The bill that would abolish involuntary shock therapy in Connecticut, particularly involuntary electroconvulsive therapy (ECT or electroshock), presently has written testimony from nineteen individuals and a copy of a report from the U.S. Food and Drug Administration (FDA). Here’s the first part of my breakdown of the written testimony, with some relevant information. (I exclude my own testimony and that of State Representative Sandy Nafis and State Senator Paul Doyle, as we spearheaded the bill.)
See the end for hyperlinks to my articles on electroshock, in chronological order.
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Kirk Lowry, legal director of the Connecticut Legal Rights Project (CLRP)
The Connecticut Legal Rights Project is a private, nonprofit law firm providing legal services to low–income people with psychiatric disabilities in the state. In his written testimony supporting the bill, executive Kirk Lowry notes that he has attended about 150 hearings for involuntary ECT. Lowry raises concerns about the judicial process, the medical safety and efficacy, and others. An excerpt:
The process we are left with is one in which the treating psychiatrist, who does not administer the shock therapy, is the only witness and the only source of information. The treating psychiatrist is unable to testify about more than the number of shock treatments this patient has been given, how the patient has reacted, the general side–effects of shock therapy, and how the patient does when shock therapy is reduced or eliminated. There is little or no cross–examination, little information from peer–reviewed literature or about randomized–controlled studies of effectiveness of ECT. There are approximately ten to fifteen patients at CVH [Connecticut Valley Hospital] who regularly receive ECT. One patient has had more than 190 treatments over a three year period. Another patient has had over 150 treatments over a three year period.
FDA Executive Summary
The FDA Executive Summary was prepared for the Administration’s Neurological Devices Panel when the panel was considering reclassification of electroshock machines (ECT devices) to a lower–risk category in 2011. The report is 154 pages long. It was compiled to address concerns of the safety and effectiveness of ECT, through a systematic review of scientific literature and public and manufacturer commentary. The testimony of Kirk Lowry summarizes the results of the Effectiveness Review section. That section is from pages 36–45 of the Executive Summary. My cursory perusal of the report finds it to be moderate and gingerly (very cautious) in its techniques and conclusions.
Although the Executive Summary involved an examination of many studies, the methodology and other aspects were still controversial.
One of the controversies was alleged conflicts of interest by the investigators and report writers. Attorney Kendrick Moxon testified that the Executive Summary was “improperly supervised by an advocate of ECT in the FDA.” Jan Eastgate, President of the Citizens Commission on Human Rights (CCHR), a psychiatric watchdog, also alleged financial conflicts of interest, particularly involving MECTA Corporation, an electroshock machine manufacturer. An excerpt of Eastgate’s testimony:
MECTA’s submission to the FDA cites 18 studies by Harold Sackeim, 13 by Dr. Richard Weiner, and 8 by Dr. Andrew Krystal, all of whom have conflicts of interest with MECTA. Dr. Sarah Lisanby, who sat on this Advisory Panel in October and now we’ve heard is being FDA paid to appear here today, has done MECTA studies as well. I’d be interested to know why she didn’t demand MECTA conduct safety studies. Dr. Lawrence Park apparently co–wrote the Executive Summary. In his APA conflicts disclosure, he says that he has affiliations with Abbott Labs, which makes Quelicin chloride which is a muscle relaxant used in ECT. This Summary is so egregious that full transparency is needed, and the FDA must provide a disclosure of all conflicts of interest for each of the studies and the rating scales it relied upon.
Both Moxon and Eastgate also denounced the methodology. Moxon criticized the FDA’s decision to downplay the 151 adverse events reports about ECT that were recorded in the Manufacturer and User Facility Device Experience (MAUDE) database. Both of them rebuked the decision to use data solely from randomized controlled trials (RCTs), as many older studies didn’t use this technique and nor did the adverse events reports. There was also in–depth criticism by psychologist John Read.
Connecticut Probate Court Administrator Paul J. Knierim
Connecticut Probate Court Administrator Paul J. Knierim submitted a letter opposing the bill. His testimony appears to be based on an incorrect view of electroshock as mainly beneficial and a false belief in the adequacy of the law allowing involuntary shock therapy, CHAPTER 319i, Sec. 17a–543(c). An excerpt of Knierim’s letter:
It is my view that the existing statute adequately addresses the concerns that underlie this bill and, further, that the bill would inadvertently preclude treatment of patients who are not capable of giving informed consent. […] The cornerstone of the existing statute is the informed consent of the patient. It is only when the patient lacks the ability to give that consent that the option of a court order becomes possible. This very narrow exception results in less than one hundred applications statewide in a given year. Without this procedure, patients who lack the ability to give informed consent would be denied beneficial treatment.
Knierim should check out my previous articles on electroshock, as well as the other written testimony. The only other written testimony on his side is that of Harold Schwartz, Psychiatrist–in–chief of the Institute of Living, who seems to have an equally improper conception of “electroconvulsive therapy.”
Jim Gottstein, President/CEO of PsychRights
Gottstein, CEO of the Law Project for Psychiatric Rights (PsychRights), is based in Anchorage, Alaska. As stated in his letter, “PsychRights is a public interest law firm whose mission is to mount a strategic legal campaign against forced psychiatric drugging and electroshock in the United States akin to what Thurgood Marshall and the NAACP mounted in the 40’s and 50’s on behalf of African American civil rights.”
Gottstein’s testimony probably provides the best references of scientific studies and other information about the weak efficacy and harm of electroshock. His letter is eight pages and is divided into sections addressing cognitive deficits, brain damage, effectualness, and mortality.
Responding to the written testimony of Paul J. Knierim, Jim Gottstein states:
I have reviewed the Probate Court Administrator’s submission and by completely failing to acknowledge the lack of effectiveness and great harm caused by electroshock it misses the mark by a wide margin. This is most likely due to the Probate Court not being provided the evidence on electroshock by the state–paid attorneys assigned to represent the patients declining electroshock. In other words, I question whether people are getting adequate legal representation in involuntary electroshock proceedings because the government should never be able to prove it is entitled to force someone to endure electroshock if a proper defense was made, including the evidence presented below. As a result, I have to question the fairness of court proceedings that result in people being ordered to endure electroshock.
Bibliography
Author: Jan Eastgate. Web page: Jan Eastgate on ECT. Web site: PsychCentral. Date: January 27, 2011. Date of access: March 3, 2013. Web address: http://psychcentral.com/lib/2011/jan-eastgate-on-ect/.
Author: Kendrick Moxon. Web page: Attorney Kendrick Moxon on ECT. Web site: PsychCentral. Date: January 27, 2011. Date of access: March 3, 2013. Web address: http://psychcentral.com/lib/2011/attorney-kendrick-moxon-on-ect/.
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