Forced electroshock: what’s good for the goose is totally unacceptable for the gander

Wednesday, August 8th, 2007 · 3 Comments »

Remember the Simone D. story? There’s been a disturbing twist.

Another patient in New York, this one a man by the name of John Kelly, has also waged a battle this summer to be spared forced electroshock treatment. Neither John Kelly nor Simone D. has been helped by ECT; both feel that they have been damaged by the treatment. Both have retained attorneys to fight the state’s attempt to force more electroshock on them. And in both cases, activists picked up the story and issued an alert, leading to a public outcry.

The difference? The state backed off with John Kelly after barely one week of public attention. Not so with Simone D., who’s still locked in her little electroshock hell.

As FlawedPlan writes (emphasis mine):

How is this possible? Simone D generated so many email complaints the state health director shut down his contact page (if you go there to complain the page says it’s temporarily disabled). Her story had much more traction than John Kelly and went on for a month, and she didn’t win her battle. It took less than one week of activism to get the same state to change its mind for the man. Is electroshock a feminist issue or not?! Same situation, but her wishes were denied, his were honored, how anyone can miss the sexism is beyond me.

I’m immensely happy for John Kelly. What I want to know is why the State of New York doesn’t show Simone D. the same respect.

Dr. Bonnie Burstow has written eloquently about the gender differential in electroshock treatment (Understanding and Ending ECT: A Feminist Imperative and Electroshock as a Form of Violence Against Women.) In her phrase:

“Overwhelmingly, it is women’s brains, memory, and intellectual functioning that are seen as dispensable.”

Even so, when I learned about John Kelly, I immediately wondered if the difference between his case and Simone D.’s was not because of gender but because of a difference in clinical situation or institutional setting.

Not surprisingly, I can’t find much information online about John Kelly’s clinical record. But comparing what is in the public domain about John Kelly’s case and Simone D.’s, there is absolutely no indication whatsoever that Simone D. has benefited from ECT in a way that John Kelly has not. Simone D.’s patient record shows clearly that she has not been helped by lengthy ECT treatment, and that in fact it has caused her significant cognitive impairment. Even her own doctors acknowledge this. With John Kelly, there is apparently only his word for it (which I don’t doubt at all) that ECT has caused him brain damage.

What about the institutional setting? John Kelly is a patient at Rockland Psychiatric Center, whereas Simone D. is a patient at Creedmoor Psychiatric Center. Are the hospital administrators at Rockland just more sensitive than those at Creedmoor? I decided to see what I could learn about ECT at the two facilities.

Again, there’s not much to find online, but I came across this paper back when we were discussing the original Simone D. post. It’s a 2001 analysis of ECT treatment at five New York state mental hospitals, including Creedmoor and Rockland. Granted, this is only one statistical snapshot, but the patterns that emerge are interesting.*

At Creedmoor, 79% of the patients receiving ECT are female, which is in line with the general trend. But Rockland, at least in this survey, is highly anomalous: the great majority of ECT patients are male. In fact, the Rockland ratio of male to female ECT patients is exactly the opposite of what is seen generally, both in institutions and private practice.

This gender anomaly becomes even more interesting when you look at the figures for forced (court-ordered) electroshock. It’s unfortunate that the report doesn’t give a gender breakdown of patients receiving forced ECT — why on earth was this not thought pertinent? — but we can make some observations nevertheless. At Creedmoor, with its typically high proportion of female ECT patients, forced electroshock is common: 32%
of the patients are receiving the treatment under court-order (which means, of course, that the hospital went to court to get the order). That figure is, again, in line with the general trend. But at Rockland, with all those male ECT patients, only one patient — only one! — was receiving treatment under court order at the time of this survey. That one patient was female.

The sample in this report is too small to prove anything, obviously. But it is intriguing that the state hospital with the highest percentage (by far) of male ECT patients is also the state hospital with the lowest percentage (by far) of forced ECT.**

Another thing that the report makes clear — and this is what struck me when I first looked at the paper a few weeks ago — is that the primary use of ECT is to control psychotic patients, not to relieve depression. Advocates of electroshock claim that it has some demonstrated effectiveness in temporarily alleviating serious depression, and since women are diagnosed with depression more than men, that’s why women are shocked more often. But that’s not actually how ECT is used, at least in institutional settings. It’s used as a knockout punch to the head to control obstreperous or uncooperative patients.

At Creedmoor, most of the patients receiving ECT are diagnosed as schizophrenic or schizoaffective: 74%. Only 21% of patients receiving ECT are diagnosed as depressed.

At Rockland, 73% of the patients receiving ECT are diagnosed as schizophrenic or schizoaffective. Only 9% of patients receiving ECT are diagnosed as depressed.

The ratios are similar at the other New York state hospitals, and the same picture has emerged in other institutional surveys of ECT. In other words, it’s not true that women are shocked more than men simply because of a diagnosis differential. Women are just shocked more than men, period.

When we delved into the research on this back in the original Simone D. thread, what ECT advocates kept glossing over was that the goddamn thing causes brain damage. Permanent brain damage. There’s no question of that. Even if ECT does offer some temporary surcease of symptoms, is it worth permanent cognitive impairment? Can you imagine a new pill on the market that promised to give you four weeks of relief from depression in exchange for a lifetime of lost memories and lowered IQ? And is it really a coincidence that this astonishingly bad bargain is forced on women twice as often as on men?

As I consider the cases of John Kelly and Simone D. — one spared further brain damage, the other not — that phrase of Dr. Burstow’s keeps running through my mind:

“Overwhelmingly, it is women’s brains, memory, and intellectual functioning that are seen as dispensable.”

*****

*The report is useful for its statistical data and for the brief clinical notes that are provided about some of the ECT patients. It is not reliable in terms of the efficacy of ECT, since pretty clearly the report authors were simply repeating what they had been told by the shock doctors at the state hospitals. For example, this statement is false:

“Professional literature indicates that ECT has been proven effective in the treatment of major depressive disorder, bipolar disorder, schizophrenia, schizoaffective disorder, and schizophreniform disorder.”

Nope. Even ECT proponents who claim that shock works for depression recognize that the indications for psychosis are iffy. The only thing ECT does for psychotics (if anything) is temporarily disorient them so they stop doing whatever they’re doing. It’s a short-term palliative at best, and even that is disputed. You could get the same result by hitting a schizophrenic in the head with a baseball bat.

And this statement is misleading:

“The major side effect, short-term memory loss, is of great concern to many individuals.”

There’s no short-term about it. Long-term memory loss and cognitive impairment have now been acknowledged even by proponents of ECT.

**Note that I’m excluding the data from the Psychiatric Institute at Columbia University, which is not a state mental hospital like the others. At PI, electroshock is only given to patients with depression as part of a voluntary research protocol.

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3 Responses to “Forced electroshock: what’s good for the goose is totally unacceptable for the gander”

  1. Infidel says:

    Wasn’t there something we have all heard about the physiology of a woman’s brain vs. a male brain, that a male only uses half his brain or some shit. Does that make it twice as bad to shock a woman’s brain or twice as necessary? I don’t see the correlation between the white convoluted mass swimming in a slimey dura, cuddled in bone; the violent or destructive and uncontrollable actions of a being having to become the responsibility of a public institution specializing in being responsible for other beings; and individual civil rights. The more you think about it though, the clearer it becomes, or seems(we all know the problem with statistics) Woman must be shocked less and must not be forced into being shocked at all. Just do it and see what happens- document the shit out of it- do the statistics- draw the conclusions- and adjust.

  2. flawedplan says:

    Thanks for digging into this, and the disturbing gender breakdown of the two hospitals. You said,

    The sample in this report is too small to prove anything, obviously.

    Yeah, well, people fetishize evidence so they can come to a conclusion and turn off the thinking. But there is a lot to be said for starting an argument.

  3. Violet says:

    Well, I felt like the best way to approach this was to walk through the questions, because I know some people are still wondering to themselves if this is a feminist issue.

    I remember your saying earlier that you thought people didn’t want to see the sexism because of their own fears. I think a big part of it is that so many people think of psychiatry as being some “other realm” that involves “other people” and surely the doctors know best. Would be very good to break down those barriers.