Doctors of Deception: What They Don't Want You to Know about Shock Treatment

Chapter 14: Erasing History

231 14 Erasing History 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 ECT during the PR era. If you’ve heard or read anything of what these authorities say about ECT, it’s likely to have been dumbed down to the size of a sound bite reassuring you that shock is safe. Virtually no one reads the original reports, but even if you had, you would be getting less than half of the story. You just have no idea what could have been, or almost was. And the reasons for “almost” are as stereotypical as a tabloid’s headline about a psycho killer. They have nothing to do with facts or science and everything to do with who has the power to enforce a particular version of the truth. Make no mistake, whenever a government entity takes on ECT (or any other topic, such as the effects of psychiatric drugs on suicides), these are hotly contested political statements, and the process by which they are developed is a political power struggle. Different constituencies fight for input, and the playing field is not level. In order to show how this plays out in real life, I have chosen three recent stories from the front lines. In each case I was directly involved in the yearslong process of trying to shape the final documents: the “Background Paper on Electroconvulsive Therapy” put out by the federal Center for Mental Health Services, an agency of the Department of Health and Human Services, in 1998; the U.S. Surgeon General’s Report on Mental Health released in 1999; and the state of Vermont’s official informed consent form adopted in 2000. In the beginning of this book I talked about the ways in which mental patients are seen as less than human and deprived of fundamental rights in daily life. That type of attitude does not disappear when we show up at the courthouse, the statehouse, or at a place like the Carter Center, which CH014.qxd 12/6/08 3:12 AM Page 231 hosted a meeting to promote the Surgeon General’s Report on mental health in 1999. I vividly remember a lunchtime conversation with a bureaucrat from the Center for Mental Health Services (CMHS), where she was working on the center’s position paper on ECT. I tried to explain to her that shock can permanently impair a person’s ability to work. I thought she might care about the economic consequences of shock, even if she didn’t care about mental patients. Her response: “But those people would never be able to work anyway.” These types of stereotyped attitudes of exclusion are played out in stereotyped mechanisms of exclusion. These are not specific to psychiatric survivors but are used successfully with other disenfranchised or dissident groups. First, the group or person is structurally excluded from participation by formal or informal rules. For example, a person can be excluded because “only” doctors, certified experts, or state residents are allowed to participate. These rules may or may not actually exist, but as long as someone with authority says they do, the person is usually dissuaded from challenging them. Second, the group or person may be procedurally excluded. Information or access is withheld in an informal manner that seems careless or accidental , and thus difficult to challenge, but usually is not. For example, letters and phone calls from the excluded persons are simply ignored (for years on end if necessary), and no details are revealed about the process that could allow them to figure out how to get involved. Procedural exclusion can also mean giving the appearance of meaningful involvement to some groups—allowing them to speak at meetings—but disregarding their input. It also encompasses tokenism, when an organization or government agency selects one person who is nominally a member of the excluded group but who is or can be convinced that it is in his or her own best personal interest to go along with what the government wants to do rather than what the group wants. It is important to note that it is not really necessary to do anything for structural and procedural exclusion of a powerless group like ECT survivors...