Protesting Shock: A Moral/Existential Calling

After 14 months…I returned home to a family I had no memory of. I didn’t know how to be a mother to my young sons or a wife for my husband. I had to learn my name, how to speak, do up buttons, brush my teeth and so on. I didn’t even know my own parents, sisters, brothers. My social work career and law aspirations vanished. (public hearing testimony, ECT survivor Wendy Funk, from Coalition Against Psychiatric Assault, tape 1, 2005)

The context of this article is ECT. ECT is a medical procedure—correction, a procedure deemed medical. The point here is, despite the fact that it is administered in hospitals by people known as doctors, by any normal understanding of the term, it cannot justifiably be termed “medical” for such naming presupposes that something is medically wrong with the person—and yet there is no proof whatever that such is the case with prospective ECT recipients. That is, there is no edema, no cell deterioration, no irregular readings, no inflammation. Moreover, it presupposes that said medical problem is corrected by the “procedure”—when solid evidence establishes that on the contrary, medical problems are thereby created where none existed before (for details see Breggin, 1991).

That understood, what concretely is ECT? It is an experimental treatment which involves passing sufficient electricity through the brain to produce a grand mal seizure. How does it work? For most of the history of ECT, doctors who promote it have answered this question with the standard claim that they do not know how it works—only that it works. The latest claim is that they have at long last figured out the answer and that it works by stimulating the production of new brain cells, all of which are healthy (e.g., Abrams, 2002). Are new brains cells indeed produced? Indeed, they are. However, what professionals making such a claim fail to tell the public is that overwhelmingly, ECT annihilates brain cells, that the brain cells thereby annihilated were in fact perfectly healthy, and what new brain cells do appear (the phenomenon is called “neurogenesis”) are irregular, the product of brain damage, and are themselves accepted indicators of brain damage (see Zarubenko et al., 2005, and Greenberg, 2007).

That noted, ECT has been proven conclusively to cause extensive brain damage (see Zarubenko et al., 2005) and extensive and enduring cognitive impairment—memory loss in particular (see Breggin 1991 and Sackeim et al., 2007). Moreover, however the so-called therapeutic effect may be theorized, it has been demonstrated to be no more effective than placebo (see, for example, Ross, 2006). Now admittedly, there have been ample studies that report effectiveness. As clearly demonstrated by Read and Bentall (2010) though, such studies are inherently flawed, with, for example, no criterion of improvement provided or improvement being predicated solely on the subjective opinion of caregivers. Correspondingly, as research like Van Daalen-Smith’s (2011) suggests, there is a dramatic mismatch between the subjective assessment of care-givers and survivors’ self-assessment (what is apropos here, in the weeks following ECT, Van Daalen-Smith interviewed both shock survivors and the nurses caring for them. All of the shock survivors assessed their state as deteriorated, as opposed to all of their nurses, who to a person assessed the condition of these very same “patients” as improved). Additionally, and what is not surprising given what has been revealed to date, as Breggin (1991) and Burstow (2015) have demonstrated, there is a one-to-one ratio between the damage done and the so-called therapeutic effect. An added reality which helps one ferret out the truth of what is happening here is that ECT is overwhelmingly given to two particular constituencies—women and the elderly (for a strong feminist and anti-ageist analysis, see Burstow, 2006), albeit the largest and most extensive study in ECT history (Sackeim et al., 2007) conclusively establishes that these are the very groups that incur the greatest damage from the procedure. 

If the best conducted research invalidates the use of ECT—and as can be seen, it does—personal testimony is at least as damning. Indeed, the history of shock is a history of survivor after survivor testifying that their lives have been devastated, of survivors bearing witness to inability to remember, to massive cognitive impairment, to inability to carry down even the simplest of jobs (see Burstow, 2006). In short, the best scientific evidence and survivor testimony concur. What do they show? That ECT is not just slightly but profoundly damaging. That ECT is in essence a diminishment of the person. That, in short, ECT is anything but a valid medical procedure. Now while mounting evidence continues to pour in, these basic facts about ECT have long been known. And yet the treatment continues unabated. Hence the call for abolition. And hence the protests. 

I have called this article “Protesting ECT”. If ECT is the ultimate context of this article, the more immediate context is indeed a protest. On May 16 2015—an international day of protest against ECT is being held. In this respect, several months ago, a call was issued by three survivors—Ted Chabasinski in California, Mary Maddock in Ireland, and Debra Schwartzkopff in Oregon—inviting survivors and their allies throughout the world to take part in an international day of protest against electroshock (for details, see Chabasinski, 2015). This article is leveraging the occasion of that protest to focus in on shock protest more generally —its nature, why we should engage in it, what we get from it, and in the process, it probes the still larger question of protest. Questions taken up include: What exactly happens when people protest? What is a protest? Why is it important to protest shock? In itself? In the context of psychiatry as a whole?  And what makes the action currently being planned significant?

To begin with the obvious, it is important to protest ECT precisely because, however it may be theorized or intended, ECT is in its very essence injurious—that is, it is not simply incidentally but is inherently injurious (the fact that it is being done in the name of help, I would add, in no way alters the equation). What is called ECT “working”, to put this another way, as can be seen, is precisely the effects of damage. Correspondingly, not just the short but the long term effects are devastating. When people are being subjected to brain damage, when people are being seriously impeded in their ongoing ability to navigate their lives, when, as so often happens, the memory of even those nearest and dearest is obliterated, when decades later people still have to write notes incessantly to get through the day because of a “procedure” to which they have been subjected, however commonplace or cosmeticized what is happening may be, we are witnessing something violent, something objectionable—that is, something that calls out for protest. In saying this, note, I am making a moral claim. At the same time, I am making an existential claim that goes to the heart of what protest is about. 

What is protest? If images of marching in the streets come to mind—and for sure, these are examples of protest—and you are tempted to say that it is a formal political challenge, let me suggest, that at its core, it is far more basic than that. It is a fundamental dimension of our being-in-the-world and of our being-with-others.  In this respect, protest is a deeply existential phenomenon. It is a way of saying “no”, of saying that “I won’t tolerate this.” And note, from our earliest years, even as infants, we have a human need to say “no” when something does not sit right. And indeed, saying “no” at such times is part and parcel of our authentic being-with one another, as it were, of our moral contract.

I am reminded here of the film The Wild Child by François Truffaut (see http://en.wikipedia.org/wiki/The_Wild_Child). In this film, as a test, the scientist at one point punishes the human creature/child that he had brought in from the wild, albeit well aware that the child had done nothing wrong. What then happened? The child protested. The scientist was reassured at seeing the protest. Leaving aside the inevitable question of the morality of forcing “civilization” upon the child in the first place or even of conducting such tests, why was the scientist reassured? Precisely because such protest signified that the child grasped the basic human covenant which we have with one another, knew that protest was called for, and responded accordingly.

Organized public protest such as the one being planned for May 16 is a variant of this existential dynamic, while turning protest into a collective action which binds people together while reaching more concretely into the public. It is a way of asserting that “we” (whoever the “we” may be) see what is happening as unacceptable; beyond this, that we are joined together in asserting loud and clear that it is unacceptable; moreover, we are appealing to others around us and/or those who may happen upon our protest to see it similarly, to bear witness to something that it outside the realm of what is tolerable, and we are demanding action. Given this latter dimension especially, I would add, there is a clear moral appeal and moral demand at the core of public protest.

I am aware of course that there are people (and no, not movement people) who cannot imagine protesting against those deemed helpers. I would suggest, though, if anything, the fact of the designation just adds to the injury for it means that betrayal of trust is involved. Correspondingly, when damage of such proportions is being done and, indeed, done with no upside, when it is accompanied by systemic deception, moreover, unleashed on vulnerable populations, irrespective of whether or not those engaged in these actions are called helpers or are convinced that they are doing good, why would one not protest?

To clear, I am in no way suggesting that public protest is invariably the best strategy. This notwithstanding, there is an upside to such action even in those instances when in the short run, it appears to bring us no closer to our goals. And that upside is precisely the witnessing engendered, together with the existential and moral factors highlighted above. All of which makes anti-ECT protest intrinsically meaningful.

Now the fact that I am taking this at least seemingly non-strategic position, I am aware, may surprise some, for I am a staunch advocate of strategic activism (see, for example, Burstow, 2014a) and the direction being highlighted here appears to conflict with the call for strategic activism. That noted, let me suggest that the strategic and the existential/relational are not mutually exclusive. In this regard, one may sometimes emphasize one dimension, sometimes the other, and at times one may be able to bring them together. Correspondingly, what is more basic here, while tailoring one’s activities strategically so that they serve our goals (read: morally called-for goals) is an important value, so is standing up and being counted. What is likewise relevant, even when it comes to the question of effectiveness itself, straight line thinking does not always serve us, for we never know when a mode of resistance that appears to have no impact will suddenly become a “game-changer”—such is the power of the existential.

What does this boil down to? It is important to protest shock whether or not such protest can be reasonably judged as likely to be effective. What relates to this, social protest with respect to recurring injury has a special significance in that it is a means of keeping faith with people across time. In the case of shock, it keeps faith with those who have been injured in the past. It keeps faith with those currently being beset. And it keeps faith with the prospective victims of the future— herein lies a commitment, however hard it may be to bring it to fruition, to such concepts as “never again”.

To turn to the action at hand, if protesting shock in general is important, this particular ECT initiative is particularly important. Why? Because it was initiated by and to a large extent is being organized by shock survivors themselves—and as such, is first order protest (that is, protest by those centrally affected). Because survivors and their allies are standing up together. Because it is part of the insurrection of subjugated knowledge (“subjugated” knowledge is the disallowed knowledge of the oppressed; see Foucault, 1980). Because it announces to the world that survivors are a constituency that can no longer be ruled/overruled. Because of the sheer size of it. It is significant in this regard that the action being planned is by far the largest international protest against shock in history. Note, twenty-eight cities had signed on when last I checked, and in no past international protest has there been more than five (achieved in the Mother’s Day Protest organized by Coalition Against Psychiatric Assault in 2011). What the sheer size, together with the survivor and the global quality signifies is that there is massive dissatisfaction with this this “treatment”, and there is a growing commitment to resist. Correspondingly, it delivers a tangible message to the public. What does it tell the public? No, ECT was not stopped years ago. No, it is not the “improved”  and benign procedure of psychiatry’s messaging. No, it is not true that most people greatly benefit from shock—in fact, quite the opposite. No, we will not be quiet about it.  And yes, there is an onus on you to do something about it.

That said, while these are primary reasons to protest ECT and while they are existential in nature, there are also formidable non-existential reasons. Whether directly or indirectly, some of these link up with the psychiatry abolitionist agenda. And it is here where the question of strategy enters in.

The point is, while it is important to protest regardless, strategic considerations themselves call for a targeting of ECT. To concretize this, insofar as we want to make inroads in reining in psychiatry, prioritizing a procedure that most psychiatrists themselves refrain from employing and which the public to varying degrees fear makes sense. Why? Because people know on some level that it is woefully misguided, even if they do not admit to themselves that they know. Correspondingly, as something that the general public inherently recognizes as violent, ECT can serve as a symbol of the violent nature of psychiatry overall. That is, it can be employed as a sensitizer, as an aid in making manifest what is now covert, and as such, unrecognized. What relates to this and is likewise significant, insofar as an attrition model of psychiatry abolition is followed, the abolition of ECT is an obvious place to begin (for a discussion of psychiatry abolition and the attrition model, see Burstow, 2014a and 2014b) Why? Again, precisely because the violence is more obvious, precisely because most psychiatrists do not practice it, moreover, because of all the fights facing our movement, arguably, it is the fight that can be most readily won.

A different but likewise strategic reason to prioritize anti-ECT protests relates back to the existential point made earlier about the nature of public protests, more pointedly, about how such processes existentially unite us as a “we” (for further elucidation on the concept, see Sartre. 1946/1953). Whatever we call this movement against psychiatry, whether it be “critical psychiatry”, “antipsychiatry”, “the mad movement”, “the disability rights movement”, or “the survivor movement”, like every other movement, it is beset by differences that pull its members apart. What is of strategic significance about ECT is that our attitude toward ECT for the most part draws us together. How so? Because overwhelmingly, movement people recognize how utterly beyond the pale ECT is. Correspondingly, insofar as this is the case, a focus on shock intensifies the cohesion inherent in protest generally, and as such, shock protest can be a potent force for movement building.

In Summation

To return to the question with which this query began, why should we be protesting ECT? To summarize, because of what both shock and human protest are, as it were, “all about”; because shock is so damaging as to be unacceptable; because in so protesting, we are expressed our own humanity in the deepest sense of the term; because it involves bearing witness to what screams out to be witnessed; because shock protest is something owed those violated, whether the people violated be ourselves or others; because it allows us to join together, to stand up together and be counted; because it is a way of keeping faith with people have already been or might yet be subjected to ECT; because such protest is part and parcel of the insurrection of subjugated knowledge. These are reasons of relevance to everyone, that place some degree of demand on everyone, and while no one can actively (capital “p”) Protest every injustice, besides that this one is especially egregious, people can always do something, however minimal, to register protest. Additionally, it makes sense for adherents of antipsychiatry/critical psychiatry to both actively protest and to prioritize shock protest not only for the moral/existential reasons listed above and not only because this is our community (meaningful in itself), but because doing so is strategic in that ECT acts as a symbol, because such protest lays bare the covert nature of psychiatry generally, because it fits with an abolition agenda, because it contributes to movement building.

That said, to return to the context which occasioned this article: On May 16^th  2015, at the instigation of shock survivors, people across the world—from the US, to Canada, to Ireland, to Brazil, to Uruguay—will be joined together in protest. I applaud all those who have taken up this task—who are planning, making posters, blogging, talking to the press. I wish everyone the best in their various efforts that day and, indeed, in all subsequent ECT protests; and I encourage folk outside the antipsychiatry and critical psychiatry fold to consider joining in. Note, if is it is a moral/existential calling, it is also a mitzvah to stand up for justice, or to use feminist Kate Millet’s descriptor for protests of this ilk (personal correspondence), to stand up for the mind. Hopefully, the article has added a new dimension of understanding, and, in the process, however modestly, contributed to the action and the cause. Correspondingly, in the spirit of solidarity, in ending, as one human being to another (read: one protestor to another), I leave you with a modified version of the Anti-Shock Proclamation, which I penned in 2011.

Please feel free to draw on it should you find it of any assistance to you, whether in this or in subsequent protests:

The Anti-Shock Proclamation

We who care,

We who are committed to decency,

We who behold with horror the disrespect for human life around us,   

We who shudder at the knowledge

Of women whose memory has been turned into ember and ashes, 

Of families brutally torn asunder by pulse waves or sine waves,

Of the elderly, whose final life reward is electrocution,  

We who hold this fearful knowledge can be silent no longer.

LEGISLATORS, on this day of international protest, May 16 2015, we hold you directly accountable and call on you to withdraw your authorization for electroshock.   

FELLOW CITIZENS who think this “practice” stopped decades ago, on this day of protest, May 16, 2015,

We tell you that the carnage continues and that you too are responsible. 

On this day of protest, May 16^th 2015, as survivors and allies, we come together to raise our voices in protest,

And we vow to return,

To return,

And return again 

Until this abomination

Is no more.  

(For more extensive analyses, see Burstow, 2015, Chapter Eight).

References

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Breggin, P. (1991). Toxic psychiatry. New York: St. Martins Press.

Burstow, B. (2006). Electroshock as a form of violence against women. Violence Against Women, 12 (4), 372-392.

Burstow, B. (2014a). The withering of psychiatry: An attrition model for antipsychiatry. In B. Burstow, B. LeFrançois, & S. Diamond (Eds.), Psychiatry disrupted: Theorizing resistance and crafting the revolution (pp. 34-51). Montreal: McGill-Queen’s University Press.

Burstow, B. (2014b). On the attrition model of psychiatry abolition. Retrieved on March 27, 2015 from http://www.bizomadness.blogspot.ca/2014/07/in-recently-released-article-i-provided.html.

Burstow, B. (2015). Psychiatry and the business of madness: An ethical and epistemological accounting. Toronto: Palgrave Macmillan.

Chabasinski, T. (2015). May 16, 2015: The international day of protest. Retrieved on March 27, 2015 from http://www.madinamerica.com/2015/03/may-16-2015-international-day-protest-shock-treatment/

Coalition Against Psychiatric Assault (2005). Narratives from Inquiry into Psychiatry. Retrieved on April 6, 2013 from http://coalitionagainstpsychiatricassault.wordpress.com/articles/personal-narratives.

Foucault, M. (1980). Power knowledge. New York: Pantheon.

Greenberg, D. (2007). Neurogenesis and stroke. CNS and neurological disorders-drug target, 6, 231-325.

Read, J. & Bentall, R. (2010). The effectiveness of electroconvulsive therapy: A literature review. Epidemiologia e Psichiatria Sociale, 19, 333 ff.

Ross, C. (2006). The sham ECT literature: Implications for consent to ECT. Ethical Human Psychology and Psychiatry, 8, 17-28.

Sackeim, H., Prudic, J., Fuller, R., Kielp, J., Lavori, P., & Olfson, M. (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32, 244-255.

Sartre, J.-P. (1943/1956). Being and nothingness (Hazel Barnes, Trans.) New York: Pocket Books.

Van Daalen-Smith, C. (2011). Waiting for oblivion: Women’s experiences with electroshock. Journal of Mental Health Nursing, 32, 457-472.

Zarubenko, I., Yakolev, A., Stepanichev, M., & Gulyaeva, N. (2005). Electroconvulsive shock induces neuron death in the hippocampus: Correlation of neurodegeneration with convulsive activity. Neuroscience and Behavioral Science, 35, 715-721.