take her own life, she said, according to Pliny, "You are wasting your time, for you can ensure me a coward's death, but you cannot prevent me from dying." With these words, she lept up from her chair, and ran into the wall opposite, knocking herself out and illustrating what she would do if her family were to deny her the easier means of killing herself afforded by a dagger. When her husband Paetus showed reluctance to take his own life, she herself unsheathed the dagger, pierced her own breast, and extracting it, handed it to her husband, declaring, "Non dolet, Paete!" ("Paetus, it doesn't hurt!"). These were lauded by Pliny as "immortal, almost godlike words" (Letters, Book III:16, pp. 75-76 of Oxford World Classics).
Outside the West, Japanese tradition also held suicide to be honorable in certain circumstances. Seppuku was the act of a noble samurai, performed if possible in a ritual setting, or if not on the battlefield (it was not so painful as one would think, for as soon as the person slit his belly, a second, or kaishaku, beheaded him. Women were permitted to die by simply slitting their throats). Sometimes Japanese lords or shoguns, such as the cruel Nobunaga and Hideoyoshi, ordered their vassals to commit suicide for no good reason. But on other occasions, seppuku was the route freely and rationally chosen by the samurai. One good reason was when one was faced with the choice of disobeying the lord to which one had pledged loyalty or doing something that one considered dishonorable. Another was defeat at the hands of a cruel enemy, who one knew would not permit one an honorable death. Finally, the Japanese, like Socrates, would commit seppuku if they violated the law, even if it was for a good reason. The famous tale of the Forty-Seven Ronin, or Chushingura, reveals the Japanese attitude both toward the assassination of an evil official and the decision to die. In the eighteenth century, the young Lord Asano of Ako Province was insulted by a Tokugawa bureaucrat, Kira, because he would not bribe him. In response he drew his sword in the shogunal palace, an unpardonable offense, and tried to kill Kira. Although he only succeeded in wounding him, he was sentenced to commit seppuku.
Dozens of Lord Asano's retainers, led by his chief retainer Oishi Kuranosuke, they secretly swore to avenge him and assassinate Kira. For years, they deliberately concealed their intentions in order to throw Kira off-guard. Then one snowy night, by pre-arrangment they descended upon Kira's mansion in Edo and overcame his guards. Finding the cowardly Kira hiding in a closet, Kuranosuke offered him the opportunity to choose an honorable death by seppuku. When he refused, Kuranosuke beheaded him. After offering his head to the gods at the temple of Sengaku-ji, the Forty-Seven turned themselves in in full recognition of what this would mean. Despite their immense popularity among the population of Edo, they were all sentenced to commit seppuku, a sentence which they accepted as calmly as Socrates accepted his. It should be noted that although the Tokugawa Regime was probably the most tyrannical which Japan had ever experienced, it did not torture the Forty-Seven or force them to "confess" that they were wrong, but permitted them an honorable death. In this respect, it showed itself far more civilized than our own present government. It is regrettable to see that Fumon Tanaka, in his otherwise excellent book, Samurai Fighting Arts: The Theory and Practice, has capitulated to Western prejudices to such an extent that he quite nonsensically denies that seppuku is suicide! (p. 48) Similarly, when a petition was circulating in California to permit voluntary euthanasia for the terminally ill, although I signed it, I was highly offended by a clause which denied that the act was suicide, as if suicide were something shameful.
And then, in Europe, the dark ages began. Centuries of domination by Christianity brought suicide into disrepute. The Church wanted people to believe that there was no escape from its tyranny and so it preached that suicide was sin and would condemn the person to hell, itself an invention of tyrannical minds (whether or not the Bible forbids suicide is irrelevant to those who, like myself, are neither Jewish nor Christian, and also to the laws of the United States, whose Constitution enjoins the separation of church and state). In the nineteenth century, psychiatrists replaced priests as buttresses of tyranny and declared suicide to be "sick", a modern variation upon the notion of "sinful". But some progress toward reason began to be made in places such as Switzerland, Scandinavia, and the United States in the late twentieth century. In the nineteen-seventies, the heretical psychiatrist Thomas Szasz wrote: "The individualistic position is that a person's life belongs to himself. Thus he has the right to take his own life, that is, to commit suicide... the medical-psychiatric position on suicide... ends in extolling mental health and survival over every other value, particularly liberty. In regarding the desire to live, but not the desire to die, as a legitimate human aspiration, the suicidologist stands Patrick Henry's famous exclamation, "Give me liberty or give me death!" on its head. In effect, it says, "Give him, commitment, give him electroshock, give him lobotomy, give him lifelong slavery, but do not let him choose death!... The result is a far-reaching infantilization and dehumanization of the suicidal person." ("The Ethics of Suicide, The Antioch Review, Spring 1971; Theology of Medicine; Political and Philosophical Foundations, pp. 75, 79-81).
In 1980 the Hemlock Society was founded by Derek Humphry, who had assisted his wife, diagnosed as terminally ill, to commit suicide. In 1991 it published the classic Final Exit, a manifesto of the right-to-die movement. I admired Humphry and wrote him in the late nineteen-eighties to say that his criteria for assisted suicide was too narrow. The right to die, I argued, should be extended first to mental patients who were suffering from inner torture which seemed incurable, and who should no more be forced to suffer than those diagnosed with a terminal physical illness. Secondly, it should be extended to those diagnosed with an incurable and severe physical illness-- blindness, paralysis and that sort of thing-- which, even if not fatal, reduced the quality of their life to the point where life was no longer living. Thirdly, it should be extended to convicts sentenced to life imprisonment, which I regard as a fate worse than death, which is why I have never supported the movement to abolish the death penalty-- what alternative is there? At the time, still believing that I lived in a democracy, I did not think to add that it should be extended to those threatened by political repression, although this obviously is only an argument for moral acceptance, for any such government would reveal the extent of its despotism precisely by denying the person this right. Humphry wrote me a polite response saying that if I wanted to extend the right to other categories of people I should found my own group, for the Hemlock Society was dedicated only to assisted suicide for those who were diagnosed with a terminal physical illness. Strategically he was right-- if people could not muster sufficient compassion to permit these people to die, how could they be expected to sympathize with mental patients, convicts, and the other categories I mentioned? But events were soon to prove that I was right in my contention that others beyond the terminally ill should be accorded the right to die.
In the nineteen-eighties, physician Jack Kevorkian began to assist terminally ill people to commit suicide in a very public way. Although his quest for publicity was to cut short his career, for which reason he was criticized by Humphry, it brought the issue into high relief among the public. In a sense America needed Kevorkian as much as it needed Humphry. But his attempt to bring the issue to a head backfired. Having helped some 130 terminally ill people to die, naturally he had his license to practice medicine revoked, for where suicide is concerned, the medical profession is still living in the dark ages. On the November, 23, 1998 broadcast of 60 Minutes, Kevorkian allowed the airing of a videotape he had made of the voluntary euthanasia of Thomas Youk. On March 1999, Kevorkian was accordingly charged with first-degree homicide. A Michigan jury found Kevorkian guilty of second-degree homicide (I have this from Wikipedia, and if it is correct, the terminology is chilling. "Homicide" is not a legal definition-- it simply means "the killing of a human being". One category of homicide-- killing in self-defense-- always has been and should be legal. Kevorkian should have been charged with manslaughter or murder, which are by definition crimes). He was sentenced to eight years in prison, which he accordingly accepted. And in prison they broke him--or at least in part. When he was released he told Mike Wallace of 60 Minutes that he would not assist anyone else to commit suicide, "because I gave my word that I would not". But this was merely a face-saving device. In fact, he had been forced to stop, because that was the condition of his release. And Kevorkian was only in an ordinary prison. What about the thousands now being held in Guantanamo and the secret CIA prisons, where fiendish tortures designed by psychiatrists are used to wear down the victim's defenses? Or those who will be sent to such prisons when our government turns openly fascist? Any incarcerated person can be broken. For that reason, in my opinion, Kevorkian himself should have committed suicide rather than allow himself to be incarcerated (oh yes, but he's running for Congress now, you will say-- but what difference can he make in a country which is no longer a democracy, where power resides not in elected officials but "Washington Insiders" and unelected bureaucrats?)
The Right-to-Die Movement has had one success story. In 1994 the governor of Oregon signed into law a "Death with Dignity" act passed by the state legislature. Oregon thus became the only one of the fifty states to be able to call itself truly civilized. Right-to-Die groups live on, although with altered names: The Hemlock Society changed its name to "Death With Dignity", "End-of-Life Choices" changed its name to "Compassion in Dying", then "Compassion in Dying" changed its name to "Compassion And Choices". The Voluntary Euthanasia Society of Australia changed its name to "Dying with Dignity" as did the Voluntary Euthanasia society of Great Britain. It is a sign of moral cowardice and our increasingly repressive times that people must engage in these ridiculous circumlocutions. As Humphry says, "Why not call a spade a spade?"
While there is such a thing as honorable suicide and death with dignity, there is also such a thing as dishonorable suicide. Kitty Dukakis is a prime example of the latter. Not long ago she gave an address to a group of college students on a northeastern campus (see "Addressing a 'Shocking' Issue, http://www.huntingtom-news.com/home/index.cfm?event=displayArticlePrinterFriendly&...) As she said, due to ECT, "I am a different person." To allow one's spirit to be killed and remade by others according to their own wishes is to display a profound lack of self-respect. But her opponents among the movement for the rights of psychiatric patients-- specifically Mind Freedom-- are no better. Having adoped the slogan "Mad Pride", which reinforces the most prevalent myth concerning mental illness-- that all mentally ill people are psychotic-- they have themselves committed a collective and dishonorable suicide. For another, when they had the chance to debate Dukakis they lost every opportunity she provided to defeat the pro-ECT forces. For one thing, they said her book was biased-- but as it is a personal account, not a scientific study, it cannot claim to be anything else. Different people value different things in life-- some value mere existence and animal gratification-- these are the people who seek dishonorable forms of suicide. Others value higher things such as freedom and independence. That Dukakis is of the former variety is evident. But in fact her own testimony can be used against ECT. She has admitted that it changed her personality. She has admitted that it affected her memory. She has admitted that the treatment has to be repeated again and again, so that it becomes in effect like an addictive drug. One could use her own testimony alone to argue against involuntary ECT.
When the issue of how it works came up, Dukakis said that the reason we don't know is because ECT equipment is produced by two small companies who cannot afford to study it. At that point Mind Freedom lost a valuable opportunity to ask if one of those companies is Mecta, and if so, why it is that Harold Sackeim, who is a consultant to that firm, found the support to do a study which finally admits that bilateral ECT causes cognitive defects but implies that unilateral is free of this risk. Clearly what we need are scientific studies aimed at assessing the cognitive effects of uniltateral ECT, but Mind Freedom shies away from this. Indeed, ECT survivor Leonard Frank, who is one of the organization's founders, told me that we already have enough information to ban ECT. But this is obviously not true, or else it would have already been banned, instead of increasing in prevalence and acceptance as it has. Sackeim has scored a spectacular coup against the movement for the rights of mental patients and they don't even recognize this fact. With friends like this, mental patients don't need enemies. There can be little doubt that increasing numbers of people will be forced to endure this spiritual murder in a society which still condemns death which is freely chosen.
For those who recognize what political opposition is ultimately going to mean in a nation headed in the direction ours is, suicide is a rational and even reassuring alternative, infinitely better than the alternatives of grovelling or being crushed in some hospital or prison. If one wonders whether it would be worth it to commit suicide under a totalitarian regime, let me quote George Orwell's villain O'Brien: "It is intolerable to us that an erroneous thought should exist anywhere in the world, however secret and powerless it may be. Even in the instant of death we cannot permit any deviation. In the old days, the heretic walked to the stake still a heretic, proclaiming his heresy, exulting in it. Even the victim of the Russian purges could carry rebellion locked up in his skull as he walked down the corridor waiting for the bullet. But we make the brain perfect before we blow it out." (1984, Signet edition, p. 210. Thus it is easy to see that the decision to die free has political significance, no matter how obscure the person who makes it may be. Let us resolve to blow out our own brains before Big Brother has even the slightest opportunity to go to work on them! But I don't advise suicide until one has exhausted every other option. And I would ask those considering it for political reasons to first ponder the following haiku I have composed on the subject:
And so the sakura
must fall. In our resolve to die lies
infinite freedom.
At the beginning of the fourth century BCE, the first prominent individualist in history, Socrates, was accused of "corrupting the morals" of Athenian youth by his argumentative debates, and sentenced to death by drinking hemlock. As he held the honorable status of Athenian citizen, he was however allowed the opportunity to escape into exile. In Plato's Crito, Socrates is depicted giving his reasons for accepting the death sentence-- that someone who has enjoyed the benefits of living under a government of law must abide by it even when the sentence is unjust, because the injustice was the error of men, not the law. This has become the foundation of our own tradition of civil disobedience, or non-violent protest. Althugh civil disobedience only makes sense in a government under law, which our nation is fast ceasing to be, for the person still fortunate enough to live in a democracy, the argument would be unanswerable and Socrates' choice of death was surely a well-considered and noble one.
Similarly, the founding of the Roman Republic was inspired by a suicide, that of Lucretia, who in the sixth century B.C. was raped by the son of the Tarquin king of Rome. According to Livy, Lucius Junius Brutus, her kinsman, grabbed the dagger from her breast and and declared war on the Tarquins. After assassinating the king, he had the Romans swear an oath that they should never again allow themselves to be ruled by kings. His descendent Marcus Junius Brutus, who is immortalized by Shakespeare as the "noblest Roman of them all", was in fact far less noble, because after the assassination he refused to sign a statement declaring Caesar to have been a tyrant in order to keep the office he had been awarded by Caesar as urban praetor. Between this and the servility of the general population, who loved Caesar for providing them with "bread and circuses", the Roman Republic was doomed. But some good men lived on. The letters of Pliny the Younger reveal the high regard in which people who committed suicide for noble reasons were held. While Pliny recognized and regretted that some people committed suicide purely on upon impulse, he praises those take their lives for good reason, as, for instance, and incurable and painful illness. His greatest hero in this regard is Arria, wife of Caecina Paetus.
When Lucius Arruntius Camillus Scribonianus led a rebellion against the Emperor Claudius in 42 CE with the intention of restoring the Republic, Caecina Paetus joined him. Scribonius was killed and Paetus was taken to Rome as a prisoner for conspiring with him. Arria attacked the wife of the leader of the rebellion for giving evidence to the prosecution, crying, "Am I to listen to you, who could go on living after Scribonius died in your arms?" After Paetus was ordered to commit suicide for his rebellion, Arria determined to join him. This should not be viewed as an expression of guilt or shame for their part in the rebellion, as Shakespeare depicts the conspirators in the assassination of Julius Caesar as feeling when they committed suicide-- rather it was an act akin to Socrates decision to drink the hemlock. When Arria's friends and relatives begged her not to take her own life, she said, according to Pliny, "You are wasting your time, for you can ensure me a coward's death, but you cannot prevent me from dying." With these words, she lept up from her chair, and ran into the wall opposite, knocking herself out and illustrating what she would do if her family were to deny her the easier means of killing herself afforded by a dagger. When her husband Paetus showed reluctance to take his own life, she herself unsheathed the dagger, pierced her own breast, and extracting it, handed it to her husband, declaring, "Non dolet, Paete!" ("Paetus, it doesn't hurt!"). These were lauded by Pliny as "immortal, almost godlike words" (Letters, Book III:16, pp. 75-76 of Oxford World Classics).
Outside the West, Japanese tradition also held suicide to be honorable in certain circumstances. Seppuku was the act of a noble samurai, performed if possible in a ritual setting, or if not on the battlefield (it was not so painful as one would think, for as soon as the person slit his belly, a second, or kaishaku, beheaded him. Women were permitted to die by simply slitting their throats). Sometimes Japanese lords or shoguns, such as the cruel Nobunaga and Hideoyoshi, ordered their vassals to commit suicide for no good reason. But on other occasions, seppuku was the route freely and rationally chosen by the samurai. One good reason was when one was faced with the choice of disobeying the lord to which one had pledged loyalty or doing something that one considered dishonorable. Another was defeat at the hands of a cruel enemy, who one knew would not permit one an honorable death. Finally, the Japanese, like Socrates, would commit seppuku if they violated the law, even if it was for a good reason. The famous tale of the Forty-Seven Ronin, or Chushingura, reveals the Japanese attitude both toward the assassination of an evil official and the decision to die. In the eighteenth century, the young Lord Asano of Ako Province was insulted by a Tokugawa bureaucrat, Kira, because he would not bribe him. In response he drew his sword in the shogunal palace, an unpardonable offense, and tried to kill Kira. Although he only succeeded in wounding him, he was sentenced to commit seppuku.
Dozens of Lord Asano's retainers, led by his chief retainer Oishi Kuranosuke, they secretly swore to avenge him and assassinate Kira. For years, they deliberately concealed their intentions in order to throw Kira off-guard. Then one snowy night, by pre-arrangment they descended upon Kira's mansion in Edo and overcame his guards. Finding the cowardly Kira hiding in a closet, Kuranosuke offered him the opportunity to choose an honorable death by seppuku. When he refused, Kuranosuke beheaded him. After offering his head to the gods at the temple of Sengaku-ji, the Forty-Seven turned themselves in in full recognition of what this would mean. Despite their immense popularity among the population of Edo, they were all sentenced to commit seppuku, a sentence which they accepted as calmly as Socrates accepted his. It should be noted that although the Tokugawa Regime was probably the most tyrannical which Japan had ever experienced, it did not torture the Forty-Seven or force them to "confess" that they were wrong, but permitted them an honorable death. In this respect, it showed itself far more civilized than our own present government. It is regrettable to see that Fumon Tanaka, in his otherwise excellent book, Samurai Fighting Arts: The Theory and Practice, has capitulated to Western prejudices to such an extent that he quite nonsensically denies that seppuku is suicide! (p. 48) Similarly, when a petition was circulating in California to permit voluntary euthanasia for the terminally ill, although I signed it, I was highly offended by a clause which denied that the act was suicide, as if suicide were something shameful.
And then, in Europe, the dark ages began. Centuries of domination by Christianity brought suicide into disrepute. The Church wanted people to believe that there was no escape from its tyranny and so it preached that suicide was sin and would condemn the person to hell, itself an invention of tyrannical minds (whether or not the Bible forbids suicide is irrelevant to those who, like myself, are neither Jewish nor Christian, and also to the laws of the United States, whose Constitution enjoins the separation of church and state). In the nineteenth century, psychiatrists replaced priests as buttresses of tyranny and declared suicide to be "sick", a modern variation upon the notion of "sinful". But some progress toward reason began to be made in places such as Switzerland, Scandinavia, and the United States in the late twentieth century. In the nineteen-seventies, the heretical psychiatrist Thomas Szasz wrote: "The individualistic position is that a person's life belongs to himself. Thus he has the right to take his own life, that is, to commit suicide... the medical-psychiatric position on suicide... ends in extolling mental health and survival over every other value, particularly liberty. In regarding the desire to live, but not the desire to die, as a legitimate human aspiration, the suicidologist stands Patrick Henry's famous exclamation, "Give me liberty or give me death!" on its head. In effect, it says, "Give him, commitment, give him electroshock, give him lobotomy, give him lifelong slavery, but do not let him choose death!... The result is a far-reaching infantilization and dehumanization of the suicidal person." ("The Ethics of Suicide, The Antioch Review, Spring 1971; Theology of Medicine; Political and Philosophical Foundations, pp. 75, 79-81).
In 1980 the Hemlock Society was founded by Derek Humphry, who had assisted his wife, diagnosed as terminally ill, to commit suicide. In 1991 it published the classic Final Exit, a manifesto of the right-to-die movement. I admired Humphry and wrote him in the late nineteen-eighties to say that his criteria for assisted suicide was too narrow. The right to die, I argued, should be extended first to mental patients who were suffering from inner torture which seemed incurable, and who should no more be forced to suffer than those diagnosed with a terminal physical illness. Secondly, it should be extended to those diagnosed with an incurable and severe physical illness-- blindness, paralysis and that sort of thing-- which, even if not fatal, reduced the quality of their life to the point where life was no longer living. Thirdly, it should be extended to convicts sentenced to life imprisonment, which I regard as a fate worse than death, which is why I have never supported the movement to abolish the death penalty-- what alternative is there? At the time, still believing that I lived in a democracy, I did not think to add that it should be extended to those threatened by political repression, although this obviously is only an argument for moral acceptance, for any such government would reveal the extent of its despotism precisely by denying the person this right. Humphry wrote me a polite response saying that if I wanted to extend the right to other categories of people I should found my own group, for the Hemlock Society was dedicated only to assisted suicide for those who were diagnosed with a terminal physical illness. Strategically he was right-- if people could not muster sufficient compassion to permit these people to die, how could they be expected to sympathize with mental patients, convicts, and the other categories I mentioned? But events were soon to prove that I was right in my contention that others beyond the terminally ill should be accorded the right to die.
In the nineteen-eighties, physician Jack Kevorkian began to assist terminally ill people to commit suicide in a very public way. Although his quest for publicity was to cut short his career, for which reason he was criticized by Humphry, it brought the issue into high relief among the public. In a sense America needed Kevorkian as much as it needed Humphry. But his attempt to bring the issue to a head backfired. Having helped some 130 terminally ill people to die, naturally he had his license to practice medicine revoked, for where suicide is concerned, the medical profession is still living in the dark ages. On the November, 23, 1998 broadcast of 60 Minutes, Kevorkian allowed the airing of a videotape he had made of the voluntary euthanasia of Thomas Youk. On March 1999, Kevorkian was accordingly charged with first-degree homicide. A Michigan jury found Kevorkian guilty of second-degree homicide (I have this from Wikipedia, and if it is correct, the terminology is chilling. "Homicide" is not a legal definition-- it simply means "the killing of a human being". One category of homicide-- killing in self-defense-- always has been and should be legal. Kevorkian should have been charged with manslaughter or murder, which are by definition crimes). He was sentenced to eight years in prison, which he accordingly accepted. And in prison they broke him--or at least in part. When he was released he told Mike Wallace of 60 Minutes that he would not assist anyone else to commit suicide, "because I gave my word that I would not". But this was merely a face-saving device. In fact, he had been forced to stop, because that was the condition of his release. And Kevorkian was only in an ordinary prison. What about the thousands now being held in Guantanamo and the secret CIA prisons, where fiendish tortures designed by psychiatrists are used to wear down the victim's defenses? Or those who will be sent to such prisons when our government turns openly fascist? Any incarcerated person can be broken. For that reason, in my opinion, Kevorkian himself should have committed suicide rather than allow himself to be incarcerated (oh yes, but he's running for Congress now, you will say-- but what difference can he make in a country which is no longer a democracy, where power resides not in elected officials but "Washington Insiders" and unelected bureaucrats?)
The Right-to-Die Movement has had one success story. In 1994 the governor of Oregon signed into law a "Death with Dignity" act passed by the state legislature. Oregon thus became the only one of the fifty states to be able to call itself truly civilized. Right-to-Die groups live on, although with altered names: The Hemlock Society changed its name to "Death With Dignity", "End-of-Life Choices" changed its name to "Compassion in Dying", then "Compassion in Dying" changed its name to "Compassion And Choices". The Voluntary Euthanasia Society of Australia changed its name to "Dying with Dignity" as did the Voluntary Euthanasia society of Great Britain. It is a sign of moral cowardice and our increasingly repressive times that people must engage in these ridiculous circumlocutions. As Humphry says, "Why not call a spade a spade?"
While there is such a thing as honorable suicide and death with dignity, there is also such a thing as dishonorable suicide. Kitty Dukakis is a prime example of the latter. Not long ago she gave an address to a group of college students on a northeastern campus (see "Addressing a 'Shocking' Issue, http://www.huntingtom-news.com/home/index.cfm?event=displayArticlePrinterFriendly&...) As she said, due to ECT, "I am a different person." To allow one's spirit to be killed and remade by others according to their own wishes is to display a profound lack of self-respect. But her opponents among the movement for the rights of psychiatric patients-- specifically Mind Freedom-- are no better. Having adoped the slogan "Mad Pride", which reinforces the most prevalent myth concerning mental illness-- that all mentally ill people are psychotic-- they have themselves committed a collective and dishonorable suicide. For another, when they had the chance to debate Dukakis they lost every opportunity she provided to defeat the pro-ECT forces. For one thing, they said her book was biased-- but as it is a personal account, not a scientific study, it cannot claim to be anything else. Different people value different things in life-- some value mere existence and animal gratification-- these are the people who seek dishonorable forms of suicide. Others value higher things such as freedom and independence. That Dukakis is of the former variety is evident. But in fact her own testimony can be used against ECT. She has admitted that it changed her personality. She has admitted that it affected her memory. She has admitted that the treatment has to be repeated again and again, so that it becomes in effect like an addictive drug. One could use her own testimony alone to argue against involuntary ECT.
When the issue of how it works came up, Dukakis said that the reason we don't know is because ECT equipment is produced by two small companies who cannot afford to study it. At that point Mind Freedom lost a valuable opportunity to ask if one of those companies is Mecta, and if so, why it is that Harold Sackeim, who is a consultant to that firm, found the support to do a study which finally admits that bilateral ECT causes cognitive defects but implies that unilateral is free of this risk. Clearly what we need are scientific studies aimed at assessing the cognitive effects of uniltateral ECT, but Mind Freedom shies away from this. Indeed, ECT survivor Leonard Frank, who is one of the organization's founders, told me that we already have enough information to ban ECT. But this is obviously not true, or else it would have already been banned, instead of increasing in prevalence and acceptance as it has. Sackeim has scored a spectacular coup against the movement for the rights of mental patients and they don't even recognize this fact. With friends like this, mental patients don't need enemies. There can be little doubt that increasing numbers of people will be forced to endure this spiritual murder in a society which still condemns death which is freely chosen.
For those who recognize what political opposition is ultimately going to mean in a nation headed in the direction ours is, suicide is a rational and even reassuring alternative, infinitely better than the alternatives of grovelling or being crushed in some hospital or prison. If one wonders whether it would be worth it to commit suicide under a totalitarian regime, let me quote George Orwell's villain O'Brien: "It is intolerable to us that an erroneous thought should exist anywhere in the world, however secret and powerless it may be. Even in the instant of death we cannot permit any deviation. In the old days, the heretic walked to the stake still a heretic, proclaiming his heresy, exulting in it. Even the victim of the Russian purges could carry rebellion locked up in his skull as he walked down the corridor waiting for the bullet. But we make the brain perfect before we blow it out." (1984, Signet edition, p. 210. Thus it is easy to see that the decision to die free has political significance, no matter how obscure the person who makes it may be. Let us resolve to blow out our own brains before Big Brother has even the slightest opportunity to go to work on them! But I don't advise suicide until one has exhausted every other option. And I would ask those considering it for political reasons to first ponder the following haiku I have composed on the subject:
And so the sakura
must fall. In our resolve to die lies
infinite freedom.
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