Thanks to Jon S. for sending me a book review of Shock Therapy from Slate.com. The review is not so much a summary of the book's content, but an argument for ECT's validity as a psychiatric treatment. The review is written by Barron H. Lerner, author, most recently, of When Illness Goes Public: Celebrity Patients and How We Look at Medicine. Lerner avers that over the years, ECT's efficacy has been called into question by brief cultural moments such as One Flew Over the Cuckoo's Nest, which he cites twice. He also writes:

Also influential was a 1974 New Yorker article by renowned medical writer Berton Roueche, who claimed that ECT caused permanent memory loss. Because the woman featured in Roueche's essay was not a representative case, her story exaggerated the importance of a real, but limited, side effect.

Lerner cites "hundreds of studies from a wide variety of institutions" that "claimed [ECT] was effective." He does not cite the ethical questions of research funding and compromise among ECT's proponents, nor the most recent studies showing that ECT does not have substantial benefit beyond a few short weeks. Further research on memory loss has shown that it can, indeed, be permanent, and that cognitive deficits can be long-term.

Lerner is Angelica Berrie-Arnold P. Gold Foundation associate professor of medicine and public health at Columbia University, the same institution where Harold Sackheim, ECT's leading proponent, works. I wonder if they ever have lunch. They'd have a lot to talk about. But that's just a specious observation. More interestingly, in 2005 Lerner reviewed a book called The Lobotomist by Jack El-Hai, which is a medical biography of the "founder" of the lobotomy, Walter Freeman. I read that book too, and enjoyed it, though I find Lerner's interpretation of it -- as a sort of contextualized defense of Freeman's behavior -- oddly skewed. It seems Lerner is pinning some of his own opinions on El-Hai, but I'm not convinced El-Hai felt the way Lerner describes:

The physician who had been compared to the Nazi doctor Josef Mengele actually appeared to have helped many people. For example, Harry Dannecker, an Indiana man with a long history of anxiety and depression, had been suicidal before he underwent a lobotomy in 1937; during World War II, completely recovered, he worked long hours in a war-materials plant. Among the pieces of evidence stressed by El-Hai are thousands of letters from grateful patients. Freeman and Watts, one wrote, "saved my mind and set my spirit free."

So, was lobotomy a reasonable intervention for a desperate problem or a routine cause of harm, as Christine Johnson, whose grandmother had a lobotomy in 1954, charges? ...

One difficulty in assessing the procedure arises from the nature of Freeman's research. He kept in touch with as many patients as possible, even traveling across the country to find them. Yet since he conducted no controlled studies, interpreting his data is difficult. For example, since mental illness in any particular patient may wax and wane, it is possible that some patients' symptoms might have improved even if portions of their brains had not been cut away. And grateful letters may represent a skewed sample. Still, it is hard to deny that some patients who had been institutionalized for years lived apparently satisfactory lives after undergoing lobotomy — even, in rare cases, becoming lawyers or physicians, according to El-Hai.

Those last words are key -- "according to El-Hai." Sometimes book reviewers are able to hide behind them to propel their own points of view, which is one of the great pleasures of book reviewing. Have an opinion but risk little for having it.

Lerner is clearly an accomplished and sophisticated thinker. But he specializes in ethics. Given that focus, I'm wondering if he really did his homework when "reviewing" Shock Therapy. Maybe he'd argue he doesn't have an agenda. If that's true, why does Slate's home page link to his review with the headline: "How Cuckoo's Nest ruined shock therapy for the rest of us"?

The Body Electric's New Look: Why shock therapy deserves its mini-revival.