Committee for Truth in Psychiatry
From Enpsychopedia
The Committee for Truth in Psychiatry, or CTIP, is a national organization of former electric shock (ECT, or Electroconvulsive Therapy) patients. They maintain that they were not truthfully informed about the nature or consequences of this treatment before consenting to it. As a consequence, they formed an organization to pool their experiences, to research, and to provide truthful information about ECT to other psychiatric patients.
Important Points About ECT
- If a person is in a state of physical suffering of nervous origin, ECT will almost certainly relieve it temporarily. ECT relaxes the nervous system and the relaxing effect lasts from a couple of days to a couple of months. Sometimes people stay well after the relaxing effect has worn off, but, typically, they quickly relapse.
* Regardless of any beneficial effect, there is always a permanently deleterious effect on memory. This consists of erasure of a good deal of pre-shock memory and dimming of more, and it frequently includes also a permanent reduction in retentiveness for post-shock experience and learning.
* These two effects in combination---the temporary feeling of well-being and the permanent harm to memory---imply that ECT "works" by damaging the brain. These are the classic symptoms of acute brain injury by any means---strokes, asphyxiation, concussion, carbon monoxide poisoning, etc. In all these events, the patient feels very well for a while but can't remember. If further evidence were needed of the principle at work in ECT's beneficial effect, it could be noted that the memory loss from ECT has always the distinctive pattern of brain damage forgetting (recent memories hardest hit) and that ECT is sometimes followed by other brain damage phenomena (examples common among our members are impairment of sense of direction and a touch of aphasia, or difficulty saying the words you meant to say).
Lobbying for Informed Consent
As a vehicle for communicating these few points about ECT to other psychiatric patients, CTIP has incorporated them (along with other information) in a model ECT informed consent statement which they are promoting in hopes of endorsement and support by some authoritative body.
Patient Information about ECT What is ECT? Electroconvulsive therapy (ECT), also known as shock treatment, consists of a series of grand mal seizures induced by electric shocks to the brain. The essence of a grand mal epileptic seizure is the intensely rapid "firing" of every brain cell. In a natural seizure this brain activity causes the body to thrash about wildly; but when a seizure is induced in ECT the bodily movements are largely suppressed by a drug. In either case, the person is unconscious. What is ECT good for? ECT is good for the intense physical and emotional suffering that accompanies a derangement of the nervous system resulting either from an overload of normal emotion -a "nervous breakdown" - or from imbalances in body chemicals that affect emotions. ECT produces profound emotional relaxation. The patient sleeps and eats well and his body has an opportunity for rest and repair. When the relaxing effect wears off, in a few days or weeks, the patient may remain well or he may relapse. How is ECT given? ECT is usually given in the morning before breakfast. First the patient receives an injection to reduce secretions in the mouth. Then he is taken to the treatment room, where he is given a general anesthetic through a vein in the arm. This takes effect quickly and is followed by another drug through the same needle, to suppress muscle movement. The anesthetic is not necessary for the shock treatment as such, because the shock would produce unconsciousness, but it is given to spare the patient the feeling of becoming paralyzed. Next, two electrodes are applied to the head and a current passed briefly between them. (Most commonly, the electrodes are on the temples and the shock is at about 140 volts for half a second, but these particulars may vary.) 'Me brain seizure that is triggered by the shock lasts about a minute. The patient does not experience pain or discomfort during the procedure, but he awakens soon afterward in a state of confusion. When the confusion subsides, he can resume his daily routine. Headache, mild muscle soreness, or nausea sometimes occur, but these usually respond to simple medication. Treatments are usually given three times a week, and a typical course of ECT consists of from six to 10 treatments. Are there adverse effects or risks? ECT has one adverse effect that occurs in all cases. That is memory loss. During a course of treatment the patient experiences a cumulative eradication of memory, which begins with recent events and learning and thoughts (including worries), and gradually extends to the distant past. Once the course is ended, memory gradually returns in the opposite time order until, in about a month, the patient has regained the main outlines of his personal history and also knowledge and skills acquired early in life. After this length of time there is little further automatic return of memory, though a good deal more has become strong enough that it can be later revived by reminders or efforts at relearning. The extent of the permanent loss varies with number of treatments, age of patient, placement of electrodes, and other factors, but the pattern of the loss is the same for all patients. 'Me loss is total or near total for the period of the ECT course and tapers back over previous years with smoothly diminishing severity and no precise cut-off point. The patient's remaining memory appears "spotty" in that the smooth amnesic blanket has merely dimmed some memories but submerged others, depending upon their original relative clarity. In addition to this erasure of preshock memory, which is certain to occur, there may also be a permanent adverse effect upon memory function after the shocking. That is, the patient's memory for new experiences and new learning may fade rapidly. Some patients do not mind their memory changes and seldom have occasion to notice them. At the opposite extreme are persons whose work or way of life is made impossible by them. In between are persons who gradually adjust to various degrees of disability. Aside from adverse effects on memory, ECT carries with it - as do other major medical and surgical procedures - some element of ordinary risk. Fatalities are rare, but there is a slight possibility that a stroke or heart attack could occur during a treatment. There is also the possibility that a particular individual may experience one or more untoward after-effects in addition to the expected deleterious effect on memory. How does ECT work? ECT is one of a number of drastic psychiatric treatments, including insulin coma and psychosurgery, that relieve suffering temporarily. All of them "work" by destroying brain tissue. That is their common denominator. In ECT both the electrical shocks and the grand mal seizures are destructive. For some still unknown reason, reducing the size of the brain not only reduces the amount of stored memory but also counteracts states of physical pain and any kind of emotion.
Origin, History
CTIP was formed in l984, with 17 founding members, to participate in the Food and Drug Administration's regulatory proceedings concerning ECT.
FDA had classified the ECT device or shock machine in the highest risk class of medical devices, Class III, which classification earmarked ECT for a safety investigation; and the American Psychiatric Association (APA) had subsequently petitioned FDA to reclassify the device to Class II, which action would constitute recognizing ECT as a safe treatment without an investigation. The FDA was preparing to grant the APA's petition when the CTIP came in to oppose reclassification and to press for an investigation. We were confident that an impartial scientific investigation would confirm in physical terms what is apparent from ECT's emotional and memory effects: that it is inherently brain damaging.
Throughout the rest of the 1980s, the CTIP both enlarged its shock patient membership and also became the central contact for other individuals and organizations who urged an FDA investigation of shock treatment, including all fifty of the state Protection and Advocacy agencies.
Expansion of the CTIP was based on its informed consent statement. Any former shock patient who endorses it is a member. Membership imposes no duties or dues, but every endorsement stregthens the patient voice. CTIP operates without elected officers.
CTIP managed for six years to forestall action toward reclassification of ECT machines. The FDA bent to the stronger pressure from the psychiatrists and published in the Federal Register of September 5, 1990 a "proposal to reclassify" the ECT device to Class II. Since then, the classification (and investigation) have been "on hold", with no reclassification or investigation having yet taken place.
Regardless of when or in what direction the FDA may move, the CTIP is continuing to work for truthfully informed consent. The problem we alone address is that patients throughout the country are routinely misinformed and misled as to the results to be expected from shock treatment. At the same time, regulatory actions concerning ECT are under way in various state and local governments, instigated in some cases by ex-patients and in some cases by the electroshock industry.