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

Chapter 6: The American Psychiatric Association Task Force

86 6 The American Psychiatric Association Task Force 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 so pleased with the way the task force strategy worked to forestall legislation in Massachusetts that it appointed the chair of that group, Fred Frankel, to head the national effort. The APA Board of Trustees selected the task force members. Five of the nine were ECT practitioners, and at least three belonged to the shock industry lobbying group, the International Psychiatric Association for the Advancement of Electrotherapy (IPAAE). Max Fink was the principal mover of the task force. The lone psychologist, Larry Squire, was a young researcher just beginning a long career in studying memory. His work would become central to the shock apologists’ plan. The Task Force Report was funded by the IPAAE, who provided “important input,” according to Gary Aden, as well as Fink’s own private foundation, the International Association for Psychiatric Research (now Scion Natural Science Association). Larry Squire also paid part of the cost of the report from his federal grant money.2 In 1976, to kick off the task force’s first public meeting, the APA declared a “crisis in ECT.” The crisis, in the words of Fink, consisted of “public demands and legislative fiats to stop the use” of ECT.3 The possibility of a problem with ECT itself was not on the table for consideration. Never did the industry stop and ask itself why patients didn’t want ECT, or whether it really was dangerous. It defined its problem as a public relations problem only, and set out to polish the image of ECT. The structure, tone, and content of the Task Force Report reflect that mission. From beginning to end it was a political, not scientific, document, written to achieve political goals. The authors relied on their M.D.s and CH006.qxd 12/6/08 2:37 AM Page 86 The APA Task Force 87 Ph.D.s to convince an uncritical public, including lawmakers, that whatever the task force produced would be upheld as sound science. That gave the authors the freedom to cut their public relations talking points from whole cloth: snipping with impunity, leaving out what didn’t suit them, tailoring what was left to fit an agenda determined in advance. A scientific investigation never begins with a public opinion poll, but a public relations campaign always does. Following the formula used in Massachusetts, the APA’s first step was to poll a 20 percent sample of its members. They weren’t going to investigate ECT; they were going to ask people’s opinions of ECT. But of course the questions were worded carefully . There were few chances for participants to comment on the adverse effects of shock. Psychiatrists were asked whether it was likely that ECT causes slight or subtle brain damage, thus disallowing the possibility of more serious damage. Forty-one percent answered yes to this question, which must have alarmed the task force members. Organized psychiatry had reason to be concerned about winning over those doubters. To give the illusion of openness, the task force held a so-called Open Forum paper presentation at the APA’s 1976 convention in Miami Beach. But the panel was stacked with ECT advocates: Fink, Frankel, Salzman, Greenblatt. There was one exception: neurologist John Friedberg, author of Shock Treatment Is Not Good for Your Brain, presented a survey of the literature that the psychiatrists wanted swept under the rug. The APA newspaper, Psychiatric News, mused disingenuously, “It was unfortunate that Friedberg alone had to carry an entire side of the debate against five other speakers”— without revealing that in fact psychiatrists had been forbidden to speak critically of ECT, so that none of them dared step up to do so, even when Friedberg offered to cede his time to a psychiatrist.4 The industry rag described Friedberg as “speaking more as if chanting a litany than reading a scientific paper.”5 A second neurologist, Robert Grimm, urged caution on the task force in a written statement, pointing out that “the use of convulsions by one branch of medicine (psychiatry) to effect a therapeutic response while another branch (neurology...