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

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

67 5 Informed Consent and the Dawn of the Public Relations Era 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 had never taken place, and against the word of innumerable ECT patients. As its numbers and influence grew over the decades, its collateral would be more than sufficient. The industry likes to point to the 1975 movie One Flew Over the Cuckoo’s Nest as the source of its problems, as if they only began when large numbers of people saw electroshock used as punishment on the rebellious mental patient character Randle McMurphy, played by Jack Nicholson. However, the novel by Ken Kesey (which was far more critical of ECT) had been published in 1962, and not a peep was heard from psychiatry; the shock industry had no need or use for it back then. But beginning in the late 1970s, the movie served retroactively to justify the public relations strategy that was already well underway. Cuckoo’s Nest is to this day a touchstone for the industry, a significant event in popular culture to which it can point and say with mock outrage , “Look how unfair!” Cuckoo’s Nest informed the strategy, to be sure, and put the meat on its bones. But it wasn’t, could not have been, a Hollywood movie that precipitated what psychiatrists perceived as a crisis in ECT. What fired up the industry, what precipitated the crisis? It was the idea that ECT patients have rights, including the right to informed consent and the right to refuse. In 1972, courts began to take this idea seriously and to rule in favor of patients. There was another, equally compelling reason why the industry needed an aggressive public relations campaign in 1972, and that was the invention of the CAT scan, a method of three-dimensionally imaging the brain and the body (CAT is shorthand for computed axial tomography). The means for a CH005.qxd 12/6/08 2:35 AM Page 67 scientific investigation of ECT’s permanent effects on the brain was finally at hand. If ECT were to survive as a viable treatment, the industry had to make sure the new technology wasn’t put to use to challenge its safety. In the first three decades of ECT, patients were not required to give consent , and doctors thought nothing of shocking people who objected vigorously . Those who resisted were physically or chemically overpowered and dragged to the shock table. In fact, a leading shock doctor recommended that patients not even be told that they had been selected for shock, since in his opinion “such information could not possibly do the patient any good.” Nor should they be asked for consent, lest they refuse; written consent should be obtained from relatives. Even less did the ECT industry concern itself with the idea of informed consent. This doctrine, which began to be put into practice in other fields of medicine in the late 1950s, holds that a consent is not valid unless a patient is fully informed about the risks and benefits of the proposed treatment, understands them, and agrees to them. Legally, informed consent is the difference between treatment and assault and battery. In 1961, one doctor told a U.S. Senate subcommittee, “I think one should go to the extreme of always explaining to a patient if he is going to get electroshock why he is going to get it and what it is going to be like and so forth. But as far as getting permission from the patient is concerned, this is not necessary .” The American Civil Liberties Union Handbook on The Rights of Mental Patients, published in 1973, stated that “generally speaking, mental patients do not have the right to refuse electroshock therapy.” That began to change in the early 1970s. The Pilot Project for “Trust Us, We’re Doctors” In 1972, Boston Globe reporter Jean Dietz began to write about ECT abuses in Massachusetts. She reported that in some cases patients had received over a hundred shocks. She also pointed out the money motive in ECT: it was being disproportionately used in the state’s small, private, pro...