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Electroshock, now known by the more benign terms "Electroconvulsive Therapy" and "ECT," is making a comeback years after being disgraced as a barbaric treatment that causes great pain and turns people into zombies. Only two months ago, the influential Journal of the American Medical Association acknowledged that ECT is medicine's "most controversial treatment" but proclaimed in an editorial that "the results of ECT in treating severe depression are among the most positive treatment effects in all of medicine." JAMA urged doctors "to bring ECT out of the shadows" of stigma and fear.
Anna Szyszko couldn't agree less. To her, electroshock is all about fear. Her older brother, Adam, a 25-year-old former college student who's been diagnosed as schizophrenic, was scooped up by police last fall and involuntarily committed to a mental hospital. After bad reactions to drug therapy, he was subjected to ECT last December at Pilgrim State Hospital on Long Island against the wishes of his family. Anna, an aspiring actress who lives in Queens, says her brother fears being zapped again. The Szyszkos have gone to court to stop the series of shocks scheduled for Adam and to have him released so he can be treated elsewhere.
"Why are the doctors playing God instead of letting the family make the decisions?" she asks.
And why are the numbers rising? Officials aren't sure. But court statistics show that the number of attempts by hospitals to shock unwilling patients is increasing at an even higher rate: 77 percent from 1999 to 2000.
The cases of Adam Szyszko and Paul Henri Thomas, a Haitian immigrant who's also fighting shock treatment at Pilgrim, have provided the therapy's opponents with enough juice to jolt New York legislators into action. The assembly's mental health committee has scheduled a hearing on the impact of ECT for Friday, May 18, in an assembly hearing room at 250 Broadway in New York City.
"Every member got e-mails on the case of Paul Henri Thomas," says committee chair Martin A. Luster, a Democrat from Ithaca. "The fact is that the legislature has not taken a fresh look at ECT in over 20 years. We all need to be brought up to date. This is not a crusade to do away with ECT."
But it will be for Anne Krauss, an activist in the city who took up Paul Henri Thomas's cause and now works for the National Association for Rights, Protection, and Advocacy. Shock therapy is like "kicking a television to make it work," says Krauss. "It's like blaming the hardware for a software problem."
No one yet knows how many New Yorkers have had their brains rebooted.
Staff attorneys at Mental Hygiene Legal Services, a division of the court system that represents mental patients in their fight against forced electroshock, compiled the figures on court-ordered ECT that showed the sharp rise, but Bruce Dix of Albany, director of one of the division's four departments, says, "We could not draw too many inferences or conclusions from the stats." That's because the numbers reflect only the cases in which hospitals are going to court to force electroshock treatment. Dix does note that most of the patients are in the New York City area.
Marvin Bernstein, director of the division that covers Manhattan and the Bronx, says stats from three of the departments show that the number of hospital applications for forced electroshock rose from 41 in 1997 to 51 in 1998, 52 in 1999, and then, in a big spike, 92 in 2000. The majority of applications are granted: Those numbers rose from 26 in 1997 to 31 in 1998, 36 in 1999, and 61 in 2000.
The state doesn't require the reporting of ECT's use, so it's not known how prevalent it is among the willing or unwilling. Some news accounts have estimated that 100,000 Americans a year are now being shocked, and Luster says that in New York, at least, "it appears the use of this treatment option is increasing."
Some doctors say the treatment is now carried out more humanely than in the past, but critics say it's still nothing more than brain damage.
"I don't think there's anything organized about it," says Bernstein. "The state Office of Mental Health is doing nothing to encourage it. But what I'm hearing is that medical personnel are finding it effective with fewer side effects. ECT, in my experience, seems to work better."
Though he's an advocate for patients, Bernstein is far from hostile to electroshock. "This is just my personal view," he says, "but if I were clinically depressed, I would choose ECT over medications."
Some of his colleagues, however, are much more skeptical.
"The new generation of drugs that were supposed to be miracle drugs with few side effects aren't working miracles, and they do have side effects," says Dennis Feld, chief attorney of the second division. "Basically, out of frustration, doctors are resorting to shock. I don't think it's an informed decision to do that. Why not psychotherapy? They say, 'Well, it doesn't work.' In most instances, hospitals won't even look at it. The insurance companies probably think of ECT as a quick fix.
"What's happening is that the hospitals are prematurely jumping to ECT," he adds. "All in the name of healing, they're harming."
Anne Krauss and other activists are angry that psychotherapy isn't a higher priority for the treatment of depression. "Psychotherapy is buried because there's no major corporate money to be made from it," says Krauss. "It's not quantifiable, and there's no quality control. Drugs you can measure."
Influence can be measured, too. At the hearings, the burden is on the hospitals to prove their cases, but they're usually much better prepared than the patients and families against whom they're squaring off. "In the contested cases," says Feld, "the facility comes in with an expert, a doctor. We don't have the resources to do that."
Feld says the hospitals are "quick to find the person incapacitated." He adds, "I think there's some callousness there, not a studied approach."
A more measured way of handling Adam Szyszko might have spared him even the single shock treatment he got. His sister Anna says Adam was a college student when he "started getting a little weird" and dropped out of school three years ago. He descended into what was later diagnosed as schizophrenia.
Last September, she says, he was wandering around his parents' neighborhood early one morning. "He was very confused, and he was knocking heavily on a neighbor's door," she recalls. "The neighbor didn't recognize him and called police. When they came, he was in front of our house, and my mom came out. The police started asking him questions. My mom said he hadn't been taking his medication. When they heard that, they took him in. I don't think they had to do it. He has never hurt anyone. And our neighbor felt bad that he had called the police."
Adam was taken to Pilgrim, where, Anna says, he went into shock from medication and was transferred to Southside Hospital for medical treatment. Against the family's wishes, he was transferred back to Pilgrim and scheduled for shock treatment. After Adam was zapped in December, the family managed to halt further shock treatments, at least temporarily. They're awaiting a judge's ruling on Adam's fate.
In the meantime, Anna Szyszko has signed up to testify at Friday's hearing.