Skeptics cling to old images, psychiatrists say

By Andrew Fegelman
CHICAGO TRIBUNE

Unbeknownst to her, Lucille Austwick became the poster girl for patient-rights advocates and psychiatry's skeptics.

"The Rosa Parks of electroshock" is how one publication described the 82-year-old retired telephone operator, a patient in a North Side nursing home.

Across the country, psychiatrists closely monitored her court case in Chicago. It examined whether Austwick, without her consent, could be given electroshock therapy to try to lift her out of depression that had caused her to stop eating. Psychiatrists believed that a ruling preventing the treatment would represent a serious setback for electroshock.

Ultimately, Austwick never received the treatment after doctors concluded that her condition had improved. But her case, and an Illinois Appellate Court ruling earlier this month prohibiting the treatment even after Austwick no longer needed it, has crystallized one of the most controversial and unusual debates in psychiatry.

Critics call it shock treatment. Doctors prefer the more benign "electroconvulsive therapy," or ECT. It is the administration of electrical charges to the brain to treat mental disorders, usually severe depression.

It isn't the first line of psychiatric treatment, but neither is it infrequently used. Experts estimate that 50,000 to 70,000 electroshock treatments are administered annually in the United States.

Electroshock first was deployed to treat mental illnesses in 1938. And for decades, controversy has surrounded its use, misuse and associated problems, ranging from broken bones to death.

While psychiatrists say techniques have vastly improved over the decades, the image of electroshock remains unsettling for many Americans.

There is R.P. McMurphy, the character played by Jack Nicholson in the film version of "One Flew Over the Cuckoo's Nest," undergoing doses of electricity to render him docile.

And then there is a humbled U.S. Sen. Thomas Eagleton (D-Mo.), bumped out as George McGovern's vice presidential running mate in 1972 after shamefully confessing to receiving ECT in the way a politician would admit marital infidelity.

Those lingering images have aided a movement that has continually battled to discredit electroshock.

One of the movement's soldiers is David Oaks, a community activist who runs the 1,000-member Support Coalition in Eugene, Ore.

The group bills itself as a patient-rights organization, but the tone of its pleadings have been decidedly anti-electroshock.

"The claims seem to be that anyone who would criticize psychiatry must be under the powers of some evil cult, and that is ridiculous," Oaks said. "What we are is pro-choice, that people get a range of alternatives, and that no force be used."

Oaks said his organization was attracted to Austwick's case by the question of whether electroshock could be used on a woman who never had consented to it.

To the dismay of psychiatrists, the group was allowed to file a brief in the Austwick case describing problems with electroshock.

The guru of the anti-electroshock movement is Dr. Peter Breggin, a Maryland psychiatrist.

Breggin once likened the treatment to a "blow to the head," saying it delivered the same kind of brain damage.

But most psychiatrists dismiss electroshock opponents as kooks and zealots. There is no better evidence, they say, than the fact that among the leaders of the anti-electroshock movement is the anti-psychiatry Church of Scientology and its Citizens' Commission on Human Rights.

"A lot of these groups aren't just against ECT, they are against psychiatry in general," said Dr. Richard Weiner, an associate professor of psychiatry at Duke University and chairman of the American Psychiatric Association's task force on electroshock.

"ECT has been the subject of a lot of public hearings, and it has always come out OK," Weiner said.

Still, no one can dismiss the successes of electroshock's critics. Their pinnacle came in 1983, when they pushed through a ban on electroshock within the city limits of Berkeley, Calif. The ban was later overturned in court.

But the legacy has lingered. California continues to have one of the toughest electroshock laws in the country, requiring full disclosure to the patient of reasons for the treatment, its duration and all possible side effects. Illinois law requires court approval of the treatment when the patient isn't able to consent to it.

That's how Austwick's case ended up in court.

But it became more than a case about her, creating an arena for much broader questions about the treatment in general. And it may have resulted in a serious setback to use of electroshock.

It wasn't supposed to be this way. During a hearing before the Appellate Court in May, Judge Thomas Hoffman warned that the Austwick matter was not supposed to be a case about the pros and cons of electroshock.

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Instead, he said, the issue was whether Austwick should have been given the treatment and what standards should be applied for answering that question, the judge said.

Although Austwick no longer needed the treatment, the Appellate Court decided that the precedent-setting case raised too many critical issues. It issued a ruling anyway saying shock therapy wouldn't be in Austwick's best interests.

The court noted the "substantial risks" associated with the treatment, including broken bones, memory loss and even death.

The ruling reflected the thinking of the opponents, and the Illinois Psychiatric Association criticized it for ignoring all the scientific evidence.

The use of anesthesia and muscle relaxants, psychiatrists said, have eliminated the incidence of broken bones.

As for memory loss, they conceded that it does occur but usually disappears.

Some patients, however, report some long-term memory loss that never dissipates.

Pyschiatrists also note that statistics show a death rate of only 1 for every 10,000 procedures performed.

Some doctors say the Austwick case illustrates the dangers of the courts trying to deal with science.

The Austwick ruling presented "not a very clear and fair description of a treatment that is really life-saving," said Dr. Philip Janicak, medical director of the Psychiatric Institute at the University of Illinois at Chicago.

"It is rooted more in impressions that go back 20 years than the facts about what modern techniques are involved."

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Date: Friday, January 6, 1995
CHICAGO TRIBUNE

Electroconvulsive or shock therapy should not be used for children under 16 because it may cause memory problems and too little is known about other potential hazards, a psychiatric consultant said Thursday.

Dr. Tony Baker, writing in the British medical journal Lancet, questioned the ethics of the treatment known as ECT, saying anecdotes of misuse and damage to unsuspecting and uninformed patients abounded.

In ECT, a short burst of electric current is sent through the brain to induce a convulsion. Although its use has declined, the therapy is still considered important for some patients with severe depression or schizophrenia.

Baker said such electric currents are associated with memory problems and that "young skulls have a lower electrical resistance and for the same electric charge will be exposed to higher current than other skulls."

The British consultant, an expert in childhood trauma, also said ECT should be conducted on those over 16 only under a license system.

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People with mental illnesses are particularly vulnerable to alcohol and drug abuse. Find out why and how dual diagnosis (mental illness plus substance abuse problem) can be treated.

In this era of community-based treatment and widespread availability of alcohol and other drugs, people with severe mental illnesses (e.g., schizophrenia, schizoaffective disorder, or bipolar disorder) are highly likely to abuse or be dependent on alcohol or other drugs, such as cocaine or marijuana. According to recent epidemiologic studies, approximately 50 percent of people with a diagnosis of severe mental illness also meet lifetime criteria for a diagnosis of substance use disorder.

Mental Illness and Susceptibility to Drugs and Alcohol

Just why individuals who are mentally ill are so prone to abuse alcohol and other drugs is a matter of controversy. Some researchers believe that substance abuse may precipitate mental illness in vulnerable individuals, while others believe that people with psychiatric disorders use alcohol and other drugs in a misguided attempt to alleviate symptoms of their illnesses or side effects from their medications. The evidence is most consistent with a more complex explanation in which well-known risk factors - such as poor cognitive function, anxiety, deficient interpersonal skills, social isolation, poverty, and lack of structured activities - combine to render people with mental illnesses particularly vulnerable to alcohol and drug abuse.

One further point about vulnerability is clear. People with an established mental disorder - probably because they already have one form of brain disorder - appear to be extremely sensitive to the effects of alcohol and other drugs. For example, moderate doses of alcohol, nicotine, or caffeine can induce psychotic symptoms in a person with schizophrenia, and small amounts of marijuana, cocaine, or other drugs can precipitate prolonged psychotic relapses. Accordingly, researchers often recommend abstinence from alcohol and other drugs for people with severe mental illness.

Substance abuse also appears to worsen health and social problems by contributing to poor nutrition, unstable relationships, inability to manage finances, disruptive behavior, and unstable housing. Substance abuse interferes with treatment as well. People with dual diagnoses (severe mental illness and substance disorder) are likely to deny alcohol and drug problems; to be non-compliant with prescribed medications, and to avoid treatment and rehabilitation in general. Perhaps due to their poor treatment compliance and psychosocial instability, people with both mental illness and substance abuse are highly vulnerable to homelessness, hospitalization, and incarceration.

The problems related to combined substance abuse and mental illness pose a substantial burden to the families of people with dual disorders. Surveys show that family members identify substance abuse and its attendant secretiveness, disruptive behavior, and violence as among the behaviors that are most disturbing. Even though relationships are strained by problems related to dual diagnoses, our research shows that families expend a great deal of time and money helping out in a variety of areas, from providing direct care to attempting to structure leisure time and increase participation in treatment. Furthermore, they are often unaware that their relative is abusing drugs or confused about how to respond to substance abuse, so education is greatly needed.

Getting Help for Dual Diagnosis

Although people with co-occuring mental illness and substance abuse desperately need help with both problems, the service system's organizational structures and financing mechanisms often provide barriers to obtaining treatment. The crux of the problem is that the mental health and substance abuse treatment systems are parallel and quite separate. Even though the majority of patients in either system have dual diagnoses, involvement in one system typically precludes or limits access to the other. In addition, both systems may attempt to avoid responsibility for clients with complicated problems.

Even when people with dual disorders are able to negotiate access to both treatment systems, they may have difficulty getting appropriate services. Mental health and substance abuse professionals often have different types of training, espouse conflicting philosophies, and use different techniques. For example, mental health professionals often view substance abuse as a symptom or response to mental illness and therefore minimize the need for concurrent substance abuse treatment. Similarly, alcohol and drug treatment professionals often emphasize the role of substance abuse in producing the symptoms of mental illness and therefore discourage active psychiatric treatment. These views can prevent accurate diagnosis and subject the client to a bewildering set of conflicting treatment prescriptions. Because many programs make no attempt to integrate treatment approaches, the client, with impaired cognitive capacity, is entirely responsible for the integration. Not surprisingly, the client often fails in this situation and is considered difficult or labeled as "treatment-resistant."

Over the past 10 years, treatment programs developed specifically for people with dual disorders have emphasized the importance of integrating mental illness and substance abuse interventions at the level of clinical care. For example, mental health programs for people with severe mental disorders can easily include substance abuse interventions as a core component of comprehensive treatment. Assertive outreach as well as individual, group, and family approaches to substance abuse treatment are incorporated into the comprehensive approach of the case management or mental health treatment teams. Because substance disorder is a chronic illness, treatment typically occurs in stages over several months or years. Clients must first be engaged in outpatient treatment. At this point, they often require motivational interventions to persuade them to pursue abstinence. Once they identify abstinence as a goal, they can use a variety of active treatment strategies to attain abstinence and to prevent relapses.

People with dual diagnoses clearly can be engaged in these programs. Over the short term, their regular participation in outpatient treatment results in decreased institutionalization. Over the long run - approximately two or three years - most people can attain stable abstinence from substance abuse. Because substance abuse is a chronic, relapsing disorder, treatment may take several months or years, and involvement in some form of treatment should continue for many years.

Unfortunately, at this point, integrated treatment programs are not widely available. Most occur as models or demonstrations. Cost is not the limiting factor because a substance abuse specialist can be hired as a member of the mental health treatment team at approximately the same salary as a mental health specialist. But the mental health system must be willing to take responsibility for this critical aspect of clients' lives and must sponsor the appropriate changes in service organization, financing mechanisms, and training. For example, effective integration of mental health and substance abuse treatments often requires cross-training of mental health and substance abuse providers to sensitize them to the philosophies and treatment techniques used in the different fields.

Families can be helpful in several ways: By being aware of the high rate of substance abuse among people who are severely mentally ill, by being alert to signs of alcohol or drug problems, by insisting that the mental health system take responsibility for addressing alcohol and drug problems, by pursuing drug and alcohol education, by participating in alcohol and drug treatments for their relatives, by advocating for the development of dual-diagnosis treatment programs, and by encouraging research into this critical area.

About the author: Robert E. Drake, M.D., Ph.D. is a Professor of Psychiatry, Dartmouth Medical School,

SOURCE: NAMI publication, The Decade of the Brain, Fall, 1994

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Complications

The federal government reimbursed the executive's company, which billed Medicare for between $20 million and $40 million in bribes that were disguised as salaries, the executive admitted.

Peter Alexis, former "administrator of the year" for Psychiatric Institutes of America, pleaded guilty to conspiracy and false-statement charges before U.S. District Judge Joe Kendall in Dallas. He said he helped bribe more than 50 physicians across the nation.

Mr. Alexis agreed to become a prosecution witness in a nationwide investigation, and prosecutors agreed not to seek additional charges against him.

Judge Kendall asked Mr. Alexis several times whether he was aware of the rights he waived with his guilty plea.

After Mr. Alexis repeatedly stated that he is voluntarily exposing himself to as many as 10 years' imprisonment, Judge Kendall replied: "I'm just wondering how many doctors out there in the Dallas-Fort Worth area aren't sleeping too well these days."

At Judge Kendall's request, Mr. Alexis explained his role in what he said was a companywide conspiracy. "I paid physicians to refer patients to our hospitals," Mr. Alexis said.

"So, it was just a mass kickback scheme? You were buying patients?" the judge asked.

"Yes, your honor," Mr. Alexis replied.

Mr. Alexis served for several years as administrator at Psychiatric Institute of Fort Worth. He became PIA's vice president for the Texas region in 1989 but resigned in 1990 after some patients complained that they had been hospitalized unnecessarily so that PIA officials could collect huge sums from insurance companies and Medicare programs.

He declined to comment after the hearing Monday.

"Mr. Alexis is the highest-ranking PIA executive to plead guilty, so far," U.S. Attorney Paul Coggins said. The continuing FBI investigation is nationwide in scope, Mr. Coggins said.

"There will be many other states affected by this investigation, " Mr. Coggins said. "We think this case may take months or even years to resolve."

Doctors weren't the only ones bribed, Assistant U.S. Attorney Christopher A. Curtis said. He said that illegal payments also went to therapists and social workers.

Psychiatric Institutes of America was absorbed last year by its corporate parent, National Medical Enterprises Inc.

Diana Takvam, a spokeswoman at NME's headquarters in Santa Monica, Calif., declined to comment on Mr. Alexis' courtroom statements.

Ms. Takvam, however, said NME is attempting to negotiate a settlement with officials at the Department of Justice and has "established a reserve of $375 million."

NME has not yet agreed to pay that money to the government, Ms. Takvam said.

Another NME official previously reported that the firm is selling or shutting down all of its psychiatric hospitals in Texas.

According to a written statement, NME officials hope that the proposed agreement with the Department of Justice "will close all open investigations of NME."

Judge Kendall told Mr. Alexis that he could not predict how many of the possible 10 years federal officials will recommend under sentencing guidelines. But he advised Mr. Alexis that federal law no longer permits parole, and he said the defendant should not expect a minimum sentence.

"Without even looking, I would guess that your guidelines . . . will be off the charts," the judge said. Judge Kendall did not immediately schedule a sentencing hearing for Mr. Alexis. He said he will wait to review the depth of Mr. Alexis' cooperation with prosecutors.

"The prudent thing to do would be to sentence you sometime off in the future," the judge said.

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NOTE: Since about 1982 the soft, soothing sounds of the ocean have been by friend and have lured me to sleep with the help of my trusty CD player. In a former relationship, after a date, my lover and I would kiss goodnight and the last thing I would say to her was, "See you at the beach." She knew that once I arrived home and my head hit the pillow I would go to my island for an imaginary rendezvous with her. The following poem describes my special island where my lover and I would meet. The link to "At the Beach... Alone Again" at the bottom of this page cronicles the completion of the relationship. - Larry James

I go to bed alone and close my eyes.

I hear the sound of the sea crashing against the rocks, then experience the momentary quiet as the ocean waves return to the open sea only to come crashing against the rocks again moments later.

I love the smell of the ocean. And when I sit on the rocks, I love the touch of the waves rolling over me.

I've been coming here to my private little island for many years now.

Always alone.

Before you - while waiting for your beautiful brown eyes to find me - I designed a sand castle or two by the seashore, skipped flat stones on the water by the brook in the meadow, and threw driftwood back to the sea.

I thought about someday having you here with me. And I didn't know who you were.

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Once, I scribbled words of desperation on a piece of paper. I stuffed it into a bottle, then threw it into the sea. "Please God, send someone who loves me and someone I can love! Whoever finds this, I love you!"

Then, there you were.

Like some new flower, beautiful and ready to be picked.

And, oh, how I loved you.

"It's our first night on the beach together. Take a chance on me. Lie down and leave your imprint in the sand, right there, beside mine."

Two imprints in the sand where there was once only one; far enough from the shore so high tide could not disturb the memory of our being there together.

I can see your beautiful body on pure white sand, laying next to me. This island's population is but two. This beach belongs only to me and you.

I remember being locked in passionate embrace, counting out the stars together.

A cozy fire of driftwood, from wood we gathered while hunting coconuts, gave us warmth as we fell asleep in each others arms; the sounds of the sea our lullaby.

Best friends and lovers.

From now to forever. . . together.

Ours is a love that knows no boundaries.

This morning we'll wade along the shoreline, make love again and count some more stars tonight.

I love to watch you brush the white sand from your cute little behind. I love the sand and I love you.

When we are together we often cling to each other as the sand to your body.

We love to run, holding hands, along the water's edge. We play. We love and spend time digging clams and just being together.

Occasionally we pause to rest by sitting on a small weather-beaten boat, once turned upside down and now long forgotten by its skipper. Nearby, one solitary oar points westerly, buried partially in the sand.

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Knee deep in the water, we knelt, facing each other, as if to pray. Together, our clasped hands reach toward the heavens. Our lips came together as the ocean gently made love to our bronze bodies. The waves are clumsy but they are kind.

As we lie together, the afternoon sun gently kisses our sun-kissed bodies and warms the sand as I count the freckles sprinkled over your beach-brown shoulders.

I love being with you, touching you, kissing your body and watching you enjoy the warmth of the sun.

The distant clouds seem to smile as they watch over the place where we lay.

As leaves blow along the beach, the bleached starfish are washed upon the shore.

I put a seashell to my ear and hear your soft voice whisper, "I love you."

As the friendly winds gently wake the palms, I show you secret places on our island known only to me. Places, created by God, made only to share with my lover.

Hand in hand, we walk through dense green foliage. We follow a path, only my feet have known, to where a crystal clear stream invites us to bathe together like Adam and Eve on our very own island paradise.

The birds of the island join in joyful chorus to sing songs of peace, love and harmony.

We take pause from our island adventure to savor the meat of a freshly cracked coconut.

We feel the mist from the island's solitary mountain fall gently upon our skin as we frolic beneath coconut trees near the waterfall in the meadow.

Thanks for the raspberries you picked for me along the way.

Lovers on the beach.

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Sleeping on your pillow of driftwood, I lie here, next to you, on our bed of white sand, experiencing our closeness, matching you in sleep breath for breath, yet awake.

Now that you lie sleeping, I'll take a moment to quietly tell you all the things I never say when you're awake.

Deep within slumber, you manage a smile. I know you hear me. I love you.

I let you sleep because I love to watch you all disheveled and unwound, dressed up in your undress.

Lying close, in your shadow, I fall asleep.

We sleep well together.

I have often been alone on the beach to spend quiet moments with my thoughts about what it would be like to be with you forever.

I love to be with those thoughts because I love you and I want to be with you wherever you are.

That I only love you, is not enough. I love you unconditionally!

I cherish the thought of a forever love relationship with you!

We've been so long at the beach we taste like the sun.

We walk in the sea breeze to the water's edge for a quick splash of cool ocean.

The beads of water on your beautiful body glisten as we walk to our favorite spot on the beach for making love.

Some would say the sun is much too hot today for love. It matters not to us.

Your eyes tell me you want me.

You only have to look at me, that's all.

Your body says, "Come closer, my love."

You wear nothing but a lavender orchid in your hair; my island angel in the sun.

We touch and I feel your body sizzle from the heat of our passion.

Your skin is soft as angel's breath.

I brush gently against your breasts and we tingle as we touch. The fire inside visibly expresses; soft lips to soft lips; thigh to thigh. How perfectly we fit together.

My hands trace new and exciting memories all over your body.

Our hot bodies communicate only words of love; so softly; words only our heart can hear and understand.

And your eyes, set on fire by desire, were made to dance by whispered sighs of love and the passion of the moment.

I quietly speak your name. "Oh, God, I love you."

The sound fades into the wind as we become lost together, somewhere out there; our brief escape to where only total trust and pure love are present.

Ecstasy!

We smell like love.

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How far away this world becomes in the harbor of each other's arms.

I want to forever be with you.

Friendly seagulls wink as if to nod their approval as we come together in the sand.

In the afterglow, we hold each other, oh, so closely.

We watch as the dolphins gracefully dance with the water. We know they know.

Suddenly an ocean breeze begins to stir, cooling our bodies - anticipating our need for it - following our passion on the sand.

Afternoon shadows gather as the sun prepares to go to sleep.

Our love has a magical quality. Who knows, in the quietness of our love, we may even see the wind together.

Now, I stand watching as you walk down the beach. Oh God, will this be the last time? I don't want to be alone again.

What will happen if I am not to again know your warm arms, your soft, suntanned shoulder next to my face in the late afternoon sun, your lips against mine?

I try hard to memorize you, knowing it may later be important. I remember the way you walked and the way you looked back over your shoulder at me.

Were we imaginary lovers only?

Was this the sound of farewell I hear screaming silently in my ears?

Do you think I'd dare to leave you walking lonesome on the beach into someone else's summer?

I still long to see you one more time coming down the beach.

I wonder if the time will ever pass till we're together even for a while again.

I'm sorry no one was there to see how happy we were together.

The clouds were sad today.

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No dolphins came to play.

The seagulls lament.

I remember how I cried when my first snowman melted. The snow, it kept falling, worthless, like the tears you cry over lost love.

How can we be sure of anything? The tide changes. Has it changed that much for us?

I'm not sure what all this means. Will the good times suddenly be forgotten? Nay! I will not sleep without your memory.

I wonder why I cannot shake our true love from my mind.

It may be that we built our love only on memories and make them more than what they were. It must be or wouldn't you still be here? I dare not say for I do not know.

I pray God allows the memories not to fade.

And lovers? They sometimes go away.

That time of loving may not come again, so I'll just add the precious times we had together to my collection of warm and wonderful memories.

Perhaps if the love we share could be unconditional, and maybe if we never allowed the presence of past hurts to affect the love and devotion we feel for each other today; or. . . what if by daily reaffirming our commitment to speak only words of love, acceptance, understanding and forgiveness we could learn to love unconditionally? Are there some answers we can ponder?

When all of the old memories I call back to help me sleep don't work, maybe I'll try thinking about pop tarts and dixie cups half filled with luke-warm coffee.

Or maybe, in my mind, I'll return to the beach, to again be with you.

I can, at will, if I choose, always create in my imagination my lovely paradise with you.

I will take no other lover to our beach. Only you.

When I think of love and loving, I'll remember you.

For myself, I've kept your smile.

If I tried, and I will not try, I could blot out all but your beautiful brown eyes. Your eyes always told the truth about the depth of love you felt for me. Your eyes never lie. Not even now.

Because I have memories, I will never be alone.

I guess I'll spend some time letting myself come first for a while. And when I tumble into sleep yours will be the last face I will see.

In loving you I've held back no reserve and so I've nothing left to give tomorrow's lover when you go.

See you at the beach!

We Get LoveNotes. . . "Your poems about the Beach were both breathtaking. I was touched by your inner-thoughts so wonderfully put into words."
Anita
A True Believer in Love

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WHEN YOU TAKE more responsibility for something than you actually have control of it, you're making yourself unnecessarily miserable.

If it wasn't really your fault or if it is something you really can't control, then taking responsibility for it, feeling that it is your fault, makes you feel bad and affects your health negatively.

If you feel responsible for something, ask yourself if you really can control the outcome. If not, give up your responsibility.

To learn more about how to do that, check out:
Stress Control

Dale Carnegie, who wrote the famous book How to Win Friends and Influence People, left a chapter out of his book. Find out what he
meant to say but didn't about people you cannot win over:
The Bad Apples

An extremely important thing to keep in mind is that judging people will harm you. Learn here how to prevent yourself from making this all-too-human mistake:
Here Comes the Judge

The art of controlling the meanings you're making is an important skill to master. It will literally determine the quality of your life. Read more about it in:
Master the Art of Making Meaning

Here's a profound and life-changing way to gain the respect and the trust of others:
As Good As Gold

What if you already knew you ought to change and in what way? And what if that insight has made no difference so far? Here's how to make
your insights make a difference:
From Hope to Change

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Abstract

Br J Psychiatry 1983 Jan;142:1-8
Author(s):Squire LR; Slater PC
Abstract: Self-reports of memory problems have been evaluated prospectively in depressed patients receiving bilateral ECT or unilateral ECT, and in depressed patients receiving treatments other than ECT. Depressed patients did not complain of poor memory at seven months after hospitalization. Compared to bilateral ECT, right unilateral ECT was associated with only mild memory complaints. At three years after treatment approximately one-half of the persons who had received bilateral ECT reported poor memory. These reports seemed to be influenced by three factors: (1) recurrence or persistence of conditions that were present before ECT; (2) the experience of amnesia initially associated with ECT and a subsequent tendency to question if memory had ever recovered; and (3) impaired memory for events that had occurred up to six months before treatment and up to about two months afterwards.

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