On November 15, l992, I was up early to catch a flight back to New York from Kansas City. I'd been in Missouri for the annual conference of NARPA (the National Association for Rights Protection and Advocacy, an organization made up about equally of lawyers for people with psychiatric labels and those like myself who are themselves considered "mentally ill".) I usually enjoy these conferences immensely, but this one had been marred by cold, rainy weather and strained relationships. In addition I'd missed my son's sixth birthday the day before and was upset that the babysitter hadn't followed through with our plans to make the day special. I was eager to get home. Many hours later, when I arrived, there was a message on my answering machine from Celeste, who'd also been at the conference. She told me that while we'd been there, our friend and colleague Marilyn Rice ("Natalie Parker" to the readers of Berton Roueche's New Yorker article of September 9, 1974) had suffered a heart attack. While we talked and dined and Celeste wowed the crowd with her performance at the talent show, Marilyn struggled to live. She died while I was on the plane home. She was sixty-nine years old. For eight years I had been anticipating this, dreading it, hoping it would not happen at all or not for the longest possible time. I was only thirty-two. Marilyn and I had agreed I would take on her responsibilities when she died. I wasn't ready. I will think about this tomorrow, I told myself. Because my son's birthday presents had to be wrapped, and I had to go to the store to get the kind of cake he likes, and some candles, so that when the sitter brought him home the first thing he would see would be the cake with six candles and the presents. Tomorrow I would try to figure out how to fill the shoes of the most extraordinary woman I've ever known. Marilyn Rice's incarnation as "Natalie Parker" was brief. It seemed as if no sooner had the ink dried on that issue of The New Yorker than anyone who cared knew or could easily find out that Natalie Parker was really Marilyn Rice. Which was mostly Marilyn's doing. Apparently Roueche insisted on pseudonymity; Marilyn had no use for it. In fact, she found it downright counterproductive. The article, titled "As Empty as Eve", has in the past twenty years achieved the status of a minor classic: reprinted in the book The Medical Detectives, cited in numerous other books and articles, referred to in lectures to medical students. This is in equal parts because of the notoriety and accomplishments over those twenty years of its subject Natalie/Marilyn, and because of the unswerving controversy surrounding its other subject, electroshock treatment. Roueche's unassuming and carefully worded article looks, from the perspective of l994, to have been nothing less than the opening salvo in a war to influence public and professional opinion about electroshock, a war in which the most powerful weapon (next to money) is words. When Berton Roueche first met her in l973, Marilyn was in her early fifties, "an attractive woman of medium height, with large gray eyes and light gray hair." Through a mutual acquaintance, he had learned about her experience with electroshock a few months earlier, an experience she was eager to talk about. The New Yorker interview was Marilyn's very first opportunity to do so in public. Roueche couldn't have known that she would keep it up for two decades. In the article he describes how Marilyn's despair and depression over ongoing mutilating dental work led to her hospitalization in a private Washington, D.C. psychiatric hospital and a series of eight electroshocks. (A note on terminology: Roueche and Marilyn used "electric shock", I like to use "electroshock" or just "shock", and there are now even more fashionable names. But the name everyone recognizes for the subject of this article is "shock treatment", the psychiatric practice of shooting electricity through a brain to cause a seizure.) The shocks left her with "oceans and oceans of blankness" in her personal and professional memory despite her psychiatrist's assurances that there would be no permanent memory loss. "Now I know how Eve must have felt, having been created full grown out of somebody's rib without any past history," she wrote a week after the shocks. "I feel as empty as Eve." It took months for her to assess the full extent of her losses. She explained to Roueche, "All my beloved knowledge, everything I had learned in my field during twenty years or more, was gone. I'd lost the body of knowledge that constituted my professional skill. I'd lost everything that professionals take for granted. I'd lost my experience, my knowing. But it was worse than that. I felt that I'd lost my self." Marilyn was forced to retire from the work she loved as a highly-paid economist and analyst for the Department of Commerce. She had been the sole support of her family. But she never, ever worked again. She was to live for the rest of her life on a disability pension---disabled due to amnesia. "Natalie's" story ends there, in the spring of l974. But Marilyn's story, and mine---a story the New Yorker article not only foreshadowed but in some knowable and unknowable ways helped to determine---was just beginning. Marilyn Rice by nature---and though her memory and abilities had been lessened by shock, her nature hadn't changed all that much---was not an activist. She was a (now) former government bureaucrat, economist, and statistician, which is to say a person of endless patience, love of detail, and delight in research and learning. A person more at ease sitting at a desk than marching in a protest. I believe she was always primarily motivated by love of knowledge and truth. Her desire to change the world where it didn't measure up to her standards was a secondary, though not less important, motivation. As she told Roueche in l974, "I've never lost my intellectual curiosity. I was curious to learn more about what had happened to me---more about the whole idea of electric-shock therapy." She described how she haunted medical libraries and, finding very little of relevance, "started bringing up the subject of electric shock whenever I meet new people." There's nothing quite like the passion born of personal experience of injustice and injury, coupled with a keen and exacting intelligence and twenty years of free time. Marilyn launched into a new career that was to sustain her until her last breath: brain researcher. Her library forays and casual interviews with acquaintances who'd had electroshock, described in the article, were just the beginning. Shooting off her mouth and typewriter in all directions, as she later put it, not only led her to Roueche, but soon garnered her a much wider audience. She wrote literally hundreds of letters on the subject of electroshock from the mid-70s through the early 80s, each one copied off to maybe two dozen people. They went to psychiatrists, researchers, editors, writers, producers, officials at the National Institute of Mental Health and the American Psychiatric Association and the American Medical Association, insurance companies, medical laboratories, Congresspeople, the Food and Drug Administration, shock machine manufacturers...and others too numerous to mention, including most importantly other people who had experienced electroshock. These letters, most of which I have now inherited, can be absolutely disarming in their directness. Recipients must have been impressed by Marilyn's obvious wealth of knowledge and brutal honesty. Although many did reply, not all had the courage to place themselves under her scrutiny. One that must surely have gone unanswered though not unread by its 22 recipients was addressed to the director of research at a state psychiatric institute. January 12, l976 Dear Dr. Davis, According to your article on electric shock in the October 27, l975 issue of Medical World News, "memory loss...generally disappears within a month." According to the only study ever made of the state of memory after electric shock, no subject had a memory even remotely resembling normal. I enclose a protocol from that study in case you are not familiar with it. What is the evidence that leads you to believe that memory is typically fine a month after shock? Yours truly, Marilyn Rice Another letter of May 2, l977 is even more blunt. It was directed to Paul Blachly, M.D., in his capacity as editor of Convulsive Therapy Bulletin, a short-lived electroshock- promoting journal. (Blachly, now dead, was not incidentally an entrepreneur who started a shock machine company called Mecta in the early 80s.) Dear Dr. Blachly, Supplementing my letter of last week on psychiatrically-induced brain damage, I should like to call your attention to the phenomenon of accidental alleviation of nervous or mental disorders via brain damaging experiences. The phenomenon is often mentioned in the literature. Here are some examples... (References follow, including one doctor musing in print that "A doctor can't very well knock a patient over the head or fling him downstairs...but what about electric shock?") Dr. Blachly, I could easily set up a psychiatric hospital as good as yours. I would just put the patients down on the sidewalk and interfere with their cerebral function by dropping flower pots on their heads. I would put crash helmets on them to prevent external bleeding. Yours very truly, Marilyn Rice References on request. From her desk in Washington where she sat with her books and typewriter for twelve hours a day, Marilyn was making unlikely allies as well as enemies. One of them was the young neurologist John Friedberg. Friedberg had had a crash course in the politics of electroshock during his residency. He had become concerned about the effects of electroshock on the brain, and when he began questioning its use he was dismissed from his residency. He was able to complete his training elsewhere, and became a public critic of electroshock from his standpoint as a doctor trained to understand and respect the human brain. In August l975 he was able to publish a critical article in Psychology Today titled "Let's Stop Blasting the Brain." He was especially critical of what was even then beginning to be referred to as the "new and improved" electroshock---meaning the standard procedure of administering electroshock with anesthesia and muscle-paralyzing drugs--- calling it "Flowers at Buchenwald". Within a month after the article appeared, Marilyn and Friedberg were corresponding, sharing articles, comparing notes. It was the beginning of a relationship that would last for the rest of her life. Friedberg was at the time working on a book called Shock Treatment is Not Good for Your Brain (Glide Publications, San Francisco, l976). It was the first book ever to include first-person accounts of electroshock survivors, who described in real-life terms the effects of shock on their memories, lives, and dreams. Dr. Friedberg wrote to Marilyn, "I can't tell you how much I admire the precision of your writing and the care with which you've done your homework...You will find your own research is better than mine..." To which Marilyn replied with characteristic modesty, "It is only because of my unemployed status that I can go into the fringe research covering animal experiments and shock doctors' funny sayings." Friedberg's paper "Shock Treatment, Brain Damage, and Memory Loss: A Neurological Perspective", published in the American Journal of Psychiatry in September l977, was based on 98 research papers on brain damage and memory loss complied for him by Marilyn. Her name appears in a note, with thanks for research assistance. A very different relationship developed between Marilyn and psychiatrist Peter Breggin, now the best known anti-shock doctor in the country. Marilyn corresponded with him in the mid-70s, providing him through her letters with a systematic compilation of all the literature on electroshock brain damage and memory loss as it existed at that time. The publication of Breggin's l979 book Electroshock: Its Brain-Disabling Effects was a landmark event; not even the most rabid shock doctor could refute all of its references. But nowhere was any credit given to Marilyn, a fact she bitterly resented. The circle had been formed. By the mid-70s there existed for the first time ever in this country a vocal network of ex- patients and professionals critical of electroshock and what they saw as the deception and scientific fraud being perpetrated by the psychiatric industry. Some of these critics were part of the broader ex-patient (then called ex-inmate) movement against all forms of psychiatric oppression, which was just being born; others, like Marilyn, focused narrowly on electroshock. In l976, when ABC News trendspotters decided to do a feature on this new human rights movement-in-the-making, the national network could be activated with just a few phone calls. Marilyn, Dr. Breggin, neurologist Robert Grimm, and others like Ted Chabasanski of Berkeley (who'd been electroshocked as part of a "research" project at the age of three) were contacted to be interviewed about electroshock, while Paul Blachly was to provide pro-shock commentary. The resulting program, aired on May 26, l977, was called "Madness and Medicine". If I had seen it, my life might have been very different. But I was probably busy that night with preparations for my high school graduation. After some discussion of psychiatric drugs and hospitals, Blachly opened the shock segment by demonstrating the technique he was promoting at the time, multiple electroshock, where several convulsions are induced at each session. (No one talks about multiple electroshock in l994; it's been totally discredited.) The host commented, "More people get more angry about electric shock than any other psychiatric procedure." Dr. Breggin said, "If you look at the studies...that allegedly proved no damage, you actually find damage in them. It's a most amazing fact if you actually look up the studies." He didn't mention that it had been Marilyn who had done the actual looking up. Then-president of the American Psychiatric Association Robert Gibson admitted "It (electroshock) has a certain hazard to it...It can be felt as a kind of attack..." In her allotted air time of about one minute, Marilyn essentially repeated in brief exactly what she'd told The New Yorker about losing her memory and being unable to work. The show closed with nationally-known psychiatrist E. Fuller Torrey (who has since done a 360-degree about-face) proposing that psychiatry be abolished. "Buried?" asked the interviewer. "Buried," said Torrey. Looking back at this show from the perspective of 1994, first, it's almost impossible to believed it was ever allowed to air at all. Second, the inescapable conclusion is that back in l976 the psychiatric industry made a mistake in underestimating the numbers and influence of its critics, especially electroshock critics, perhaps since those critics were and are the most stigmatized and devalued people in our society. If so, it was not a mistake the industry's voice, the American Psychiatric Association, has or will ever make again. Three months after the airing of Madness and Medicine, the APA's new president, Jack Weinberg, sent out a letter to all members which was also published in the industry's trade journal, Psychiatric News. The letter stated, "We clearly need to intensify our efforts to communicate positive information about the profession, especially in light of the growing criticism from many quarters---perhaps best illustrated by the biased and outrageous ABC network TV show, Madness and Medicine." Weinberg asked each member for at least $10, ostensibly to conduct a survey of public attitudes to "pinpoint the direction our public affairs program must take...APA cannot launch a truly effective program to improve the accuracy of the public's perception of psychiatry without a scientific analysis of what the misperceptions are, and why they exist." APA might have asked Marilyn, or Ted Chabasinski, or thousands of other survivors of psychiatric treatment who would have told them for free. But, of course, the problem as ingeniously framed by the APA wasn't that there was or could possibly be anything wrong with the practice of psychiatry, only with the perceptions of it. APA members gave more than $30,000 in just two months to its Joint Commission on Public Affairs, chaired by Shervert Frazier. Besides its survey, APA had grander plans, all of which would find financial backing and be carried out within the next two years. Beginning in 1977, the Joint Commission on Public Affairs developed and cultivated a "Roster of Media Contacts", a list of 500 self-selected "experts" who signed on to do public relations for psychiatry...and to preclude anyone else not media-savvy from doing so. The Commission provided "training and guidance" to these public relations spokespeople. Never again would a writer like Roueche have to rely on dead doctors, dusty textbooks, and papers presented to strange- sounding medical societies at remote European conferences (to name three of the sources of information Roueche was forced to resort to in l974). Now, all he would need would be a single phone call to APA headquarters in Washington, where he'd connect with someone as much at ease in an interview or in front of a TV camera as in a hospital, maybe even someone whose name and face would be reassuringly familiar and instantly recognizable from other articles and TV shows. He'd never be at a loss for the perfect quote of exactly the right length and tone...and no more digging up back issues of hard-to-find medical journals to corroborate those quotes; after all, he'd be talking with an expert. Back in those pre-public relations days Roueche had cited seven experts of his own choosing (eight if you count The New Home Medical Encyclopedia, a faux pas impossible to make today.) Interestingly, only one of them apparently had what it takes to make the cut onto the PR team of the 80s and 90s. Larry Squire, a psychologist whose career interest is in memory, thereby amnesia, thereby electroshock, lent (or perhaps bent, since much of it does not support a benign view of electroshock) his work to the PR campaign for a while, even being quoted in The New York Times more than once. But he appears to have had his fill of the spotlight and is now focusing on less controversial ways of assessing memory function. There remained the problem of how to train reporters and producers---some of whom, lamented APA's Marketing Director, "prefer to ferret out the news story themselves"---in this new way of conducting their business, while preserving their illusions of doing the ferreting. APA's solution made its debut in 1978, with the first APA-sponsored "National Symposium for Media Writers". Media people would be targeted, courted, and invited to this symposium, the first of many "designed to alert them to advances in the field." Dining and schmoozing were allowed. Since the l978 symposium was in Snowmass, Colorado, skiing may have been on the agenda as well. Those who produced the stories the APA liked best were eligible for special APA awards for reporting excellence to be presented at the APA's well-funded annual conference. Subjected to a steady diet of handfed stories, like squirrels in Central Park more than a few reporters in the intervening decades may have lost their ferreting instincts altogether, or failed to develop them at all. "Media psychiatrists," sometimes recruited through ads in Psychiatric News, sometimes appointed, were courted and trained as well. They were regularly supplied with "Public Affairs Guidelines" to hone their skills. "To ensure that a statement is used with a minimum of editing," coaches one such set of guidelines, "keep it under 45 seconds in length...Listeners and viewers have a hard time absorbing facts and figures...on-camera impressions say more." None of this would have availed, of course, had the APA not been able to orchestrate consistent and unwavering consensus from the mouths of all media psychiatrists on a given topic. Toward this end groups, called with military precision Task Forces, were formed within the APA to hammer out position papers on various psychiatric subjects. A Task Force on ECT---electroconvulsive therapy, the elegant new PR-conscious name for electroshock---published its report in 1978. Its conclusions could easily have been foreseen. Two of these Task Force members had already formed a shock-promoting organization they called the International Psychiatric Association for the Advancement of Electrotherapy. A third, Dr. Max Fink, was already known as the biggest shock doctor in the United States. He admits financial ties to at least one shock machine company. The Task Force represented electroshock as wholly beneficial and harmless to brain and memory. Some of the studies discovered by Marilyn were cited only to be misrepresented or dismissed. The doctors allowed that "ECT may lead individuals to have persistent illusions of memory impairment." The recommended consent form tells patients, "The majority of patients treated with ECT do not find these memory changes of great importance and many individuals in the professions, in high academic positions, and in responsible executive jobs in commerce and industry, have returned to fill their former occupations effectively." In l978, the Task Force report became the standard answer to any journalist asking about electroshock. "In 1979," crowed the APA Marketing Director, "When NBC, Time, and The New York Times became interested in ECT, writers knew where to turn for official answers to respond to their queries...The fact that they knew whom to contact is no accident." He especially praised the Time article which "follows the line of APA's Task Force report, pointing out the importance of this life-saving treatment." To learn the tricks of the trade, the APA did what politicians and film stars do: it hired a public relations firm. First to do so, in 1980, was the largest branch, New York State. (APA's internal structure is as intricate as that of any state government, including speakers and assemblies.) With so much of the national media headquartered in New York City, members were willing to chip in $30,000 per year for a professional PR firm. The firm would guide the handpicked "experts" on each topic to the correct answers. "This cadre of experts," APA members were assured, "will form the backbone of reshaping the public's image of psychiatry in one of the nation's key information centers, New York." Even with all this damage control successfully underway, there was one more avenue to be pursued by the APA. This was a formal complaint made against ABC-TV to the Federal Communications Commission, under what is known as the Fairness Doctrine. The doctrine is supposed to ensure that TV news coverage is balanced and unbiased. The APA's complaint read in part "that the Madness and Medicine program failed...to provide a fair or balanced basis on which the public could evaluate some of those patients who were specifically portrayed in the program." Recognizing herself as one of the "some" whom APA inferred could have been portrayed less sympathetically, Marilyn wrote to the FCC with so much more of her story of psychiatric mistreatment that the FCC could only have concluded that psychiatry had gotten off lightly in her case. FCC eventually granted the APA's public affairs chairman free air time to sell the public on the benefits of psychiatric treatments. More importantly, a message was sent to those journalists who would tread on psychiatry's turf as to what would happen if they got out of line again. Print journalists were sent the same message through their own regulatory body. The vehicle for this was the March l980 article in The Atlantic by Fred Hapgood titled "Electroshock: The Unkindest Therapy of All." Hapgood wrote, The long, sad history of ECT should give caution to those who believe that when professional and popular opinions differ on medical issues, it is always the physician who is right...ECT appeals mightily to that purest of motives, the urge to heal, and to do so with a single, clear-cut act, literally with the push of a button...But what the history of ECT teaches is that one can concentrate so fixedly on closing old wounds as to overlook that in the same motion one has opened new ones. The Atlantic piece still stands as one of the most thoughtful and intelligent articles ever written on electroshock. Sadly, it would be just as relevant if published today. But it's unimaginable that such an article could be published today. The New York branch of the APA immediately complained to the National News Council. But their real coup was in getting a long letter from one Raymond Glasscote, said to be a happy shock patient, published in the Atlantic letters column. Glasscote denied any memory loss from his alleged treatment, in what seemed a calculated refutation of Hapgood's statement about negative popular opinions on electroshock. However, as Marilyn quickly discovered, Raymond Glasscote was no mere patient. He was in fact the editor of Psychiatric News and a highly placed official within the APA---his title being Director, Joint Information Service of the American Psychiatric Association and the National Institute of Mental Health. In her typical investigative reporter fashion, Marilyn contacted Glasscote and many collateral sources but was unable to find any documentation of his alleged treatment. (He told her the hospital which had the records had burned down.) In disgust she rallied other individuals and groups to try to get the Atlantic to at least publish Glasscote's affiliation, but they were not successful. The magazine's editors seemed to care more about appeasing the powerful psychiatrists' trade organization. As the media tide continued to turn, the APA newspaper which Glasscote edited reported glowingly on triumph after triumph, each one "completely predictable". All the favorable press was then interpreted by APA official Melvin Sabshin as a sign that green pastures lay ahead for psychiatry, the troubled times of the 70s being forgotten. Marilyn was having none of it. "The praise and optimism he refers to were put there by APA itself," she commented wryly. "Nevertheless, if the media continue to present evaluations of psychiatry ghosted by its trade association, his prediction could come true... So unless we hear some sort of declaration of independence from the media, it appears that Dr. Sabshin is going to be right about the future of psychiatry. Its domination of everything should be complete by about 1984." 1984 is a year that never happened to me. I have no memory of it. But it would be too Orwellian, and also inaccurate, to single out that year, since I also have no memory of l985, l983 and much of l982 and l981. I was twenty-four in November of 1984, when I had fifteen shocks at New York Hospital's Payne Whitney Clinic. I had graduated from New York University, which I'd attended as a National Merit Scholar, in l982 or l983. After graduation I worked steadily as a critic and theorist in the rarefied and intellectually rigorous field of photography history and criticism, publishing eight articles in two years. Like Marilyn, I had a genius IQ. As far back as I could remember I'd been known as "The Brain"; as an adult I could have defined myself in one word---intellectual. At 24 I'd been accepted to graduate school, and planned to teach college and write for the rest of my life. Like Marilyn, I loved and lived for my work. And like Marilyn, I had consented to shock on my doctor's assurance that I would be able to return to work as good as new, and that any memory lost would return within six weeks. In New York Hospital after the shocks, I'm told I experienced the kind of pleasant, mindless vegetation Marilyn described. A nurse urged me to talk other patients into shock, and I obediently complied. Home a week later, I was sobered up by the enormity of what I didn't know about myself. Early on I got a phone call from my close friend and the editor who'd worked with me on the last article I wrote. He was congratulating me on the article's publication, and I had no knowledge of having written it. Worse, when I did see it for the first time, it was as if it were written in another language, one I didn't understand. What happens when you've always trusted your mind, and then you're confronted with evidence your mind isn't working and you don't know why? There's no parallel human experience to this universal horror of shock survivors outside of science fiction, to which Marilyn compared it. I think I tried to cover up, to pretend to remember, in order to preserve the illusion of my mental competence with this friend and others. But I couldn't do it. Too much was missing, including the entire substance and history of our relationships. Missing too was more than memory; it was the very essence of what had made me the person they knew and loved. The loss of my relationships was itself not a direct result of the memory loss and brain damage but was a kind of compounding of them. For me and so many other shock survivors there is a way in which loss compounds like interest, with no end in sight. It was three months after leaving New York Hospital that I first heard of Marilyn Rice. I have to recount our first contact from Marilyn's memory, not mine, since I suffer from anterograde as well as retrograde amnesia; that is, I have no memories for the year after shock. (Think science fiction again: as you're living your life you don't realize it's being erased just as soon as you've lived it. Think, to use one of Marilyn's metaphors, of footprints in the sand at a beach, washed away by the tide even as you're leaving more.) I heard Marilyn on the radio, speaking about shock. I got her number from the station and reached her at her home that afternoon. I imagine she told me gently that I wasn't crazy or alone, and invited me to join the organization of shock survivors she had formed even as I was on the shock table. She called it the Committee for Truth in Psychiatry. Later that day, she sat down and wrote me a letter. Dear Linda, Your call today moved me greatly or, in the vernacular, shook me up. It was eerie to hear you describing so precisely how I myself felt a dozen years ago, including the urge to do something about it... You are such an obviously splendid person and your situation so heart-breaking, I don't know what to say. Perhaps I'd best just stick to the positive and say there certainly is a big role for you to play in this cause if you care to do so. I cared. Like Marilyn, I'd been left career-less by the loss of my accumulated body of knowledge. Fortunately my political and social consciousness had not been lost to electroshock. Once again it appeared that the shrinks had shocked the wrong person. But if electroshock is a kind of unwanted and tragic rebirth as a fundamentally different person, then the world I was born into in 1985 was a very different one than the one Marilyn had been shocked into a decade earlier. The APA's successful public relations campaign had created a changed, almost opposite, political climate. My baptism took place that spring, when Marilyn put me in touch with the producers of ABC's 20/20. They said they wanted to do a show about electroshock. Like Marilyn, I was eager to tell my story so that future patients might be spared a similar tragic experience. The producer assured me the show was going to be "balanced". I agreed to be interviewed at my home. The crew, the lights, the cameras arrived, and I was interviewed for three and a half hours. I told people I thought the interview had gone very well. On May 23, l985, I watched in horror as the most innocuous 15 seconds of the interview were all that appeared onscreen. Two and a half minutes of the show were devoted to a clip of a person getting electroshock; a clip from One Flew Over the Cuckoo's Nest was used for contrast. One doctor, Peter Breggin, appeared to speak against electroshock versus three in favor. If I could possibly be said to represent a negative view from a patient, there were three others who spoke only positively. Electroshock was new and improved, it was said; the abuses and bad press were history. Experts agreed it couldn't cause brain damage or serious memory loss. Any controversy or doubts about its safety were due to misperceptions. In fact, it was about to make a comeback. This news show pleased the manufacturers of electroshock devices so much that they bought the rights to use the segment---unedited---to promote and sell their electroshock machines. One who did so is Mecta Corp., manufacturer of the device used to shock me. So now I appear on a promotional tape for Mecta---by implication an endorser of their product. Only in America can you not only be shocked against your will, but end up an involuntary salesperson for the machine that shocked you. The names of the shock-promoting "experts" on the 20/20 show meant nothing to me as a neophyte to shock politics. Over the years since then, they've become as familiar as bread. They were then just beginning to be, and are now, the stars in the electroshock firmament: Harold Sackeim, Richard Weiner, Ed Coffey. There are other, though less than a dozen names in the constellation of media doctors who are electroshock's main promoters. They include Max Fink; Charles Welch; Charles Kellner; and Matthew Rudorfer. (Another of the biggest names in electroshock, though arguably the most telegenic of all, is a potential liability as a media shrink since it might come out that he's also the owner and president of one of the biggest shock machine companies, and makes most of his money from peddling shock boxes.) Before the APA's image-polishing campaign of the late 70s and early 80s had its impact, it wouldn't have been possible to know exactly which doctors volunteered, were appointed, or were trained to be the "experts" whose names the APA Public Affairs Office gives out in response to any media inquiry about electroshock. Today, one need only tally up the frequency with which these names appear on television and in the press. The same names appear, over and over again. As the APA said in 1979, that's no accident. More troublingly, these same men who "consult" for shock machine companies, do promotional videos for them, receive royalties from them, and are paid to represent the defense---always the defense---in malpractice lawsuits, are also the men holding out their hands for, and receiving, hundreds of thousands dollars in government funding to do supposedly unbiased electroshock research. Clearly a weighty ethical dilemma would face a man who's built a career and a considerable reputation promoting a treatment were his research findings to present a less than favorable assessment of the treatment. So far, the ECT promoters have been able to design only research which evades such moral quandaries---by choosing to count neurons in rat brains, for example, rather than to ask human survivors relevant questions about their memories. A study which investigates shock's effects on the human brain, such as a simple before-and-after brain scan study, is "uninteresting" and "unlikely to be funded", according to #1 public relations spokesman and recipient of hundreds of thousands of federal research dollars, psychologist Harold Sackeim of the New York State Psychiatric Institute. No critic of electroshock makes any money from electroshock, and in fact risks rather than advances his or her career. Peter Breggin had to administer electroshock as a young psychiatrist and has written an article about it, called "The Shame of My Life". It is unthinkable that a Harold Sackeim or a Richard Weiner would have the courage to end their lucrative careers by doing the same, should their research find that permanent amnesia really does always occur. Electroshock is, after all, a $2- to $3-billion dollar a year industry. I didn't understand all this back in 1985. I didn't understand for many years why all the shows I appeared on turned out cookie-cutter fashion, no matter what I or anyone else might say. I really didn't know what I was up against. There were many of these shows from l985 to 1990, as the APA's "comeback of electroshock" campaign premiered on 20/20 swung into high gear. I lived through hell during those years, as the acute phase of what's known as organic brain syndrome wore off and I began to try to navigate a new life by trial and error. At 25 I had no answers to the questions: who am I now? What can I do? On what can I build an identity, a self, a life? Repeated neuropsychological testing confirmed my worst fears. There was no question that I had suffered brain damage---to the extent that my IQ had been reduced from about 150 to 115. I felt exactly as Marilyn had ten years earlier when she described "great waves of horror: Me! Brain Damaged!" There are probably not two more devastating words in the English language. I remember crying my eyes out in Central Park after being handed the test results, then feeling that I needed to get something to eat. I went to a restaurant and ordered a hamburger, and as I ate it I kept thinking to myself, I am an average person eating a hamburger. Everything was changed, not even the simplest thing was the way it had always been. My intelligence had been my pride, my pleasure, and my identity. Like Marilyn, I had lost my self. I didn't know how to get a new one. An unplanned pregnancy during this period didn't help. I was so confused I couldn't make a decision to have the child; rather, I let it happen. I spent the pregnancy rereading books and articles I had read in college, trying to recapture their meaning or even a glimmer of why I had ever been interested in them. There wasn't any course or book I could turn to on how to become an art critic and theorist. My education had been self-directed, but even if I could've reconstructed it, it wouldn't have been the same without the passionate interest I had lost to electroshock. Marilyn had offered me the hope of a future in the burgeoning human rights movement against forced and coerced psychiatric treatment. I couldn't imagine such a future, but there was nothing else on the horizon, so I decided to try. I began meeting people from all walks of life who'd experienced psychiatric treatment and were now leading the movement for reform---people who were proud to proclaim themselves not victims but survivors of institutionalization and electroshock. But beyond putting myself out there, I wasn't at all clear about what I could do. I was terribly in awe of Marilyn. Because of her twenty-some years in the federal bureaucracy, she had a unique understanding of the workings of that system (and of the minds of bureaucrats, a totally foreign species to me) that enabled her to intervene effectively in the Food and Drug Administration's ongoing regulation of the electroshock device. She would patiently explain to me the draconian intricacies of the Code of Federal Regulations and the meanings of the classifications of medical devices. (Shock machines were and are in the high-risk Class III, meaning that serious risks to health exist and that benefits have not been shown to outweigh risks.) We'd discuss strategies to use to try to get the FDA to do the scientific investigation of electroshock which has never been done, and to rally the public to oppose the APA's petition to reclassify shock machines to a safer category without an investigation. I did whatever Marilyn asked---for example, I filed a petition with the FDA asking for a CAT scan study of my brain---but with little real sense of mastery or pride. Mostly, I did interviews with TV and print reporters who'd gotten in touch with Marilyn by word of mouth. Each interview would end up in a pro-shock show or article. Before long I was feeling mightily helpless and discouraged about my new "career". Like most Americans, I'd grown up thinking censorship of the media didn't exist. So I'd blame myself: if I'd just been more articulate, or better looking, more charming, etc. etc., then maybe I would have been believed. After a couple of years of this, I wrote a letter to Marilyn stating just how I felt about being a mental patients' rights activist: "Do you really not expect me to be resentful and angry and bitter, to forget about everything else in life to do this unpaid, boring, depressing and frustrating work for fifty years? Do you really think that anyone, even a shock zombie, could do something so unrewarding for so long without burning out and giving up?" The letter continued in that vein, until at a certain point it became clear to me that what I had been feeling while engrossed in writing was not an attack of indigestion. I gave up on the letter and twelve hours later my son was born. I've always been glad that I never sent Marilyn that letter. Probably she would have been hurt and our friendship damaged. Maybe I didn't send it because I knew that one day I might feel differently, although it would take a very, very long time. The media campaign to sell electroshock continues to this day. I can't figure out if that's because it has been successful---or because it hasn't. It's been going on for about ten years now. Though the APA's media script is so well-worn it's in tatters, there have been subtle changes along the way. The 20/20 shock promo stated only electroshock might be making somewhat of a comeback. It was also at least marginally tied in with a real newsworthy event, the 1985 National Institute of Mental Health conference on electroshock. More recent news articles and TV shows herald the "comeback of electroshock" as a newsworthy "event" in and of itself. Aware that media interest might not always spring fullblown from the head of the APA, I developed the habit of asking reporters and producers, "What's the news angle? Why a story on shock now?" The answer, inevitably, was: "We've heard that shock treatment is making a comeback." In the same fashion, the differences between the 1978 and 1990 ECT Task Force reports by the APA are telling. The 1978 report was developed in large part so that media psychiatrists could have a party line to refer to. The 1990 report was hailed as a media event in and of itself, generating a flurry of "comeback" headlines nationwide all year in 1990- --and even a near full-length picture of a grinning Harold Sackeim in the New York Times. Marilyn and I have collected dozens of comeback articles published in the past ten years, most since 1988. I don't think a single article has escaped our notice, for one or both of us was contacted for any article contemplated, even if we weren't quoted in the final product. These articles appeared all over the country. A brief survey would include: "Shock Therapy Makes Comeback," Hartford Courant, March 10, l988; "Electroshock Makes Comeback," San Jose Mercury News, December 13, l988; "Electroshock Back in Favor as Psychiatric Therapy," Baltimore Sun, October 22, 1989; "Electroconvulsive Therapy Not as Shocking as it Once Was," Arizona Republic, October 29, 1989; "The Quiet Comeback of Electroshock Therapy," The New York Times, August 2, 1990; "The Return of Shock Therapy," Providence Journal-Bulletin, September 18, 1990; "The Return of Electroshock," New Haven Advocate, May 30, 1991; "A New Image for Shock Therapy," Los Angeles Times, September 15, 1992; "With Reforms in Therapy, Shock Treatment Loses Shock," The New York Times, July 19, 1993. The articles differ superficially. But in the important aspects they are as similar as if generated by a computer into which the APA had fed its public relations propaganda. There are certain bases they all cover. These are: 1) reference to electroshock's prior "bad image" or "terrible public image", usually swiftly accomplished by citing Cuckoo's Nest, or showing a clip on television; 2) the assertion that shock is now, since some never-specified date, "new and improved"; 3) the claim that shock now involves "less electricity" than in the past; 4) a description of an electroshock treatment---for television, include a picture of a twitching toe; 5) a quote from an APA-appointed "expert", most commonly Richard Weiner; and 6) the assertion as fact that the use of electroshock is rising, and that shock is making a comeback. Just as important as what is mandatory is what must not be allowed to be said. Taboo is any mention of the FDA's ongoing regulation of electroshock devices, the fact that the devices are now in the hazardous Class III category, or the fact that electroshock survivors are united and organized in their assertions of permanent memory loss. A common scenario was that a reporter, normally curious and without any knowledge about electroshock, would call us, listen intelligently to what we said, and ask good questions. They'd be interested in the FDA angle precisely because they'd never heard of it; they'd ask for the names of shock survivors in their area. Then they'd call the APA, and get the names of their electroshock experts. When the article was published, none of the survivors would have been contacted, the FDA would have been completely omitted, and all of the APA bases would have been covered. There has been one notable and historic exception to all the sloppy prefabricated journalism. That was Vince Bielski's article published in the San Francisco Bay Guardian on April 18, 1990. In a magazine-length article Bielski did a thorough job of objective investigative reporting, breaking all the taboos along the way. He included sidebars on the FDA's involvement, on the reality of uninformed consent (quoting a nurse who said, "Patients are railroaded to have electroconvulsive therapy"), and on "The Profit Motive". He talked to and used quotes from the APA's standard experts, but they weren't the quotes the APA wanted handed out. My all-time favorite is Richard Weiner slipping from diagnostic precision to say, "Those people at Truth in Psychiatry are off the wall." A footnote gives a hint of just how much it can take to get beyond the APA's prepackaged propaganda: "Vince Bielski prepared this article, involving more than a dozen interviews and extensive research over the course of several months, with the assistance of a grant from the Northern California fund for investigative journalism." How many reporters will commit themselves to even a portion of the time and effort invested by Bielski? More to the point, why should they, when their story is spoon-fed to them by the APA Public Affairs office, and when anything they write will be edited to meet the APA's requirements anyway? I've seen wonderful, well-researched articles killed because they couldn't be edited to meet them. Recently, I've tried doing part of each reporter's job for him or her. I copy original research articles, provide references, get them material that's cumbersome to obtain like some of the hundreds of letters survivors of electroshock have written to the FDA begging for a safety investigation. I tell them which of APA's "facts" cannot be verified (yes, the APA makes up fake statistics, like the "1 in 200" people said to have memory loss, which gets into most articles absolutely unquestioned.) None of this has made any difference. All journalists would need to do is a little thinking and researching of their own, and their articles would contradict every point in the electroshock lobby's public relations litany. There has been no "comeback", or increased use, of electroshock, which is not to say there has not been created a (mis)perception of its increased use. The genius of the APA PR team has been to render this distinction irrelevant. In doing so they may actually have, in a circular fashion, achieved what they wished for---for if people, patients and doctors alike, perceive shock to have become more acceptable, they will be much more likely to accept it. Recall that back in the late 70s when the APA launched its PR campaign to improve "the accuracy of the public's perception of psychiatry", there was no talk of improving psychiatry itself. A harder-nosed reporter than most who ply their trade today would ask for numbers to support the "comeback" theme. He or she would find those numbers hard to come by, largely due to the efforts of the APA itself. There simply aren't any national statistics on how many people get electroshock in the U.S. today, or have gotten it in the past. What we have is some sketchy information about insurance reimbursement, and some information from the three states which require reporting of electroshock use. (A fourth state, Texas, passed a reporting law too recently for data to be available.) Medicare and Medicaid both pay unquestioningly for electroshock. Medicare reports electroshock data, Medicaid does not. The Medicare data is open for interpretation, because it reports electroshock use in different ways; dollars spent vs. number of sessions, for example. Just looking at numbers of electroshock sessions in the 1980s, one sees ups and downs rather than a clear upward trend. The available statistics show that there was less money spent on electroshock in 1992 than in 1989, and that there has never been a year where the government spent more on electroshock than 1987. For the record, the amount of money being spent directly on electroshock in the Medicare program alone has been around $10,000,000 per year in recent years. (This is what the insurance pays, not what hospitals charge.) But electroshock has been and continues to be more widely used in private institutions, where the National Association of Private Psychiatric Hospitals noted a downward trend in usage from 1986 to 1988. Similarly, Blue Cross reported a decline in billings for electroshock in a major metropolitan area from 1982 to 1985. The three states which are required to keep records of the amount of electroshock administered are California, Massachusetts, and Colorado. California reports that the use of electroshock has remained steady since 1977. Massachusetts reported a 70% drop in the use of electroshock from 1974 to 1984. No more recent figures have been published. Colorado reported an increase from 1980 to 1990. However, the amount of electroshock used in that state remains insignificant; only 270 people received it in 1990. No wonder the APA brought out all its ammunition to oppose an electroshock reporting bill which was proposed in New York State in 1991. With the largest mental health system in the country, it is safe to say that New York does the most electroshock. What an embarrassment it would be, then, if the actual figures did not support a "comeback" theme. APA does not wish to take that chance. Doctors and hospitals deluged then-New York State Assemblymember Jerrold Nadler, sponsor of the reporting bill, with letters opposing it. The bill simply required that the number of shocks given be counted. The letter from the Legislative Representative of the New York County branch of the APA, is typical. While never stating a rational reason for opposing the reporting system, it reads like a precis of the APA press kit, including the mandatory reference to Cuckoo's Nest. "The public---and perhaps you too---has been misinformed," it states. The Nadler bill, written with input from electroshock survivors who had no funds to hire lobbyists, did not pass. Finally, the National Institute of Mental Health, while it does not maintain anything like statistics on electroshock, has three times in recent years done surveys at selected hospitals and projected estimates of national use of shock. They showed a 46% decrease in the use of electroshock from 1975 to 1980, and then no change from 1980 to 1986. When these findings were published in The American Journal of Psychiatry in 1987, Max Fink was first in line for damage control. He wrote a letter to the journal's editor in protest, saying they were wrong about the decrease in use because of "increasing interest" during the past decade. Signs of this interest, Fink says, are the increasing number of articles about electroshock written by people like himself and published in places like his own journal Convulsive Therapy. Fink doesn't mention that the small band of electroshock promoters are overrepresented as authors of such articles. Others in this small group take the same line of argument when challenged on the "comeback", citing the increased number of seminars given on electroshock, never mentioning that it is themselves and only themselves who create, promote, and profit from such seminars. We are back in the land of circular reasoning. Recall Marilyn's tacit comment about the APA claiming a bright future for psychiatry on the basis of glowing media reports it has planted itself. Nor is there any more solid foundation for the second stalwart plank of the APA public relations platform, the claim that electroshock is "new and improved". This is the claim that electroshock is now safer than in the past because 1) muscle-paralyzing drugs and anesthesia are used, and 2) less electricity is used. There is universal confusion in the media about when these alleged improvements actually took place. A reporter wouldn't need a very hard nose to find out that muscle paralyzers and anesthesia have been standard in electroshock practice since the 1960s. This "new" electroshock is more than 30 years old. Back then, when psychiatrists were not so PR conscious, there were no claims of "improvement" over the 40s and 50s. Nor has there ever been any claim, then or now, that these techniques were developed for the patient's safety and comfort. Sure, anesthesia and drugs made broken bones caused by violent thrashing about during seizures a thing of the past, but at the cost of requiring a larger amount of electricity to the brain. That's because the anesthetic makes it more difficult to override the brain's seizure threshold, its natural protection against seizures. Even the most rabid electroshock promoter like Ed Coffey of the 20/20/Mecta videotape will admit this freely when not talking with the media. As Coffey tells his students in his how-to-do-electroshock seminars, The indication for anesthesia is simply that it reduces the anxiety and the fear and the panic that are associated or that could be associated with the treatment, OK? It doesn't do anything else beyond that...There are, however, significant disadvantages in using an anesthetic during ECT...The anesthetic elevates seizure threshold...Very, very critical... However, the media psychiatrists soon discovered that anesthesia and muscle paralyzers had beneficial effects for the APA. They made shock into a visually benign procedure. All that now appears to be happening during shock is the twitching of a toe; the grand mal seizure can't be seen except as a pretty computer printout. No TV show in the past decade has failed to show an actual shock treatment, usually contrasted with a clip from Cuckoo's Nest. Reporters are always warmly invited to come watch a treatment; it's the APA's best selling point. There's also another claim on which all reporters bite. This is that the electroshock machines in use today use less electricity than those of the far-off, never-defined old days. Fast-talking media shrinks can snow even the hard-nosed on this one. How many people know that there are different types of electricity, and can compare them? Shock survivors learn about this, too late. Survivor and author Doug Cameron has written reams on this topic. He can tell you that the types of shock machines that have been promoted since 1980 as being "safer" are neither new nor improved. They simply use a different waveform of electricity, called brief pulse. Doctors first experimented with brief pulse electricity in 1942. At first they genuinely thought it might make shock machines safer. It didn't, and brief pulse never caught on until the public relations era of the 1980s, when doctors like Paul Blachly and Richard Weiner realized that it wouldn't matter if these machines were old wine in new bottles as long as a perception of greater safety could be created and the machines aggressively marketed. As Cameron points out in his forthcoming article in the Journal of Mind and Behavior, any confusion over whether today's machines use less electricity is totally unnecessary. Mathematical formulas, which are completely objective, can be used for comparison. Cameron sets out the formulas in his article, and shows that the machines used in today's clinical practice produce not less electricity, but more. And, in fact, not only are they designed to produce more electricity than the machines of the 40s through the 70s, but the latest models of each manufacturer are even more powerful than those of ten years ago. And in fact, this is admitted by electroshock's proponents when the press is not listening. Max Fink tells the doctors who pay $500 or more for one of his electroshock seminars to get rid of machines made before 1984, not because they produce too much electricity, but because they produce too little. He has also written candidly in Convulsive Therapy about how the brief pulse machines touted to the media are in his view very poorly designed---by which he means they can't put out as much electricity as he'd like. Harold Sackeim agrees. In 1992 he published an article titled "Are ECT Machines Underpowered?" The answer was yes. Try explaining the above to a reporter with the attention span of a soundbite. I have, and I have wondered: How much responsibility for the hoax that's been perpetrated on the American public is the media's? Do APA's prefabricated, feel-good stories fit so well into the way print and broadcast journalism is practiced today that no other way of reporting on electroshock (or any other topic) is possible? Marilyn Rice, born in 1923, grew up in a pre-TV era. She lived her entire life not knowing what a soundbite or a spin doctor was. In her day presidents did not have handlers, crime victims did not have advisors, and doctors did not hire public relations firms. When Marilyn named her fledgling organization of electroshock survivors the Committee for Truth in Psychiatry, she was calling up the noblest, bravest, strongest magic she could against the APA's manyfold greater resources. She couldn't have imagined a world in which one day "truth" would seem hopelessly naive, old-fashioned, or simply irrelevant. If truth is what we read in the paper and see on TV--- if truth is, after all, what those with the power to define reality decide it to be-- - then the experiences of shock survivors don't matter. We haven't got the political clout to make them true. Marilyn's truth, my truth, and that of all of us who've had electroshock, is simply too complex to be packaged into a slick little package like the APA's. It's too painful, too tragic, too complicated. It makes people uncomfortable. Doctors lie, people are robbed of their precious memories, brains are damaged for profit. Any one of the hundreds of stories in the Committee or on view at the FDA could break your heart, if you heard it. If you believed it. I haven't been appearing on TV much lately. Partly that's because I've been finding other ways to be an activist, ways that feel more substantial and satisfying to me. But it's also because reporters have been so flummoxed by the vague talk of the "new electroshock" that they're not sure I really had it. Ten years ago, when I had shock, sounds like a very long time ago. They're worried about making a mistake and presenting one of the old horror stories instead of the modern ones. Now they call me and ask for someone fresher---though they're never sure how fresh is safe. "Someone who had it within the last year, I guess," they say. In early 1994, CBS's 48 Hours didn't want me, so I found them Selma Lanes. Selma is where this story will end, or more precisely, will begin all over again. In the electroshock story everything just keeps going around in circles. Selma is Marilyn Rice all over again, for the 90s. She was shocked 20 years after Marilyn, 10 years after me. She is now just about the age Marilyn was when the New Yorker interviewed her, and is like Marilyn in all the important ways. She had a long and successful career in a highly demanding intellectual field; she was a book editor before electroshock. Her description of her attempted and aborted return to work is just like Marilyn's in 1974. "I went back to work, and it was an appalling experience. I had no idea where the ladies' room was. I did not know half the people on my staff. I didn't know any of the projects I was on. It was terrifying." She concludes, with the forthrightness so characteristic of Marilyn, "I'd go out a window before I'd have ECT again." 48 Hours didn't mention that Selma was shocked by Dr. Harold Sackeim. She was in fact a subject in one of his federally-funded "research" projects on the cognitive effects of electroshock. Sackeim swore up and down she must have had a stroke without knowing it, since no one had ever had memory loss due to electroshock. Selma got 60 seconds on camera. A clip of someone getting the "new" electroshock got nearly 3 minutes. Yes, the show included a clip from Cuckoo's Nest. "What's different about ECT now and that `shock treatment' we all remember from the movie?" asked the perky blonde hostess. The APA- approved "expert" replied that ECT now uses only "one-fifth" of the electricity of the "old days". She didn't think to ask Selma. I no longer expect anything but electroshock promos from the media. That's one way in which I'm different from when I started in this shock business ten years ago. Many people who do activism around electroshock and other psychiatric issues, working long hours for no money with no recognition, get burned out with anger and frustration. For a long time I thought that was going to happen to me too. Marilyn did her work of organizing shock survivors and prodding the government to protect patients for twenty years, right up to the day of her heart attack. To me, she always seemed too pessimistic about the possibility of real change. Now I think that besides being realistic, she was maintaining the attitude she needed to survive for the long run. And she did. She got tired towards the end, when she was nearing 70, but she stayed the course. She was able to be at least as proud of her 20-year career as an advocate for informed consent, and of the organization she founded, as she had been of her 20-year career as an economist. This is the happiest possible outcome of brain injury, and I hope I'm as lucky. I guess I'm in for the long run too, now. What will hold my interest and demand my best efforts for a lifetime is not so much a debate about the merits of putting electricity through people's brains. I am sure that one day we as a society will look back on, say, Richard Weiner's articles on how to build shock machines with the same shudder of horror we now feel reading an article on how to build gas chambers. In a way a gruesome pseudomedical procedure is not the real issue. It is the larger, and universal, human drama which holds my interest. Marilyn understood what I mean perfectly when she directed that the purpose of the Committee for Truth in Psychiatry should to be ensure that each person gets truthful and accurate information about memory loss and brain damage before consenting or deciding not to consent to electroshock. Only then can it be said that a person makes a choice as to what is to be done to her brain, body, and life, instead of having that choice made for her by someone else. Marilyn believed as I do in a person's absolute right to that choice, even if that person is devalued and labelled mentally ill. Electroshock's proponents, at least the more blunt ones, understand this too and can stop pretending this is a scientific or medical debate long enough to say so clearly. Max Fink is unabashed (at least when the media's not listening) in his defense of what he called good old- fashioned paternalism. He believes doctors have the right, even the duty, to make treatment decisions for their patients. After all, they know what's good for them. People---especially mentally ill people--- can't always be trusted to know what's good for them in medical matters. If that means they must be drugged and dragged to the shock table, so be it. Fink and his colleagues act as if the only issue is which drug to drug them with. After 50 years of giving electroshock, I can't believe Fink knows any less about the extent of permanent memory loss and disability than I do. I believe he and his fellow apologists are making a value judgment about the worth of their patients' memories and lives, and deciding on that basis to essentially trade brain damage for temporary relief of depression. I have even heard some admit this. Were a patient to have information about shock's longterm effects, of course, she might make a different decision than that which her doctor thinks is best. I'm not the first to note the fundamental difference in values between electroshock promoters and opponents. An article published in 1986 on this subject noted that promoters have a paternalistic viewpoint and that "paternalism does not pay much attention to patient education or self-esteem". The opponents of electroshock tend to value personal sovereignty and choice over social control, coercion and unquestioning deference to authority. Little wonder, then, that in Fink's worldview opposition to electroshock is conflated with opposition to other forms of oppressive authority. He likes to say that opposition to shock is just a holdover from the Vietnam war era: "The war made it very difficult for all the people in our country. We began to challenge all authority, not just the authority of our President and the Congress that had forced the war on people, but we also challenged the authority of physicians and medicine..." In this way he's able to trivialize the movement against electroshock as nothing more than a fad, like bellbottoms---while unwittingly getting to the very heart of the matter. Yes, it is about challenging those in authority who make choices for us without our consent and without telling all they know. No, it has nothing to do with the Vietnam war. It's not surprising that the newest player in the electroshock drama is the National Alliance for the Mentally Ill, the wealthy and powerful family organization made up overwhelmingly of elderly white parents of adult "children" labelled schizophrenic or manic-depressive. NAMI parents believe they know what's good for their 20- to 40-year-old children, even if they have to force it on them. For example, they advise making friends with your local police force to make the day you must call them to take away your child go more smoothly, and their publications are full of tips for dealing with medication "noncompliance". NAMI Board member Rael Jean Isaac has become an outspoken advocate for both electroshock and loosened commitment laws to make it easier to put someone in a mental hospital against their will. She'd like anyone who doesn't take prescribed psychiatric drugs to be commitable for not recognizing their "medical" need for the drugs. Like Max Fink, she subscribes to a grand conspiracy theory by which anyone with anything critical to say about electroshock is part of a vague "antipsychiatry" movement bent on nothing less than the abolition of the individual's "right to treatment" (wanted or unwanted) and the psychiatrists' "right" to treat as they please. In her hysterical and inaccurate book Madness in the Streets, electroshock is just a "domino" to be pushed over on the way to toppling all of psychiatry---which must be upheld at any cost to those labelled mentally ill. As John Friedberg and others have pointed out, electroshock was born in an authoritarian place and time---fascist Italy. If it is able to be made acceptable and even fashionable in the 1990s, what does that say about our times? I don't see electroshock ever going away. I see my work cut out for me for the next fifty years, and then being carried on by my son or by some woman who becomes the "Linda Andre" for the 2030s. That's because there really isn't any compromise possible between those who believe we have a right to control our own bodies and minds and those who want to reserve the right to control others. Or, between those who believe in qualifying that "we" to exclude those who are different or labelled deficient in some way, and those who believe that to qualify it at all compromises everyone's rights. Maybe Marilyn was wrong about the possibility of true informed consent. Maybe it can only be achieved in a society where there is respect for each individual instead of deceit and coercion. In 1993, some electroshock survivors who have tired of asking for informed consent formed an organization to work for a total legislative ban of electroshock. Should they succeed, the history of electroshock will look more like an abruptly truncated line than like a circle. More likely, it will not. LINDA ANDRE 13 St. Marks Place, NYC 212 473-4786 This file came from anonymous ftp sjuvm.stjohns.edu cd MADNESS The MADNESS ftp site is a service of MADNESS, an online discussion on LISTSERV@sjuvm.stjohns.edu Please credit the list if you copy this file.