Choices: Story of a Tomboy

Choices: Story of a TomboyRunning down the concrete hill from the crowded school bus to home, I would fly down the street feeling free to finally follow my tomboy ways. It was the discoveries awaiting me in the woods behind our house that propelled me through the air with such excited fervor. After quickly changing out of my school uniform and grabbing my fishing pole, I'd head down to the lake. It was my haven of peace. My own, private playground. As I made my way through the woods, I wondered if I would hook that big bass I had spotted slowly gliding under the water's edge the day before. Maybe I'd catch a frog or some bluegill to fry up in a pan of butter for an after-school snack. You never knew what you were going to get down by the lake. That was the thrill.

"A walk down memory boulevard"

How many little girls do you know who take their brother's boy scout equipment out into the woods alone pretending they're frontiersmen, living off the land? Or cook soup over an open fire they built themselves, shoot BB guns, or actually WANT to catch and hold frogs? Girls don't like being alone. They don't like getting dirty. Right? Well I did. It wasn't that I didn't like playing with dolls or giggling with my friends, I just had other interests as well. By all anatomical appearances I was a girl, but my interests and behavior said all-boy.

The little women in my neighborhood didn't enjoy foraging in the woods, swinging from vines, fishing, or going on imaginary hunting expeditions. Boys played too rough, took more risks than I was comfortable with, and liked killing things. So I spent a lot of time alone in my childhood, even though I lived on a street brimming with children.

I wasn't lonely sitting by that lake. I actually didn't want anyone else around. Girls seemed to bore quickly in the quietness and boys made too much noise, scaring the wildlife away. I enjoyed being there by myself, sitting still for hours, watching the sounds and sights of nature move around me in its business of being. I'd watch the geese land skidding onto the lake or be mesmerized by my bobber as it lay on the water. I'd try to imagine what world lived under the mirrored liquid.


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One day as I was making my lure hop and dance over the wet muddy bank, a big Ole bullfrog dove for and latched itself onto my hook. I felt the exhilaration of connection. As I held his slick body in my hand I realized he had swallowed the hook. After several attempts to dislodge it, panic set in. One singular, but powerful thought consumed me. This frog may die, but he will NOT suffer because of me. My mind whirled as I tried to think of the quickest, least painful way to end his life.

Fish die quickly with one sure blow to the forehead. For some reason that seemed too brutal for this animal. This creature hopped, made sounds, could look at you and had soft fleshy skin. Somehow that made him different from fish. He was too much like me.

I ran back up to the house. My eyes darted over the garage shelves looking for anything toxic. As I sprayed this helpless creature with every imaginable household cleaner and spray paint I could find, my face was red and wet from tears of anguish. It wasn't working. He was still alive, but now bright orange from the spray paint. I finally relented and took away his misery with multiple blows of a shovel. With my eyes squeezed tightly shut, I struck at him, wanting to squeeze out my own suffering as well as his.

Upon reflection I can see the outrageousness and perhaps even the humor in the frantic actions of a child who wanted to do the right thing. One who didn't know toxic doesn't mean immediate death. When I think back to that day, I remember the feelings of a desperate child and feel compassion for both the little girl and her dilemma.

As I ventured into my teen years, my awareness of the differences in thought, word and deed between myself and other women, heightened. My un-feminine ways continued. I played sports, and worse yet, I was good at them. Being six feet tall attracted the interest of many coaches with dreams of transforming my young, gangly frame and awkwardness into a coordinated winning machine. With this special attention and added practice, I started my sports career and became known as a jock.

I enjoyed nothing better than playing a game of one-on-one basketball with the boys on the weekend, but something about that didn't feel right. I was suppose to be dating these guys, not trying to block their jump shots. I remember the body contact held a certain unique, tingly sensation that was fun. Maybe I partially enjoyed those games because they gave us a reason to be groping each other.

My masculine and feminine qualities were often at odds. I was competitive, but wouldn't risk relationships to win. I liked my fully-developed, female body, but resented men for their muscles and strength which put me at a competitive disadvantage. I taught myself to accept losing, but felt less worthy afterwards. Without that "win at any price," competitive drive, I didn't go on to be a college-star athlete. Not being fully female, I wasn't the picture perfect beauty queen of gentility, charm and grace, either. I didn't fit a stereotype. Many times I wish I had. Teenage years are confusing enough without having to go through a gender crisis. I struggled with accepting my oddities, while society told me I wasn't behaving "normally" for a woman. I was sure there was something wrong with me.


Choices: Story of a TomboyAs I matured, I learned to act like a woman. I learned to suppress my strength once I realized men wanted to protect me, not compete with me. When my confidence intimidated them, I turned myself into a giggly, ditzy blonde. I knew I couldn't maintain a facade like that my whole life, so I assumed I would never find a man strong enough to enjoy my dualities. Eventually, I found a man who appreciated my independence and unique combination of qualities. I was a full grown woman, and married, but I still carried the Tomboy inside.

Other women held close guarded secrets about how to fulfill their roles as women and wives. They innately knew how to decorate and make a house look pretty. They knew about flowers and plants. They knew how and what to cook. They were, in some ways, better equipped as women for the "business of life." Although I was passionate about my career, I didn't fit in with the power-driven, brief-case-carrying career women. And although I loved writing and painting, I didn't fit in with the Sunday bake-offs and crafts groups, either. Maybe that was the problem. I was unclassifiable. I couldn't find a niche I could slide into.

It felt like no matter how hard I tried, I would never have the innate talents other women possessed. I would copy and fake my way through it, unnaturally, not like a real woman. So I didn't decorate, garden, cook, or fiddle with domesticity. To make myself feel better about this apparent inadequacy, I chalked all those qualities and interests up as being trivial, simple minded and certainly beneath me.


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Not only couldn't I seem to do "women things" but I also couldn't muster up the desire to have children. I didn't want to have babies. Was I low on estrogen or missing some crucial mommy gene? I must have misplaced my maternal instinct because it was unfathomable to women that I didn't find babies cute or want to hold them. I felt awkward when someone shoved a little human at me. Whatever the case, I chose to raise kittens instead of conceiving.

It wasn't until last year when my husband and I left Cincinnati, Ohio, that those beliefs about being "womanly challenged" were put to the test. Our real estate agent told us we'd get more money for the house if it looked more like a model home. I kinda, sorta knew what she meant but I didn't have a clue what to do. Too cheap to hire a decorator, I sat down and started looking through interior decorating magazines. Then it hit me. I didn't know how to decorate because I had never paid attention to how it was done! Since I assumed it was an innate womanly quality that I didn't have, I never even tried to learn. I studied those magazines and got busy totally redecorating the house.

When our agent returned, she was very pleased and surprised to find the place looking so "architectural-digest-like". More importantly, I was pleased! With that, I had a type of paradigm shift. I realized that I had been making choices about my life based on beliefs of inadequacy. I figured I might be able to change all those areas in which I had doubted myself, by simply paying attention to how others did them. Then, do them myself. I didn't know if I would enjoy these traditionally female interests, but I wanted to find out.

After we had moved into our new home on the Gulf Coast of Mississippi, I began decorating. I taught myself to cook. I designed a landscaping layout and planted shrubs and ground covers. I even tried my hand at flowering bulbs. Perennials of course. I'm not a masochist.

I had always dreamed of having a garden. It seemed so earthy. So I planted a vegetable garden. In typical type A personality, I planted almost every seed I could find. Corn, green beans, strawberries, tomatoes, potatoes, onions, and green and hot peppers became my laboratory subjects.

My biggest tomato was the size of a Ping-Pong ball and the entire garden was eventually massacred by deer, squirrels and raccoons, but that's not the point. The point is, I did it. I created something from nothing. Maybe it was the "living off the land" idea coming back to me from my childhood. The garden required me to pull both the Ying and yang aspects of myself to the forefront. I used my pioneering spirit, independence, and leaderships skills, which are traditionally male, as well as my sensitivity, nurturing and mother-earth type qualities, which are generally associated with women.

So began my blossoming into a woman. Or did I just blossom more into who I am? A more authentic me with fewer fears and self doubts. By experimenting, I was able to discover what I truly enjoyed. Having faced my own beliefs about what it means to be a woman, I now know my choices are based in freedom, and not in fear or feelings of inadequacy.

So what is a tomboy, anyway? Doesn't the term or label imply that our gender requires certain characteristics and behavior? It seems a sweeping generality to me, but perhaps all generalities hold some vestige of truth in them. But don't we limit ourselves when we demand our children to think and act a certain way, based entirely on gender? Where is the strengthening of natural tendencies?

I no longer buy into society's beliefs about how someone with breasts is suppose to behave. We limit ourselves when we set up such tight parameters in which men and women can operate. Life is all about feeling free to follow our desires and wants. It's about choices. Maybe that's what I got from being a tomboy, considerably more choices then the little girls who had no interest in "boy things".

next: Intensity Seeker (poem) ~ back to: My Articles: Table of Contents

APA Reference
Staff, H. (1997, September 30). Choices: Story of a Tomboy, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/relationships/creating-relationships/choices-story-of-a-tomboy

Last Updated: June 23, 2015

American Psychiatrist Calls Shock 'Barbaric'

Kenora Enterprise
July 20, 1997
By Jim Mosher

Doctors say girl should remain committed, needs additional ectroshock therapy and that the father is an unfit guardian because he disagreed with them.Psychiatrist and author Peter Breggin says shock treatment is little more than an electrical lobotomy. Breggin says electroconvulsive therapy (ECT) causes brain damage - and, he says, most psychiatrists know it.

"It's barbaric," Breggin said during a recent telephone interview from his summer home in West Virginia. "It causes brain damage. That was the argument used when it was first introduced in 1938. It was held as an electrical lobotomy."

Breggin has written more than a dozen popular books about modern psychiatry, including Toxic Psychiatry and Talking Back to Prozac. In Toxic Psychiatry, he makes the claim that ECT is bad medicine, and worse when it's combined with drugs.

He says claims that ECT is safer now than when it was first introduced are typical of the siege mentality of psychiatric associations, which he claims always go to bat for whatever technique is in fashion.

"They claim that it is safe, but there have never been any follow-up studies," he said. "If you claim a technique is safe, you have to show that with animal studies."

"To say that things are safer and better now is not true," he continued. "They said that in the '50s about lobotomies."

(Frontal lobotomies were a standard treatment in the 1950s. A portion of the frontal lobe of the brain was removed, usually by drawing it out through an eye socket. At the time, psychiatrists cited the witnessed 'improvement' in previously combative patients. Neurological studies later showed that the improvement resulted after some essential brain functions were literally eliminated after the removal of the frontal lobe. The practice has since been discontinued.)

Shock treatment is often combined with drug therapy. That's hardly surprising to Breggin. "It shows you how inadequate ECT is - they load you up with drugs," he said.

Professional psychiatric organizations have come out squarely behind ECT as a necessary and safe treatment for acute depressive disorders.

The Canadian Psychiatric Association's most recent position paper on the treatment notes that ECT remains "an important part of the therapeutic armentarium in contemporary psychiatric practice."

The CPA says ECT is a suitable treatment for single episode or recurrent major depression, bipolar disorder and chronic schizophrenia.

"For these disorders, there is either overwhelming evidence in the literature attesting to the efficacy of ECT or a consensus among experienced Psychiatrists as to its position paper.

But the use of ECT to treat other disorders should only be undertaken in "exceptional circumstances" because "compelling evidence of the effectiveness of ECT' (in these circumstances) is lacking."

Breggin remains uncowed. He's convinced of the barbarity of ECT. He says it takes away one's identity. It's hardly surprising that ECT patients are more pliant and cooperative, he says. That witnessed improvement is due, he claims, to brain damage.

In Toxic Psychiatry, he cites cases where ECT was used to make a previously combative and disputative wife into a docile and submissive 'perfect wife'. Breggin says there is reason to fear this 'social engineering'.

He says few psychiatrists are willing to speak out against ECT. "It's simply not true that all psychiatrists agree with this treatment," he said. "But I've been one of the few who has been willing to take a stand."

next: An Introduction to Neuropsychological Assessment
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

APA Reference
Staff, H. (1997, July 20). American Psychiatrist Calls Shock 'Barbaric', HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/depression/articles/american-psychiatrist-calls-shock-barbaric

Last Updated: June 21, 2016

Psychologist Jailed 2 Years For Sex With His Patients

Therapist called 'predator' who 'brainwashed' his victims

Psychologist sentenced to two years in prison for having sex with his patients. Accused of brainwashing patients into having sex with him.A once-prominent psychologist has been sentenced to two years in prison for "brainwashing" two of his former patients into having sex with him.

Both vulnerable victims "suffered substantial mental harm" at the hands of George Matheson, Mr. Justice George Ferguson said yesterday.

The former chief of psychology at Etobicoke General Hospital controlled, manipulated and mentally dominated the two women, the Ontario Court, general division judge said.

"I hope it sends a message to other doctors," one of the victims said of the sentencing.

"I'm glad it's over," the second victim said of the ordeal of having to testify in open court.

Prosecutor James Ramsay called Matheson a sexual "predator" who had violated the special trust between a therapist and his patients.

The charges specified the two victims submitted to him sexually or did not resist him because of "the exercise of (his) authority" as their therapist.

The judge quoted an expert witness in the case as saying that "when a psychologist has sex with a patient, therapy goes out the window."

Ferguson said people such as Matheson occupy a privileged position in society and must exercise the enormous power and authority they have only for their patients' benefit.

Matheson, who often helped various police forces by hypnotizing witnesses, has since lost his license to practise and now helps his girlfriend run a bed and breakfast house in Victoria,B.C.

The judge said that even though Matheson apologized for his conduct, he "continues to (wrongly) believe that he did not breach the (criminal) law" and is only guilty of professioonal misconduct.

Both victims testifed they had been sexually abused as children and were suffering from extreme depression when they became patients of Matheson.

One said her husband, in effect, paid Matheson approximately $5,000 - the fee for therapy - for Matheson to have sex with her, although he eventually returned the money.

The other testified Matheson told her he had fallen in love with her and he constantly phoned her, wrote her passionate letters and sent her gifts.

When he was out of town, he left her his cologne so she could smell him, and some of his clothes so she could hug them, the second victim told the court.

She said Matheson's wife caught them in bed together.

Toronto ex-therapist jailed for sex assaults - Patients abused in 'blatant' breach of trust.

BY DONN DOWNEY
THE GLOBE AND MAIL, May 13,1997

TORONTO- A once prominent Toronto psychologist who "brainwashed" two female patients and then sexually assaulted them was sentenced to two years in penitentiary yesterday.

In March, George Clifford Matheson, 48, was found guilty on two counts of sexual assault for a series of incidents involving two women over several years. Although they had consented to the encounters, the Crown took the position that they had submitted to sexual intercourse because of Dr. Matheson's authority over them.

Yesterday, he was seated for the first time in the prisoner's box, but earlier in the trial he was allowed to sit at the side of his lawyer, Alan Gold. He had asked Mr. Justice George Ferguson of the Ontario Court's General Division for a suspended or conditional sentence, but Judge Ferguson made it clear from the outset that Dr. Matheson would be going to jail.

Dr. Matheson was released on bail, pending appeal.

Judge Ferguson described Dr. Matheson as a predator who practiced mind control over two extremely vulnerable women in what "amounts to brainwashing."

He "continues to believe he did not breach the law" and shows no remorse for his criminal act although he voluntarily surrendered his professional certificate, acknowledging that he had violated the ethics of his profession.

He sentenced the psychologist to one year on each count, the sentences to be served consecutively.

If he had been sentenced to a day less, he would have gone to a provincial reformatory, but a two-year sentence must be served in a federal penitentiary, which generally houses the nation's most hardened criminals.

One of his victims was assaulted over five months in 1992 and the other was assaulted over two years beginning in 1987. The relationships amounted to "blatant long-term breach of trust," Judge Ferguson said. "He had the power to pressure and manipulate and he did so."

The victims, now 39 and 56, desperately needed therapy when they went to Dr. Matheson and made themselves vulnerable by revealing intimate details concerning their personal problems. They did not want sex, they wanted therapy, Judge Ferguson said.

One victim testified that Dr. Matheson told her that she would not get better unless she got rid of her husband.

Dr. Matheson is well known in legal circles, having served as an expert witness in the field of hypnosis. He also has aided police investigations by enhancing the memories of potential Crown witnesses.

He has three failed marriages and has two sons. Before he was sentenced, he was living with a female psychologist in Victoria, where they ran a bed-and-breakfast business.

next: Psychopathology of Frontal Lobe Syndromes
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

APA Reference
Staff, H. (1997, May 13). Psychologist Jailed 2 Years For Sex With His Patients, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/depression/articles/psychologist-jailed-2-years-for-sex-with-his-patients

Last Updated: June 23, 2016

Woman Sets Record For Shock Treatment

The Times
BY JEREMY LAURANCE, HEALTH CORRESPONDENT

Is treatment with electroconvulsive therapy barbaric or a miracle? There are patients and psychiatrists on both sides of the ECT fence.A WOMAN has undergone the longest continuous course of electric shock treatment for depression.

Since 1989 the unnamed patient has received more than 430 treatments, in which a pulse of electricity is passed through her brain, triggering convulsions. For the first four years she had treatment twice a week but it was then cut to once a fortnight.

The regular shocks were effective in warding off her despair, which was accompanied by feelings of guilt, and did not cause progressive mental damage, as doctors had feared. The depression returned when the shocks were administered less than once a fortnight.

The woman had been treated for depression from the age of 43 with regular stays in hospital. Before the course of treatment began she had spent most of the previous five years in hospital. Since 1989, she has lived in a residential home and has been virtually free of symptoms. She is now 74, and understands fully the nature of her treatment.

Electric shock treatment, also known as electro-convulsive therapy, has a controversial history and was once described as barbaric. Today it is widely accepted by psychiatrists as a last-resort treatment for severe depression, although concern remains about its long-term effect on intellectual function.

The case is described by David Anderson, consultant psychogeriatrician at Rathbone Hospital, Liverpool, in the Journal of the Royal College of Psychiatrists.

next: Appendix B
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

APA Reference
Staff, H. (1997, February 28). Woman Sets Record For Shock Treatment, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/depression/articles/woman-sets-record-for-shock-treatment

Last Updated: June 21, 2016

Anxiety at Work - Managing Your Boss

Tips for managing your boss, a difficult boss. Also if you're criticized unfairly by your boss, here's the way to respond to criticism from your boss.

Marilyn Puder-York, Ph.D., answers your questions. Dr. Puder-York is a clinical psychologist in New York who specializes in workplace stress issues.

Q. How do you manage the prototypical "difficult boss?"

Tips for managing your boss, a difficult boss. Also if you're criticized unfairly by your boss, here's the way to respond to criticism from your boss.A. Successfully managing a difficult boss is a challenge but often feasible. First, you should try to understand the reasons for your boss' difficult behavior. Assuming your boss generally behaves in a fairly reasonable manner, and that his/her difficult behavior seems to be a result of stress overload rather than his/her character, chances are good that the behavior can be modified. If your boss' behavior seems to reflect a chronically hostile, abusive style of interacting regardless of the amount of stress in the worksite, the chances are less positive that the behavior can change. In fact, you may want to consider seeking counsel from a trusted mentor or human resources professional to evaluate your options.

Second, you have to manage your own negative emotions regarding his/her behavior so that you do not engage in self-defeating behavior (e.g. stonewalling, or counter-attacking your boss).

Third, once you understand and have managed your own negative reactions, you may work to communicate your issues/concerns -- but framed in a helpful positive manner -- creating an atmosphere for problem resolution.

Q. If you feel you've been criticized unfairly by your boss, what's the best way to confront the boss with your concerns?

A. You should discuss your concerns -- not confront your boss. There is a difference. You need to carry out the discussion of your concerns in a non-adversarial way. Like a marriage, you should try to handle your complaints in a manner that does not do further damage to your relationship.

Q. What's the best way to respond to criticism from your boss?

A. Try to see the criticism as valuable information about how to do better, not as a personal attack. Try to separate your personal ego from your business persona. Try hard to control your impulses to react emotionally or defensively. Try to see the criticism as an opportunity to work together with your boss on a development plan. See yourself as a partner with your boss on this plan, rather than on seeing yourself as a victim of a power struggle.

Q. What's the current trend of job stress? Is there more or less?

A. The downsizing and reorganization of corporate America in the last 10-15 years has set off unmistakable pressures and stresses. There is a very real and persistent fear of loss of employment and job insecurity in the majority of employees. The impact of job loss on individuals and families has been enormous. According to the New York Times, more than 43 million jobs have been lost in the U.S. since 1979.

Q. How can empowering employees help lessen stress agents in the workplace?

A.When employees feel less like "victims of circumstances out of their control," they feel more empowered. Employees who are given candid timely and consistent communications from management about the status of their careers, as well as more responsibility to directly manage their careers and their work relationships, they tend to be less anxious and more highly motivated. Although few employees believe that job security is a guarantee anymore, employees who are empowered with ore information and responsibility over their future, tend as a whole, to cope more effectively -- because they feel less powerless.

Q. Sometimes employees are hesitant to speak to their boss about criticism. Is there a way to overcome that fear or retribution?

A. The chances that your fear of retribution will turn into reality will be significantly reduced to the degree that you can discuss criticism with your boss in a reasonable non-emotional, non-defensive manner. You can avoid setting up your boss to be angry at you and therefore risk retribution by careful planning and diplomatic communication.

Q. What's the best way to deal with stress in the workplace?

A. Stress is always in the eye of the beholder. What may cause one employee stress in the workplace, may not even cause a ripple of concern to another. The key to dealing with stress is knowing the specific stresses on the work environment that you are particularly sensitive to and the warning signs in your own body and mind that signal stress overload. Once you have identified your vulnerability, you can create on-going stress management strategies to cope with the issues.

If you feel unable to manage this process yourself, or feel overwhelmed, it may be a good idea to consult an objective professional, such as a psychologist. Your collaboration with a professional may go a long way in making you feel more empowered to manage the stresses.

Copyright © 1997 American Psychological Association

next: Anxiety at Work - Stress in the Workplace
~ anxiety-panic library articles
~ all anxiety disorders articles

APA Reference
Staff, H. (1997, January 1). Anxiety at Work - Managing Your Boss, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/anxiety-panic/articles/anxiety-at-work-managing-your-boss

Last Updated: July 2, 2016

Anxiety at Work - Downsizing Survivors

Downsizing leaves employees to cope with either being laid off or losing a job. Tips for employers and managers to deal with downsizing survivors.

Downsizing

Downsizing leaves employees to cope with either being laid off or losing a job. Tips for employers and managers to deal with downsizing survivors.One word, but a myriad of consequences to those who must cope with either being laid off or losing a job.

Whether it's your job that is deemed "unnecessary" or your good friend down the hallway who is laid off, downsizing affects everyone in the office.

Feeling helpless. Fearing "who's next?" Watching as trust among co-workers disintegrates and a "me, first" attitude permeates the atmosphere.

By thinking through the situation and considering some of the following suggestions as options, you can increase your chances of standing up to downsizing.

Employers can:

  • Create an in-house employee assistance program to help employees with stress management and career transition.
  • Consider alternate solutions to downsizing. By advocating ideas such as job sharing or reduced work weeks, you can foster cooperation between employees and employers.
  • Keep changes in perspective.
  • Limit crisis orientation as much as possible.

Managers can:

  • Keep employees well-informed and involve them in the decision-making process as much as possible.
  • Allow employees time to "grieve" for those being laid off and be receptive to those who feel a need to discuss their feelings about the process.
  • Help laid-off workers deal with practical realities of losing their job. Encourage those employees to support each other as they look for new jobs.

Laying off or firing workers can increase stress and decrease morale. It can create a multitude of negative psychological and behavioral consequences for those left behind.

Management can help lessen the impact by providing services for employees to discuss and understand these very normal feelings.

Copyright © 1997 American Psychological Association

next: Anxiety at Work - Managing Your Boss
~ anxiety-panic library articles
~ all anxiety disorders articles

APA Reference
Staff, H. (1997, January 1). Anxiety at Work - Downsizing Survivors, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/anxiety-panic/articles/anxiety-at-work-downsizing-survivors

Last Updated: July 2, 2016

Shock Therapy...IT'S BACK

By SANDRA G. BOODMAN
The Washington Post
September 24 1996, Page Z14

Table of Contents

It is unlike any other treatment in psychiatry, a therapy that still arouses such passionate controversy after 60 years that supporters and opponents cannot even agree on its name.

Proponents call it electroconvulsive therapy, or ECT. They say it is an unfairly maligned, poorly understood and remarkably effective treatment for intractable depression.

Critics call it by its old name: electroshock. They claim that it temporarily "lifts" depression by causing transient personality changes similar to those seen in head injury patients: euphoria, confusion and memory loss.

Both camps agree that ECT, which is administered annually to an estimated 100,000 Americans, most of them women, is a simple procedure -- so simple that an ad for the most widely used shock machine tells doctors they need only set a dial to a patient's age e and press a button.

Is treatment with electroconvulsive therapy barbaric or a miracle? There are patients and psychiatrists on both sides of the ECT fence.Electrodes connected to an ECT machine, which resembles a stereo receiver, are attached to the scalp of a patient who has received general anesthesia and a muscle relaxant. With the flip of a switch the machine delivers enough electricity to power a light bulb for a fraction of a second. The current causes a brief convulsion, reflected in the involuntary twitching of the patient's toe. A few minutes later the patient wakes up severely confused and without any memory of events surrounding the treatment, which is typically repeated three times a week for about a month.

No one knows how or why ECT works, or what the convulsion, similar to a grand mal epileptic seizure, does to the brain. But many psychiatrists and some patients who have undergone ECT say it succeeds when all else -- drugs, psychotherapy, hospitalization -- have failed. The American Psychiatric Association (APA) says that about 80 percent of patients who undergo ECT show substantial improvement. By contrast antidepressant drugs, the cornerstone of treatment for depression, are effective for 60 to 70 percent of patients.

"ECT is one of God's gifts to mankind," said Max Fink, a professor of psychiatry at the State University of New York at Stony Brook. "There is nothing like it, nothing equal to it in efficacy or safety in all of psychiatry," declared Fink, who is so committed to the treatment that he remembers the precise date in 1952 that he first administered it.

There is no doubt that mainstream medicine is solidly behind ECT. The National Institutes of Health has endorsed it and for years has funded research into the treatment. The National Alliance for the Mentally Ill, an influential lobbying group composed of relatives of people with chronic mental illness, supports the use of ECT as does the National Depressive and Manic Depressive Association, an organization composed of psychiatric patients. The APA, the Washington-based trade association that represents t he nation's psychiatrists, has long battled efforts by lawmakers to regulate or restrict shock therapy and in recent years has sought to make ECT a first-line therapy for depression and other mental illnesses, rather than the treatment of last resort.

And the Food and Drug Administration has proposed relaxing restrictions on the use of ECT machines, even though the devices have never undergone the rigorous safety testing that has been required of medical devices for the past two decades. (Because the machines had been used for years before the passage of the 1976 Medical Device Act, they were grandfathered in with the understanding that they would someday undergo testing for safety and effectiveness.)

Many of the nation's most prestigious teaching hospitals -- Massachusetts General in Boston, the Mayo Clinic, the University of Iowa, New York's Columbia Presbyterian, Duke University Medical Center, Chicago's Rush-Presbyterian-St. Luke's -- regularly administer ECT. In the past three years a few of these institutions have begun to use the treatment on children, some as young as 8.

Managed care organizations, which have sharply cut back on reimbursement for psychiatric treatment, apparently look with favor upon ECT, even though it is performed in a hospital and typically requires the presence of two physicians -- a psychiatrist and an anesthesiologist -- and, sometimes, a cardiologist as well. The cost per treatment ranges from $300 to more than $1,000 and takes about 15 minutes.

Medicare, the federal government's insurance program for the elderly, which has become the single biggest source of reimbursement for ECT, pays psychiatrists more to do ECT than to perform medication checks or psychotherapy. Increasingly, the treatment is being administered on an outpatient basis.

In the Washington area more than a dozen hospitals perform ECT, according to Frank Moscarillo, executive director of the Washington Society for ECT and chief of the ECT service at Sibley Hospital, a private hospital in Northwest Washington. Moscarillo said that Sibley administers about 1,000 ECT treatments annually, more than all other local hospitals combined.

"With the insurance companies there isn't a limit [for ECT] like there is for psychotherapy," said Gary Litovitz, medical director of Dominion Hospital, a private 100-bed psychiatric facility in Falls Church. "That's because it's a concrete treatment they can get their hands around. We have not run into a situation where a managed care company cut us off prematurely."


Anecdotal Miracles

Because of the stigma of psychiatric illness in general and of shock treatment in particular, most patients do not openly discuss their experiences. Among the few who have is talk show host Dick Cavett, who underwent ECT in 1980. In a 1992 account of his treatment Cavett told People magazine that he had suffered from periodic, debilitating depressions since 1959 when he graduated from Yale. In 1975 a psychiatrist prescribed an antidepressant that worked so well that once Cavett felt better, he simply stopped taking it.

His worst depression occurred in May 1980 when he became so agitated that he was taken off a London-bound Concorde jet and driven to Columbia-Presbyterian Hospital. There he was treated with ECT. "I was so disoriented I couldn't figure out what they were asking me to sign, but I signed [the release for treatment] anyway," he wrote.

"In my case ECT was miraculous," he continued. "My wife was dubious, but when she came into my room afterward, I sat up and said, `Look who's back among the living.' It was like a magic wand." Cavett, who was in the hospital for six weeks, said that he has taken antidepressants ever since.

Twice in the past six years writer Martha Manning, who for years practiced as a clinical psychologist in Northern Virginia, has undergone a series of ECT treatments. In her 1994 book entitled "Undercurrents," Manning wrote that months of psychotherapy and numerous antidepressants failed to arrest her precipitous slide into suicidal depression. When her psychologist Kay Redfield Jamison suggested shock treatments, Manning was horrified. She had been trained to regard shock as a risky and barbaric procedure reserved for those who had exhausted every other option. Ultimately Manning decided that she had too.

In 1990 she underwent six ECT treatments while a patient at Arlington Hospital. She said she suffered permanent memory loss for events surrounding the treatment and was so confused for several weeks that she got lost driving around her neighborhood and didn't remember her sister's visit 24 hours after it occurred.

"It is scary, despite anybody's promises to the contrary," Manning said in an interview. Although some of her memories before and during ECT have been forever obliterated, Manning said she suffered no other lasting problems. "I felt I got 30 IQ points back" once the depression lifted.

"I was lucky," said Manning, who says her depression is now controlled by medication. "ECT was safe for me and very, very helpful. It was a break in the action, not a cure."

"I'm coming from a position of seeing ECT at its best," added Manning, who said she would have ECT again if she needed it. "I'm sure there are other people who've seen it at its worst."

Vanished Memories

Ted Chabasinski is one of those people.

A lawyer in Berkeley, Calif., Chabasinski, 59, says he has spent years trying to recover from the dozens of ECT treatments he underwent more than a half-century ago. At age 6, he was taken from a foster family in the Bronx and sent to New York's Bellevue Hospital to be treated by the late child psychiatrist Lauretta Bender.

As a child Chabasinski was precocious but very withdrawn, behaviors that a social worker who regularly visited the foster family believed were the beginnings of schizophrenia, the same illness from which his mother, who was poor and unmarried, suffered. " At the time hereditary causes of mental illness were fashionable," he said.

Chabasinski was one of the first children to receive shock treatments, which were administered without anesthesia or muscle relaxants. "It made me want to die," he recalled. "I remember that they would stick a rag in my mouth so I wouldn't bite through my tongue and that it took three attendants to hold me down. I knew that in the mornings that I didn't get any breakfast I was going to get shock treatment." He spent the next 10 years in a state mental hospital.

Bender, who shocked 100 children, the youngest of whom was 3, abandoned the use of ECT in the 1950s. She is best known as the co-developer of a widely used neuropsychological test that bears her name, not as a pioneer in the use of ECT on children. That work was discredited by researchers who found that the children she treated either showed no improvement or got worse.

The experience left Chabasinski with the conviction that ECT was barbaric and should be outlawed. He convinced residents of his adopted hometown; in 1982 Berkeley voters overwhelmingly passed a referendum banning the treatment. That law was overturned by a court after the APA challenged its constitutionality.

The Old and the New

There is little dispute that ECT administered before the late 1960s, commonly referred to as "unmodified," was different from later treatment. When Chabasinski underwent ECT, patients did not routinely receive general anesthesia and muscle paralyzing drug s to prevent muscle spasms and fractures, as well as continuous oxygen to protect the brain. Nor was there monitoring by an electroencephalogram. All of these are standard today. In the old days shock machines used sine-wave electricity, a different -- and ECT supporters say riskier -- form of electrical impulse than the brief pulse current dispensed by contemporary machines.


But critics contend that these changes are largely cosmetic and that "modified" ECT merely obscures one of the most disturbing manifestations of earlier treatments -- a patient grimacing and jerking during a convulsion. Some opponents say that the newer machines are actually more dangerous because the intensity of the current is greater. Others note that modified treatment requires that patients undergo repeated general anesthesia, which carries its own risks.

"The characteristics of the treatment that caused people to be outraged and shocked are now kind of masked so that the procedure looks rather benign," said New York psychiatrist Hugh L. Polk, an ECT opponent who is medical director of the Glendale Mental Health Clinic in Queens.

"The basic treatment hasn't changed," he added. "It involves passing a large amount of electricity through people's brains. There's no denying that ECT is a profound shock to the brain, [an organ that is] enormously complicated and of which we have only t he barest understanding."

Fifty years after Chabasinski was treated at Bellevue, Theresa E. Adamchik, a 39-year-old computer technician, underwent ECT as an outpatient at a hospital in Austin, Tex. Adamchik said that two years of therapy, antidepressants and repeated hospitalizations had failed to alleviate an unremitting depression caused in part by the breakup of her second marriage.

Adamchik said she agreed to have the treatments, which were covered by her health maintenance organization, after doctors assured her "it would snap me right out of my depression." When she asked about memory loss, she said, "They told me it would kill as many brain cells as if I went out and got drunk one night."

But Adamchik said that her memory problems persisted much longer than her doctors had predicted. "It's very strange. Sometimes there are memories without emotions and emotions without memories. I have flashes of things -- bits and pieces," she said. The treatments also erased memories of events that occurred years earlier, such as the 1978 funeral of her 2-year-old son, who drowned in a backyard swimming pool.

Adamchik said that although she has returned to work and is no longer depressed, she would never again consent to shock treatments. "I didn't have any memory problems before ECT," she said. "I do now. Sometimes I'll be in the middle of a sentence and I'll just forget what I'm talking about."

Sketchy Data

One of the chief problems in evaluating the effectiveness of ECT, noted University of Maryland anesthesiologist Beatrice L. Selvin, who reviewed more than 100 ECT studies conducted since the 1940s, is that "even the more recent literature is still rife with contradictory findings. . . . few research papers report well-controlled studies, similar procedures, measurements, techniques, protocols or data analyses," Selvin concluded in a 1987 article in the journal Anesthesiology. Her conclusion echoes a 1985 report by an NIH consensus conference, which cited the poor quality of ECT research.

A 1993 APA fact sheet said that at least 80 percent of patients with severe, intractable depression will show substantial improvement after ECT. Studies have shown that after a course of six to 12 treatments 80 percent of patients have better scores on a commonly used test to measure depression, usually the Hamilton depression scale.

But what the APA fact sheet does not mention is that improvement is only temporary and that the relapse rate is high. No study has demonstrated an effect from ECT longer than four weeks, which is why growing numbers of psychiatrists are recommending monthly maintenance, or "booster," shock treatments, even though there is little evidence that these are effective.

Many studies indicate that the relapse rate is high even for patients who take antidepressant drugs after ECT. A 1993 study by researchers at Columbia University published in the New England Journal of Medicine, found that while 79 percent of patients got better after ECT -- one week after their last treatment they had improved scores on the Hamilton scale -- 59 percent were depressed two months later.

Richard D. Weiner, a Duke University psychiatrist who is chairman of the APA's ECT task force, says that ECT is not a cure for depression. "ECT is a treatment that's used to bring someone out of an episode," said Weiner, who compares it to the use of antibiotics to treat pneumonia.

Yet other psychiatrists may not be as convinced of ECT's effectiveness. An article by researchers at Harvard Medical School published last year in the American Journal of Psychiatry found such disparities in the use of ECT in 317 metropolitan areas in the United States that they called the treatment "among the highest variation procedures in medicine." The researchers, who attributed the disparities to doubts about ECT, found that the popularity of the treatment was "strongly associated with the presence of an academic medical center."

ECT use was highest in several relatively small metropolitan areas: Rochester, Minn. (Mayo Clinic), Charlottesville (University of Virginia), Iowa City (University of Iowa Hospitals), Ann Arbor (University of Michigan) and Raleigh-Durham (Duke University Medical Center).

Another unresolved question about ECT is its mortality rate. According to the 1990 APA report, one in 10,000 patients dies as a result of modern ECT. This figure is derived from a study of deaths within 24 hours of ECT reported to California officials between 1977 and 1983.

But more recent statistics suggest that the death rate may be higher. Three years ago, Texas became the only state to require doctors to report deaths of patients that occur within 14 days of shock treatment and one of only four states to require any reporting of ECT. Officials at the Texas Department of Mental Health and Mental Retardation report that between June 1, 1993, and September 1, 1996, they received reports of 21 deaths among an estimated 2,000 patients.


"Texas collects data no one else collects," said Steven P. Shon, the department's medical director. The state, however, does not require an autopsy in these cases. "We need to be very careful" of attributing these deaths to ECT, he added. "Unless there's an autopsy, there's no way to make a causal connection."

Records show that four deaths were suicides, all of which occurred less than one week after ECT. One man died in an automobile accident in which he was a passenger. In four cases the cause of death was listed as cardiac arrest or heart attack. One patient died of lung cancer. Two deaths were complications of general anesthesia. In eight cases there was no information on the cause of death. At least two-thirds of patients were over 65, and in nearly every case treatment was funded by Medicare or Medicaid.

Suicide Preventive?

One of the most common reasons cited by doctors for performing ECT is that it prevents suicide. The report of the 1985 NIH Consensus Conference states that "the immediate risk of suicide" that can't be managed by other treatments "is a clear indication for consideration of ECT."

In fact there is no proof that ECT prevents suicide. Some critics suggest that there is anecdotal evidence that the confusion and memory loss after treatment may even precipitate suicide in some people. They point to Ernest Hemingway, who shot himself in July 1961, days after being released from the Mayo Clinic where he had received more than 20 shock treatments. Before his death Hemingway complained to his biographer A.E. Hotchner, "What is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure, but we lost the patient."

A 1986 study by Indiana University researchers of 1,500 psychiatric patients found that those who committed suicide five to seven years after hospitalization were somewhat more likely to have had ECT than those who died from other causes.

The researchers, who also reviewed the literature on ECT and suicide, concluded that these findings "do not support the commonly held belief that ECT exerts long-range protective effects against suicide."

"It appears to us that the undeniable efficacy of ECT to dissipate depression and symptoms of suicidal thinking and behavior has generalized to the belief that it has long-range protective effects," concluded the researchers in an article in Convulsive Therapy, a journal for ECT practitioners.

Another factor in ECT's growing popularity is economic, suggests Tampa psychiatrist Walter E. Afield. It can be summed up in one word: reimbursement.

"Shock is coming back, I think, because of the change in psychiatric reimbursement," said Afield, former a consultant to Johns Hopkins Hospital who founded one of the nation's first managed mental health care companies. "[Insurers] no longer will pay psychiatrists to do psychotherapy, but they will pay for shock or for medical tests."

"We're being pushed as a specialty to do what's going to pay," said Afield, who is not opposed to ECT, but to its indiscriminate use. "Finances are dictating the treatment. In the old days when insurance companies paid for long-term hospitalization, we had patients who were hospitalized for a long time. Who pays the bill determines what kind of treatment gets done."

The growing popularity of ECT concerns some psychiatrists. "It's better than it used to be, but I have grave reservations about it," said Boston area psychiatrist Daniel B. Fisher, who has never recommended ECT for a patient. "I see it now being used as a quick and easy and not very lasting solution and that worries me."

Questions About Memory Loss Persist

Does ECT cause long-term memory loss?

The model consent form drafted by the American Psychiatric Association and copied by hospitals says that "perhaps 1 in 200" patients report lasting memory problems. "The reasons for these rare reports of long-lasting memory impairment are not fully understood," it concludes.

Critics such as David Oaks, director of the Support Coalition of Eugene, Ore., an advocacy group composed of former psychiatric patients, say that the 1 in 200 statistic is a sham. "It's totally fictional and without scientific justification and is designed to be reassuring," said Oaks. Complaints about long-term memory loss are widespread among patients, Oaks said. Some insist that ECT wiped out memories of distant events, such as high school, or impaired their ability to learn new material.

Harold A. Sackeim, chief of biological psychiatry at the New York State Psychiatric Institute and a member of the APA's six-member shock therapy task force, says that the 1 in 200 figure is not derived from any scientific studies. It is, Sackeim said, "an impressionistic number" provided by New York psychiatrist and ECT advocate Max Fink in 1979. The figure will likely be deleted from future APA reports, Sackeim said.

No one knows how many patients suffer from severe memory problems, said Sackeim, although he believes that the number is quite small.

"I know it happens because I've seen it," he said. He attributes such cases to improperly performed ECT. Yet even when properly administered, Sackeim notes that greater memory loss is more likely after bilateral treatment -- when electrodes are attached t o both sides of the head -- rather than one side. Because doctors believe bilateral ECT is more effective, it is administered more often, experts say.

While blaming ECT for memory problems is understandable, it may not be accurate, noted Larry R. Squire, a neuroscientist at the University of California at San Diego.


In a series of studies in the 1970s and 1980s Squire, a memory expert who has spent years studying ECT, compared more than 100 patients who underwent ECT with those who never had the treatment. He found that memories from the days shortly before, during and after shock treatments were probably lost forever. In addition, some patients demonstrated memory problems for events up to six months before ECT and as long as six months after treatment ended.

After six months, however, Squire said that ECT patients "perform as well on new learning tests and on remote memory tests as they performed before treatment" and as well as a control group of patients who never had ECT.

The widespread perception that ECT has permanently impaired memory is "an easy way to explain impairment," Squire said in interview. When patients are pressured to have ECT, he said, "outrage . . . combined with a sense of loss or low sense of self-esteem " could account for such a belief, even if there is no empirical evidence to support it.

Some psychiatrists are skeptical of Squire's hypothesis. They question the ability of standard tests to detect subtle memory problems and point to their own clinical experiences with patients.

Daniel B. Fisher, a psychiatrist and director of a community mental health center near Boston, has "grave reservations" about ECT's effects on memory and says he has never recommended it to a patient.

"The variability is still there, the unpredictability and uncertainty about the nature of the side effects," said Fisher, who has a doctorate in neurochemistry and worked as a neuroscientist at the National Institute of Mental Health before he went to medical school. "You see these people who can perform routine functions [after ECT] but have lost some of the more complex skills." Among them, he said, is a woman he treated who coped adequately with everyday life but no longer remembered how to play the piano.

ECT Experts' Ties to Shock Machine Industry

Among the small fraternity of electroshock experts, psychiatrist Richard Abrams is widely regarded as one of the most prominent.

Abrams, 59, who retired recently as a professor at the University of Health Sciences/Chicago Medical School, is the author of psychiatry's standard textbook on ECT. He is a member of the editorial board of several psychiatric journals. The American Psychiatric Association's 1990 task force report on ECT is studded with references to more than 60 articles he has authored. Abrams, whose interest in ECT dates back to his residency in 1960s, has served on the elite committee that planned the National Institutes of Health's 1985 consensus conference on ECT. In addition he has long been a sought-after expert defense witness on behalf of doctors or hospitals sued by patients who allege that ECT damaged their brains.

What is less well known is that Abrams owns Somatics, one of the world's largest ECT machine companies. Based in Lake Bluff, Ill., Somatics manufactures at least half of the ECT machines sold worldwide, Abrams said. Most of the rest are made by MECTA, a privately held company in Lake Oswego, Ore.

Yet Abrams's 340-page textbook never mentions his financial interest in Somatics, the company he founded in 1983 with Conrad Melton Swartz, 49, a professor of psychiatry at East Carolina University in Greenville, N.C. Neither does the 1994 instruction manual for the device written by Abrams and Swartz, the company's sole owners and directors, which contains extensive biographical information.

Financial ties between device manufacturers, drug companies and biotech firms "are a growing reality of health care and a growing problem," said Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania School of Medicine.

For doctors "the questions that such financial conflicts of interest generate are, do patients get adequate full disclosure of options or are you skewing how you present the facts because you have a financial stake in the treatment and you personally profit from it every time it's used?" Caplan asked.

"It's especially disturbing with ECT because it's so controversial" and public mistrust of the treatment is so great, he added.

Abrams said his publisher at Oxford University Press knew about his ownership of Somatics. "No one ever suggested I list it," said Abrams. "Why should it be?" Abrams said he has disclosed his directorship of Somatics after several medical journals began requiring information about potential conflicts of interest. Caplan said that a growing number of medical journals are requiring disclosure of payments greater than $1,000.

Abrams said he sees "no specific conflict" between his role as an ECT expert and his ownership of a company that makes shock machines. He said he has not decided whether to list his ownership in the third edition of his book, which is due out next year.

Abrams declined to say how much he has earned from Somatics. Approximately 1,250 machines, priced at nearly $10,000, have been sold to hospitals worldwide, he said. Between 150 and 200 machines are sold annually, according to Abrams. Somatics also sells reusable mouthguards for $29, which are designed to minimize the risks of chipped teeth or a lacerated tongue.

Swartz, 49, declined to be interviewed. Last year USA Today reported that he considered his financial interest in Somatics to be "a non-issue." Swartz is quoted as saying that the company was founded to provide better machines and to "advance ECT."


"Psychiatrists don't make much money and by practicing ECT they can bring their income almost up to the level of the family practitioner or internist," Swartz is quoted as saying. Swartz also said that the profits from Somatics are comparable to having an additional psychiatry practice. (Last year psychiatrists earned an average of $132,000, according to the American Medical Association.)

Abrams and Swartz are not the only ECT experts with financial ties to the industry.

Max Fink, 73, a professor of psychiatry at the State University of New York at Stony Brook, whose passionate advocacy is widely credited with reviving interest in ECT, receives royalties from two videos he made a decade ago. Fink is one of six ECT experts who served on the APA's 1990 ECT task force, which drafted guidelines for the treatment.

In 1986 he made two videos about ECT, one for patients and their families, the other for hospital staff. Each sells for $350 and is used by hospitals that administer ECT. Fink said that Somatics paid him $18,000 for the rights to the videotapes; he said he receives 8 percent of the royalties. He declined to disclose how much money he has earned from the videos.

Duke University's Richard D. Weiner, 51, chairman of the APA task force on ECT, appears on a MECTA videotape. Weiner said he served as a consultant to the company about 10 years ago but has not "received any money directly" for his services. Instead MECTA deposited between $3,000 and $5,000 in a university account that Weiner controls which, according to a Duke spokesman, is earmarked for "research support and other educational functions."

Harold A. Sackeim, director of ECT research at New York's Columbia-Presbyterian Hospital, is also a member of the APA task force on ECT. Sackeim, who has consulted for both MECTA and Somatics, says he has not accepted cash payments from the manufacturers because he does not want to be perceived as "benefiting personally" from ECT. Instead both companies have made payments to his lab. Sackeim estimates that his lab has received about $1,000 from Somatics and "several tens of thousands of dollars" from MECTA.

Ethicist Caplan said that he believes such donations raise fewer ethical questions than do direct payments to a doctor or an equity interest in a company. Even so, he said, it is up to physicians who receive such payments to disclose this to the public an d especially to prospective patients.

"There needs to be full disclosure in writing and the information needs to be repeated over and over again," Caplan said. "Doctors need to give patients the opportunity to ask questions if they want, not to make those decisions for them by saying they won 't be interested."

Changes in Population and Insurance Make Elderly Women Most Common Patients

Forty years ago, the typical ECT patient resembled Randall P. McMurphy, the antihero immortalized by actor Jack Nicholson in "One Flew Over the Cuckoo's Nest." Like McMurphy, ECT recipients tended to be under 40, male and impoverished -- patients confined to state mental hospitals, often against their will.

These days the typical ECT patient is an elderly white woman -- clinically depressed, and usually middle or upper middle class -- who has signed herself into a private hospital. Because she is over 65 her bill is paid, in whole or in part, by Medicare, the federal government's insurance program for the elderly.

The profound shift in the demographics of ECT reflects several factors, experts say. Among them are the dramatic growth of the nation's elderly population and of Medicare; a growing awareness by doctors of the problem of geriatric depression, and the push by insurers that psychiatrists provide more fast-acting "medical" treatments and less talk therapy.

A 1990 report by the American Psychiatric Association concluded that advanced age is no bar to ECT; it cited the case of a 102-year-old patient who received the treatment. Because some psychiatrists believe shock therapy works faster and is less risky than drugs, it is increasingly being administered to elderly patients. Frank Moscarillo, director of ECT at Washington's Sibley Hospital, said the typical patient at his hospital is over 60. His oldest patient was 98, "a little old lady" in Moscarillo's words.

But some published studies have found that shock treatment can be risky, particularly for elderly patients with significant medical problems. They include the following:

  • A 1993 study by Brown University psychiatrists of 65 hospitalized patients over age 80 found that those who received ECT had a higher mortality rate up to three years after treatment than did a group treated with medication. Of 28 patients who received drugs, 3.6 percent were dead after one year. Of 37 patients who got ECT, 27 percent were dead within a year. The authors concluded that the differences in death rates were not primarily due to ECT, but to the fact that ECT patients had more serious physical problems.

  • A 1987 study of 136 patients by researchers at Washington University in St. Louis found that complications after ECT, including severe confusion and heart and lung problems, increased with age.

  • A 1984 study by doctors at New York Hospital-Cornell Medical Center found that geriatric patients developed significantly more complications, not all of them reversible, after ECT than did younger patients. Problems included irregular heartbeats, heart failure and aspiration pneumonia, which occurs when an anesthetized patient inhales vomit into the lungs. All three conditions can be fatal.

  • A 1982 study of 42 ECT patients at New York's Payne Whitney Clinic found that 28 percent developed heart problems after ECT. Seventy percent of patients previously known to have cardiac problems experienced complications.

  • Even so, all of the researchers concluded that the potential benefits of ECT for depressed elderly patients tend to outweigh the risks. Shock, they say, is effective in quickly treating life-threatening dehydration or weight loss caused by severe depression.


Instances of involuntary electroshock

At the same time, there is concern that the elderly are particularly vulnerable to inappropriate or dangerous treatments.

Last year the Illinois Appellate Court ruled that ECT was too risky and not in the best interests of Lucille Austwick, an 82-year-old nursing home patient who suffers from dementia and chronic depression.

The state's highest court reversed the decision of a lower court in Chicago that had ordered Austwick, a retired telephone operator, to undergo as many as 12 ECT treatments at Rush-Presbyterian-St. Luke's Hospital against her will. Austwick, who has no family, had previously been declared incompetent by a court.

In a strongly worded opinion the judges detailed contradictions in the testimony of Austwick's psychiatrist, who said he had sought a court order "because medication therapy would take a long time [and] he felt it would be better to get [the patient] out of here [the hospital] rather than stay here and spend time and money."

In Wisconsin, the state agency that protects the rights of the mentally ill last year issued a report detailing nine cases in which patients at St. Mary's Hospital in Madison received ECT against their will or without proper informed consent.

All but one of the patients was over 60 and female. Two were coerced into having ECT, the report by the Wisconsin Coalition on Advocacy stated. In another case the hospital threatened to get a court order to administer shock over a spouse's objections, investigators said.

The agency concluded that "medical and nursing practices surrounding ECT at St. Mary's psychiatric unit may not consistently reflect the minimum standards required by state law and relevant professional standards."

Hospital officials denied that St. Mary's had violated patients' rights. They noted that regulatory officials had not taken any action. The hospital made changes in its ECT consent documents, but not as a result of the commission's report, officials said.

Discovered in 1938, Electroshock Has Fluctuated in Popularity

Even its most ardent defenders agree that ECT arouses primitive fears: of being struck by lightning, of Dr. Frankenstein's experiments, of electrocution and the electric chair.

"ECT is something that just because of its nature doesn't look good," said Richard D. Weiner, chairman of the American Psychiatric Association's 1990 task force on ECT and an associate professor of psychiatry at Duke University Medical Center. "You're talking about putting electricity on top of somebody's head."

"ECT is a bizarre treatment," agreed Harold A. Sackeim, chief of the ECT service at New York's Columbia-Presbyterian Hospital. "In terms of its surface features, it has a horrific aspect to it."

For thousands of years, the notion of using electricity to treat illness has held a fascination for doctors. In 47 A.D. Roman healers applied electric eels to the heads of headache sufferers. In the 1920s and '30s American and European psychiatrists began treating some mental illnesses by inducing epileptic-like convulsions through massive doses of insulin and other drugs. They discovered that some patients showed dramatic, albeit temporary, improvement.

ECT was discovered somewhat by accident in 1938 after an Italian psychiatrist adapted a pair of tongs used to stun hogs before slaughter and applied them to the temples of a 39-year-old engineer from Milan, shocking him out of a delirious state in which h e spoke only gibberish.

By the 1940s insulin coma and electric shock treatments were widely used in American mental hospitals, especially the overcrowded public institutions that housed as many as 8,000 patients and as few as 10 doctors.

Historical accounts are replete with examples of shock used to subdue and punish patients, sometimes under the guise of treatment. Particularly troublesome patients received hundreds of shocks, often several in a single day.

"ECT stands practically alone among the medical/surgical interventions in that misuse was not the goal of curing but of controlling the patients for the benefits of the hospital staff," medical historian David J. Rothman of Columbia University told an NIH consensus conference in 1985. "Whatever the misuse of penicillin or coronary artery bypass grafts, the issue of staff convenience was not nearly as prominent as with ECT."

The invention of Thorazine and other antipsychotic drugs led to a decline in the use of ECT. So did published accounts of abusive treatment. The most famous was "One Flew Over the Cuckoo's Nest," Ken Kesey's 1962 novel based on his experiences in an Oregon state mental hospital, which in 1975 was made into a movie starring Jack Nicholson.

By the mid-1970s ECT had fallen into disrepute. Psychiatrists increasingly turned to drugs, which were cheaper and easier to administer and aroused less opposition. In addition, a series of landmark cases involving the abuses of shock therapy helped form the basis for patients' rights and informed consent legislation.

The late 1980s marked a resurgence in the use of ECT, and in recent years ECT opponents in a few states have tried to restrict or ban the treatment. In 1993 the Church of Scientology, which opposes psychiatric treatment, and several groups of anti-ECT activists helped persuade Texas lawmakers to bar ECT for children under 16 and to require hospitals to report deaths within 14 days of treatment.

Last year a bill to ban ECT was the subject of a two-day public hearing before a Texas legislative committee that heard testimony from 58 witnesses. That bill died in committee but its sponsors predict it will be resurrected next year when the legislature reconvenes.


FAMOUS PATIENTS WHO HAD ECT:

Ernest Hemingway fatally shot himself after being released from the Mayo Clinic, where he had undergone ECT.

James Forrestal, the first U.S. secretary of defense, committed suicide in 1949. Forrestal, 57, had received a series of insulin coma treatments, a precursor of ECT.

Poet Sylvia Plath described her shock treatments in her 1971 book, "The Bell Jar." She wrote, "with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant."

Former Sen. Thomas Eagleton (D-Mo.) was forced to relinquish his spot as vice presidential candidate on the Democratic ticket in 1972.

Performer and political activist Paul Robeson underwent a series of ECT treatments in London in 1961.

At 17, rock star Lou Reed was given shock treatments designed to "cure" his homosexuality at a New York state mental hospital.

Film actress Frances Farmer received shock treatments while confined to a state mental hospital in Washington.

New Zealand writer Janet Frame described her harrowing experiences with ECT in a 1961 autobiography.

Former Boston Red Sox outfielder Jimmy Piersall wrote that ECT helped pull him out of a serious depression in the early 1950s.

Vaslav Nijinksy, the famed ballet dancer, underwent a series of insulin coma treatments in Europe in the 1930s.

Writer Zelda Fitzgerald underwent insulin coma treatments, a precursor of ECT, at a North Carolina hospital.

Literary critic Seymour Krim, a chronicler of the Beat Generation, received ECT in the late 1950s.

Movie actress Gene Tierney underwent eight shock treatments in 1955, according to her autobiography.

Pulitzer prize-winning poet Robert Lowell was hospitalized repeatedly for manic depression and alcoholism.

Film star Vivien Leigh, pictured in "Gone with the Wind," received shock treatments.

Talk show host Dick Cavett had a series of ECT treatments in 1980. "In my case, ECT was miraculous," he wrote.

Robert Pirsig described his experiences with ECT in his 1974 best-selling book, "Zen and the Art of Motorcycle Maintenance."

Piano virtuoso Vladimir Horowitz received shock treatments for depression and later returned to the concert stage.

Concert pianist Oscar Levant described his 18 ECT treatments in his book "Memoirs of an Amnesiac."

Letters to the Washington Post on the "Shock Therapy" Article

I was impressed with the evenhandedness of "Shock Therapy: It's Back" [Cover, September 24]. I had 12 shock treatments in early 1995 and 17 early this year. The results? I have major memory loss of at least the past two years. I still get somewhat confused when driving, even in familiar areas.

I retired from my job between the two series of treatments, and there were three different retirement parties for me. I have no recollection of any of them. I have kept a daily journal for the past two years. Most of it is so unfamiliar to me that it could have been written by somebody else.

Another result of the treatments is that I am alive to write this; I did not kill myself. I believe that my "cure," if any of us can be cured of our maladies of the mind and of the soul, will come from my continuing talk therapy. Recovering from depression is real work, and neither pill nor machine can substitute for the labor involved.

A fellow human who has been trained can make the work of recovery just bearable, but possible. It is the human touch that makes the difference; the hand that can reach to the bottom of the barrel to find me, that can give a shove from behind or a pull from ahead and that can squeeze my hand in encouragement as we move ahead together.

I have the utmost respect for people in the mental health fields. I intensely hope that researchers will be doing studies that will shed more light on the memory problems connected with ECT [electroconvulsive therapy]. There is research going on into treatments with similarities to ECT and continuing research into many aspects of depressive illness.

With managed care doing its part, perhaps we can look forward to bringing down the true costs of serious depression, which are suffering, broken physical health, broken homes, lost productivity and suicide.

Ann M. Hargrove
Arlington


The superb article raised serious questions not only about the procedure's usefulness but about its safety.

The American Psychiatric Association's model informed consent form, which many ECT facilities use at least in part, makes false claims on two safety issues: that "perhaps 1 in 200" ECT patients report lasting memory problems and that one in 10,000 patients dies as a result of ECT.

The crucial question is not, "Does ECT cause lasting memory problems?" but, "How severe and disabling are they?"

The article reported on a group of more than 2,000 ECT patients in Texas that had a death rate of roughly one in 100. It also cited a 1993 study of 65 hospitalized patients over 80 years of age, 28 of whom were treated with medications and 37 with ECT. Within a year, one in the medicated group and 10 in the ECT group were dead.

In these and other ways, psychiatrists are misleading tens of thousands of patients annually into accepting ECT.

I underwent electroshock involuntarily in 1963.

Leonard Roy Frank
San Francisco


As a psychiatric survivor of more than 50 insulin subcoma shocks, shock critic and anti-psychiatry activist, I congratulate you for publishing a sound and well-researched critique. Electroshock is increasing at an alarming rate as a psychiatric pacification weapon north and south of the (U.S.-Canada) border.

Don Weitz
Toronto


I am a former teacher and registered nurse whose life was forever changed by 13 outpatient ECTs I received in 1983. Shock "therapy" totally and permanently disabled me.

EEGs [electroencephalograms] verify the extensive damage shock did to my brain. Fifteen to 20 years of my life were simply erased; only small bits and pieces have returned. I was also left with short-term memory impairment and serious cognitive deficits.

It is beyond me how the government and the FDA can take issues such as the labeling of orange juice as "concentrated" or "fresh" as important to the American people while disregarding issues such as shock machines. There is no government inspection of ECT devices.

Shock "therapy" took my past, my college education, my musical abilities, even the knowledge that my children were, in fact, my children. I call ECT a rape of the soul.

Barbara C. Cody, BS, RN
Hoffman Estates, Ill.


Your cover story correctly notes that electroconvulsive therapy is broadly considered by organized medicine to be a treatment of proven efficacy against severe depression. However, it is inaccurate in stating that the American Psychiatric Association "has sought to make ECT a first-line therapy for depression and other mental illnesses, rather than a treatment of last resort."

The APA Task Force Report on ECT recommends that the treatment be used only when other forms of therapy, such as medications or psychotherapy, have not been effective or cannot be tolerated, and in life-threatening cases when other treatments will not work quickly enough.

It is significant that the National Alliance for the Mentally Ill and the National Depressive and Manic-Depressive Association, two major organizations representing patients and families, support the appropriate use of ECT.

Melvin Sabshin, MD
Medical director
American Psychiatric Association
Washington


In 1995, Texas State Reps. Dawnna Dukes, Billy Clemmons and I introduced bipartisan legislation in the House of Representatives to outlaw the use in Texas of the barbaric psychiatric treatment known as electroshock therapy. We were aided by advocacy groups like the National Association for the Advancement of Colored People (NAACP), the National Organization for Women (NOW) and the World Association of Electroshock Survivors.

Our legislation died in committee. Fortunately, Texas has a law requiring detailed reporting on the use of shock therapy. As your story pointed out, vulnerable elderly women are the primary targets.

Since introducing my bill, I have met with and heard from scores of human "after-shock" victims who were treated like lab rats and now suffer permanent new afflictions such as memory loss, learning disabilities and seizure disorders. Few people are properly warned of the known dangers of shock treatment.

Senfronia Thompson
State representative
Austin

next: Shock Treatment Victim Supports ECT Lawsuit
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

APA Reference
Staff, H. (1996, September 24). Shock Therapy...IT'S BACK, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/depression/articles/shock-therapyits-back

Last Updated: June 23, 2016

Intensity Seeker

Milling through the passages
of a wanting heart's desires
I lur
In the stillness I feel clawse intensity to my door
at each pass
looking, seeking frenzied peaks
for a hunger
origins unknown
fulfillment fleeting
encouraging moments
to look back..forward
seeing with new eyes
the crocked limbs of the dead trees
to the places my desires
have led me

Intensity Seeker

The darkness of it sends shivers
turns my head
to ask
how did I arrive here
in this murky forest

Whispers of light
shine through my outstretched hands
holding at bay
the future visions
projected before me
yet beacons me to
see, see, see what's before you
open your eyes love

To honesty's end I have found
little intensity
but calm assurance
peace which sustains
the pure essence
of a momentarily
desperate heart

Now I call to you
come to me peace
cradle me in your arms
nurse this hunger
who's wanton glow
burns eternal

 


continue story below


next: My Photo Gallery ~ back to:  My Articles: Table of Contents

APA Reference
Staff, H. (1996, August 31). Intensity Seeker, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/relationships/creating-relationships/intensity-seeker

Last Updated: June 23, 2015

Internet Addiction: The Emergence of a New Clinical Disorder

Researcher paper by Internet addiction expert, Dr. Kimberly Young on reports of people becoming addicted to the Internet.

Kimberly S. Young
University of Pittsburgh at Bradford

Published in CyberPsychology and Behavior, Vol. 1 No. 3., pages 237-244

Paper presented at the 104th annual meeting of the
American Psychological Association, Toronto, Canada, August 15, 1996.

ABSTRACT

Anecdotal reports indicated that some on-line users were becoming addicted to the Internet in much that same way that others became addicted to drugs or alcohol which resulted in academic, social, and occupational impairment. However, research among sociologists, psychologists, or psychiatrists has not formally identified addictive use of the Internet as a problematic behavior. This study investigated the existence of Internet addiction and the extent of problems caused by such potential misuse. This study utilized an adapted version of the criteria for pathological gambling defined by the DSM-IV (APA, 1994). On the basis of this criteria, case studies of 396 dependent Internet users (Dependents) and a control group of 100 non-dependent Internet users (Non-Dependents) were classified. Qualatative analyses suggests significant behavioral and functional usage differences between the two groups. Clinical and social implications of pathological Internet use and future directions for research are discussed.

Internet Addiction: The Emergence Of A New Clinical Disorder

Methodology

  • Subjects
  • Materials
  • Procedures

Results

  • Demographics
  • Usage Differences
  • Length Of Time Using Internet
  • Hours Per Week
  • Applications Used
  • Extent Of Problems

Discussion

References

INTERNET ADDICTION:

THE EMERGENCE OF A NEW CLINICAL DISORDER

Recent reports indicated that some on-line users were becoming addicted to the Internet in much the same way that others became addicted to drugs, alcohol, or gambling, which resulted in academic failure (Brady, 1996; Murphey, 1996); reduced work performance (Robert Half International, 1996), and even marital discord and separation (Quittner, 1997). Clinical reseach on behavioral addictions has focused on compulsive gambling (Mobilia, 1993), overeating (Lesieur & Blume, 1993), and compulsive sexual behavior (Goodman, 1993). Similar addiction models have been applied to technological overuse (Griffiths, 1996), computer dependency (Shotton, 1991), excessive television viewing (Kubey & Csikszentmihalyi, 1990; McIlwraith et al., 1991), and obsessive video game playing (Keepers, 1991). However, the concept of addictive Internet use has not been empirically researched. Therefore, the purpose of this exploratory study was to investigate if Internet usage could be considered addictive and to identify the extent of problems created by such misuse.




With the popularity and wide-spread promotion of the Internet, this study first sought to determine a set of criteria which would define addictive from normal Internet usage. If a workable set of criteria could be effective in diagnosis, then such criteria could be used in clinical treatment settings and facilitate future research on addictive Internet use. However, proper diagnosis is often complicated by the fact that the term addiction is not listed in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV; American Psychiatric Association, 1994). Of all the diagnoses referenced in the DSM-IV, Pathological Gambling was viewed as most akin to the pathological nature of Internet use. By using Pathological Gambling as a model, Internet addiction can be defined as an impulse-control disorder which does not involve an intoxicant. Therefore, this study developed a brief eight-item questionnaire referred to as a Diagnostic Questionnaire (DQ) which modified criteria for pathological gambling to provide a screening instrument for addictive Internet use:

  1. Do you feel preoccupied with the Internet (think about previous on-line activity or anticipate next on-line session)?
  2. Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?
  3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?
  4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?
  5. Do you stay on-line longer than originally intended?
  6. Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?
  7. Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet?
  8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?

Respondents who answered "yes" to five or more of the criteria were classified as addicted Internet users (Dependents) and the remainder were classified as normal Internet users (Non-Dependents) for the purposes of this study. The cut off score of "five" was consistent with the number of criteria used for Pathological Gambling. Additionally, there are presently ten criteria for Pathological Gambling, although two were not used for this adaptation as they were viewed non-applicable to Internet usage. Therefore, meeting five of eight rather than ten criteria was hypothesized to be a slightly more rigorous cut off score to differentiate normal from addictive Internet use. It should be noted that while this scale provides a workable measure of Internet addiction, further study is needed to determine its construct validity and clinical utility. It should also be noted that the term Internet is used to denote all types of on-line activity.

METHODOLOGY

Subjects

Participants were volunteers who respondent to: (a) nationally and internationally dispersed newspaper advertisements, (b) flyers posted among local college campuses, (c) postings on electronic support groups geared towards Internet addiction (e.g., the Internet Addiction Support Group, the Webaholics Support Group), and (d) those who searched for keywords "Internet addiction" on popular Web search engines (e.g., Yahoo).

Materials

An exploratory survey consisting of both open-ended and closed-ended questions was constructed for this study that could be administered by telephone interview or electronic collection. The survey administered a Diagnostic Questionnaire (DQ) containing the eight-item classification list. Subjects were then asked such qustions as : (a) how long they have used the Internet, (b) how many hours per week they estimated spending on-line, (c) what types of applications they most utilized, (d) what made these particular applications attractive, (e) what problems, if any, did their Internet use cause in their lives, and (f) to rate any noted problems in terms of mild, moderate, or severe impairment. Lastly, demosgraphic information from each subject such as age, gender, highest educational level achieved, and vocational background were also gathered..

Procedures

Telephone respondents were administered the survey verbally at an arranged interview time. The survey was replicated electronically and existed as a World-Wide-Web (WWW) page implemented on a UNIX-based server which captured the answers into a text file. Electronic answers were sent in a text file directly to the principal investigator's electronic mailbox for analysis. Respondents who answered "yes" to five or more of the criteria were classified as addicted Internet users for inclusion in this study. A total of 605 surveys in a three month period were collected with 596 valid responses that were classifed from the DQ as 396 Dependents and 100 Non-Dependents. Approximately 55% of the respondents replied via electronic survey method and 45% via telephone survey method. The qualitative data gathered were then subjected to content analysis to identify the range of characteristics, behaviors and attitudes found.




RESULTS

Demographics

The sample of Dependents included 157 males and 239 females. Mean ages were 29 for males, and 43 for females. Mean educational background was 15.5 years. Vocational background was classified as 42% none (i.e., homemaker, disabled, retired, students), 11% blue-collar employment, 39% non-tech white collar employment, and 8% high-tech white collar employment. The sample of Non-Dependents included 64 males and 36 females. Mean ages were 25 for males, and 28 for females. Mean educational background was 14 years.

Usage Differences

The following will outline the differences between the two groups, with an emphasis on the Dependents to observe attitudes, behaviors, and characteristics unique to this population of users.

Length of Time using Internet

The length of time using the Internet differed substantially between Dependents and Non-Dependent. Among Dependents, 17% had been online for more than one year, 58% had only been on-line between six months to one year, 17% said between three to six months, and 8% said less than three months. Among Non-Dependents, 71% had been online for more than one year, 5% had been online between six months to one year, 12% between three to six months, and 12% for less than three months. A total of 83% of Dependents had been online for less than one full year which might suggest that addiction to the Internet happens rather quickly from one's first introduction to the service and products available online. In many cases, Dependents had been computer illiterate and described how initially they felt intimidated by using such information technology. However, they felt a sense of competency and exhilaration as their technical mastery and navigational ability improved rapidly.

Hours Per Week

In order to ascertain how much time respondents spent on-line, they were asked to provide a best estimate of the number of hours per week they currently used the Internet. It is important to note that estimates were based upon the number of hours spent "surfing the Internet" for pleasure or personal interest (e.g., personal e-mail, scanning news groups, playing interactive games) rather than academic or employment related purposes. Dependents spent a M = 38.5, SD = 8.04 hours per week compared to Non-Dependents who spent M= 4.9, SD = 4.70 hours per week. These estimates show that Dependents spent nearly eight times the number of hours per week as that of Non-Dependents in using the Internet. Dependents gradually developed a daily Internet habit of up to ten times their initial use as their familiarity with the Internet increased. This may be likened tolerance levels which develop among alcoholics who gradually increase their consumption of alcohol in order to achieve the desired effect. In contrast, Non-Dependents reported that they spent a small percentage of their time on-line with no progressive increase in use. This suggests that excessive use may be a distinguishable characteristic of those who develop a dependence to on-line usage.

Applications Used

The Internet itself is a term which represents different types of functions that are accessible on-line. Table 1 displays the applications rated as "most utilized" by Dependents and Non-Dependents. Results suggested that differences existed among the specific Internet applications utilized between the two groups as Non-Dependents predominantly used those aspects of the Internet which allowed them to gather information (i.e., Information Protocols and the World Wide Web) and e-mail. Comparatively, Dependents predominantly used the two-way communication functions available on the Internet (i.e., chat rooms, MUDs, news groups, or e-mail).

Table 1: Internet Applications Most Utilized by Dependents and Non-Dependents

  Type of Computer User
Application Dependents Non-Dependents
Chat Rooms 35% 7%
MUDs 28% 5%
News groups 15% 10%
E-mail 13% 30%
WWW 7% 25%
Information Protocols 2% 24%



Chat rooms and Multi-User Dungeons, more commonly known as MUDs were the two most utilized mediums by Dependents. Both applications allow multiple on-line users to simultaneously communicate in real time; similar to having a telephone conversation except in the form of typed messages. The number of users present in these forms of virtual space can range from two to over thousands of occupants. Text scrolls quickly up the screen with answers, questions, or comments to one another. Sending a "privatize message" is another available option that allows only a single user to read a message sent. It should be noted that MUDs differ from chat rooms as these are an electronic spin off of the old Dungeon and Dragons games where players take on character roles. There are literally hundreds of different MUDs ranging in themes from space battles to medieval duels. In order to log into a MUD, a user creates a character name, Hercules for example, who fights battles, duels other players, kills monsters, saves maidens or buys weapons in a make believe role playing game. MUDs can be social in a similar fashion as in chat room, but typically all dialogue is communicated while "in character."

News groups, or virtual bulletin board message systems, were the third most utilized application among Dependents. News groups can range on a variety of topics from organic chemistry to favorite television programs to the best types of cookie-dough. Literally, there are thousands of specialized news groups that an individual user can subscribe to and post and read new electronic messages. The World-Wide Web and Information Protocols, or database search engines that access libraries or electronic means to download files or new software programs, were the least utilized among Dependents. This may suggest that the database searches, while interesting and often times time-consuming, are not the actual reasons Dependents become addicted to the Internet.

Non-Dependents viewed the Internet as a useful resource tool and a medium for personal and business communication. Dependents enjoyed those aspects of the Internet which allowed them to meet, socialize, and exchange ideas with new people through these highly interactive mediums. Dependents commented that the formation of on-line relationships increased their immediate circle of friends among a culturally diverse set of world-wide users. Additional probing revealed that Dependents mainly used electronic mail to arrange "dates" to meet on-line or to keep in touch between real time interactions with new found on-line friends. On-line relationships were often seen as highly intimate, confidential, and less threatening than real life friendships and reduced loneliness perceived in the Dependent's life. Often times, Dependents preferred their "on-line" friends over their real life relationships due to the ease of anonymous communication and the extent of control in revealing personal information among other on-line users.

Extent of Problems

One major component of this study was to examine the extent of problems caused by excessive Internet use. Non-Dependents reported no adverse affects due to its use, except poor time management because they easily lost track of time once on-line. However, Dependents reported that excessive use of the Internet resulted in personal, family, and occupational problems that have been documented in established addictions such as pathological gambling (e.g., Abbott, 1995), eating disorders (e.g., Copeland, 1995), and alcoholism (e.g., Cooper, 1995; Siegal, 1995). Problems reported were classified into five categories: academic, relationship, financial, occupational, and physical. Table 2 shows a breakdown of the problems rated in terms of mild, moderate, and severe impairment.

Table 2: Comparison of Type of Impairment to Severity Level Indicated

  Impairment Level
Impairment None Mild Moderate Severe
Academic 0% 2% 40% 58%
Relationship 0% 2% 45% 53%
Financial 0% 10% 38% 52%
Occupational 0% 15% 34% 51%
Physical 75% 15% 10% 0%

Although the merits of the Internet make it an ideal research tool, students experienced significant academic problems as they surf irrelevant web sites, engage in chat room gossip, converse with Internet penpals, and play interactive games at the cost of productive activity. Students had difficulty completing homework assignments, studying for exams, or getting enough sleep to be alert for class the next morning due to such Internet misuse. Often times, they were unable to control their Internet use which eventually resulted in poor grades, academic probation, and even expulsion from the university.




Marriages, dating relationships, parent-child relationships, and close friendships were also noted to be poorly disrupted by excessive use of the Internet. Dependents gradually spent less time with real people in their lives in exchange for solitary time in front of a computer. Initially, Dependents tended to use the Internet as an excuse to avoid needed but reluctantly performed daily chores such as doing the laundry, cutting the lawn, or going grocery shopping. Those mundane tasks were ignored as well as important activities such as caring for children. For example, one mother forgot such things as to pick up her children after school, to make them dinner, and to put them to bed because she became so absorbed in her Internet use.

Loved ones first rationalize the obsessed Internet user's behavior as "a phase" in hopes that the attraction would soon dissipate. However, when addictive behavior continued, arguments about the increased volume of time and energy spent on-line soon ensue, but such complaints were often deflected as part of the denial exhibited by Dependents. Dependents become angry and resentful at others who questioned or tried to take away their time from using the Internet, often times in defense of their Internet use to a husband or wife. For example, "I don't have a problem," or "I am having fun, leave me alone," might be an addict's response. Finally, similar to alcoholics who hide their addiction, Dependents engaged in the same lying about how long their Internet sessions really lasted or they hide bills related to fees for Internet service. These behaviors created distrust that over time hurt the quality of once stable relationships.

Marriages and dating relationships were the most disrupted when Dependents formed new relationships with on-line "friends." On-line friends were viewed as exciting and in many cases lead to romantic interactions and Cybersex (i.e., on-line sexual fantasy role-playing). Cybersex and romantic conversations were perceived as harmless interactions as these sexual on-line affairs did not involve touching and electronic lovers lived thousands of miles away. However, Dependents neglected their spouses in place of rendezvous with electronic lovers, leaving no quality time for their marriages. Finally, Dependents continued to emotionally and socially withdraw from their marriages, exerting more effort to maintain recently discovered on-line relationships.

Financial problems were reported among Dependents who paid for their on-line service. For example, one woman spent nearly $800.00 in one month for on-line service fees. Instead of reducing the amount of time she spent on-line to avoid such charges, she repeated this process until her credit cards were over-extended. Today, financial impairment is less of an issue as rates are being driven down. America On-line, for example, recently offered a flat rate fee of $19.95 per month for unlimited service. However, the movement towards flat rate fees raises another concern that on-line users are able to stay on-line longer without suffering financial burdens which may encourage addictive use.

Dependents reported significant work-related problems when they used their employee on-line access for personal use. New monitoring devices allow bosses to track Internet usage, and one major company tracked all traffic going across its Internet connection and discovered that only twenty-three percent of the usage was business-related (Neuborne, 1997). The benefits of the Internet such as assisting employees with anything from market research to business communication outweigh the negatives for any company, yet there is a definite concern that it is a distraction to many employees. Any misuse of time in the work place creates a problem for managers, especially as corporations are providing employees with a tool that can easily be misused. For example, Edna is a 48 year old executive secretary found herself compulsively using chat rooms during work hours. In an attempt to deal with her "addiction," she went to the Employee Assistance Program for help. The therapist, however, did not recognize Internet addiction as a legitimate disorder requiring treatment and dismissed her case. A few weeks later, she was abruptly terminated from employment for time card fraud when the systems operator had monitored her account only to find she spent nearly half her time at work using her Internet account for non-job related tasks. Employers uncertain how to approach Internet addiction among workers may respond with warnings, job suspensions, or termination from employment instead of making a referral to the company's Employee Assistance Program (Young, 1996b). Along the way, it appears that both parties suffer a rapid erosion of trust.

The hallmark consequence of substance abuse are the medical risk factors involved, such as cirrhosis of the liver due to alcoholism, or increased risk of stroke due to cocaine use. The physical risk factors involved with Internet overuse were comparatively minimal yet notable. Generally, Dependent users were likely to use the Internet anywhere from twenty to eighty hours per week, with single sessions that could last up to fifteen hours. To accommodate such excessive use, sleep patterns are typically disrupted due to late night log-ins. Dependents typically stayed up past normal bedtime hours and reported being on-line until two, three, or four in the morning with the reality of having to wake for work or school at six a.m. In extreme cases, caffeine pills were used to facilitate longer Internet sessions. Such sleep depravation caused excessive fatigue often making academic or occupational functioning impaired and decreased one's immune system leaving Dependents' vulnerable to disease. Additionally, the sedentary act of prolonged computer use resulted in a lack of proper exercise and lead to an increased risk for carpal tunnel syndrome, back strain, or eyestrain.




Despite the negative consequences reported among Dependents, 54% had no desire to cut down the amount of time they spent on-line. It was at this point that several subjects reported feeling "completely hooked" on the Internet and felt unable to kick their Internet habit. The remaining 46% of Dependents made several unsuccessful attempts to cut down the amount of time they spent on-line in an effort to avoid such negative consequences. Self-imposed time limits were typically initiated to manage on-line time. However, Dependents were unable to restrict their usage to the prescribed time limits. When time limits failed, Dependents canceled their Internet service, threw out their modems, or completely dismantled their computers to stop themselves from using the Internet. Yet, they felt unable to live without the Internet for such an extended period of time. They reported developing a preoccupation with being on-line again which they compared to "cravings" that smokers feel when they have gone a length of time without a cigarette. Dependents explained that these cravings felt so intense that they resumed their Internet service, bought a new modem, or set up their computer again to obtain their "Internet fix."

DISCUSSION

There are several limitations involved in this study which must be addressed. Initially, the sample size of 396 Dependents is relatively small compared to the estimated 47 million current Internet users (Snider, 1997). In addition, the control group was not demographically well-matched which weakens the comparative results. Therefore, generalizability of results must be interpreted with caution and continued research should include larger sample sizes to draw more accurate conclusions.

Furthermore, this study has inherent biases present in its methodology by utilizing an expedient and convenient self-selected group of Internet users. Therefore, motivational factors among participants responding to this study should be discussed. It is possible that those individuals classified as Dependent experienced an exaggerated set of negative consequences related to their Internet use compelling them to respond to advertisements for this study. If this is the case, the volume of moderate to severe negative consequences reported may be an elevated finding making the harmful affects of Internet overuse greatly overstated. Additionally, this study yielded that approximately 20% more women than men responded which should also be interpreted with caution due to self-selection bias. This result shows a significant discrepancy from the stereotypic profile of an "Internet addict" as a young, computer-savvy male (Young, 1996a) and is counter to previous research that has suggested males predominantly utilize and feel comfortable with information technologies (Busch, 1995; Shotton, 1991). Women may be more likely to discuss an emotional issue or problem more than men (Weissman & Payle, 1974) and therefore were more likely than men to respond to advertisements in this study. Future research efforts should attempt to randomly select samples in order to eliminate these inherent methodological limitations.

While these limitations are significant, this exploratory study provides a workable framework for further exploration of addictive Internet use. Individuals were able to meet a set of diagnostic criteria that show signs of impulse-control difficulty similar to symptoms of pathological gambling. In the majority of cases, Dependents reported that their Internet use directly caused moderate to severe problems in their real lives due to their inability to moderate and control use. Their unsuccessful attempts to gain control may be paralleled to alcoholics who are unable to regulate or stop their excessive drinking despite relationship or occupational problems caused by drinking; or compared to compulsive gamblers who are unable to stop betting despite their excessive financial debts.

The reasons underlying such an impulse control disability should be further examined. One interesting issue raised in this study is that, in general, the Internet itself is not addictive. Specific applications appeared to play a significant role in the development of pathological Internet use as Dependents were less likely to control their use of highly interactive features than other on-line applications. This paper suggests that there exists an increased risk in the development of addictive use the more interactive the application utilized by the on-line user. It is possible that a unique reinforcement of virtual contact with on-line relationships may fulfill unmet real life social needs. Individuals who feel misunderstood and lonely may use virtual relationships to seek out feelings of comfort and community. However, greater research is needed to investigate how such interactive applications are capable of fulfilling such unmet needs and how this leads to addictive patterns of behavior.

Finally, these results also suggested that Dependents were relative beginners on the Internet. Therefore, it may be hypothesized that new comers to the Internet may be at a higher risk for developing addictive patterns of Internet use. However, it may be postulated that "hi-tech" or more advanced users suffer from a greater amount of denial since their Internet use has become an integral part of their daily lives. Given that, individuals who constantly utilize the Internet may not recognize "addictive" use as a problem and therefore saw no need to participate in this survey. This may explain their low representation in this sample. Therefore, additional research should examine personality traits that may mediate addictive Internet use, particularly among new users, and how denial is fostered by its encouraged practice.

A recent on-line survey (Brenner, 1997) and two campus-wide surveys conducted at the University of Texas at Austin (Scherer, 1997) and Bryant College (Morahan-Martin, 1997) have further documented that pathological Internet us is problematic for academic performance and relationship functioning. With the rapid expansion of the Internet into previously remote markets and another estimated 11.7 million planning to go on-line in the next year (Snider, 1997), the Internet may pose a potential clinical threat as little is understood about treatment implications for this emergent disorder. Based upon these findings, future research should develop treatment protocols and conduct outcome studies for effective management of this symptoms. It may be beneficial to monitor such cases of addictive Internet use in clinical settings by utilizing the adapted criteria presented in this study. Finally, future research should focus on the prevalence, incidence, and the role of this type of behavior in other established addictions (e.g., other substance dependencies or pathological gambling) or psychiatric disorders (e.g., depression, bipolar disorder, obsessive-compulsive disorder, attention deficit disorder).




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APA Reference
Staff, H. (1996, August 15). Internet Addiction: The Emergence of a New Clinical Disorder, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/addictions/center-for-internet-addiction-recovery/internet-addiction-research-paper

Last Updated: June 24, 2016

Woman Says Electric Shock Treatment Destroyed Her Life

Melissa Holliday talks about  electroshock therapy. Her message is, it has ruined her life.Melissa Holliday sang at a Chrysler convention, landed a job as an extra on the Baywatch television series, appeared as a Playboy foldout model in January 1995 and, at times, was making $5,000 a day.

Now she lives at her father's apartment in Seabrook, gets $525 a month from Social Security, has not worked in a year and, instead of singing This is My Country for Lee Iacocca, is poised to become an entirely different sort of performer.

Her new topic is electroshock therapy. Her message is, it has ruined her life.

"I was making $2,500 to $5,000 a day," she recalled Wednesday. "I had opportunities other people only dream about. I would've become a star and made a lot of money. I'd have a life.

"Now, everyday is like the Olympics for me. I don't want another person to go through what I've been through. Electroshock is not a form of therapy. Doctors are getting rich off doing brain damage to people."

Holliday on Wednesday filed a civil lawsuit accusing a Santa Monica, Calif., hospital and three physicians of assault and battery and personal injury over what she said was done to her from June 26-July 12, 1995.

Holliday, 26, said she had worked hard at singing, dancing and acting for years, and finally was achieving success. She was modeling and doing voice-overs for TV commercials. She had meetings with people from Warner Bros. and Columbia Pictures.

But through it all, she said, she was in constant pain from a uterine problem. It left her depressed, and at 24, she was told, her only medical solution was a full, unwanted hysterectomy.

Her depression worsened. Finally, she was referred to a female doctor in Santa Monica.

Before long, Holliday said, she was checked into St. John's Hospital and Health Center in Santa Monica and placed on a lengthy regimen of drugs. Her father, Randy Halberson, said his daughter was given uppers, downers and every shade in between.

Although she wasn't informed of it at the onset, Holliday said, she soon learned she was due for electroshock therapy.

"They'd given me so many drugs, I didn't know if I was coming or going," she said, "A week after I got there, the doctor mentioned shock. She didn't ask me if I wanted it. She said if I didn't want it, I'd go to the fourth floor, a lock-up ward. Then nobody could see me and I couldn't go outside."

Nine times she was shocked, Holliday said.

"I've been through a rape, and electroshock therapy is worse," she said. "If you haven't gone through it, I can't explain it."

When it ended, she said, her show-business career was over. "I couldn't leave my house for six months," she said. "I couldn't drive my car for eight months."

Holliday's relatives tell of nine suicide attempts, a total loss of self-confidence, continual anxiety and depression worse than when she went to the Santa Monica hospital.

Holliday's situation has caught the attention of Jerry Boswell of Austin, director of the Citizens Commission on Human Rights of Texas, a group that champions the rights of medical patients. Boswell is leading the charge to abolish electroshock therapy in Texas.

About 1,800 people underwent electroshock therapy in Texas last year, Boswell said, and 70 percent were women.

"Now," he said, "the main target is elderly people. There is a 36 percent increase in shock treatment between age 64 and age 65. When you turn 65, you become eligible for Medicare, and Medicare pays for electroshock. For a few seconds of electricity, the hospital gets $300."

State Rep. Senfronia Thompson, D-Houston, tried last year to push legislation aimed at banning electroshock therapy. Now she is preparing for another try.

"My bill died in committee, but the chairman was kind enough to give me a hearing," Thompson said. "It lasted until the wee hours and we heard from 150 people."

Half the witnesses raved about the good things electroshock treatment had done for them, Thompson said, and the other half related horror stories, how it caused memory loss and even seizures that continued long afterward.

A Houston psychiatrist, Charles S. DeJohn, said electroshock therapy nowadays is unlike that in decades past when it was a more common medical tool for treating depressed people who could not otherwise be helped.

Now it is done with more careful monitoring of "seizure duration and oxygenization levels," DeJohn said. Anesthesiologists typically are present during sessions. Care is taken to prevent patients from breaking their own bones during electrically induced seizures.

"There is no significant deficit,"DeJohn said. "It's reserved for people who haven't responded to treatment and whose condition is such that you can't wait for a response (from drug therapy). It is perceived as a legitimate form of treatment."

DeJohn said he has referred educated patients -- attorneys, professors and others -- for shock treatments and "all responded well."

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APA Reference
Staff, H. (1996, June 26). Woman Says Electric Shock Treatment Destroyed Her Life, HealthyPlace. Retrieved on 2024, December 24 from https://www.healthyplace.com/depression/articles/woman-says-electric-shock-treatment-destroyed-her-life

Last Updated: June 23, 2016