Doctors of Deception

Contents

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pp. vii-

Acknowledgments

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pp. ix-

I would not, could not have written this book if I hadn’t had the good fortune to have known Marilyn Rice (1923–1992) and to have inherited her voluminous archives of published and unpublished material on shock. To find all this material on my own would have been...

Notes on Terminology

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pp. xi-

The words we use have tremendous power to shape our perceptions and our reality. Nowhere is this truer than in the field of psychiatry. Here words affect our very sense of who we are and, by making our choices seem limited, can have real and sometimes disastrous effects on our...

Chapter 1: The Trouble with Time

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pp. 1-12

Imagine you wake up tomorrow with your past missing. Although you look and feel the way you always have, and although everyone around you acts as if nothing’s wrong, you slowly become aware that you don’t have the most vital information about who you are. You may not recognize your home or know where your bank accounts are or what...

Chapter 2: Eugenic Conceptions I: Ticking Time Bombs

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pp. 13-27

I’d lost my whole world and gained a psychiatric label. Now I was thrust into a world I hadn’t known existed, a kind of parallel universe. I was not prepared for what happened there. I didn’t feel like a mental patient, had no memory or experience of any psychiatric treatment or symptoms, and never went near a psychiatrist again; yet I had...

Chapter 3: Eugenic Conceptions II: Useless Eaters

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pp. 28-43

Within memory of those still alive today is a time when it was not only acceptable to speak of mental patients as worthless defectives and malignant growths, it was possible for those at the highest levels of society and within organized psychiatry to act on these...

Chapter 4: A Little Brain Pathology

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pp. 44-66

If it were a drug or a medical device coming onto the market today, electroshock would have to be proven safe and effective in controlled trials, and would have to be cleared for use by the Food and Drug Administration (FDA). Because there were no such safeguards in effect in 1938, and because ECT’s inventors and promoters had never thought...

Chapter 5: Informed Consent and the Dawn of the Public Relations Era

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pp. 67-85

The ECT industry entered the public relations era in 1972. At that point the industry committed itself to a strategy to which it has held fast ever since. It made the decision to act as if ECT had been proven safe and effective. In effect, its power and credibility would serve as collateral against the fact that a thorough and unbiased scientific investigation...

Chapter 6: The American Psychiatric Association Task Force

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pp. 86-106

In direct response to what it perceived as “challenges,” including real and imaginary legislative initiatives, organized psychiatry took action. In the fall of 1974, just as California passed its first ECT patients’ rights bill, the APA established the Task Force on ECT “to defend against the complaints that the treatments were dangerous and abused.”¹ It was...

Chapter 7: The Making of an American Activist

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pp. 107-123

The American Psychiatric Association’s PR script does not allow for any criticism of electroshock. It is so overbroad in its denial of harm from contemporary ECT, and so committed to its denial, that it must dismiss all its critics as irrational. It does this effectively, without ever addressing any of their claims, by maligning their character, sanity, or...

Chapter 8: The ECT Industry Cows the Media

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pp. 124-137

The campaign to sell psychiatry and its wares to the public began in earnest in August 1977, in specific response to the Madness and Medicine program. The newly elected president of the American Psychiatric Association, Jack Weinberg, sent out a letter to all its members that was also published in Psychiatric News.¹ It announced the beginning of the...

Chapter 9: Long Strange Trip: ECT at the Food and Drug Administration

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pp. 138-155

In the 1980s the ECT industry convinced the federal government that ECT was safe without ever doing a single safety study. In place of clinical trials, it substituted a massive lobbying campaign to the Food and Drug Administration (FDA). The American Psychiatric Association, the National Institute of Mental Health, and doctors from the most prestigious...

Chapter 10: The Committee for Truth in Psychiatry

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pp. 156-169

Marilyn Rice had developed a core network of fellow survivors over the years, but she had never put together any kind of formal organization. “Organizing is definitely not my bag,” she was known to say, but by 1984 people were interested and the time was right. The work they were already doing at the FDA begged for a formal structure. ...

Chapter 11: Anecdote or Evidence?

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pp. 170-188

The APA was convinced that it needed to bolster its position with letters to the FDA from former patients who were satisfied with their treatment. It was aware of the letters pouring in from ex-patients reporting permanent memory loss and cognitive disability. In an effort to neutralize the effect of these reports, Richard Weiner begged for letters in...

Chapter 12: Shaming Science

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pp. 189-211

Medical science today is a practice far removed from the idealistic notions of helping patients or advancing scientific knowledge. Scientific research now requires institutional support and competitive funding. It’s a high-stakes, profit-driven enterprise where stakeholders with conflicting interests compete to influence and spin the results. Billions of...

Chapter 13: The Lie That Won’t Die

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pp. 212-230

For the most part, the general public doesn’t have the time or expertise to pore through original scientific research, or to investigate whether it has been biased by financial conflicts of interest. How, then, are we to tell good science from bad science, good advice on health matters from bad or biased advice? Whether we are deciding if we ought to...

Chapter 14: Erasing History

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pp. 231-252

Besides the media, the public generally gets its opinions about shock and other treatments for mental illness from official sources, trusted authorities like the federal Center for Mental Health Services, the National Institute of Mental Health, the Surgeon General, and state departments of mental health. All of these have taken positions on...

Chapter 15: The Triumph of Public Relations over Science

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pp. 253-266

In its public relations campaign, the APA has successfully reshaped perception of the nature and risks of shock for a whole generation of doctors, patients, and the public. In doing so, it has subtly redefined the very meaning of words like “informed consent” and “competency” to its advantage. The result is that the ECT industry has found...

Chapter 16: Should ECT Be Banned?: The Moral Context

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pp. 267-286

It is impossible for anyone—doctors, patients, the public, the media—to discuss shock without speaking about it in moral terms. Questions such as, how much risk is justified for how much benefit? what should patients be told or not told? and whether forced shock can ever be justified—these are by their very nature moral questions, to be decided based...

Chapter 17: Where Do We Go from Here?

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pp. 287-301

Despite the success of the public relations campaign, the battles over shock, primarily between doctors and patients, show no sign of subsiding. There are some subtle but hopeful signs that people who have experienced ECT and those who have the critical thinking skills to see through the industry propaganda may yet shift the balance in favor of...

Epilogue

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pp. 302-305

Even in a book this long, so much has had to be left out. For this I apologize to those whose stories got told only in passing or not at all. I had difficult choices to make. Two of the most important stories left out were those of the citywide ban on shock in Berkeley...

Appendix: Letters from FDA Docket No. 82P-0316

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pp. 306-315

Notes

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pp. 316-348

Resources

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pp. 349-

If you have had ECT, are considering it, or just want to know more about it, far and away the most comprehensive and unbiased source of information is www.ect.org. The site has been in operation since 1995. You will find, among other things, journal articles, legal information, updates on forced shock cases, and the opportunity to interact with...

Index

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pp. 351-359

About the Author

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pp. 361-

Linda Andre writes and surfs in New York City. She is the director of the Committee for Truth in Psychiatry, a national nonprofit organization of ECT survivors that advocates for truthful informed consent. She has published numerous articles in general interest and scholarly...