New Sparks Over Electroshock

On some gut level, the whole idea of electroshock therapy is absurd. At a time when people with mental illnesses can choose from a pharmacological cornucopia, why would they have electricity run through their brain instead? Didn't electroshock disappear around the same time as three-martini lunches?

Actually, electroconvulsive therapy, as psychiatrists call it, has remained a common treatment for those who are severely depressed and who don't respond to (or can't tolerate) drugs. Its use has been quietly on the rise in the past two decades. Because most states don't require reporting on electroshock, there are no hard figures, but many people in the electroshock world agree that at least 100,000 Americans receive the treatment annually, up from a 1980 federal estimate of 33,000. Research on electroshock has also surged. Just last month the American Psychiatric Association released a second edition of its report on electroconvulsive therapy; it lists more than 1,000 citations.

Why all the interest? One reason is that electroshock remains a nagging scientific puzzle: it works a little bit like banging the side of a fuzzy TV--it just works, except when it doesn't. Second, a small but persistent group of advocates wants to ban it--they say it causes brain damage--and a larger, more mainstream group of activists wants more research before the treatment spreads any further. Many of these folks are former patients (or survivors, to use a term of choice), and they have helped persuade a handful of state legislatures to consider a ban. No states have agreed, though at least four have enacted restrictions.

Psychiatrists and some former patients who found the treatment beneficial are rushing to try to prove the dissenters wrong. An ugly war of words has erupted. Dr. Peter Breggin, a psychiatrist who has written four books critical of electroshock and who favors therapy and human services instead, told TIME that shock is used by "cold, aloof guys who seem to feel more comfortable with machines than patients." Dr. Harold Sackeim, who runs the department of biological psychiatry at the New York State Psychiatric Institute, responds that caregivers who forgo the use of electroshock and other biological methods to treat the suicidally depressed "are going to end up with a lot of dead patients."

If you are a filmgoer of a certain age, your image of electroshock was shaped by such movies as The Snake Pit or One Flew Over the Cuckoo's Nest. In the latter, a small army of orderlies and nurses restrain Randle Patrick McMurphy (Jack Nicholson) as he is connected to the electrodes. The treatment is agonizing because McMurphy isn't given anesthesia, which has been routine for years.

But even today, when the worst pain is usually a headache after patients awaken, some say they are coerced into electroshock and lied to about it. "The doctor told my family it was an absolute cure for depression," says Juli Lawrence, who underwent electroshock in 1994. But the following week she attempted suicide. She says her doctor also failed to warn her about the memory loss usually associated with electroshock, which can range from forgetting where you parked your car to forgetting that you own a car at all. The memory loss is often temporary, but not always. (A 1999 Surgeon General's report says there are "no reliable data" on the incidence of severe memory impairment.) Lawrence says she can't recall any events from nearly two years before and from several months after her treatment. She now runs ect.org , a website critical of electroshock that works to stop the treatment from being forced on people. (Roughly 1% of those who undergo electroshock are ordered by a judge to do so, according to state figures published on ect.org .)

Of course, uninformed medical consent is a problem not exclusive to electroshock, and judges can force other kinds of treatment as well. But electroshock is an unusually retro procedure, one that some psychiatrists avoid. According to the Surgeon General, the response rate for electroshock is an impressive 60% to 70%--about the same as today's superpills, including Prozac and its kin. But that fact itself embarrasses some psychiatrists, who would rather not think of themselves as well-educated electricians. Not all psychiatric residents learn electroshock. Younger psychiatrists are more ambivalent about it than older ones, according to a 1999 survey. After all, even the latest electroshock devices look something like Led Zeppelin-era stereo equipment. They are based on technology so old the FDA says they predate its regulatory authority (the agency has classified the devices in the category it uses for equipment whose risks are high or unknown). The website for the Thymatron, the Cadillac of electroshock devices, still features a painfully outdated page on how to test the device for Y2K compliance.

But when performed properly, psychiatrists say, electroshock is simple, safe and looks a lot more boring than its cinematic counterpart. Curtis Hartmann, 47, a Westfield, Mass., lawyer who has received about 100 electroshocks since 1976 to help control his bipolar illness, knows the procedure well. Hartmann fasts the night before, a routine practice before general anesthesia. He leaves his home around 4 a.m. and drives to nearby Holyoke Hospital. He goes to the second floor and turns left toward the short-stay surgery unit. His body is prepared for electroshock in three ways: an anesthesiologist puts him to sleep; a chemical relaxes his muscles; a respirator helps him breathe.