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

Chapter 15: The Triumph of Public Relations over Science

253 15 The Triumph of Public Relations over Science 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 a foolproof way to get around the laws protecting patients’ rights to full disclosure and to refuse treatment. As well, it has been able to insulate itself from potential liability for damages. Patients today often have, in reality, fewer rights and less recourse than they had before the PR campaign. How did this happen? The PR Line for the Twenty-First Century Beginning in the 1990s, the industry began to formulate a novel public relations solution to its enduring problem of shock patients who continue to allege brain damage. It now claims that mental illness causes brain damage. Since everyone who has had shock was labeled mentally ill at some point, this theory serves as a convenient smokescreen for reconceptualizing brain damage as the result of intrinsic disease rather than an outcome of treatment . (In one fell swoop, the estimated fourteen million Americans who are labeled depressed have been defined as brain damaged—a story no one in the media has picked up on yet.) By the rules of the doubting game, the onus is now placed on others to prove that depression does not cause brain damage, not on the industry to prove that it does. Meanwhile, a brand new answer to the embarrassing question of how ECT exerts its therapeutic effects is offered. According to Harold Sackeim and others, not only does shock not cause brain damage, it causes patients to grow new brain cells. I first heard Sackeim talk about this at the beginning of the 1990s. This was in the context of an interview that was to have been a discussion of ECT research, but instead, he wanted to talk about his new explanation for why CH015.qxd 12/6/08 3:14 AM Page 253 ECT survivors report brain damage and memory loss. They were mistaking the effects of psychiatric conditions for the effects of ECT. He tried to tell me that my massive loss of intelligence post-ECT was caused by psychosis. But I was never psychotic. He had nothing to hang this theory on. Nevertheless, he continued to elaborate on his theory that mental illnesses are literally toxic conditions that damage the brain. Depression, he said, is a progressive cerebrovascular disease, and any changes in the brain are due to this ongoing degenerative disease process, not ECT. That was why, according to Sackeim, there was no need for a brain scan study looking at people before and after shock. It was in the best interest of humanity, he concluded , that scientists were investigating this new theory of depression, rather than that tired and boring old question of whether ECT causes brain damage. During a 2001 conversation, he repeated the claim he first made to me ten years earlier. I queried him on all angles, so that there was no chance of misunderstanding him. Depression itself, period, causes permanent brain damage, he said, even when it’s successfully treated, even if the person recovers and never again has any symptoms. In my case, he said, a single episode of depression lasting a few months, sixteen years earlier, must have damaged my brain severely enough to cause permanent cognitive problems. This was true even though I hadn’t had any of these cognitive problems while I was depressed, only after the ECT when I was not. In support of his theory, Sackeim—who speaks in literature citations whenever possible—threw out some names, dates, and journal references. I read the articles, but they didn’t say what he claimed they did. Intrigued, I got in touch with the scientists themselves. All do brain research. None of them do ECT. Some work only with animals, not humans. None were aware of Sackeim’s attempts to hitch his theories to their research. All were willing to discuss their work with me in detail. Scientists Respond to Sackeim All of the researchers told me, in no uncertain terms, that Sackeim’s “depression causes brain damage” theory was not supported by the science. The scientist Sackeim mentioned most enthusiastically as supporting his theory was psychiatrist Yvette Sheline of Washington University in...