New Sparks Over Electroshock

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All these steps are taken to protect him from the physical side effects of having a seizure, which is what happens when the electrodes are attached to Hartmann's head and electricity courses into him. For reasons no one quite understands--just as no one is precisely sure how all antidepressants work or why some people improve with good old-fashioned talk therapy and others don't--the seizure is key. Hartmann explains it this way: "The seizure just kind of dynamites the depression out of my brain somehow."

Before Italian researchers first tried electricity in 1938, doctors used chemicals to induce the frightening, painful seizures. Electricity worked faster, but the pain of uncontrolled convulsions remained. Patients fractured their spine, bit their tongue, broke bones. Consequently, the devils who ran some asylums used electroshock as punishment. In many circles, it retains a frisson of barbarity. Writers such as Ernest Hemingway and Sylvia Plath reinforced the image. "It was a brilliant cure," Hemingway wrote sarcastically in the days after his electroshock and before shooting himself, "but we lost the patient."

Hartmann quotes that line in his fascinating, not yet published memoir, Life as Death. He knows some people don't respond to electroshock, and he understands the risk he takes when he undergoes it (his most recent treatment was last summer; he currently takes medications). A tiny number of patients die: the National Institute of Mental Health says the figure is 1 in 10,000, about the same as any procedure involving anesthesia. Antishock activists cite Texas statistics from the mid-'90s, saying about 1 in 320 electroshock patients died in the two weeks after treatment, though the deaths weren't necessarily caused by electroshock. The activists also say electroshock causes brain damage. Dr. Breggin says the damage produces delirium so severe that patients can't fully experience depression or other higher mental functions during the several weeks after electroshock.

Yet a 1999 Surgeon General's report argues that "there are virtually no absolute health contraindications" for electroshock. It notes that psychiatrists have revised their technique for delivering the electricity in the past generation so that less power is needed and, consequently, fewer side effects result. For his part, Hartmann says he has often gone to work around noon after morning electroshock sessions. "The people in the office are just agog that you can add two and two, that you're not drooling," he says. "But my concentration was actually improved, and I felt so much better." Hartmann says the memory problems he has experienced have been minor--getting confused about what he ordered from the hospital menu, for instance.

More important to Hartmann is the fact that since he first experienced depression at 15, electroshock has been "the only thing that has ever let me feel 100%...Depression is like being a corpse with a pulse. I tried everything else. I had a loving family, thousands of hours of good psychotherapy, and none of it ever helped." Hartmann believes he would have killed himself--perhaps by starving himself, as he tried once--if not for electroshock.

It's no panacea, of course. Electroshock's effects are short term, lasting weeks or months before depression can descend again. At $2,500 a treatment, it's also expensive, though insurance usually covers it. Antishock activists say it's just a cash cow for hospitals and that the response rates cited by the Surgeon General are inflated. In 1996, Lawrence of ect.org surveyed 41 former electroshock patients and found that 70% said the treatment had no effect on their depression. Joseph Rogers, executive director of the National Mental Health Consumers' Self-Help Clearinghouse, says 3 out of 4 of the electroshock patients he speaks with had negative experiences: coercion by psychiatrists, confusion, memory loss. Rogers and Lawrence don't want the treatment banned, but they believe few would undergo it if they knew all the risks beforehand.