PUBLIC HEARING ON ELECTROCONVULSIVE TREATMENT (electroshock)\ MENTAL HEALTH COMMITTEE OF THE NEW YORK STATE ASSEMBLY\ New York, NY,\ May 18, 2001
(Links to additional testimony below)
Testimony of Anne Krauss, Advocate and NARPA Administrator\ May 18, 2001
Hello. My name is Anne Krauss. I'm presently employed as the Administrator for the National Association for Rights Protection and Advocacy, although I am here today as a private citizen, not as a representative for that organization. Up until March 21 this year, I worked for the New York State Office of Mental Health as Recipient Affairs Specialist for Long Island. On March 9, I received a call from John Tauriello, Deputy Commissioner and Counsel of the New York State Office of Mental Health (NYS OMH) and Robert Meyers, NYS OMH Deputy Director of the Division of Community Care Systems Management. They informed me that if I continued to actively advocate on behalf of Paul Thomas in his efforts to prevent Pilgrim Psychiatric Center from shocking him, OMH would view this as a conflict of interest with my employment. I explained that I was engaged in this activity on my own time and at my own expense. However, they insisted that, since Mr. Thomas is engaged in a legal battle with the organization for which I worked, that it would be unethical for me to advocate for Mr. Thomas while working for OMH. On March 21, I submitted my letter of resignation, which was accepted on March 22.
Up until December, 2000, electroshock had not been an issue to which I had devoted much attention. I would have been surprised to learn that less than four months later, electroshock would be the issue which would lead me to resign. When I learned in December that Pilgrim Psychiatric Center was seeking to treat a patient with electroshock against his family's wishes, I began to seriously educate myself about this complicated issue. When I learned that Paul Thomas, whom I first met in 1998, had received over 50 shock treatments in less than two years despite his objections, I felt compelled to act.
I am a person who firmly believes that it is important to gain a scientific understanding of a problem before reaching any decisions about a course of action. I come from a family of scientists. Both my father and my brother were educated at the California Institute of Technology. I was a physics major at Harvard University when I married and dropped out to raise a family. My husband received a Ph.D. at Cal Tech in biochemistry after receiving a medical degree at Cornell College of Medicine. I eventually finished my undergraduate education at Empire State College, then entered a Ph.D. program in experimental psychology and cognitive neuroscience at Syracuse University. Once again, family obligations cut short my educational pursuits, but my devotion to scientific approaches remains unwavering.
Proponents of ECT claim that research overwhelmingly supports the hypothesis that electroshock is safe and effective. A cursory glance at the research literature would appear to support this claim. However, I would caution the members of this Assembly Committee to look very closely and critically at the scientific evidence which is currently available. In ten minutes, there is not time to adequately examine what research has been done, or, more importantly, what research has not been done. Even if this whole day were devoted to understanding the research picture, we could only scratch the surface. However, let me share some information which I hope will pique your curiosity, as it did mine, so that you will withhold judgment until you have time to thoroughly investigate the evidence.
Electroshock devices are classified by the Food and Drug Administration as Class III medical devices. Class III is the most stringent regulatory category for medical devices. Electroshock devices were placed in this category because of their potential to cause unreasonable risk of illness or injury. These devices can be marketed under current regulations only because they have been "grandfathered" in by virtue of being marketed prior to 1976, when the medical device classification and regulation system was put into place. The manufacturers of these devices have never submitted the evidence which the premarket approval process requires of all devices introduced after 1976. Premarket approval is a process of scientific and regulatory review to ensure the safety and effectiveness of class III devices. Keep this in mind if you hear that older reports of neuropathology resulting from electroconvulsive therapy in experimental animals and humans are "outdated". Similar studies have not been conducted using contemporary shock techniques and devices. Such studies have not been required for marketing, since these new devices are accepted by the FDA to be "as safe and as effective or substantially equivalent" to the older devices. Until such studies are conducted, there is a lack of scientific evidence that these newer devices actually are safer, as claimed.
You may have noticed that I prefer the term "electroshock" rather than "ECT" or "electroconvulsive therapy". The term ECT implies that the effectiveness of the treatment depends upon the production of a convulsion, or seizure. If this were indeed the case, the safest device would use the minimum dosage of electricity necessary to induce a convulsion. Such a device was developed, and, indeed, the memory changes, confusion, and agitation observed in people shocked with this device were not as large as observed in association with higher dose machines. However, use of low dose machines was abandoned, because psychiatrists found them considerably less effective. This suggests that the size of the electric shock, rather than simply the length of the convulsion, plays an important role in this treatment. It also suggests that negative side effects are inseparable from what psychiatrists perceive as the therapeutic effect. It is also interesting to note that even proponents of electroshock do not claim a therapeutic effect lasting longer than a few weeks, which coincidentally is the same length of time required for the most obvious of the memory disruptions to clear.
In considering the evidence, I also caution you to distinguish between solid research evidence and mainstream medical opinion. Remember that Moniz was awarded a Nobel prize for the lobotomy, which was considered a major medical breakthrough in its day. Remember also that tardive diskenesia was recognized by critical researchers and, yes, anecdotally by patients, for well over a decade before the medical establishment was willing to admit the true dimensions of this serious problem associated with pharmaceutical treatment of psychosis. Remember this before you hastily marginalize researchers and patients who are critical of electroshock.
During these past five months I have learned that, despite rhetoric which pays lip service to a concept of recovery from psychiatric disability based on self-help and empowerment, in practice OMH acts as though the only legitimate treatments are pharmaceuticals or electroshock. Twelve years ago I was hospitalized with what was diagnosed as a schizophreniform psychosis, and I had experienced considerable psychiatric disability even prior to my hospitalization. Symptoms of neuroleptic malignant syndrome, a life-threatening side-effect of medication, abruptly ended the pharmaceutical treatment I had been receiving. Since that time, a combination of psychotherapy and self-help through peer support have helped me to recover to a point that I no longer consider myself to have a psychiatric disability.
I realize that my story can be criticized as anecdotal, however, a careful review of the literature will reveal considerable evidence that, even for people experiencing extreme psychiatric states, effective alternatives exist other than drugs and shock. Dr. Bertram Karon conducted a study in which psychotherapeutic treatment of people diagnosed with schizophrenia was compared to pharmaceutical treatment. This study, which was funded by NIMH, provided evidence that the outcomes for the group treated with psychotherapy were superior to those of the drug treated group.
In his book, Recovery from Schizophrenia, Richard Warner compares conditions in non-industrialized countries to those in the West, in an effort to explain why, although the appearance of altered state is relatively constant across cultures, recovery rates seem to be much higher in the non-industrialized world. The factors he identifies which appear to promote recovery in non-western cultures are remarkably similar to those present in the self-help community which I found helpful in my recovery.
Both of the people I know for whom OMH is seeking court ordered shock have not been given adequate access to psychotherapy. Limitations on visitation have also seriously curtailed their access to peer support. One person is still not permitted to receive visitors other than immediate family members. The ward environment in which he must live would be stressful for anyone, and certainly has not been designed to effectively promote recovery in a person who is experiencing an altered state. Yet OMH claims that electroshock is the only available option for both of these individuals, because of dangerous effects each has experienced from drug treatment.
At a minimum, a moratorium on forced electroshock treatment should be sought in New York State until FDA premarket approval requirements are met. No person should be involuntarily subjected to treatment with a Class III device for which the FDA has not yet received reasonable assurance of both safety and effectiveness. Acceptance by the medical community is not a substitute for rigorous testing.
Reporting requirements for basic information on each procedure administered in New York should be instituted, including patient age, location of treatment, status as voluntary or involuntary patient, and any death of a patient occurring within two weeks of the procedure. Similar reporting requirements in Texas indicate that a person receiving 60 treatments, the number Mr. Thomas has undergone in the past two years, faces a risk of death of approximately 2%. A retrospective study of electroshock in New York would also be illuminating.
Capacity determinations should be made by psychologists, not by psychiatrists, and certainly not by the same psychiatrists whom have determined that a particular treatment is the best or only treatment option. Under the present system, disagreement with the psychiatrist's opinion is considered evidence of "lack of insight", which in turn is viewed as a symptom of mental illness. Separating the issue of capacity to make a reasoned treatment decision, which is more of a psychological than a psychiatric question, from the question of agreement or disagreement with the proposed treatment, could effectively address this problem. Legislators could gain a better understanding of this issue if they read the transcript of Mr. Thomas' hearing.
It is very difficult to devise a legislative approach to guaranteeing that patients will have access to alternatives to electroshock. Increased funding and continued support for psychotherapy and self-help, including research in these areas, is important. However, as long as mental health treatment is ultimately under the control of psychiatrists, it is likely that alternatives to somatic treatments will not be viewed as legitimate. Psychiatry tends to view all mental difficulties as resulting from physical abnormalities in the brain. At the risk of oversimplification to make a point, I'll claim that in many cases this makes about as much sense as blaming the Intel Pentium processor for Microsoft's buggy software. Perhaps psychiatry's "hardware" bias could be offset through giving greater power to both psychologists, who by analogy are "software" experts, and to those of us who have experienced altered state, and know in the most intimate and direct way how somatic treatments and human relationships impact upon us.
TESTIMONY OF LEONARD ROY FRANK\ May 18, 2001
I've taken the epigraph for my presentation from a talk on the Holocaust by Hadassah Lieberman, the wife of Sen. Joseph Lieberman, which was rebroadcast on C-SPAN last month. She quoted the Bal Shem Tov, founder of Hasidism, a Jewish religious movement: "In remembrance lies the secret of redemption."
My name is Leonard Roy Frank. I was born in 1932 in Brooklyn and was raised there. After graduating from the Wharton at the University of Pennsylvania, I served in the U.S. Army and then worked as a real estate salesman for several years. Three years after moving to San Francisco in 1959 I was diagnosed as a "paranoid schizophrenic" and committed to a psychiatric institution where I was forcibly subjected to 50 insulin-coma and 35 electroconvulsive procedures. This was the most painful and humiliating experience of my life.
It also left me with a memory gap covering the three preceding years. It was a complete wipe-out (like cutting a path across a heavily chalked blackboard with a wet eraser). Afterwards I didn't know that John F. Kennedy was president although he had been elected three years earlier. There were also big chunks of memory loss for events and periods spanning my entire life; my high school and college educations were effectively destroyed. I felt that every part of me was less that what it had been.
Following years of study reeducating myself, I became active in the psychiatric survivors movement, becoming a staff member of Madness Network News (1972) and co-founding the Network Against Psychiatric Assault (1974); both based in San Francisco. I am currently a member of the Support Coalition International (based in Eugene, Oregon). All three organizations were and are dedicated to ending abuses in the psychiatric system. In 1978 I edited and published The History of Shock Treatment. Since 1995, three books of quotations I edited have been published: Influenced Minds, Random House Webster's Quotationary, and Random House Webster's Wit & Humor Quotationary.
Over the last thirty-five years I have researched the various shock procedures, particularly electroshock or ECT, have spoken with hundreds of ECT survivors, and have corresponded with many others. From all these sources and my own experience, I have concluded that ECT is a brutal, punitive, dehumanizing, memory-destroying, intelligence-lowering, brain-damaging, brainwashing, heart-damaging, life-threatening, social-engineering technique. ECT robs people of their memories, their personality and their humanity. It reduces their capacity to lead full, meaningful lives, it crushes their spirits. Put simply, ECT is a method for gutting the brain in order to control and punish people who fall or step out of line.
Brain damage may be the most important and obvious effect of ECT. The American Psychiatric Association's 1991 Task Force Report on The Practice of Electroconvulsive Therapy (p. 68), denies this in stating that "in light of the available evidence, 'brain damage' need not be included [in the ECT consent form] as a potential risk." Neurologist Sidney Sament backs the brain-damage charge. In a letter to Clinical Psychiatry News (March 1983), he wrote,
"After a few sessions of ECT the symptoms are those of moderate cerebral contusion, and further enthusiastic use of ECT may result in the patient functioning at a subhuman level. Electroconvulsive therapy in effect may be defined as a controlled type of brain damage produced by electrical means.... In all cases the ECT "response" is due to the concussion-type, or more serious, effect of ECT. The patient "forgets" his symptoms because the brain damage destroys memory traces in the brain, and the patient has to pay for this by a reduction in mental capacity of varying degree."
Additional evidence of ECT-caused brain damage comes from an earlier report of an APA Task Force study of ECT (1978), in which 41% of a large group of psychiatrists responding to a questionnaire agreed with the statement that ECT produces "slight or subtle brain damage." Only 28% disagreed.
And finally there is the evidence from the largest published survey of ECT-related deaths. In his Diseases of the Nervous System article titled "Prevention of Fatalities in Electroshock Therapy" (July 1957), psychiatrist David J. Impastato, leading proponent of ECT, reported 66 "cerebral" deaths among the 235 cases in which he was able to determine the likely cause of death following ECT.
The 1991 Task Force Report on ECT referred to earlier states that the death rate from ECT is "approximately one per 10,000" (p. 157), but the rate may be much higher, especially now that the elderly are being electroshocked in growing numbers; statistics based on California's mandated ECT reporting system suggest that upwards of 50% of all ECT patients are 60 years of age and older. What does this mean in terms of ECT deaths? A 1993 study involved 65 patients, 80 and older, who were hospitalized for major depression. Here are the facts taken directly from this study: The patients were divided into 2 groups. One group of 37 patients was treated with ECT; the other group of 28 patients, with medication. After 1 year, 1 patient among the 28 in the medicated group was dead; 10 patients among the 37 in the ECT group - a rate of 1 in 3.7, or 27% - were dead. (David Kroessler and Barry Fogel, "Electroconvulsive Therapy for Major Depression in the Oldest Old,"American Journal of Geriatric Psychiatry, Winter 1993)
The term "brainwashing" came into the language during the early 1950s. It originally identified the technique of intensive indoctrination developed by the Chinese for use on political dissidents following the Communist takeover on the mainland and on American prisoners of war during the Korean War. While electroshock is not used overtly against political dissidents, it is used against cultural dissidents, social misfits and the unhappy, the troubled and the troubling, whom psychiatrists diagnose as "mentally ill" in order to justify ECT as a medical intervention. Indeed, electroshock is a classic example of brainwashing in the most meaningful sense of the term. Brainwashing means washing the brain of its contents. The term itself derives from the Chinese words meaning "brain" and "wash." Electroshock destroys memories and ideas by destroying the brain cells in which memories and ideas are stored. As psychiatrists J. C. Kennedy and David Anchel, both ECT proponents, described the procedure's effects in 1948, "Their minds seem like clean slates upon which we can write" ("Regressive Electric-shock in Schizophrenics Refractory to Other Shock Therapies,"Psychiatric Quarterly). Tabula rasa therapy! For these reasons, I have proposed that the procedure now called electroconvulsive treatment (ECT) be renamed electroconvulsive brainwashing (ECB). And perhaps ECB is putting it too mildly. Maybe we should keep the acronym "ECT" and have the "T" stand for torture - electroconvulsive torture. We might ask ourselves, Why is it that 10 volts of electricity applied to a political prisoner's private parts is seen as torture while 10 or 15 times that amount applied to the brain is called "treatment"?
If electroshock is an atrocity, as I maintain, how can its use on more than 10 million Americans since being introduced more than 60 years ago be explained? Here are several reasons:
ECT is a money-maker. An in-hospital ECT series can cost anywhere from $50,000-75,000. Using a low figure of 100,000 Americans who are electroshocked annually, most of whom are covered by private or government insurance, ECT brings in $5 billion a year.
The myth of informed consent. While outright force is used in a relatively small number of cases, genuine informed consent is never obtained because ECT candidates can be coerced and because electroshock specialists refuse to accurately inform ECT candidates and their families of the procedure's true nature and effects. ECT specialists lie not only to the parties vitally concerned, they lie to themselves and to each other. Eventually they come to believe their own lies, and when they do, they become even more persuasive to the naïve and uninformed. As Ralph Waldo Emerson said in 1852, "A man cannot dupe others long who has not duped himself first." Here is an instance of evil so deeply ingrained that it's no longer recognized as such. And you have such outrages, as ECT specialist Robert E. Peck titling his 1974 book, The Miracle of Shock Treatment and Max Fink, who for many years edited the leading professional journal in the field, now called The Journal of ECT, telling a Washington Post reporter in 1996, "ECT is one of God's gifts to mankind." (Sandra G. Boodman, "Shock Therapy: It's Back," 24 September)
Lack of accountability. Psychiatry has become a Teflon profession: the criticism, what little there is of it doesn't stick. Here you have all these psychiatrists carrying out brutal acts of inhumanity and no one calls them on it. Not the courts, not the government, not the people. Psychiatry has become an out-of-control profession, a rogue profession, a paradigm of authority without responsibility, which of course is a good working definition of tyranny
Sadism and anger. Psychiatrists do not feel kindly toward "patients" who are unresponsive to their "ministrations," those who cannot or will not cooperate with their supposed "healers." They are a source of embarrassment, a mark of failure. Instead of taking responsibility for their ineptitude, psychiatrists blame the patient or the disease. The patient is "treatment-resistant," they say. "Quick Henry, the little black box and we'll get him, or more likely her, back under control - our control." (About two-thirds of those undergoing ECT are women).
Electroshock could never have become a major psychiatric procedure without the active collusion and silent acquiescence of tens of thousands of psychiatrists. Many of them know better; all of them should know better. The active and passive cooperation of the media has also played an important role in expanding the use of electroshock. Amidst a barrage of propaganda from the psychiatric profession, the media passes on the claims of ECT proponents almost without challenge. The occasional critical articles are one-shot affairs, with no follow-up, which the public quickly forgets. With so much controversy surrounding this procedure, one would think that some investigative reporters would key on to the story. But it hasn't happened up to now. And the silence continues to drown out the voices of those who need to be heard. I'm reminded of Martin Luther King's 1963 "Letter from Birmingham City Jail," in which he wrote "We shall have to repent in this generation not merely for the vitriolic words and actions of the bad people, but for the appalling silence of the good people."
I am here representing the Support Coalition International, a group of psychiatric survivors allied with more than 100 "sponsoring groups"who oppose forced psychiatric oppression and who promote humane empowering alternatives. But more significantly, I'm also here representing the true victims of electroshock: those who have been silenced, those whose lives have been ruined, and those who have been killed. All of them bear witness through the words I have spoken here today.
I'll close with a short paragraph, in way of summary, and a poem I wrote about 15 years ago.
If the body is the temple of the spirit, the brain may be seen as the inner sanctum of the body, the holiest of holy places. To invade, violate, and injure the brain, as electroshock unfailingly does, is a crime against the spirit and a desecration of the soul.
With "therapeutic" fury\
using instruments of infamy\
conduct electrical lobotomies\
in little Auschwitzes called mental hospitals\
Electroshock specialists brainwash\
their apologists whitewash\
as silenced screams echo\
from pain-treatment rooms\
down corridors of shame.\ Selves diminished\ we return\ to a world of narrowed dreams\ piecing together memory fragments\ for the long journey ahead.\
From the roadside\
awash in deliberate ignorance\
sanction the unspeakable -\
Silence is complicity is betrayal.
[Leonard Roy Frank currently lives in San Francisco.]
Testimony of Tina Minkowitz\ NYS Assembly MH Committee \ July 18, 2001
Good morning. My name is Tina Minkowitz and I am a law graduate and a survivor of psychiatric abuse. In 1997 I spent 6 months observing hearings in the Brooklyn, NY Mental Hygiene Court and wrote a report on those hearings which is the basis of my testimony today. I was also present at some of the Thomas court hearings. I will speak about problems with existing judicial procedure on forced treatment, and propose alternative approaches. The report, which I will make available to you, is entitled, Do Psychiatric Inmates Have the Right to Refuse Drugs? An Examination of Rivers Hearings in the Brooklyn Court.
The Rivers case held that mental illness is not synonymous with lack of capacity. Nevertheless, lower courts have allowed lack of capacity to be established by psychiatric diagnosis, particularly of paranoia, unsupported by specific factual evidence connecting the diagnosis to lack of capacity in the individual case. Lower courts have also accepted resistance-based conduct and beliefs as evidence of lack of capacity. This includes refusal to speak to psychiatrists, belief that one is a political prisoner, belief that involuntary commitment was illegal, expression of hostility towards psychiatrist, and similar types of conduct and beliefs. It also includes absence of belief that one is mentally ill, and disagreement with the need for proposed treatment.
Rivers requires clear and convincing evidence. It is difficult to imagine how such prejudice and stereotype can constitute clear and convincing evidence. Yet that is the routine state of affairs as found in my report, and by other observers as cited in that report. Also, the Americans with Disabilities Act requires individualized and fact-based objective determinations when making judgments based on a disability. The ADA clearly applies here. Legislation should support and be consistent with the important public policies articulated by Rivers and the ADA which reflect our evolving understanding of fundamental rights.
On the issue of best interests, Rivers held that institutional convenience and other concerns unrelated to the well-being of the patient and those around her (referring to the emergency police powers) could never overcome the patient's interest in refusing treatment. However, such concerns are routinely accepted by lower courts. Furthermore, Rivers acknowledged the seriousness of the danger posed by psychiatric drugs, but lower courts are usually uninterested in this, to the extreme of ignoring respondents' medical conditions that may be adversely affected. Rivers requires courts to consider less intrusive alternatives, but there is no indication that courts do so.
I will now read some excerpts and summaries from the 1998 report.
The following were offered on three occasions to show lack of capacity: Lack of belief that she is mentally ill (8/5/97 #1), lack of insight into the need to take medication (8/14/97 #1), "lack of insight, lack of judgment, can't make reasoned decision because of mental illness"(8/12/97 #3).
"Have you explained to her the benefits and the risks?" "Yes, many times." "Do you think she lacks the capacity to make a reasoned decision?" "Yes - it's overshadowed by her psychosis." (10/28/97 #1)
6/24/97 #2, "she says she's been kidnapped, doesn't have a mental illness, wants to go home." This is an example of her "delusions,"and "lack of insight and judgment."
Believing that one is a political prisoner, refusing to talk to the psychiatrist and refusing to come to court were labeled paranoia. (8/12/97 #3) Being "socially isolative" (9/23/97 #1) and being "suspicious and guarded" when talking to the psychiatrist (10/14/97 #2) were similarly used to establish lack of capacity.
9/30/97 #3, "Did you attempt to explain the risks and benefits to her?" [Yes.] "And what was her answer?" "That I needed a bullet through my head."
In all these cases, the courts accepted generalized or punitive opinions as expert testimony to establish lack of capacity, contrary to the standard set in Rivers and the ADA requirement of fact-based objective determinations free of disability-based stereotypes.
Judges ignore respondents' own testimony as probative of either capacity or their best interests. Here are some examples of respondents' testimony.
8/5/97 #1 She doesn't want chemicals in her body. "The medications change your thinking and I don't want to change my thinking."
9/30/97 #3: "I take it but when it doesn't make me feel good I don't."
10/21/97 #2: He couldn't concentrate and he couldn't do other things he used to do. "I'm a very calm person, now I can't sit still."
6/7/97 #7: "I'm not taking it." "I don't want it." "These are my feelings."
6/10/97 #2: "What did the doctor tell you the medicine was for?" "He said it was to make me feel better." "And did it make you feel better?" "No."
7/8/97 #2: "He's in a free country, America, he has a right to hear the voices, and a right not to take medication. He understands he will always hear the voices and feels he can live with them."
In each of these cases, the judge granted a forced treatment order.
There are several problems with application of the best interest part of the standard. First, judges fail to require meaningful proof that treatment is in the individual's own best interest.
On four occasions, in answer to the question "Why did you choose this medication for this person?" the psychiatrist answered "because it's available in long-acting (decanoate) form (6/24/97 #1, 7/15/97 #3, 9/9/97 #1, 10/28/97 #1). This concern is clearly about institutional convenience rather than the patient's best interest, contrary to the requirements of Rivers. On another occasion, the psychiatrist couldn't answer why the treatment was appropriate for his patient's mental condition. (7/8/97 #2).
Other cases: Haldol "calms him down," 9/16/97 #1; she is "more pleasant and agreeable" after being injected with haldol (9/30/97 #3); he was "more pleasant and agreeable" when he took olanzapine for a few days (9/9/97 #1).
9/9/97 #1: Psychiatrist wants to return him to mother, only support system is family. They don't want him back without medication.
I note here that making the individual more pleasing to others is an impermissible consideration similar to institutional convenience.
Secondly, adverse effects are not given full or adequate consideration..
9/11/97 #1 This was the case of an elderly woman with a heart condition (heart attack the previous year) and cancer. She had been taking haldol but stopped. MHLS asked, "Will haldol have any effect on her heart condition?" but accepted the psychiatrist's answer, "No," without further challenge. An observer noticed the PDR in the adjoining clerk's office, which would have clearly contradicted this testimony.
Before a different judge in another case, the following evidence was brought out: There was another doctor's report, in the man's record, saying he's taking AZT, possible dementia. Psychiatrist testifying was not aware of the AZT, and in response to the question, "Doesn't that mean he has HIV?" the psychiatrist answered that he'd have to give an HIV test.
The judge was disturbed by this lack of familiarity with the patientís medical condition when prescribing drugs with serious medical effects. But it was obvious that his reaction was atypical in that court.
Thirdly, the possibility of less intrusive alternatives is rarely discussed and, in my observation, it has never been taken seriously. The obvious possibility, psychotherapy or counseling, is treated dismissively. I have heard a psychiatrist testify that his purpose in giving therapy was to get the patient to agree to take medication. A reliable observer has told me that this was also evident in the Thomas case.
I make the following recommendations for action.
Public policy needs to move in the direction of a totally voluntary community-based mental health system that safeguards human dignity and respects individual autonomy.
People labeled with psychiatric disabilities should have a major role in the direction and control of programs and services designed for their benefit.
Public policy should move toward the elimination of electro-convulsive therapy and psycho surgery as unproven and inherently inhumane procedures.
Limiting the use of electroshock to treatment given with voluntary and competent informed consent would move NY in the right direction.
Bill A9081 should be amended to remove the suggested capacity protocol. Virtually all the suggested factors are subject to misuse or reflective of stereotype and prejudice.
Until it is possible to eliminate all forced treatment, the judicial standard should be simple and reflect the public policies stated above, by giving preference to respondent's expressed wishes and limiting capacity to the narrow question of ability to understand what is at issue, e.g. electroshock or a psychiatric drug. The person need not consider this to be treatment or agree that she/he has a mental illness or agree with the psychiatrist's assessment of the risks and benefits. Diagnostic categories, resistance to hospitalization, and sociability should not be permissible factors. Reasonable accommodation should be made for actual or perceived disability in communication and/or cognitive capacity. Expert testimony should be inadmissible on the issue of capacity, and hearings should be bifurcated so that testimony on need for treatment is clearly separated from capacity issue.
Substituted consent of an appointed guardian is of dubious constitutionality in NY and has the potential to increase rather than limit forced treatment. Bill A8960 should be amended to remove that provision.\
Additional testimony from this public hearing
Testimony of neurologist John M. Friedberg, M.D. Testimony of John Breeding, Ph.D. More Testimony from the May 18, 2001, New York State Assembly Hearing on Electroshock Written Testimony Submitted By Don Weitz For The New York State Assembly Hearing on Electroshock NY Post covers legislative Proposal To "Leash Zap-Happy Shock Docs"
For more information on electroshock see: