By Linda Andre Rutgers University Press, 2009 Review by Leo Uzych, J.D., M.P.H. on May 18th 2010
Doctors of Deception is a book about "shock" treatment, in the form of electroconvulsive therapy ("ECT"). The author, Linda Andre, experienced ECT personally, and is the director of an entity called the Committee for Truth in Psychiatry. The writing of Andre, focusing sharply on ECT, is bluntly critical and discerningly opinionated. Following the historic path of ECT, Andre examines its scientific, legal, and regulatory evolution instructively; the perceived "politicizing" of ECT, historically, also draws Andre's rapt attention. As observed by the critically discerning eye of Andre, ECT historically has been twisted and shaped, in a scientifically disfiguring way, by the arms of politics and public relations. The insinuation of myriad, financial related conflicts of interest into many crevices of ECT, as sighted by Andre, likewise elicits harshly critical comment.
A thematic current coursing powerfully through the ocean of the text is that the science of ECT should be data driven, rather than being politicized and immersed in a sea of public relations. And with regard to the law of ECT, a further thematic emphasis of the text is that legal "consent", for ECT, should be truthfully "informed" in nature.
An "Appendix" is joined to the text. As explained by Andre, the Appendix is comprised of selected letters sent to the FDA by former ECT patients. These letters, soberingly, describe real life effects of ECT, in the words of persons who have actually experienced it.
The textual matter is referenced considerably. Citations for referenced research materials are presented in the "Notes" section, following the Appendix. Some of the references, in the Notes, present pithily annotated comment.
Some "Figures", interspersed in the text, enhance its contents.
The writing of Andre, stylistically, is lay reader friendly.
Over the course of the text, Andre reviews critically an abundance of scientific research materials. The thought provoking efforts of Andre spawn multitudinous questions. For example, about how many persons each year receive ECT? What percentage of these persons actually "benefit" from ECT? Based on scientific data, what are the known, and suspected, clinical "benefits" of ECT? What is the mechanism? Are the benefits, based on scientific evidence, likely to be short term, long term, or permanent in nature? Are the "benefits" possibly a side effect of brain damage, resulting from ECT?
Questions about risks, associated possibly with ECT, abound similarly. For instance, as evidenced by scientific data, what are the known, and suspected, adverse effects of ECT?Is ECT, based on scientific data, associated possibly with: brain damage? memory loss? cognitive impairment? learning impairment? loss of creativity? loss of intelligence? Based on scientific evidence, are the risks likely to be short term, long term, or permanent in nature? What is the relationship between suicide and ECT? What is the mortality rate, of ECT? Can ECT harmed persons be rehabilitated? Are there alternative treatments which may provide the intended clinical benefits of ECT, albeit without deleterious side effects?
Questioning legal strands, as well, are sewed adeptly by Andre into the textual fabric. Some of the legal strands are tied to the issue of informed consent. Should ECT ever be allowable, legally, absent "informed consent"? What scientific data supported information about ECT should providers be obligated, legally, to provide to patients, in order for any "consent" (to ECT) to be "informed" in nature?
Other legal strands are tied to the issue of competence. In the context particularly of ECT, what is the legal meaning of "competence"? If a patient, on the advice of the patient's provider, "consents" to ECT, should the law presume the patient's "competence"? Do "competent" patients have a right, legally, to refuse to consent to ECT? If a patient, against the advice of the patient's provider, refuses to consent to ECT, should there be a legal presumption of "incompetence"? What does "incompetence" mean, with respect to ECT?Can an "incompetent" patient give "informed consent", to ECT? Should the law ever allow ECT with regard to an "incompetent" patient?
Regarding the issue of "involuntary" ECT, what percentage of ECT patients are given ECT involuntarily? Under what circumstances, if any, should the law allow involuntary ECT? Is there a compelling state interest in possible support of involuntary ECT?
The ECT tapestry spun by Andre has many interwoven legal issues. At an overarching level, is there presently adequate legal protection of the rights of patients, concerning ECT? Should ECT be banned legally?
The many ECT centric questions raised, explicitly or implicitly, by Andre are an intellectually empowering feature of the book, and may help foment constructive debate and study.
From a critical perspective, it may be opined that Andre's strongly vented views regarding ECT are iconoclastic to a degree rendering her writing vulnerable to criticism as being tantamount to a diatribe, far outside the bounds of mainstream thinking. Other critics may add that Andre has crafted a caricature of ECT, which blinds the reader to its full picture.
In a different vein, because issues across a range of professional disciplines are broached by Andre, the book, alternatively, may have been structured appropriately as an edited collection of papers prepared by experts from different disciplines connected to ECT.
But the pages of this sobering book fuel a fire of concern about ECT, which should sharply spike the interest of lay readers.
The distinctive perspective of Andre should also enthrall the interest of a multitude of professionals, extending to: psychologists, psychiatrists, psychiatric nurses, neurologists, neuropsychologists, neuroscientists, neurobiologists, neurophysiologists, neurosurgeons, neuroanatomists, neuropathologists, radiologists, healthcare lawyers, law professors, judges, legislators, health policy makers, social workers, medical historians, manufacturers of ECT devices, FDA officials, mental health commissioners, hospital administrators, epidemiologists, and medical journal and lay media editors.
Leo Uzych (based in Wallingford, PA) earned a law degree, from Temple University; and a master of public health degree, from Columbia University. His area of special professional interest is healthcare.