Ect and Permanent Brain Damage

193 Electroconvulsive therapy (ECT) is a very controversial treatment. It is a topic for which it is difficult to obtain an objective perspective because emotional undercurrents tend to run strong. It may, in this respect, be comparable to other 214 emotionally laden issue? such as ethnic differences in IQ and the bad effects of marijuana. Friedberg (1977), an outspoken critic of ECT, attributed ECT in the 1930s to the authoritarian political era in Europe in which "inmates" in German psychiatric hospitals were starved, beaten, drugged, and gassed to death. On the other hand, Shukla (1981) stated, "Despite abhorrence in 225 some quarters, it is still being practiced as one of the cheapest and safest, and yet one of the most effective, therapeutic techniques in the whole of medical science" (p. 569). Hoffmann (1986) provided a scholarly discussion of the philosophical differ­ ences between those who favor and those who are opposed to ECT. He said that the former have a paternalistic philosophy and those who oppose it have libertarian and Kantian assumptions. He argued, "Paternalism does not pay much attention to patient education or self-esteem and libertarian ethics do not consider patient pain, fear, or dependency." He said that traditionally medicine has operated from a paternalistic point of view and that the attack on ECT can be viewed as arising from the valuing of freedom and autonomy in our soC;iety, the fact that politically educated persons have little tolerance for obliga.Lvl government rule. However, it is here noted by the present author that a study indicated that the psychiatrists and other mental health professionals who were more favorably disposed toward ECT were more experienced and knew more correct facts about ECT Qanicak, Mark, Trimakas, &: Gibbons, 1985). The use of ECT in the United States is decreaSing. In fact, there was a 46% decrease from 1975 to 1980. However, even in 1980 there were 33,384 psychiat­ ric patients given ECr (Thompson &:' Blain, 1987). In California, legislation in 1975 severely restricted the use of ECr. Nevertheless, from 1977 to 1983, 18,627 patients received a total of 99,425 ECT treatments in California, with little year­ to-year variation (Kramer, 1985). ECr is far from becoming an obsolete treatment modality. And, because controlled research has demonstrated its efficacy, and