Opinion

The media’s damaging impact on public perception of electroconvulsive therapy

Stigma is a significant challenge that infects every issue surrounding mental illness. Mass media depictions of mental illness and treatments of psychiatric disorders perpetuate misconceptions by repeated presentation of negative stereotypes. The impact is seen when patients with mental illness are reluctant to seek the treatment they need.

Negative depictions of Electroconvulsive Therapy (ECT) contribute to the stigma of mental illness, by marginalizing this treatment and therefore those severely ill patients who receive it. It is a disservice to a vulnerable group of patients who could benefit from ECT, but who delay treatment and continue to suffer because they fear they will end up like Jack Nicholson’s fictional character in One Flew Over the Cuckoo’s Nest.

Most recently, the Toronto Star ran a series of sensationalist and stigmatizing articles (December 14; December 15; December 16; December 23), which reported that ECT “patients across Ontario … describe numerous cognitive side effects as a result of the treatment and want it abolished”. The same articles contained numerous long descriptions of patients reporting negative side effects. The articles claimed the number of treatments is increasing at an alarming rate. The pictures that accompanied the article did not depict modern ECT, but instead showed ECT treatment in the 1930s and referenced the shock therapy scene in 1975 film One Flew Over the Cuckoo’s Nest (a work of fiction).

The Star articles were followed by Drs. Blumberger and Daskalakis’ OpEd, ECT: A Life-Saving Medical Procedure and a letter by myself that gave more balanced perspectives about electroconvulsive therapy. But the damage had already been done.

Depression and bipolar disorder, the two commonest conditions treated by ECT, take a serious toll on people’s lives. Many die by suicide. In the next decade, depression is projected to be the costliest medical illness in western society. A significant number of patients with these disorders will not respond to medications and/or psychotherapy. As reported by Blumberger and Daskalakis “ECT works when other treatments do not. However, ECT is used in only about 1 per cent of patients with medication-resistant depression. This is primarily due to the media and social stigma that engender irrational fear and avoidance of this very effective treatment.”

The Star articles perpetuated the myth that ECT is a barbaric, inhuman treatment. It incorrectly claims that ECT is painful and that memory is permanently wiped out. Such characterizations are not supported by the facts. ECT is given under carefully controlled conditions and there is very little risk. The patient does not feel anything except the prick of the IV needle used to give anaesthetic. As Blumberger and Daskalakis report “ECT today is a very different procedure than that portrayed in old movies. During ECT, the patient is asleep under general anaesthetic and a current is passed between electrodes on the scalp to induce a controlled therapeutic seizure that is barely visible to the naked eye. This seizure usually lasts between 20 to 60 seconds. Afterward, the typical response of both the medical observer and patient alike is, ’Is that it?’”

When asked after treatment, most patients who have received ECT are very positive about the beneficial effects and say they would have ECT again if they became depressed again. Unfortunately, despite their positive experience they also report anxiety about the stigma associated with ECT.

The Star implied that ECT causes permanent brain damage. Studies have demonstrated that ECT does not cause brain damage, nor does it cause permanent brain dysfunction. In fact, ECT often improves the cognitive functioning of patients with severe depression. By treating the depression, patients often report that they are able to concentrate better and think more clearly. ECT can cause temporary memory loss, but when asked about it, patients respond by saying not being depressed is more important than their temporary memory loss.

The Star’s claim that ECT rates have increased dramatically is inaccurate and misleading. There have been modest increases in recent years, but the dramatic increase the Toronto Star reported was not due to an actual increase, but only improved reporting and collection of data. The actual number of patients receiving treatment is recorded in Ontario Health Insurance Plan (OHIP) billing data, which shows that in 2010-2011, 1,606 patients received ECT, which is up only 13% over the 1,425 patients who received ECT in 2002-2003. During this same time frame there was an 11% increase in psychiatric services and a 20% increase in the number of patients seen by psychiatrists in Ontario. In view of those numbers, a 13% increase in the number of patients receiving ECT should be expected.

But the most flagrant negative depiction of ECT in the Star articles is the use of pictures from the 1930s and referencing the 1975 movie One Flew Over the Cuckoo’s Nest that portrayed ECT as a torture rack with voltage. One cannot imagine a newspaper report about current day amputations using pictures of amputations from the Civil War. Or worse, from Hollywood movies, which often show Civil War amputations being done without anaesthetic, when in fact anaesthesia was in common and widespread use during the Civil War. When did substituting fiction for fact become the standard for responsible journalism?

All of the above contributes to the negative stereotype of ECT and the psychiatric conditions it treats. The suffering of psychiatric patients is not being taken seriously. Patients accept the side effects of ECT because it alleviates their suffering, just as cancer patients accept the side effects of chemotherapy for the same reason. I recently had a patient who had been hospitalized several times, been treated unsuccessfully with multiple anti-depressants, was unable to work, and who spent his days in bed thinking about ways to kill himself. After ECT he was active, able to work, involved with his children and no longer depressed. If you ask him about the memory loss associated with ECT he would tell you that the improvement to his life and being able to concentrate, learn and work again, far outweighed any problem with memory loss around the time of the treatment.

We have to have an open and frank discussion about mental health and its treatments. That discussion cannot take place if the mainstream media does not stop perpetuating negative stereotypes.

The issue of mental health stigma has received lots of attention in the past few years. The playing field is full of advocates such as the Mental Health Commission of Canada, the Canadian Mental Health Association, the Canadian Psychiatric Association and others. But all these efforts will be for nought if media outlets like the Toronto Star continue to use stigma as a way to sell papers.

If newspapers were to stop demonizing effective treatments and started to take the suffering of patients with psychiatric disorders seriously, that would be the beginning of the end of stigma. The mainstream media has extraordinary power over public consciousness, and could do more than any government commission to open the door to reasoned debate about mental health policy. I hope journalists will soon recognize this and take a leadership role in combating stigma and helping us heal mental illness.

 

For those who would like more information on the literature regarding general attitudes toward electroconvulsive therapy (ECT), and why there are so many misconceptions regarding this form of treatment I would suggest they read: Electroconvulsive Therapy Attitudes and Misconceptions or for information written from a patient’s perspective I would suggest reading Shock: The Healing Power of Electroconvulsive Therapy.

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27 Comments
  • Kenny says:

    My name is Kenny F. I am currently 30 years old. I underwent ECT, also known as electroconvulsive therapy, at the age of 21. I had a total of 30 rounds of electroshock at that time. What compels me to tell my experience is that I would never want anyone to go through what I have as a result of shock. What happened to me could be what happens to you, so I’m just trying to warn the public of a possible outcome.

    I have experienced permanent mental and physical problems from electroshock that still, to this day, 9 years later, have not resolved.

    At age 13, I was experiencing multiple issues that were not going away. Extreme fatigue, coldness, anxiety and depression. My parents suggested I see our family doctor for some tests. Through blood tests, it was finally discovered I was suffering from hypothyroidism (low thyroid hormone in the blood). My doctor advised me to take a thyroid replacement hormone the rest of my life. I started it that day.

    Unfortunately, my symptoms were not resolving so my family doctor added an antidepressant to help “boost” the effects of the hormones I was taking. Sometime after that I was getting worse so he then suggested I see a psychiatrist. I took his word for it and from that day my life forever changed.

    The psychiatrist found I was obviously not responding well to the antidepressants. He began a process of taking one drug away and adding another, then adding more. This back and forth of drugs was really driving my brain and body to go haywire. He then diagnosed me with bipolar disorder and added mood stabilizers on top of the antidepressants and anti-anxiety drugs. The cocktail of drugs and adding and re-adding drugs was obviously not going well for me, especially being that I was very young — just a teen still growing into a young man.

    This continued to go on from the age of 13 to 21. Throughout those years, it was such a struggle to get through school with the fatigue, cognitive, and overall physical side effects of these drugs. Despite the cocktail of drugs, in high school I was still an honor roll student.

    After seeing more doctors and psychiatrists and being put on multiple more drugs, I was diagnosed by one psychiatrist, at the age of 21, as “treatment resistant.” He suggested I needed to undergo ECT or electroshock therapy as a last resort for my condition. Keep in mind that at the time I saw this psychiatrist, I was on over 5 or 6 different drugs! It’s clear, looking back now, no wonder I was in such a bad way on so many different drugs!

    The psychiatrist said I would experience only temporary side effects of memory loss, confusion, and headaches, but he said they would go away after a few weeks. I trusted them and figured they knew best. Unfortunately, I took the psychiatrist’s advice and started the procedure as a last resort.

    We started off with 6 to 12 treatments and then he wanted me to continue to do them until I was feeling better. At 30 rounds or so my memory and cognition were getting so bad I couldn’t do much of anything for myself anymore. One day I was at the bottom of the staircase at home and my father had to reteach me how to tie my shoes! I was the one that had to put a stop to this ECT. My psychiatrist wanted me to keep going, but I couldn’t take it anymore and was getting very scared I may have dementia. I had to put a stop to it. The psychiatrist reluctantly agreed to a break. I never went back.

    ECT wiped out all my memories of high school, graduation, and my childhood. I literally had almost my whole past wiped out due to this procedure! It’s a constant identity crisis for me every day to this day! The psychiatrists said the side effects were temporary (they weren’t) and my memories would come back (they didn’t).

    I had to see 2 neurologists after ECT because my cognition was so bad. I got neurocognitive testing done 6 months after ECT and found my IQ was measured at 88 — 85 is mentally retarded. I had to relearn how to do basic things like read and write.

    The shocks also caused many physical problems. I was referred to a cardiologist because I was dealing with heart palpitations and arrhythmias that weren’t going away. I had severe headaches for years after that would not go away. The shock doctors prescribed me Vicodine. I also dealt with spontaneous seizures as a result of the shock. The only things the neurologist offered me was more drugs for the pain and symptoms I was dealing with, which I declined.

    Several years ago, I started developing night terrors every night in my sleep due to the shock. I’m assuming because of the trauma done to me and the neurological issues shock caused in me.

    My life is a living nightmare since shock and I would never ever recommend this to any human being, not even an animal. I consider shock a “rape of the soul” because I will never fully remember who that young boy was prior to having this done to me. I will never know what type of human being I could have become. I was an honor student in high school. Now I am stuck with permanent memory loss that makes me feel like I don’t know who I am, constant cognition problems, ongoing night terrors every night from the trauma, feeling constantly anxious and sad, heart problems ongoing, problems remembering from day to day, the list goes and on and on.

    I have a severe hard time trusting people due to the betrayal by the psychiatrists.

    Please take my story as a warning. I hope I can help even one person feel validated in their experience, after they have been invalidated by a psychiatrist telling them that the damage they have from shock is not from shock, but is their mental illness. If I could prevent this from happening to another human being, it was all worth speaking out. Life is very short and don’t waste your time like I have. It can take you years and years just to recover to some degree from ECT and you will most likely end up with a lot of permanent effects like me.

  • John Breeding, PhD says:

    The problem for the shock industry is that when perception lines up with science they are out of business. The only reason shock continues long after the death of the two other members (lobotomy and insulin coma shock) of mid-20th century unholy trinity of barbaric psychiatric treatments is that psychiatry fought a big PR battle to override the facts, and managed to keep it going a bit (see Linda Andre’s terrific book, Doctors of Deception, for the best description of the battle between PR and science re shock). The bottom line is that electroshock causes brain damage; electroshock causes memory loss, often profound; electroshock sometimes kills; and electroshock is never necessary. (see http://www.endofshock.com)

  • deborah L schwartzkopff says:

    In your community there are people who have had the procedure called ECT or electroshock. In the last decade, use has greatly increased, and is used for many reasons now, and offered readily. Used at leading facilities. I am submitting from Oregon, but speak on behalf of my peers, as many cannot. We are showing damages on MRI, EEG, neuro/cognitive testing and SPECT. This is a public health issue that needs to come to light.

    As a result of receiving this untested FDA procedure, patients are now living with traumatic brain injury outcomes, at minimum. Electrical trauma impacts all bodily systems, so there are other issues in addition to the baseline of TBI. This has now been proven in the California courts in a now national device suit, yet facilities are still doing this. ECT also impacts our children, veterans and women in pregnancy. Suits filed against the FDA, and firms interviewing for medical malpractice.

    My opinion is that providers, who are well aware of these poor outcomes, have a duty to warn, protect and not cause harm. There is an oppressive silence around this, as when it comes to light there will be much to account for. Those standing by silently in complicity and collusion are just as responsible. We need these providers that include nurses, to step in to advocate and intercede for these vulnerable patients.

    We are told in consent to expect temporary memory loss to resolve in six weeks and typical anesthesia risks. Their own research reports structural brain changes that result from this. They dare to take this upon themselves, and withhold these known damages? They cannot just suddenly stop doing this now without admitting harm.

    Electrical trauma can extend years out to include ALS and CTE. There is a great betrayal of patient trust. We are betrayed with the initial procedure, and again when we can find little assistance to address our outcomes following. Many would like to see criminal charges levied.

    Very sadly we can find little help in addressing our outcomes of repeated brain injuries that all other TBI patients have at their disposal. Doctors will not address in referrals and testing, as it will implicate peers and facilities, and risk their standings whatever that may be. My peers sometimes commit suicide as a direct result of damages, and they are isolated. We are greatly suffering and need extensive rehabilitation. Our complaints are written off as psychiatric to protect those responsible. Billions involved annually in the U.S. alone from this in cover ups of decades.

    This is trauma pure and simple, not help. Creating temporary euphoria and memory loss for difficulties that led to admission result from brain injury, and is not mental health. There is a two time increase in suicide following ECT secondary to brain injury and isolation in outcomes. Please let others know what is taking place. Others, which may include someone you care about, are at great risk if they are offered this. See ectjustice.com, Thank you.

    Deborah Schwartzkopff

  • deborah L schwartzkopff says:

    No FDA testing of device or procedure that inflicts up to 450 volts and greater to the brain. CA courts have proved brain injuries around devices. This is purely low voltage electrical trauma. Electrical trauma can evolve years out to include ongoing cardiac and respiratory issues, CTE, ALS, etc. Product suit now national so contact DK law group to see about joining. See ectjustice and ect.org for truth of this. Medical malpractice firms interviewing around fallible consent and suits pending against the FDA. See recent you tube videos on this as well.

  • Patti Suleski says:

    I have trouble reminding friends I have memory loss. Most don’t believe me because I will remember something and it will be pointed out. I have trouble with relationships because I truly forget dates I make with friends. They always get mad and believe I use it as an excuse. I have people lose their patience with me and few rare understanding. I lose things all day long. Some have told me they have paid back a loan when they haven’t.

    Don’t get me wrong. I am not a victim. I was only pointing out the disappointments I have

    • deborah L schwartzkopff says:

      Dear Ms. Suleski,
      See the above comments also posted if you may be interested in pursuing suit around devices used? Also you can refer friends and family for understanding to the above sites noted in comments as well. You will find support on the international fb page for electroshock survivors. I wish you well. You have suffered repeated and extensive brain injuries. You can also find support by attending brain injury support groups in your area. I would have some testing done to identify injuries for possible medical malpractice suit if you are in time frames. There are blog articles on ectjustice around this. Most brain injury firms have been contacted with extensive information around this in every state and as well as national firms. Please ref. the ectjustice site in any submission so they may reference. My regards and best wishes.

  • Chris Porter says:

    MMMmmmm. Some memory loss or suicide?? REALLY??? I find it ironic that you, as a journalist, is questioning doctors about a medical procedure. ECT has saved my wife’s life. Depression and suicidal thoughts were an everyday occurrence until ECT. A 20 second procedure a couple times a week. Sure, there is some short-term memory loss, but we would take that over debilitating depression any day!!

    • deborah L schwartzkopff says:

      Dear Mr. Porter,
      I am not a journalist. I am a retired level one trauma nurse who worked at leading facilities for 20 years, and am a survivor of this procedure. I assisted in bringing the law suits around the devices used in ECT that is now national. Other types of suits also researched, and firms interviewing for medical malpractice is several states now. Material risk of brain injury missing from consent so consent fallible. Suits filed against the FDA and hundreds of complex litigators have recently been contact to address fraud, false claims, and discrimination involving this. Your wife was lied to like all patients are lied to around this procedure. Your wife was given repeated brain injuries that can evolve into CTE down the road or ALS or ongoing cardiac issues. All bodily systems are impacted by electrical trauma. Providers research shows actual structural brain changes result from this. I have a survey of hundreds that filled it out describing damages they live with current and that evolve years out. We have been lied to in consent. We had an untested device and procedure involving up to 450 volts to the brain and greater used on us under the guise of help. This was done with providers who feel they have a right to take this upon themselves and play willy nilly with peoples lives and futures. I know that they know about mechanism of trauma. When I have lawyers that are also boarded in medicine, “everyone knows ECT causes brain damage”, that is not okay with me. This involves 5 billion annually in the US alone. This coming to light will impact neuroscience and other fields invested in products and research that could be compromised so many will not step up to protect patients. We as patients are betrayed and harmed. Providers have forgotten their oath taken to warn, protect, and not cause harm. We around the world are working very hard on this and we will be successful. Great reparations are needed along with accountability. My former site of ectjustice is now owned by the law firms participating in the national device suit. Many resources also on Life After ECT. With regards to your wife sir, I have to say after speaking with my peers from around the world for the last decade that there is actually a significant risk in suicide following ECT. The temporary euphoria wears off and when one recognizes the brain injury and little help to address, this escalates suicide risk. Your wife as many often experience what is called anosognosia, and all of this is from traumatic brain injury outcomes. It means that secondary to brain trauma she may not recognize the incurred nor the severity of the incurred damages. Brain injury is not mental health no matter how they try to dress it up. I fear for your wife’s future despite the ease of living current. I personally have lesions progressive to frontal and temporal lobes, abnormal EEG, 5 abnormal neuro/cognitive tests, abnormal VNG showing as well damages to my cerebellum and brain stem. I am on full permanent disability from trusting my providers. My regards to you both. Please contact the DK law group if you may be interested perhaps in joining the ongoing device suit.

  • Dr. Doug Weir says:

    I am glad to see that my original blog inspired so many comments.

    I would be interested to see Rob Wipond’s data on the statement that “The brain damaging effects of ECT were proven in the 30s and 40s so conclusively that people stopped studying them.” I am not sure how “people” were able to study the “brain damaging” effects of ECT in the 30s and 40s. I will stand by the references in my original blog “ Studies have demonstrated that ECT does not cause brain damage, nor does it cause permanent brain dysfunction.”

    Rob Wipond states “That’s why it took until 2006 before any study on long-term memory and cognitive impacts was even done, and then only under enormous public pressure.” There is a large body of research on the effects of ECT on memory and I can reassure readers that it has been going on for over 50 years and there continue to be studies that are examining this issue.

    I never said that patients’ memory was not affected by ECT. What I said was most patients have said that the treatment by ECT of their depression was better than the adverse memory problems. The ability to acquire new memories typically resolves after a few weeks (anterograde amnesia is a loss of the ability to create new memories), but retrograde memory deficits (retrograde amnesia is a loss of access to events that occurred, or information that was learned, before ECT) may take longer and may not completely resolve in some patients. Most studies report that the risk of the more severe and long-lasting memory loss is uncommon.

    In the study Rob Wipond sites http://www.power2u.org/downloads/Sackheim-2007.pdf over 200 patients were given a neuropsychological battery (ten tests) at pre-ECT baseline, within days of completing the ECT course, and at 6-month (24-week) follow-up. The article is an important description of cognitive impairment that occur after a study that looked at all forms of ECT Sine wave bilateral, brief pulse bilateral and RUL brief pulse. The article shows that some domains of memory are impaired after a course of ECT. The more severe memory impairments were seen with Sine wave ECT (which the APA has recommended NOT to be used since 2001). More severe impairments were also seen with bilateral ECT and with greater number of treatments. Most of the cognitive measures at 6 months were improved compared to the pre-ECT baseline. The memory impairment associated with RUL brief pulse ECT was less than Bilateral.

    When ECT is explained to patients they are typically told that there is generally a period of permanent memory impairment for the time around the acute treatment course due to the disruption in ability to lay down new memories. This is why we don’t give ECT to every patient and why we have detailed informed consent that weighs the risks of cognitive impairment with the twice or three fold higher rate of remission. In addition, since 2008 ECT practioners are increasingly using ultra-brief pulse width ECT (Sackeim et al Brain Stimul. 2008 Apr;1(2):71-83. http://www.brainstimjrnl.com/article/S1935-861X(08)00005-3/abstract ) which causes even less cognitive impairment as the pulse width is more physiologic allowing for the elicitation of seizures with far less total energy delivered to the brain.

    Tuesday, February 12 is Bell Let’s Talk Day which is about increasing awareness, reducing stigma and helping to change behaviours and attitudes about mental health issues. It is a good time to reflect on what can newspapers do to reduce the stigma associated with mental health issues such as ECT and depression. There is an important role that newspapers and journalists can play in promoting a serious discussion about mental health issues. Reporting that use mental illness as an opportunity to sensational and report in the most dramatic manner possible do not allow a serious discussion of issues such as lack of resources and quality of care.

    Readers may want to read Whitley, Rob, Berry, Sarah, Trends in Newspaper Coverage of Mental Illness in Canada: 2005–2010, Can J Psychaitry 2013;58(2):107-112 http://publications.cpa-apc.org/browse/documents/584 for more information on how the popular media reports about mental illness.

    And for those who would like more information on the history of ECT I would refer you to the book mentioned in my original piece Shock: The Healing Power of Electroconvulsive Therapy.

    Doug Weir

  • Dr. J. Jefferson says:

    Maybe the medical profession could start with destigmatizing the psychiatric illnesses of its own.

  • cindy billingsley says:

    Personally I believe ECT is barbaric and should be abolished and I have been lucky not to hav encountered them but many others have not.

  • Catherine Richards says:

    Having read Dr. Weir’s post and the Toronto Star articles and the many comments here, I will add my comments.

    I wonder Dr. Weir if you were reading the Toronto Star articles with a pro ECT bias because when I read the articles I consider them to be balanced and informative. My perception is that they are calling for consistency in ECT protocols and more regulation, oversight and accountability for the use of ECT. And, the government and the powerful medical community including the OMA is at least as influential as the press and have many opportunities to provide their viewpoints to educate and to sway public opinion.

    I think the Toronto Star has done a spectacular job in its efforts to cover mental health, to raise awareness about the need for access to services and to address the issue of societal stigma. Stigma surrounding mental health is full of complexity and I don’t think that any one opinion on a particular treatment serves to reduce it. We need to hear from many people, the people with lived experience with a mental health diagnoses and their families, along with the professionals who try hard to find the best ways to treat the whole person and thereby alleviate their pain and add to their sense of resilience and hope.

    My late Mom had ECT, known to our family back in the day simply as shock treatments. My maternal grandmother before her had the same. When they had these treatments they most definitely suffered from severe and prolonged memory loss but their depression was also lifted for a time. I know my mother, who was a relatively young woman when she had shock treatments, was traumatized by her experience with ECT. The fear of having to repeat these treatments caused her to feel utter terror. I don’t think her personal account of her subjective experience should be thought of as suspect or dismissed by those who have had better experiences. Each person’s experience is valid in my opinion and should be respected. When my Mom was properly diagnosed with Bi-Polar illness (late 1970s), then more familiarly known by most as manic depression, and when a psychiatrist prescribed her lithium, her mental and emotional health found balance. Her outlook improved dramatically and she enjoyed a fairly stable state of mental health for the remainder of her life. Her challenge in life was accepting her diagnoses (a lot of the resistance I believe was due to the associated stigma) and in consistently taking her medication.

    I have another relative who is “older” and who fairly recently had ECT at a very well respected mental health facility in Ontario. The results proved positive and the anticipated fear of ECT was gone once the person experienced it and did not have negative side effects. The stubborn depression was alleviated for a quite some time and although one could not classify the ECT as a cure, it helped.

    I don’t think it serves anyone to denounce the Toronto Star for publishing its articles about ECT. I thought they were presented in a fair and balanced way and they had the research to back up what they wrote. I think it is unfortunate that the medical community does not come together on mental health by keeping the conversations active even when uncomfortable, to encourage more sharing of ideas, stories and opinions, and to inspire people to talk openly and to question authority and assess the facts as they find them. I think people will and should make up their own minds about how they think and feel about mental health and the available treatments and alternatives for healing and coping.

    TVO’s program, The Agenda has also been instrumental, along with the Toronto Star, and Bell for really promoting mental health matters and I hope this is a trend that will continue. For those dealing with mental health issues, and that includes those directly affected and their families, there will be people who have been – even recently – negatively impacted by ECT just as there will be those who swear that it saves lives. The truth lives in both extremes and all perceptions in between. There’s room for healthy debate on all treatments for mental health, and by remaining open to the opinions of others, by validating that no one treatment plan is all good or all bad when it comes to complex individuals, I think we will make more meaningful progress if we all keep talking and accepting that mental health matters. I hate to see the staunch supporters of mental health promotion be perceived as irresponsible villains. We need not be alienated by criticism; rather all sides of the argument should be motivated to embrace every opportunity to de-stigmatize all mental health matters. And mental health matters because people matter and need help to find their own way to self-acceptance without having any pressure to choose one side of the debate about ECT or the other.

  • Basem Gohar, MSc, PhD Cand. says:

    Excellent article!

    There is so much that I would like to say:

    I was fortunate enough to have done my Master’s thesis on ECT and published a portion of it. I did a hefty review of literature:tons of peer reviewed articles and a couple of books. I will spit out what I have learned. Please note, I am not a psychiatrist, this is purely from the research I gathered.

    1. There are three types of cognitive deficits with ECT: postictal confusion, interictal confusion, and some types of amnesia. The most common one is the postictal confusion, as it’s stated in this well written blog that it is temporary (seconds, to minutes to maybe some hours). Interictal/delerium or amnesia are extremely uncommon.

    2. Electrode placements play a key role in risk of the temporary cognitive deficits (lateral vs. temporal). Temporal is more effective, but its risks are slightly higher. However, even then, it has been stated that benefits of the treatment truly out-weight these short-term cognitive deficits with the treatment. The placement of the electrode is based on clinical judgement.

    3. Not EVERYONE is a candidate for the treatment. You don’t just tell your doctor “Doc, I’m depressed” and you go for the treatment. I think it is pitiful to make the treatment sound like it is increasing and people are complaining that they can’t remember anything anymore. Very inaccurate! If anything, I would say that the pharmaceutical industry is the field where there is more “pushing”. But that’s another can of worms that I don’t believe I should open as it is not my scope.

    4. In my humble opinion, unless you have not worked directly with patients who are suffering from unipolar or bipolar depression, you would not fully understand how great the treatment really is. It is very true, depression is becoming more prevalent and it was actually ranked as 4th cause of premature death worldwide (and this was back in 96).

    Thank you

  • Rob Wipond says:

    Weir writes that ECT only causes “temporary” memory loss and that “Studies have demonstrated that ECT does not cause brain damage, nor does it cause permanent brain dysfunction.”

    I am a journalist, and I must say, it’s so disturbing to see a doctor, a psychiatrist, a leader of a medical association discussing a medical topic while being so obviously uninformed or deliberately misrepresentative of scientific research.

    The brain damaging effects of ECT were proven in the 30s and 40s so conclusively that people stopped studying them. Then ECT became popular with psychiatrists again, and they started promoting it as ‘new and improved’ while studiously avoiding studying the ‘new and improved’ brain damaging effects. That’s why it took until 2006 before any study on long-term memory and cognitive impacts was even done, and then only under enormous public pressure. That study, notably led by long-time ECT-proponent Harold Sackheim, found memory loss and cognitive impairment were common effects from routine ECT. It’s stunning and so disturbing that Weir would claim otherwise. Read the study yourself here:
    http://www.power2u.org/downloads/Sackheim-2007.pdf

    Indeed, did Weir even read the studies he himself is citing with his links? One notes that “memory loss may persist”, and the other study on cognition stopped after only 15 days, thereby sidestepping altogether the long-term impacts Sackheim found.

  • Emily Nicholas says:

    I commend Dr. Weir for writing such a thoughtful and informed piece. He addresses not just the broad misconceptions about ECT but he highlights current problems with health reporting. With the pressure on the media to be the first to report or to have the most shocking (excuse the term) headline, the stage is set for a news culture which is inflammatory and quick to insufficiently supported conclusions. Reporting in this way re-enforces misconceptions that health care is black and white – that all treatments either work or don’t, that interventions are either good or bad and that all people will respond the same way to a therapy. To create engaged, educated patients we need to give them unbiased and honest information and give them the chance to discuss and investigate options themselves. Let’s have less media spin and more Healthy Debates!

    Emily Nicholas
    Boards Member Patients Association of Canada
    @Emily_Nicholas8

  • Dr. Chris Simpson says:

    This thoughtful and eloquent piece should be required reading for every journalist.

    As I read Dr. Weir’s piece, I was struck by the fact that I, as a heart rhythm specialist, also use the application of electricity as a treatment (electrical cardioversions for atrial fibrillation). I apply energy to the heart; mental health professionals apply energy to the brain. However, neither I nor my patients have to face the stigma or battle the negative perceptions faced by Dr. Weir, his colleagues, and their patients.

    It is a double standard that shouldn’t exist in 2013. We all have a responsibility to stand up and speak out whenever and wherever we see these misconceptions, untruths and negative biases.

    • deborah L schwartzkopff says:

      Dr. Simpson,
      As a cardiologist then you are aware of the full impact of up to 450 volts to the brain and greater from this will impact all systems to include the heart? You and all others fully aware of mechanism of trauma are aware of this, yet you to not address this to stand up for patients impacted? Your defibrillators at least have FDA testing for safety and effectiveness. Your defibrillators are still classed FDA at level 3. Electroshock devices and the procedure were recently declassified from experimental to class 2, that of eye glasses and syringes so more insurers would pay. This was reduced with still no FDA testing of either device or procedure for safety or effectiveness. This was reduced with an active suit in place showing brain injuries. Let’s be honest here and say all is quiet for the money and reputations at stake. I am clearing your misconceptions here, by clearly stating your failing, and the failing of so many to take a stand no matter the risk. That it is needed to expose this great harm that has occurred for decades in mass cover ups, to protect vulnerable patients moving forward. This issue is not going to go away. As a cardiologist, we survivors of this have ongoing cardiac issues, but of course in your notes you would most likely attribute it to other causation?

  • Dr.Mark Voysey. Adolescent Psychiatrist, Toronto. says:

    If I get seriously depressed – I have let it be known that my preferences (Living Will) are to have ECT; it is a life saver, safe, and more effective the older you get.
    I would also like to note that the ACTUAL movie one Flew Over the Cuckooès Nest is about PSYCHOSURGERY – the main character actually IMPROVES after he has ECT, but the (mostly discredited and extremely limited) psychosurgery is what really does him in. These negative stereotypes distort even medias perception of their own media (fiction)!!!

  • J. Nourse says:

    Yes thank you to Dr Weir for writing this and for helping to undo the damage done by the Toronto Star when they published their article. Having lived most of my life dealing with depression in various degrees of severity, and having received ECT on several occasions, the article was very upsetting to me. In fact, so much so that I wrote the Star a letter. To my surprise they actually published it and because I want to reinforce what Dr Weir has written here, as well as what Drs Daskalakis and Blumberger had to say in their response to the Star, I’d like to share abit of my letter here:

    “Your article, the one that referred to ECT as a “brute force assault on the brain”, lashed out and assaulted a treatment that is for many, myself included, lifesaving. Like chemotherapy or transplants or countless other treatments that people go through to save their life, there is potential for undesirable side-effects. It is unfortunate that those mentioned in your story had such negative experiences, however, what about those of us who have also had the treatment and do not have such a negative story to tell? Yes, I have experienced some memory loss but, considering the alternative, I’ll LIVE with it. It has not stopped me from returning to my job or doing any of the things I did before I received ECT. When I initially spoke out about my depression and having received ECT I wanted to help address the stigma surrounding both the illness and the treatment. To think that stigma and fear is all that may prevent someone from receiving a treatment that can potentially give them back their life is tragic to me. Also tragic to me is that your article has probably done exactly that. Shame on you.”

    So thank you again to Dr Weir and to everyone who has spoken out about this, because in doing so, not only are you setting the record straight with the actual truth about the matter, you are also helping to support those of us who have spoken out and shared our stories because we wanted to help get rid of all the stigma and in doing maybe help others. Heartfelt thanks for that.

  • Dr. Gordon Yanchyshyn, M.D., FRCPC, Psychiatrist and Psychoanalyst says:

    Raising public awareness about mental illness will only be worthwhile if the information provided is balanced and truthful. Dr, Weir has written an excellent rebuttal to the Toronto Star’s misinformed and distorted articles on ECT. Those of us in the mental health field have to remain vigilant and vocal about the continuing stigmatization of our patients and our therapeutic work.

    I only hope that the general public reads important blogs like this one and contributes to the dialogue.

    • deborah L schwartzkopff says:

      Your therapeutic work when you are aware of harm, includes reporting known harm. CA. courts have proved brain injuries result from this at baseline, yet that is still not part of consent. Patients are also deserved notice that both the device and procedure have not been tested for safety or effectiveness, that too is part of your job to expose when known. When patients tell you of their poor outcomes from this it is your job to document, address, and protect. It is not a time to minimize, blame shift, nor gas light someone already struggling with extensive neuro/cog damages from this. Doctor protecting doctor has to end and remember who you are supposed to stand up for.

  • Dr D. Ray Freebury MB BCh, FRCPC, DLFAPA Training Analyst Toropnto Institute of Psychoanaklysis says:

    Depressed patients in Canada owe a debt of gratitude to Dr. Weir for his commitment to removing the stigma both of mental illness and its necessary treatments.
    There is no controversy amongst psychiatrists about the benefits of modern application of ECT for treatment resistent depression.
    The harm done by the media through such manipulative reporting is unconscionable

    • deborah L schwartzkopff says:

      The truth of modern application of ECT still results in brain trauma. You inflict unresponsiveness with an electrical mechanism of trauma, seizure, antero/retrograde amnesia, temporary euphoria etc. is still brain trauma and outcomes of same. Your research actually speaks to structural brain changes from this. Bilateral ECT can impact the brain stem where vital functions reside, yet none of this on consent. No mention of no testing on consent of device or procedure. There is no controversy with psychiatrists around this procedure you state. Of course not, because they would implicate themselves and there peers, their research, their monies. This is trauma pure and simple. Psychiatry has much influence and power currently, but you are not above ONE law. Doctors and nurses have a responsibility to intervene and advocate for patients who are at their most vulnerable and trusting.

  • Aidan says:

    Dr. Weir continues to be a great advocate for mental health. It’s crucial that we continue to help educate the public about this illness, and the stigma associated with it. Hopefully Dr. Weir will continue this work after he’s done as President of the OMA.

  • Dr. William Robinson MD.CM. CRCP (C) Training Analyst , Toronto Institute of Psychoanalysis says:

    Thank God for the presence and insightful comments of Dr. Weir . His diligence in assessment of and treatment of patients in the realms of general psychiatry and psychoanalysis is well established and highly respected . Of crucial importance in the midst of all of this is also the trust , admiration and respect that he has worked so hard to achieve -and indeed has achieved- in the entire world of medicine in Ontario , to the point wherein he was elected as President of The Ontario Medical Association in the last election . This is no small achievement , because it reflects a respected grasp , not only in his chosen branch of medicine , but in the whole field of medicine wherein his colleagues can see him as a man of good judgment and a leader .
    Can we not see , then , that his comments on this whole field of depression and selected treatment with ECT has to be accepted as respected and valid . It is not defensive propaganda , but studied and practised clinical judgment

    • deborah L schwartzkopff says:

      No. I do not accept his opinion. This is not safe and needs to be abolished. He may be a good doctor, a personable and respected professional, but I do not respect nor agree with the cover ups around this harm of patients.

  • dr.Janusz Gawlik says:

    ECT remains most effective therapeutic approach particularly for treatment resistant patients, and older patients or/and patients with complex medical problems. However, as a psychiatrist in private practice I do have very limited access to ECT due to long waitng time for treatment which often is needed now, today, otherwise becomes quite remote therapeutic optijon.

Author

Doug Weir

Contributor

Doug Weir is the President of the Ontario Medical Association and has been practicing psychiatry in Toronto for over 30 years.