Psychiatric Hospitals Can Still Force Patients to Accept Shock Treatment. One Connecticut Patient Has Been Shocked 500 Times in Five Years.

Despite concerns about efficacy and side effects, courts are slow to act on behalf of patients who don’t want the treatment.

Gina Teixeira, an attorney with the Connecticut Legal Rights Project, got the call last May. A court was going to force a man to undergo shock therapy, and he wanted her help fighting the order.

He wasn't alone. Teixeira regularly receives inquiries from Connecticut patients facing involuntary shock treatment court orders, including one client who she says has been unwillingly subjected to the shocks 500 times.

"I think it happens a lot more than people realize," Teixeira says.

Shock therapy, also known as electroconvulsive therapy (ECT), was developed in the late 1930s as a psychiatric treatment for severe psychosis and catatonia. Patients undergoing the procedure receive jolts of electricity from electrodes placed on their temples, triggering a brain seizure and convulsions that last up to a minute. After the two Italian psychiatrists who invented the treatment reported positive results, a 1938 news headline declared "Madness Cured with Electricity."

It soon became evident, though, that the treatment could cause severe cognitive impairment and memory loss. In a 1944 study, shock therapy recipients "described losses such as the inability to recognize friends and acquaintances" which "remained after years and appeared to be permanent." Another study worryingly concluded that patients who improved or recovered after the seizure-inducing treatments had a "high frequency of relapse." 

Reports subsequently emerged in the 1950s of psychiatric hospital doctors and orderlies using the novel treatment to modify the behavior of harmless and healthy patients. One woman was given shock treatment because her family was upset she had run off with her apparently "homosexual" boyfriend and "walked about carrying 'Proust' under her arm." 

To counter evidence of shock therapy's serious side effects, limited therapeutic benefits, and potential for abuse, the American Psychiatric Association (APA) partnered with shock industry lobbyists in the 1970s to persuade the public that the treatment was safe and effective. Though it took time, the public relations campaign succeeded. Prominent media outlets regularly report that today's "safe and effective" version of electroconvulsive therapy no longer resembles the barbaric shock procedure depicted in One Flew Over the Cuckoo's Nest. 

Many recipients voluntarily consent to shock therapy, which is typically given for treatment-resistant depression, and get better. In 2008, the National Mental Health Association reported that shock treatments tripled to 100,000 a year, a figure that is frequently re-printed in other news publications. In 2016, Dr. Linda Lagemann, a former associate professor at the University of California, San Francisco, estimated that shock therapy generates $1.8 billion in costs annually, half of which are covered by Medicare.

Corresponding with shock therapy's comeback, reports of the procedure's devastating side effects and limited effectiveness re-appeared. A 2010 review of eight meta-analyses concluded that, because shock therapy causes persistent and permanent memory loss and a slight increased risk of death, "its use cannot be scientifically justified." In 2018, as the result of a class-action lawsuit, ECT device maker Somatics added a warning to its instruction manual that in "rare cases, patients may experience…permanent brain damage."

Despite such accounts, warnings and studies, many states still allow physicians to force shock therapy onto people who don't want it. While physicians are typically required to secure court orders before forcibly shocking patients, the Minnesota City Pages has called the process "more of a bureaucratic formality than a serious deliberation." 

It is virtually impossible to know how many Americans are involuntarily shocked, since, besides Texas, states don't require hospitals to report how often they administer the procedure. Likewise, medical privacy laws make it prohibitively difficult for the public to attend involuntary shock hearings.

Without proper scrutiny, patients in Connecticut are especially vulnerable to getting unnecessarily shocked. It is one of the only U.S. states that allows civil psychiatric facilities to hospitalize individuals involuntarily for an indefinite length of time, with minimal judicial oversight: Patients are entitled to a clinical review by a doctor just once a year, and only entitled to a full judicial review every two years. In early 2018, the Connecticut Legal Rights Project filed a class-action lawsuit to declare the state's civil commitment statute unconstitutional.

The man who contacted Teixeira last May, referred to as John Doe in court records, was a patient at the Greater Bridgeport Community Mental Health Center, a Connecticut state-run civil facility that treats adults with prolonged psychiatric and co-occurring illnesses. He had never undergone shock therapy before.

On May 3, 2019, clinicians testified at Bridgeport Probate Court that it was medically necessary to forcibly shock the man. Judge Paul Ganim agreed, and he empowered the man's parents, who act as his conservators, to permit the shock therapy for up to 45 days. (No other details from the court hearing are public, as probate mental health court records are automatically sealed.)

That's when the patient contacted Teixeira.

"He obviously was sophisticated enough to contact me and ask me to file an appeal," Teixeira told the Connecticut Post. "The client told me he is really scared and asked me to help him. This should not be forced on him."

Teixeira subsequently filed for an emergency order to halt the shock treatments, citing the man's fear of side effects, including memory loss. Connecticut Assistant Attorney General Emily Melendez, representing the mental health center, then filed a motion opposing the order. Incredibly, Melendez asserted in her motion that the patient "does not allege any facts to support that such side effects exist or that if they do, that the risk of harm in not providing this treatment outweighs whatever other harm might come from the treatment."

To bolster her emergency order filing, Teixeira asked Connecticut's Department of Mental Health and Addiction Services for assistance. Department officials never got back to her, and the probate court refused to postpone the procedure.

John Doe was forced to undergo his first round of shock therapy on May 17.

Teixeira was able to schedule an appeal hearing for June 3 at the Superior Court in Bridgeport. During the hearing, Melendez confessed that medical staff violated Connecticut's shock statute.

In Connecticut, shock therapy can be administered over a patient's objection only if the head of a hospital and two qualified physicians agree the patient is incapable of giving informed consent. In this case, Melendez conceded, only the head of the hospital and one qualified physician approved the procedure. The mental health center had improperly allowed a physician's assistant to sign-off on the procedure in lieu of a second qualified physician.

It was a moot point, though, since the hospital had completed the medically necessary rounds of shock therapy, according to Melendez. (Melendez did not respond to multiple requests for comment.)

After Melendez' disclosure, Superior Court Judge Barbara Bellis advised the hospital's legal team that these "are liberty interests that are so important and the statutory protections are there for a reason." She then sustained the patient's appeal to halt any future shock treatments during the 45-day treatment window. 

The man has not been shocked since, according to Teixeira, though she is not authorized to say if he is still hospitalized.

Despite being appreciative of the judge's ruling, Teixeira was furious that the court did not issue an automatic stay after she initially filed her appeal. "This what I really want to talk about, how flawed our shock statute is," she said. "You have a probate order found to be legally defective—and it didn't matter to my client because he was still shocked. To be deprived of that opportunity because the law does not include an automatic stay is a real problem." 

According to Teixeira, the lack of authorization from a second qualified physician wasn't the only defect in the shock application. The state's shock statute requires any possible "less intrusive beneficial treatment" to be given to a patient before shock therapy is forcibly administered. Teixeira contends that the hospital violated this when it didn't offer John Doe the opportunity to take psychiatric medication.

Teixeira is now representing Carol Levesque, a Connecticut woman fighting a shock application filed by Middletown's Connecticut Valley Hospital. According to a complaint Teixeira filed in October, Levesque has been held against her will at the state-run psychiatric hospital since 2015. During that period, she has been shocked 500 times.

Teixeira is incensed at the hospital's most recent shock therapy application, because the procedure has clearly not benefited Levesque. "After years of this forced shock and not having enough benefit for discharge," Teixeira complained, "what's the point?"

In that case, Teixeira was able to persuade a judge to grant a stay of the shock order prior to the appeal hearing. "Now she has the opportunity to challenge the order without constant threat," Teixeira noted.

Even if Teixeira and Levesque win their appeal, the hospital can reapply for shock therapy after 45 days. "You can constantly petition for years and years, and no one is gonna tell you to stop," Teixeira notes. "It's a flaw in the system that doesn't protect people."

Since the shocks were halted, Levesque's physical and mental health appear to have improved. "The hospital says without shock she deteriorates," Teixeira says. "Every time I see her, she looks better."