1995 USA Today Series on ECT
By Dennis Cauchon, USA TODAY
The electrodes were placed on her head. With the push of a button, enough electricity to light a 50-watt bulb passed
through her skull.
Her teeth bit hard into a mouth guard. Her heart raced. Her blood pressure soared. Her brain had an epileptic-style
grand mal seizure. Then, Ocie Shirk had a heart attack.
Four days later, on Oct. 14, 1994, the 72- year-old retired health department worker from Austin, Texas, was dead
of heart failure – the leading cause of shock-related death.
After years of decline, shock therapy is making a dramatic and sometimes deadly comeback, practiced now mostly
on depressed elderly women who are largely ignorant of shock’s true dangers and misled about shock’s real risks.
Some lose already fragile memories. Some suffer heart attacks or strokes. And some, like Ocie Shirk, die.
A four-month USA TODAY investigation found: The death rate for elderly patients who receive shock is 50 times
higher than patients are told on the American Psychiatric Association’s model consent form. The APA sets the chance
of dying at 1 in 10,000. But the death rate is closer to 1 in 200 among the elderly, according to mortality studies
done over the past 20 years and death reports from Texas, the only state that keeps close track.
Shock machine manufacturers greatly influence what patients are told about shock’s risks.
Virtually all “educational” videos and brochures shown to patients are supplied by shock machine companies. And
the APA’s 1-in-10,000 death rate estimate is attributed to a book written by a psychiatrist whose company sells
about half the shock machines sold each year.
Shock therapy is strongly regaining favor among psychiatrists as a treatment for depression. Although exact figures
are not kept, one indication of the trend comes from Medicare, which paid for 31% more shock treatments in 1993
than it did in 1986.
The elderly now account for more than half of the estimated 50,000 to 100,000 people who receive shock each year,
with women in their 70s getting more shock than any other group. In the 1950s and 1960s, young male
schizophrenics got most shock therapy.
Shock therapy is the most profitable practice in psychiatry, and economics strongly influences when shock is given
and who gets it.
In Texas, the only state that keeps track, 65-year- olds get 360% more shock therapy than 64-year-olds. The
difference: Medicare pays.
Shock treatment may shorten the lives of the elderly, even if it doesn’t cause immediate problems.
In a 1993 study of patients 80 and older, 27% of shock patients were dead within one year compared to 4% of a
similar group treated with anti-depressant drugs. In two years, 46% of shocked patients were dead vs. 10% who
had the drugs. The study, by Brown University researchers, is the only study of long-term survival rates in the
elderly.
Doctors rarely report shock treatment on death certificates, even when the connection seems apparent and death
certificate instructions clearly indicate it should be listed.
For this story, USA TODAY reviewed more than 250 scientific articles on shock therapy, watched the procedure at
two hospitals and interviewed dozens of psychiatrists, patients and family members.
Outside of medical journals, accurate information about shock is sketchy. Only three states make doctors report who
gets it and what complications occur. Texas has strict reporting requirements; California and Colorado less stringent
rules.
The information that is available raises serious questions about how shock therapy is practiced today, particularly on
the elderly.
“We’ve learned nothing from the mistakes of my generation,” says psychiatrist Nathaniel Lehrman, 72, retired
clinical director of Kingsboro state mental hospital in New York. “The elderly are the people who can least stand”
shock. “This is gross mistreatment on a national scale.”
A changing image
Monday, Wednesday and Friday morning is shock therapy time in hospitals across the country.
Most patients get a total of six to 12 shocks: one a day, three times a week until the treatment is finished. Patients
generally receive a one- or four-second electrical charge to the brain, which causes an epileptic-like seizure for 30 to
90 seconds.
The American Psychiatric Association information sheet for patients says: “80% to 90% of depressed people who
receive (shock) respond favorably, making it the most effective treatment for severe depression.” Psychiatrists who
do shock therapy also are convinced of its safety.
“It’s more dangerous to drive to the hospital than to have the treatment,” says psychiatrist Charles Kellner, editor of
Convulsive Therapy, a medical journal. “The unfair stigma against (shock) is denying a remarkably effective medical
treatment to patients who need it.” Psychiatrists say shock therapy is a gentler procedure today than it was in its
heyday in the 1950s and 1960s, when it was an all-purpose treatment for everything from schizophrenia to
homosexuality.
And advocates say it’s nothing like its portrayal 20 years ago in the movie One Flew Over the Cuckoo’s Nest, which
showed electroshock being used to punish mental patients.
The movie helped send shock therapy into decline and prompted laws across the nation making it hard to give shock
treatment without the patient’s written consent.
Because of abuse in the past, shock is seldom done now at state mental hospitals, but mostly at private hospitals
and medical schools.
The language is softer today, too, reflecting an effort to change shock’s image: Shock is “electroconvulsive therapy”
or, simply, ECT. The memory loss that often accompanies it is called “memory disturbance.” These changes come as
doctors expand shock’s reach – to high-risk patients, to children, to the elderly – altering the profile of who gets
shock therapy so much that the typical patient now is a fully insured, elderly woman treated for depression at a
private hospital or medical school.
Someone like Ocie Shirk.
Died in recovery room
Shirk, a widow coping with recurring depression, already had one heart attack and suffered from atrial fibrillation, a
condition that causes rapid heart quivers.
On a Monday at 9:34 a.m., Oct. 10, 1994, she received shock therapy at Shoal Creek Hospital, a for-profit
psychiatric hospital in Austin. She had a heart attack in the recovery room. Four days later, she died of heart failure.
Yet shock therapy isn’t mentioned on Shirk’s death certificate, despite repeated instructions on the form to include
every event that may have played a role in the death.
The medical examiner confirms that shock should have been on the death certificate. “If it happens so close after
(shock) therapy, it definitely should be listed,” says Roberto Bayardo, Austin’s medical examiner.
Gail Oberta, chief executive of Shoal Creek Hospital, declines comment on Shirk. But she says, “When I checked all
our records and went through all the reviews we do, there were no deaths related to ECT.” A Texas Department of
Health investigation found Shirk’s treatment didn’t meet the required standard of care because her medical records
did not include a current medical history or physical that would let doctors accurately assess shock therapy’s risks.
The hospital agreed to correct the problem.
In addition to Shirk, state records show two other patients died after shock therapy at Shoal Creek. Asked about
these deaths, Oberta repeats: “We could find no correlation between deaths of patients and receiving ECT at this
facility.” Getting to the facts behind shock-related deaths is very difficult even in Texas, which in 1993 became the
only state with a strict law on shock therapy. The law, passed after lobbying from shock opponents, requires all
deaths that occur within 14 days of shock therapy be reported to the Texas Department of Mental Health and
Retardation.
In the 18 months after the Texas law took effect, eight deaths – including the three at Shoal Creek – were reported
out of the 2,411 patients who received shock therapy in the state. About half those who received shock were
elderly.
Six of the eight dead patients were older than 65.
Stated another way: 1 in 197 elderly patients died within two weeks of receiving shock therapy. The state does not
release enough information to know if shock caused the deaths.
Nationally, record-keeping is almost nonexistant.
The Centers for Disease Control reports shock therapy was listed on death certificates as a factor in only three
deaths over the five years ending 1993 – a number so low that it contradicts even the most favorable estimates of
shock mortality.
The CDC records shock-related deaths under a category called “Misadventures in Psychiatry.” “For obvious reasons,
doctors are reluctant to list anything that falls into this category,” says Harry Rosenberg, head of mortality data at
the CDC, “even though we encourage them to be forthright.”
Elderly deaths: 1 in 200
The American Psychiatric Association shock therapy task force report has been the bible of shock practice since its
publication in 1990. It says 1 in 10,000 patients will die from shock therapy.
This estimate is included on the APA’s model “informed consent” form, which patients sign to prove they’ve been
fully informed of the risks of shock treatment.
The source for this estimate: A textbook written by psychiatrist Richard Abrams, president and co- owner of shock
machine manufacturer Somatics Inc. of Lake Bluff, Ill.
Somatics is a private company. Abrams won’t say how much of the company he owns or how much he earns from it.
“I don’t know where they got that (estimate) from,” Abrams says of the 1-in-10,000 death rate.
When pointed to page 53 of his 1988 textbook Electroconvulsive Therapy, where the death rate appears twice,
Abrams notes that the number was dropped from the 1992 edition.
His updated textbook states the death rate differently, but Abrams agrees it amounts to the same thing.
Abrams’ revised book says a death will occur once in every 50,000 shock treatments. He says it’s fair to assume
that the average patient gets five treatments, making the death rate about 1 in 10,000 patients. Five shocks is
average because some patients stop their treatment early.
Abrams’ figures are based on a study of shock deaths that psychiatrists report to California regulators. But USA
TODAY found that shock deaths are significantly underreported in California and elsewhere.
At a recent professional meeting, for example, a California psychiatrist told how shock therapy caused a stroke in
one of his patients. The man, in his 80s, died several days later. But the death was never reported to state
regulators.
Consistently, the studies of elderly death rates conflict with the 1-in-10,000 estimate: A 1982 Journal of Clinical
Psychiatry study found one death among 22 patients aged 60 and older. A 71-year-old woman had
“cardiopulmonary arrest 45 minutes after her fifth treatment. She expired despite intensive resuscitative efforts.”
Two men in the study, ages 67 and 68, suffered life- threatening heart failure but survived. Seven more had less
serious heart complications.
A 1984 Journal of American Geriatrics Society study – often cited as proof of shock therapy’s safety – found 18 of
199 elderly patients developed serious heart problems while receiving shock. An 87-year-old man died of a heart
attack.
Five patients – ages 89, 81, 78, 78 and 68 – suffered heart failure but were revived.
A 1985 Comprehensive Psychiatry study of 30 patients age 60 and older found one death. An 80-year-old man had a
heart attack and died several weeks later. Four others had major complications.
A 1987 Journal of the American Geriatrics Society study of 40 patients age 60 and older found six serious
cardiovascular complications but no deaths.
A 1990 Journal of the American Geriatrics Society study of 81 patients age 65 and older found 19 patients developed
heart problems; three cases were serious enough to require intensive care. None died.
These studies looked only at complications that occurred while a patient was undergoing a series of shock
treatments; long-term mortality rates were not considered.
Taken together, the five studies found three of 372 elderly patients died. Another 14 suffered serious complications,
but survived. These results are similar to a study of shock therapy deaths done in 1957 by David Impastato, a
leading shock researcher of the time.
He concluded: “The death rate is approximately 1 in 200 in patients over 60 years of age and gradually decreases to
1 in 3,000 or 4,000 in younger patients.” Impastato found heart problems were the leading cause of shock-related
death, followed by respiratory problems and stroke – the same pattern as in recent studies.
“The claim that 1 in 10,000 people die from shock is refuted by their own studies,” says Leonard Roy Frank, editor of
The History of Shock and a shock opponent. “It’s 50 times higher than that.” But Abrams, who has reviewed the
studies, calls it “irrational and incomprehensible” to attribute so many of the deaths to shock itself. Even if a patient
has a heart attack minutes later – as Ocie Shirk did – Abrams says, “it may very well not be ECT-related.” Duke
University psychiatrist Richard Weiner, chairman of the APA task force, also believes studies show the 1-in-10,000
estimate is accurate and disagrees the elderly death rate could be as high as 1 in 200.
“If it were anywhere near that high, we wouldn’t be doing it,” Weiner says. He says health problems, not age, cause
the appearance of a higher death rate among elderly.
Still, some doctors who consider shock therapy a relatively safe treatment are conc
erned about the complications in elderly patients.
“Almost every death in the literature is an elderly person,” says William Burke, a University of Nebraska psychiatrist
who’s studied shock and the elderly. “But it’s hard to hazard a guess on a death rate because we don’t have the
data.”
Shock is profitable The financial incentives of performing shock may be driving the increase in its use.
Shock therapy fits well into the economics of private insurance. Most policies don’t pay for psychiatric hospital stays
after 28 days. Drug therapy, psychotherapy and other treatments can take much longer. But shock therapy often
produces a dramatic effect in three weeks.
“We’re looking for more bang for the buck in health care today. This treatment gets people out of the hospital fast,”
says Dallas psychiatrist Joel Holiner, who performs shock.
It is also the most profitable procedure in psychiatry.
Psychiatrists charge $125 to $250 per shock for the five- to 15-minute procedure; anesthesiologists charge $150 to
$500.
This bill for one shock at CPC Heritage Oaks Hospital in Sacramento, Calif., is typical: $175 for the psychiatrist.
$300 for the anesthesiologist.
$375 for use of the hospital’s shock therapy room.
The patient got a total of 21 shocks, costing about $18,000. The hospital charged another $890 a day for her room.
Private insurance paid.
Those figures add up. For example, a psychiatrist who does an average of three shocks a week, at $175 per shock,
would increase his or her income by $27,300 a year.
Medicare pays less than private insurance – the payment varies by state – but it is still lucrative.
Before turning 65, many people are uninsured or have insurance that does not cover shock. Once someone qualifies
for Medicare, the chance of getting shock therapy soars – as the 360% increase in Texas shows.
Stephen Rachlin, retired chairman of psychiatry at Nassau County (N.Y.) Medical Center, believes shock therapy is
useful treatment. But he worries that financial rewards may influence its use.
“The rate of reimbursement by insurance is higher than anything else a psychiatrist can do in 30 minutes,” he says.
“I’d hate to think it’s done solely for financial reasons.” Psychiatrist Conrad Swartz, co-owner with Abrams of
Somatics Inc., the shock equipment manufacturer, defends the financial rewards.
“Psychiatrists don’t make much money, and by practicing ECT they can bring their income almost up to the level of
the family practitioner or internist,” says Swartz, who performs shock himself.
According to the American Medical Association, psychiatrists earned an average of $131,300 in 1993.
A doctor says ‘no’
Michael Chavin, an anesthesiologist from Baytown, Texas, participated in 3,000 shock sessions before he stopped
two years ago, worried he was hurting elderly patients.
“I began to get very disturbed by what I was seeing,” he says. “We had many elderly patients getting repeated
shocks, 10 or 12 in a series, getting more disoriented each time. What they needed was not an electroshock to the
brain, but proper medical care for cardiovascular problems, chronic pain and other problems.” In Chavin’s view,
when the cardiovascular system is dramatically stressed in the elderly, doctors risk triggering a fatal decline.
“As an anesthesiologist, what I do for three to five minutes can have serious consequences later,” Chavin says. “But
psychiatrists cannot bring themselves to admit any harm from ECT unless the patient gets electrocuted to death on
the table while being videotaped and observed by a United Nations task force.
“These deaths are telling us something. Psychiatrists don’t want to hear it.” Chavin, then chief of anesthesiology at
Baycoast Medical Center, stopped doing shock in 1993, reducing his income by $75,000 a year.
He says he feels ashamed that his waterfront home and pool were partially financed by what he considers to be
“dirty money.” In spite of his growing doubts, Chavin didn’t quit doing shock right away. “It was hard to give up the
income,” he says.
First, Chavin turned away patients. “I’d tell the psychiatrist: ‘This 85-year-old woman with high blood pressure and
angina is not a good candidate for repeated anesthesia.’ ” Then, to confront his doubts, he began looking at the
research on shock therapy. “I found it was done by psychiatrists who do electroshock for a living,” Chavin says.
He finally quit doing shock and another anesthesiologist took over. Two months later, on July 25, 1993, a patient
named Roberto Ardizzone died from respiratory complications that began as he received shock therapy.
The hospital stopped doing shock altogether.
Former patient still suffering
USA Today Series
12-06-1995
Former patient still suffering
Delores McQueen of Lincoln, Calif., received shock treatment in 1993 at CPC Heritage Oaks Hospital in
Sacramento. Her bill: $18,000.
“I wouldn’t have minded so much if it had done any good,” says McQueen, who still suffers from deep
depression.
McQueen, who has fought depression much of her life, suffered a relapse after her sister died. She was
hospitalized and even slashed her wrists in a suicide attempt.
Her psychiatrist recommended shock therapy. She received more than 20 shocks.
McQueen says shock destroyed large parts of her memory:
She couldn’t remember the names of her children.
She got lost driving once-familiar hometown streets.
She forgot how to ride horses, which she’d once trained and showed.
She couldn’t remember family hunting and fishing trips.
She didn’t know who her old friends were, even when they greeted her at the mall.
She couldn’t remember information she’d just read.
“I was assured the problem was short-term, but my memory hasn’t come back. I’m convinced now that
it’s gone for good,” she says.
Doctors told her that depression was responsible for the memory loss. “But I’ve had depression for a
long time and hadn’t had memory problems,” McQueen says.
After leaving the hospital, McQueen kept getting shock treatment. The treatment was leaving her
confused. She also doubted it was helping her depression. But she was reluctant to go against her
doctor’s recommendation.
With her church group, she prayed for God to tell her whether to keep getting shocks.
In November 1993, the hospital called to postpone a treatment.
“I took that as a sign from God,” she says. “When they called to reschedule, I said, `No more.’”
By Dennis Cauchon, USA TODAY
Stunningly quick results often fade
USA Today Series
12-06-1995
Stunningly quick results often fade
Does shock therapy work?
Many psychiatrists and patients are supporters of shock therapy because of the startlingly quick
changes it usually produces.
Shock therapy lifts 70% to 95% of patients out of depression, according to most studies. That compares
favorably with the most popular anti-depressants: Prozac (51%) and Zoloft (59%), according to a
recent study of those drugs.
And shock therapy often seems to work on people who don’t respond to drugs. It’s also frequently used
on high-risk patients – the elderly, those with AIDS, multiple sclerosis, Alzheimer’s, pregnancy, even
heart transplants – who should avoid anti-depressants because they could interact badly with other
medications.
But, unlike drugs, shock therapy’s benefits fade quickly.
Researchers have been unable to document any anti-depressant effect from shock that lasts longer
than four weeks – a fact not disclosed to patients in educational literature or consent forms.
The standard measure of shock therapy’s effectiveness is the Hamilton Depression Score. A severely
depressed person would have a score of 30 or more; a nondepressed person, less than 10.
If, after shock, the depression score goes down, the shock is judged a success.
It’s been proven repeatedly that shock therapy lowers the scores.
The American Psychiatric Association information sheet for patients says: “We know ECT works: 80% to
90% of depressed people who receive it respond favorably, making it the most effective treatment for
severe depression.”
But the APA doesn’t mention that this success disappears as quickly as it comes.
Two controlled studies have been done to track how long shock’s effect lasts. The two studies compared
depressed patients who were shocked with a similar group who had “fake shock” – given anesthesia and
muscle relaxants but not shocked.
The results:
In a 1980 study, shocked patients’ depression scores were 26% lower than patients who received fake
shock.
But one month later, there was no difference in depression scores between the two groups. A six-month
follow-up also found no difference.
A 1984 study found shock patients were less depressed at two and four weeks than those receiving fake
shock. But there was no difference at 12 weeks or 28 weeks.
No study has addressed the subject since. Shock researchers now consider it unethical to do studies
with placebos (fake shock) on the grounds that it would be withholding treatment from a sick patient.
Shock therapy is strongly recommended to help suicidal patients.
Electroconvulsive Therapy, the textbook written by the owner of shock machine manufacturer Somatics
Inc., says suicidal patients should be shocked as the first treatment, before drugs or other therapies.
And a suicide threat is a common justification for giving forced shock to patients who don’t want it,
under court order, according to University of Kansas sociologist Carol Warren.
But the studies show shock therapy doesn’t stop people from killing themselves.
A 1986 study involving 1,494 patients found no difference in suicide rates between shocked and
non-shocked depressed patients. The study, published in Convulsive Therapy, then reviewed all
previous studies on shock and suicide.
“A close examination of the literature does not support the commonly held belief that ECT exerts
long-range protective effects against suicide,” the study concludes.
By Dennis Cauchon, USA TODAY
Memory loss prompts woman to stop treatment
USA Today Series
12-06-1995
Memory loss prompts woman to stop treatment
Like most shock patients, Jeanne Bengston of Hilton Head, S.C., was shown an “educational” video
before getting her series of shock treatments.
The video, sold by shock machine manufacturer MECTA Corp. of Lake Oswego, Ore., does not mention
death rates or the views of critics who believe that shock causes brain damage.
Instead, the video ends with a patient declaring: “It was a good experience. If I do feel myself slipping,
I’d like to come back for a tune-up. It works!”
For Bengston, the reality was more complicated.
She became severely depressed last fall after having knee surgery; for some reason, every hospital
visit in her life – whether to give birth or have an operation – has triggered depression.
“Something about being in the hospital – either the environment or a reaction to anesthesia – triggers
her depression,” says her husband, Dean, a retired Air Force pilot.
She received nine shocks in November 1994. Her depression lifted temporarily but quickly returned.
She had 12 more shocks in March and April.
The doctors wanted to give more shocks, but the Bengstons stopped because she was experiencing
serious memory loss.
Jeanne Bengston isn’t depressed anymore, and much of her memory has come back, but not all of it.
She can’t remember family trips taken two years earlier. She doesn’t play bridge as well. And she has
to use recipes to make food she once knew how to make by heart.
Dean Bengston isn’t sure whether the shock therapy or the passage of time was responsible for ending
his wife’s depression.
“The doctors wanted us to go on, but I’m convinced now it was right to stop when we did. It’s a hard
decision to make. There are so many factors, and we probably don’t know them all.”
By Dennis Cauchon, USA TODAY
Patients often aren’t informed of danger
USA Today Series
12-06-1995
Patients often aren’t informed of danger
The electrodes were placed on her head. With the push of a button, enough electricity to light a 50-watt
bulb passed through her skull.
Her teeth bit hard into a mouth guard. Her heart raced. Her blood pressure soared. Her brain had an
epileptic-style grand mal seizure. Then, Ocie Shirk had a heart attack.
Four days later, on Oct. 14, 1994, the 72- year-old retired health department worker from Austin,
Texas, was dead of heart failure – the leading cause of shock-related death.
After years of decline, shock therapy is making a dramatic and sometimes deadly comeback, practiced
now mostly on depressed elderly women who are largely ignorant of shock’s true dangers and misled
about shock’s real risks.
Some lose already fragile memories. Some suffer heart attacks or strokes. And some, like Ocie Shirk,
die.
A four-month USA TODAY investigation found: The death rate for elderly patients who receive shock is
50 times higher than patients are told on the American Psychiatric Association’s model consent form.
The APA sets the chance of dying at 1 in 10,000. But the death rate is closer to 1 in 200 among the
elderly, according to mortality studies done over the past 20 years and death reports from Texas, the
only state that keeps close track.
Shock machine manufacturers greatly influence what patients are told about shock’s risks.
Virtually all “educational” videos and brochures shown to patients are supplied by shock machine
companies. And the APA’s 1-in-10,000 death rate estimate is attributed to a book written by a
psychiatrist whose company sells about half the shock machines sold each year.
Shock therapy is strongly regaining favor among psychiatrists as a treatment for depression. Although
exact figures are not kept, one indication of the trend comes from Medicare, which paid for 31% more
shock treatments in 1993 than it did in 1986.
The elderly now account for more than half of the estimated 50,000 to 100,000 people who receive
shock each year, with women in their 70s getting more shock than any other group. In the 1950s and
1960s, young male schizophrenics got most shock therapy.
Shock therapy is the most profitable practice in psychiatry, and economics strongly influences when
shock is given and who gets it.
In Texas, the only state that keeps track, 65-year- olds get 360% more shock therapy than
64-year-olds. The difference: Medicare pays.
Shock treatment may shorten the lives of the elderly, even if it doesn’t cause immediate problems.
In a 1993 study of patients 80 and older, 27% of shock patients were dead within one year compared
to 4% of a similar group treated with anti-depressant drugs. In two years, 46% of shocked patients
were dead vs. 10% who had the drugs. The study, by Brown University researchers, is the only study of
long-term survival rates in the elderly.
Doctors rarely report shock treatment on death certificates, even when the connection seems apparent
and death certificate instructions clearly indicate it should be listed.
For this story, USA TODAY reviewed more than 250 scientific articles on shock therapy, watched the
procedure at two hospitals and interviewed dozens of psychiatrists, patients and family members.
Outside of medical journals, accurate information about shock is sketchy. Only three states make
doctors report who gets it and what complications occur. Texas has strict reporting requirements;
California and Colorado less stringent rules.
The information that is available raises serious questions about how shock therapy is practiced today,
particularly on the elderly.
“We’ve learned nothing from the mistakes of my generation,” says psychiatrist Nathaniel Lehrman, 72,
retired clinical director of Kingsboro state mental hospital in New York. “The elderly are the people who
can least stand” shock. “This is gross mistreatment on a national scale.”
A changing image
Monday, Wednesday and Friday morning is shock therapy time in hospitals across the country.
Most patients get a total of six to 12 shocks: one a day, three times a week until the treatment is
finished. Patients generally receive a one- or four-second electrical charge to the brain, which causes
an epileptic-like seizure for 30 to 90 seconds.
The American Psychiatric Association information sheet for patients says: “80% to 90% of depressed
people who receive (shock) respond favorably, making it the most effective treatment for severe
depression.” Psychiatrists who do shock therapy also are convinced of its safety.
“It’s more dangerous to drive to the hospital than to have the treatment,” says psychiatrist Charles
Kellner, editor of Convulsive Therapy, a medical journal. “The unfair stigma against (shock) is denying
a remarkably effective medical treatment to patients who need it.” Psychiatrists say shock therapy is a
gentler procedure today than it was in its heyday in the 1950s and 1960s, when it was an all-purpose
treatment for everything from schizophrenia to homosexuality.
And advocates say it’s nothing like its portrayal 20 years ago in the movie One Flew Over the Cuckoo’s
Nest, which showed electroshock being used to punish mental patients.
The movie helped send shock therapy into decline and prompted laws across the nation making it hard
to give shock treatment without the patient’s written consent.
Because of abuse in the past, shock is seldom done now at state mental hospitals, but mostly at private
hospitals and medical schools.
The language is softer today, too, reflecting an effort to change shock’s image: Shock is
“electroconvulsive therapy” or, simply, ECT. The memory loss that often accompanies it is called
“memory disturbance.” These changes come as doctors expand shock’s reach – to high-risk patients, to
children, to the elderly – altering the profile of who gets shock therapy so much that the typical patient
now is a fully insured, elderly woman treated for depression at a private hospital or medical school.
Someone like Ocie Shirk.
Died in recovery room
Shirk, a widow coping with recurring depression, already had one heart attack and suffered from atrial
fibrillation, a condition that causes rapid heart quivers.
On a Monday at 9:34 a.m., Oct. 10, 1994, she received shock therapy at Shoal Creek Hospital, a
for-profit psychiatric hospital in Austin. She had a heart attack in the recovery room. Four days later,
she died of heart failure.
Yet shock therapy isn’t mentioned on Shirk’s death certificate, despite repeated instructions on the form
to include every event that may have played a role in the death.
The medical examiner confirms that shock should have been on the death certificate. “If it happens so
close after (shock) therapy, it definitely should be listed,” says Roberto Bayardo, Austin’s medical
examiner.
Gail Oberta, chief executive of Shoal Creek Hospital, declines comment on Shirk. But she says, “When I
checked all our records and went through all the reviews we do, there were no deaths related to ECT.”
A Texas Department of Health investigation found Shirk’s treatment didn’t meet the required standard
of care because her medical records did not include a current medical history or physical that would let
doctors accurately assess shock therapy’s risks. The hospital agreed to correct the problem.
In addition to Shirk, state records show two other patients died after shock therapy at Shoal Creek.
Asked about these deaths, Oberta repeats: “We could find no correlation between deaths of patients
and receiving ECT at this facility.” Getting to the facts behind shock-related deaths is very difficult even
in Texas, which in 1993 became the only state with a strict law on shock therapy. The law, passed after
lobbying from shock opponents, requires all deaths that occur within 14 days of shock therapy be
reported to the Texas Department of Mental Health and Retardation.
In the 18 months after the Texas law took effect, eight deaths – including the three at Shoal Creek –
were reported out of the 2,411 patients who received shock therapy in the state. About half those who
received shock were elderly.
Six of the eight dead patients were older than 65.
Stated another way: 1 in 197 elderly patients died within two weeks of receiving shock therapy. The
state does not release enough information to know if shock caused the deaths.
Nationally, record-keeping is almost nonexistant.
The Centers for Disease Control reports shock therapy was listed on death certificates as a factor in
only three deaths over the five years ending 1993 – a number so low that it contradicts even the most
favorable estimates of shock mortality.
The CDC records shock-related deaths under a category called “Misadventures in Psychiatry.” “For
obvious reasons, doctors are reluctant to list anything that falls into this category,” says Harry
Rosenberg, head of mortality data at the CDC, “even though we encourage them to be forthright.”
Elderly deaths: 1 in 200
The American Psychiatric Association shock therapy task force report has been the bible of shock
practice since its publication in 1990. It says 1 in 10,000 patients will die from shock therapy.
This estimate is included on the APA’s model “informed consent” form, which patients sign to prove
they’ve been fully informed of the risks of shock treatment.
The source for this estimate: A textbook written by psychiatrist Richard Abrams, president and coowner of shock machine manufacturer Somatics Inc. of Lake Bluff, Ill.
Somatics is a private company. Abrams won’t say how much of the company he owns or how much he
earns from it.
“I don’t know where they got that (estimate) from,” Abrams says of the 1-in-10,000 death rate.
When pointed to page 53 of his 1988 textbook Electroconvulsive Therapy, where the death rate
appears twice, Abrams notes that the number was dropped from the 1992 edition.
His updated textbook states the death rate differently, but Abrams agrees it amounts to the same thing.
Abrams’ revised book says a death will occur once in every 50,000 shock treatments. He says it’s fair to
assume that the average patient gets five treatments, making the death rate about 1 in 10,000
patients. Five shocks is average because some patients stop their treatment early.
Abrams’ figures are based on a study of shock deaths that psychiatrists report to California regulators.
But USA TODAY found that shock deaths are significantly underreported in California and elsewhere.
At a recent professional meeting, for example, a California psychiatrist told how shock therapy caused a
stroke in one of his patients. The man, in his 80s, died several days later. But the death was never
reported to state regulators.
Consistently, the studies of elderly death rates conflict with the 1-in-10,000 estimate: A 1982 Journal
of Clinical Psychiatry study found one death among 22 patients aged 60 and older. A 71-year-old
woman had “cardiopulmonary arrest 45 minutes after her fifth treatment. She expired despite intensive
resuscitative efforts.” Two men in the study, ages 67 and 68, suffered life- threatening heart failure but
survived. Seven more had less serious heart complications.
A 1984 Journal of American Geriatrics Society study – often cited as proof of shock therapy’s safety –
found 18 of 199 elderly patients developed serious heart problems while receiving shock. An
87-year-old man died of a heart attack.
Five patients – ages 89, 81, 78, 78 and 68 – suffered heart failure but were revived.
A 1985 Comprehensive Psychiatry study of 30 patients age 60 and older found one death. An
80-year-old man had a heart attack and died several weeks later. Four others had major complications.
A 1987 Journal of the American Geriatrics Society study of 40 patients age 60 and older found six
serious cardiovascular complications but no deaths.
A 1990 Journal of the American Geriatrics Society study of 81 patients age 65 and older found 19
patients developed heart problems; three cases were serious enough to require intensive care. None
died.
These studies looked only at complications that occurred while a patient was undergoing a series of
shock treatments; long-term mortality rates were not considered.
Taken together, the five studies found three of 372 elderly patients died. Another 14 suffered serious
complications, but survived. These results are similar to a study of shock therapy deaths done in 1957
by David Impastato, a leading shock researcher of the time.
He concluded: “The death rate is approximately 1 in 200 in patients over 60 years of age and gradually
decreases to 1 in 3,000 or 4,000 in younger patients.” Impastato found heart problems were the
leading cause of shock-related death, followed by respiratory problems and stroke – the same pattern
as in recent studies.
“The claim that 1 in 10,000 people die from shock is refuted by their own studies,” says Leonard Roy
Frank, editor of The History of Shock and a shock opponent. “It’s 50 times higher than that.” But
Abrams, who has reviewed the studies, calls it “irrational and incomprehensible” to attribute so many of
the deaths to shock itself. Even if a patient has a heart attack minutes later – as Ocie Shirk did –
Abrams says, “it may very well not be ECT-related.” Duke University psychiatrist Richard Weiner,
chairman of the APA task force, also believes studies show the 1-in-10,000 estimate is accurate and
disagrees the elderly death rate could be as high as 1 in 200.
“If it were anywhere near that high, we wouldn’t be doing it,” Weiner says. He says health problems,
not age, cause the appearance of a higher death rate among elderly.
Still, some doctors who consider shock therapy a relatively safe treatment are concerned about the
complications in elderly patients.
“Almost every death in the literature is an elderly person,” says William Burke, a University of
Nebraska psychiatrist who’s studied shock and the elderly. “But it’s hard to hazard a guess on a death
rate because we don’t have the data.”
Shock is profitable The financial incentives of performing shock may be driving the increase in its use.
Shock therapy fits well into the economics of private insurance. Most policies don’t pay for psychiatric
hospital stays after 28 days. Drug therapy, psychotherapy and other treatments can take much longer.
But shock therapy often produces a dramatic effect in three weeks.
“We’re looking for more bang for the buck in health care today. This treatment gets people out of the
hospital fast,” says Dallas psychiatrist Joel Holiner, who performs shock.
It is also the most profitable procedure in psychiatry.
Psychiatrists charge $125 to $250 per shock for the five- to 15-minute procedure; anesthesiologists
charge $150 to $500.
This bill for one shock at CPC Heritage Oaks Hospital in Sacramento, Calif., is typical: $175 for the
psychiatrist.
$300 for the anesthesiologist.
$375 for use of the hospital’s shock therapy room.
The patient got a total of 21 shocks, costing about $18,000. The hospital charged another $890 a day
for her room. Private insurance paid.
Those figures add up. For example, a psychiatrist who does an average of three shocks a week, at $175
per shock, would increase his or her income by $27,300 a year.
Medicare pays less than private insurance – the payment varies by state – but it is still lucrative.
Before turning 65, many people are uninsured or have insurance that does not cover shock. Once
someone qualifies for Medicare, the chance of getting shock therapy soars – as the 360% increase in
Texas shows.
Stephen Rachlin, retired chairman of psychiatry at Nassau County (N.Y.) Medical Center, believes shock
therapy is useful treatment. But he worries that financial rewards may influence its use.
“The rate of reimbursement by insurance is higher than anything else a psychiatrist can do in 30
minutes,” he says. “I’d hate to think it’s done solely for financial reasons.” Psychiatrist Conrad Swartz,
co-owner with Abrams of Somatics Inc., the shock equipment manufacturer, defends the financial
rewards.
“Psychiatrists don’t make much money, and by practicing ECT they can bring their income almost up to
the level of the family practitioner or internist,” says Swartz, who performs shock himself.
According to the American Medical Association, psychiatrists earned an average of $131,300 in 1993.
A doctor says ‘no’
Michael Chavin, an anesthesiologist from Baytown, Texas, participated in 3,000 shock sessions before
he stopped two years ago, worried he was hurting elderly patients.
“I began to get very disturbed by what I was seeing,” he says. “We had many elderly patients getting
repeated shocks, 10 or 12 in a series, getting more disoriented each time. What they needed was not
an electroshock to the brain, but proper medical care for cardiovascular problems, chronic pain and
other problems.” In Chavin’s view, when the cardiovascular system is dramatically stressed in the
elderly, doctors risk triggering a fatal decline.
“As an anesthesiologist, what I do for three to five minutes can have serious consequences later,”
Chavin says. “But psychiatrists cannot bring themselves to admit any harm from ECT unless the patient
gets electrocuted to death on the table while being videotaped and observed by a United Nations task
force.
“These deaths are telling us something. Psychiatrists don’t want to hear it.” Chavin, then chief of
anesthesiology at Baycoast Medical Center, stopped doing shock in 1993, reducing his income by
$75,000 a year.
He says he feels ashamed that his waterfront home and pool were partially financed by what he
considers to be “dirty money.” In spite of his growing doubts, Chavin didn’t quit doing shock right away.
“It was hard to give up the income,” he says.
First, Chavin turned away patients. “I’d tell the psychiatrist: ‘This 85-year-old woman with high blood
pressure and angina is not a good candidate for repeated anesthesia.’ ” Then, to confront his doubts, he
began looking at the research on shock therapy. “I found it was done by psychiatrists who do
electroshock for a living,” Chavin says.
He finally quit doing shock and another anesthesiologist took over. Two months later, on July 25, 1993,
a patient named Roberto Ardizzone died from respiratory complications that began as he received shock
therapy.
The hospital stopped doing shock altogether.
By Dennis Cauchon, USA TODAY
How shock therapy works
USA Today Series
12-06-1995
How shock therapy works
Although shock therapy has been performed for decades, researchers still don’t know precisely how it works to combat depression.
“We’ve been looking for 50 years, but ECT causes many changes, and we haven’t pinned down which one has the anti-depressant
effect,” says Charles Kellner, editor of Convulsive Therapy.
The major theories:
Neurotransmitter theory. Shock works like anti-depressant medication, changing the way brain receptors receive important
mood-related chemicals, such as serotonin and dopamine and norepinephrine.
Anti-convulsant theory. Shock-induced seizures teach the brain to resist seizures. This effort to inhibit seizures dampens abnormally
active brain circuits, stabilizing mood.
Neuroendocrine theory. The seizure causes the hypothalamus, part of the brain that regulates water balance and body temperature, to
release chemicals that cause changes throughout the body. The seizure may release a neuropeptide that regulates mood.
Brain damage theory. Shock damages the brain, causing memory loss and disorientation that creates a temporary illusion that
problems are gone. Shock supporters strongly dispute the theory, advanced by psychiatrist Peter Breggin and other shock critics.
“Not only hasn’t the Breggin brain damage theory been proven, it’s been disproven,” says shock researcher Harold Sackheim of
Columbia University.
By Dennis Cauchon, USA TODAY
Doctor’s financial stake in shock therapy
USA Today Series
12-06-1995
Doctor’s financial stake in shock therapy
When medical students learn about shock therapy, they turn to the only textbook on the subject:
Electroconvulsive Therapy, published by Oxford University Press.
Richard Abrams, a professor of psychiatry at the Chicago Medical School, writes that shock therapy is
proven safe and effective for depression and other problems, even in children and the elderly.
He advises that shock should be considered as the first treatment given, not as the last resort.
He concludes with an attack on doctors who criticize shock treatment and attaches a form to have
patients sign when they consent to shock therapy.
But Abrams doesn’t tell the medical students one thing: He owns Somatics Inc., one of the nation’s two
shock machine manufacturers.
He didn’t tell his publisher, either.
“Wow,” says Joan Bossert, executive editor of Oxford University Press. “I did not know that.” She would
have had him disclose that in the book’s preface, she says.
“I really wish he’d told us, but it doesn’t take away from his expertise,” she says.
Neither did Abrams disclose his financial interest in the academic journal Psychiatric Clinics in
September 1994, when he wrote an upbeat article on shock titled, “The Treatment That Will Not Die.”
In some recent articles, Abrams disclosed that he’s a “director” of Somatics. But readers weren’t told
that he is also president and owns the company with shock researcher Conrad Swartz, a University of
South Carolina psychiatry professor.
Abrams says it’s ridiculous to think his ownership of a shock machine company may create a conflict of
interest.
“Most advances in medical instruments and technology have come from practicing physicians putting
(their) knowledge to work in building better equipment,” he says.
He says he thought Oxford University Press knew he owned Somatics. “The association is very
well-known in the community,” he says.
In a 1991 deposition, Abrams said Somatics provided half his income.
Abrams and Swartz started Somatics Inc., in Lake Bluff, Ill., in 1985. Somatics makes about half the
USA’s shock machines; MECTA Corp. of Lake Oswego, Ore., makes the rest.
Abrams wouldn’t reveal company revenues or profits, but the Somatics Thymatron shock machine is
used in about 500 hospitals nationwide and costs approximately $10,000.
“It’s a very small industry,” Swartz says. “The sales of these machines don’t compare with the sales of
any one drug.”
Swartz says Somatics’ profits are comparable to having an additional psychiatry practice. (The average
psychiatrist made $131,300 in 1993.)
Swartz writes extensively on shock therapy, too, and also rarely discloses his Somatics ties.
For example, when a doctor wrote in Convulsive Therapy, a medical journal, that doctors could save
money using sports mouth guards during shock treatment, Swartz wrote a letter attacking the idea. He
did not disclose that Somatics sells specially designed mouth guards for $23 a dozen.
Abrams and Swartz should “absolutely, without a doubt, disclose their ownership in all their
publications,” says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.
They also should disclose it to patients on informed consent forms before shock treatment, Caplan says.
“True informed consent is not what the doctor thinks you should know, it’s what a reasonable patient
might want to know,” he says.
Swartz calls this absurd.
“It’s a nonissue. Every doctor who does ECT makes money, just as every doctor who prescribes drugs
does,” he says. “Patients know . . . and don’t particularly care.”
Swartz says Somatics was founded because MECTA wasn’t listening to psychiatrists who do shock
therapy.
“I’m now able to improve machines. Who else can best advance ECT? Someone like me, who knows
what they’re doing,” says Swartz, who has a Ph.D. in engineering as well as a medical degree.
For his part, Abrams is the most quoted shock therapy researcher.
The American Psychiatric Association’s 1990 task force report on how to practice shock therapy cites
him more than any other expert.
His 340-page textbook is often the sole source of information about shock therapy in general medical
books and articles read by doctors and patients.
Abrams’ textbook never mentions Somatics by name.
But he describes new shock machine innovations found only on Somatics machines.
For example, his textbook reports that a charge “delivered over four to eight seconds will optimize the
risk-benefit ratio for ECT and provide maximal clinical efficacy with minimal cognitive consequences.”
Only one machine gives a four to eight second charge: the Somatics Thymatron DGx.
And Abrams sells it.
By Dennis Cauchon, USA TODAY
Famous shock-therapy patients
USA Today Series
12-06-1995
Famous shock-therapy patients
Dick Cavett, talk-show host. “In my case, ECT was miraculous. My wife was dubious, but when she
came into my room afterward, I sat up and said, ‘Look who’s back among the living.’ It was like a magic
wand,” he wrote in People in 1992.
Lou Reed, rock musician. “Lou’s conservative parents, Sidney and Toby Reed, sent their (17-year-old)
son to a psychiatrist, requesting that he cure Lou of his homosexual feelings and alarming mood
swings. . . . Lou suffered through eight weeks of shock treatments haunted by the fear that in an
attempt to obliterate the abnormal from his personality, his parents had destroyed him,” according to
Transformer: The Lou Reed Story.
Thomas Eagleton, former Democratic senator. He lost the Democratic vice presidential nomination in
1972 when it was revealed that he received shock treatment for depression.
Ernest Hemingway, writer. He had shock therapy at the Mayo Clinic in 1961, shortly before committing
suicide. He told biographer A.E. Hotchner, “What is the sense of ruining my head and erasing my
memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the
patient.”
Sylvia Plath, poet. She wrote a shock therapy scene in her autobiographical novel The Bell Jar: “I
wondered what terrible thing it was that I had done” to get shock therapy.
By USA TODAY
Shock treatment therapy
USA Today Series
12-06-1995
Shock treatment therapy
About this series
Shock therapy is making a dramatic comeback, primarily as a treatment for severely depressed elderly
patients. After a four-month investigation, USA TODAY reported Wednesday that patients are not
adequately informed of shock’s risks, including the chance of death:
Studies show the death rate for elderly patients is as high as 1 in 200, not 1 in 10,000, as the
American Psychiatric Association states.
Shock machine manufacturers greatly influence what patients are told about shock.
Shock therapy is the most lucrative practice in psychiatry, and economics influence when shock is given
and who gets it. In Texas, the only state that keeps track, 65-year-olds get 360% more shock therapy
than 64-year-olds. The difference: Medicare pays.
Psychiatrist Richard Abrams, an influential shock researcher and author of the only medical school
textbook on shock therapy, also owns shock machine manufacturer Somatics Inc.
Questions to ask if a family member is considering shock therapy:
Ask your doctor for a detailed explanation of potential risks and benefits.
Visit a medical library to read studies on shock therapy.
For information supportive of shock therapy, contact the American Psychiatric Association:
202-682-6000.
For information skeptical of shock therapy, contact the National Empowerment Center: 800-769-3728.
ECT: History of shock
The modern use of electroshock began in 1938 in Rome, when psychiatry professor Ugo Cerletti
shocked a homeless man speaking gibberish.
The first jolt was too low to cause a full brain seizure, but it did cause a brief spasm. What happened
next was described by psychiatrist David Impastato in 1960: “After the electric spasm . . . the patient
burst into song. The professor suggested that another treatment with a higher voltage be given. . . .
The patient suddenly sat up and pontifically proclaimed no longer in jargon, but in clear Italian, ‘Not
again! It will kill me!’ This made the professor think and swallow, but his courage was not lost. . . . and
the first electroconvulsion in man ensued.”
‘Cuckoo’s Nest’
Ken Kesey’s novel One Flew Over the Cuckoo’s Nest (1962) and the movie (1975) were influential in
bringing about a decline in shock therapy’s use.
In Cuckoo’s Nest, McMurphy (Jack Nicholson’s character) is shocked to punish his behavior.
Unlike the movie, shock patients are now put under general anesthesia and given muscle relaxants. But
Cuckoo’s Nest remains the image of shock therapy for many.
“The movie permeates our culture. It comes up every time I talk to patients,” says Dallas psychiatrist
Michael Lambert, who does shock therapy.
An excerpt from Cuckoo’s Nest, the book: “The Shock Shop, Mr. McMurphy … might be said to do the
work of the sleeping pill, the electric chair and the torture rack. It’s a clever little procedure, simple,
quick, nearly painless it happens so fast, but no one ever wants another one. Ever.”
By USA Today
A high-risk case’s tragic end
USA Today Series
12-06-1995
A high-risk case’s tragic end
The late Roberto Ardizzone was a physical wreck – the type of high-risk patient who frequently
undergoes shock today. The pizza chef from Sicily weighed 372 pounds and stood only 5 feet, 7 inches.
The 32-year-old giant had a big heart and a big temper. He’d do anything for friends, but when his
mood swung, he might attempt suicide or punch out windows.
He’d had shock therapy in 1990 to help depression. He wanted it again. But he weighed 100 pounds
more than last time. His doctors at the University of Texas-Medical Branch in Galveston refused to do
it. He was “morbidly obese,” they said. The doctors believed his weight made it too dangerous.
Psychiatrist John Wamble agreed to do it. So did anesthesiologist Aslam Ilahi, who asked the hospital’s
chief of anesthesiology for advice. “I told her, ‘Don’t do it. You’ll lose his airway,’ ” says Michael Chavin,
then chief of anesthesiology at Baycoast Medical Center in Baytown, Texas.
The airway is a tube inserted to give the patient oxygen during the procedure. According to a Texas
Department of Health report, Ardizzone’s pre-shock medical assessment stated: “Short, thick neck. May
have difficult airway.”
Shock therapy went ahead at 11:30 a.m. July 23, 1993. Almost immediately, Ardizzone lost his airway.
“We almost lost him on the table,” says Chavin, who rushed in from another operating room to help.
Ardizzone awoke combative, struggling to breathe. He was sent to intensive care. For two days, he
remained agitated, screaming, struggling to breathe. He told a nurse he couldn’t take it anymore. At
10:50 p.m. July 25, Ardizzone staggered to the nurse’s station – face pale, lips blue.
He collapsed and died.
His death certificate lists: “Respiratory Insufficiency, severe; (possible) pulmonary embolism; morbid
obesity; hypertension.”
Wamble says the death “was an adverse drug reaction. If you look at ECT-related death . . . the major
risk is putting someone to sleep.”
He says Ardizzone was insistent on shock: “He was a rather emotional fellow. But he was well liked by
the nursing staff. If he wasn’t jumping up and down hollering, he got along very well with everyone.
“In retrospect, he had a smaller trachial airway than the average person,” Wamble says. “But presented
with the same situation, I wouldn’t have done anything differently.”
Ilahi declined comment. After Ardizzone’s death, Baycoast stopped doing shock altogether.
Salvatore Ardizzone, the patient’s brother, is bitter. He thinks the doctors should have denied his
troubled brother’s request. He filed a lawsuit in July over his brother’s death.
“This is the treatment saved for people society considers worthless. Roberto used to tell me, ‘Sal, I want
to die. I want to be an angel.’ “They” gave him his wish.”
By Dennis Cauchon, USA TODAY
For one girl, treatment and success
USA Today Series
12-06-1995
For one girl, treatment and success
Valerie seemed like a happy, well-adjusted 8-year-old when she went to summer camp for a week in
1993.
She was popular at school. She got excellent grades. She worked hard to please people.
But when Valerie came home from camp, she was withdrawn. She cried. She was hard on herself,
always worrying that she was being bad. She kept saying, “I don’t feel like myself.”
Her parents – who asked that the family’s last name not be used because they feared Valerie’s name
would later turn up in a computer database, possibly stigmatizing her – took her to a psychiatrist at the
University of Iowa College of Medicine. The doctor put Valerie on 20 milligrams a day of Paxil, a newly
released anti-depressant.
A week later, Valerie was worse. She began hitting herself with her fists. She ate less. She spoke in
whispers and became so overly compliant that she asked permission to do the simplest tasks.
Valerie was hospitalized in a psychiatric ward. Her daily dose of Paxil was increased to 30 milligrams,
then 40 milligrams. Still, she got worse.
She became bedridden and rigid. She had to be fed through a tube.
After a month, she was taken off Paxil and put on Haldol, then nortriptyline, bethanechol and Ativan –
all anti-psychotic drugs.
Yet she remained largely silent and emotionless.
“No medicines seemed to work,” said her mother, Deb, who, like Valerie’s father, is a dentist in Iowa
City, Iowa. “She went downhill faster and faster.”
The psychiatrists suggested electroconvulsive therapy, commonly called shock therapy or ECT.
“By the time we got to ECT as an option, I begged to have it done,” Deb says.
Valerie was shocked 19 times, once every Monday, Wednesday and Friday morning for about six weeks.
She got a two-second electrical jolt each time. Her brain seizures averaged 52 seconds.
Doctors first noticed improvement after the eighth shock. But Valerie’s parents didn’t see it.
“After eight treatments, I said, ‘What are we doing to this little girl?’ ” Deb recalls. “But we had no good
options left.”
After the 11th shock, Valerie’s parents noticed a change. Their daughter seemed more alert.
After the 12th treatment, Valerie’s dog was smuggled in against hospital rules. Bugsy, a Boston terrier,
jumped onto Valerie’s lap and lovingly licked the girl’s face.
Valerie smiled.
Sitting in a wheelchair, she hugged and petted her dog.
“To this day, she credits the dog with curing her,” says her mother.
After her 13th shock, Valerie had a party and ate three slices of pizza.
“It was a miracle,” Deb says.
The last four shocks were done to the right side of her head – not the front, where they cause more
disorientation – because Valerie was acting confused and uninhibited, telling toilet jokes.
“She probably would’ve gotten better on her own at some point,” says Valerie’s psychiatrist, Beth
Cizaldo. “But that could have meant losing a year of life in the middle of elementary school. That was
an unacceptable trade-off.”
“I credit ECT with saving my daughter’s life,” Deb says.
Deb thinks it can help other children, too, and she’s telling that to other parents.
“Last night, I spent an hour on the phone with someone who’s 12-year-old boy is undergoing ECT. He’s
only had three. I said, ‘Don’t blame yourself. This will work.’ ”
It’s still unclear what caused Valerie’s decline in the first place.
The adults couldn’t find evidence of anything traumatic, such as molestation, at summer camp.
Paxil’s safety and effectiveness in children hasn’t been established. But the doctor doesn’t think Paxil
caused her decline: Catatonia hadn’t been a reported side effect. However, stupor and lack of emotion
have been infrequently reported side effects.
Also, Valerie was having hormonal changes at the time, which foreshadowed early puberty.
Her parents wondered if they were to blame.
They admit to being hard-driving perfectionists who expect a lot of themselves, Valerie and her younger
brother. Deb talks rapid-fire, bustling with energy and vibrancy. She successfully defended her doctoral
dissertation recently.
“I’ve asked, ‘Did we put the stress on our young girl? ” Deb says. Some mental illness runs in Deb’s
family: a sibling spent seven months in a psychiatric hospital at age 10 but recovered and is now a
successful physician.
Students welcomed Valerie back at school. Her parents and doctors lectured the children at school
about her illness and the shock treatment.
Valerie, now 10, says she’s doing OK: “I get mad at my brother and those kind of things, but I feel
pretty good.” She likes school, gymnastics, roller blades and “hard-down dirty soccer.”
She loves the doctors and nurses who treated her, but says she remembers only three things about the
hospital: her dog and two other patients.
“This kid, Jarvis, always made me laugh,” Valerie says. “Anything he did, even the way he took a step,
was funny. And this kid, Andrew, who was deaf, we did sign language together.”
She has no memory at all of summer camp in 1993.
Valerie caught up with her school work in two weeks: “I work hard.” She still gets A’s.
But she scored slightly lower on the standardized Iowa aptitude test, her mother says. She
concentrates a little less well than before.
And Valerie sometimes laughs at odd things or doesn’t seem fully engaged. She takes 20 milligrams of
Prozac a day. “She’s still a sensitive little girl,” her mother says.
By Dennis Cauchon, USA TODAY
More children undergo shock therapy
USA Today Series
12-06-1995
More children undergo shock therapy
For the first time in four decades, children and adolescents are being used as subjects of significant new
shock therapy studies.
The studies are being done quietly at respected schools and hospitals such as UCLA, the Mayo Clinic and
the University of Michigan.
Shock therapy’s use is on the rise, especially among the elderly. Children and other high-risk patients
are receiving more shock as well, mostly as a treatment for severe depression.
Children still account for a small percentage of shock patients, and no national estimates exist.
But at a seminar for shock therapy doctors in May, one-third of psychiatrists raised their hands when
asked if they did shock on young people.
University of Pennsylvania neuroscientist Peter Sterling, a shock opponent, calls the child studies
“horrifying. . . . You’re shocking a brain that is still developing.”
California and Texas ban shock therapy on kids under 12. Most states permit it with approval of two
psychiatrists and a parent or guardian.
Shock researchers met in Providence, R.I., in the fall of 1994 to discuss early results of the new
studies, mostly unpublished.
“There’s no evidence that electroconvulsive therapy affects brain development of children in any
permanent way,” says researcher Kathleen Logan, a Mayo Clinic psychiatrist.
“Parents and patients have been receptive in a vast majority of cases,” Logan says. “We do a lot of
education. We show them a video and the ECT suite. They’re so desperate that they’ll give it a try.”
The latest child shock researchers compare their results to the pioneering work in the field: a 1947
study by psychiatrist Lauretta Bender.
Bender’s study reported on 98 children (ages 3-11) shocked at Bellevue Hospital in New York. She
reported a 97% success rate: “They were better controlled, seemed better integrated and more
mature.”
In 1950, Bender shocked a 2-year-old who had “a distressing anxiety that frequently reached a state of
panic.” After 20 shocks, the boy had “moderate improvement.”
But in a 1954 follow-up, other researchers could not find improvement in Bender’s children: “In a
number of cases, parents have told the writers that the children were definitely worse,” they wrote.
Today’s researchers interpret Bender’s study as evidence that shock works, at least temporarily.
The new studies are again reporting great success. A UCLA study had 100% success in nine
adolescents. The Mayo Clinic found 65% were better. At Sunnybrook Hospital in Toronto, 14 who
received shock spent 56% less time in the hospital than six who refused the treatment.
Ted Chabasinski, who as a 6-year-old foster child was shocked 20 times by Bender, says the research is
unethical and should stop.
“It makes me sick to think children are having done to them what was done to me,” says Chabasinski, a
lawyer. “I’ve never met anyone other than myself who’s functional after being shocked as a child.”
By Dennis Cauchon, USA TODAY
[For more from this series, and other articles, see http://www.ect.org/category/ect-news/page/5/
.