TREATMENTS OF THE TIME
A father’s life forever changed
The Riverview Hospital “ward notes” about my father’s shock therapy read largely without expression, which, not without coincidence, is how my father came to be.
“Record of coma insulin treatment: 166 hours, 5 minutes on treatment. 29 hours, 15 minutes in coma. 27 comas,” says a ward note dated June 16, 1954, less than a week after he was involuntarily admitted to the mental hospital. “7 grand mal seizures.”
There is no record my father, Harold Todd, his parents or his wife ever gave what is now called “informed consent” to this sudden series of shock treatments at B.C.’s large psychiatric facility in Coquitlam.
Nevertheless, my dad, at age 28, endured being repeatedly strapped onto a bed for scores of electro-convulsive therapy sessions, the kind made infamous in the movie One Flew Over the Cuckoo’s Nest. He was also subjected to even more experimental insulin shock treatments, which for a decade or so were the big thing in psychiatry until they fell out of favour in the late 1950s, when their healing effects were debunked as “mythical.”
It would probably be going too far today to refer to such shock therapies as state-sanctioned torture.
Instead, I’ll simply describe how my father was injected on scores of occasions with lithium, a metallic element used in batteries. Invented by Austrian-American psychiatrist Manfred Sakel, lithium coma therapy was supposed to “shock” schizophrenia patients and others into health through epileptic-like seizures.
Like tens of thousands of other shock therapy patients across North America, my dad was one of those who was, for his protection, tied onto a bed or held down by nurses, when his limbs began to flail, madly. As one medical journal reported: “Many would be tossing, rolling, moaning, twitching, spasming or thrashing around.”
Before my father was thrust into these treatments, my mother said, he had been an intelligent, sensitive and kind husband and father to my older brother and me.
Yet there is no doubt, when he was admitted in 1954, he was showing signs of what the ward notes call “paranoia” and “grandiosity.”
He wasn’t particularly experiencing delusions or hallucinations, the most overt signs of schizophrenia, which is one form of psychosis, a term covering how people can lose touch with reality for a period of time. In his first months of incarceration at Riverview, my father would exhibit “resentment” and “hostility.” Which seems understandable.
But when one doctor, in a rare gesture, talked to him while he was under the effects of amytal (sometimes known as “truth serum”) Harold apparently “expressed appreciation for the fact he had someone who would listen sympathetically to his story.”
There is no doubt schizophrenia is a difficult condition, but we now know it’s something from which many can recover. To get to the point, however, I have to declare that within a few months of his seemingly endless rounds of shock therapies in 1954, my father ended up becoming, for most of the rest of his life, what could be uncharitably described as a zombie.
Riverview notes about him in 1955 and after describe him as “very vague and uninterested,” “apathetic,” “withdrawn and secluded,” “staring into space” and “wandering the halls and vestibules.”
In other words, he didn’t get a chance.
Most of the time I’m not too angry about my dad’s tragic life.
That was then. That was when the medical profession was in an almost total fog about how to treat mental illness, particularly the signs of schizophrenia my father exhibited a few years after returning from driving an ambulance in the Second World War. He earned a bachelor of commerce degree from the University of B.C., married my mother, Mary, had two sons and worked as an accountant. Then something mysteriously flipped in his mind.
Reading my father’s medical history — which I obtained with his consent through his psychiatrist, before he died in 1999 — has left me with many questions. They include ethical concerns about the best ways to respond to past wrongs, and especially about how to discern possible grave mistakes being perpetrated today, in medicine and beyond.
I have written about the Sunday visits my mother, brother and I had with my father at Riverview and at my grandparents’ house, but now, after willing myself to read 100 or so pages of his medical records, I am wondering how far offspring should go when their parents have suffered mistreatment.
It is the age of political apologies. But is that what I want in regard to the grim folly that was lithium shock therapy, and thencrude electro-shock treatments, which were brutally inflicted on patients without anesthetics?
It’s not lost on me that family members of former adult and child patients at Woodlands mental institution in New Westminster, which closed in 1994, went to battle for more than a decade and, as recently as this year, obtained $10,000 each in compensation for their loved ones.
Should I be campaigning for a collective apology and compensation?
After all, there is a strong possibility my father’s various shock treatments contributed to him, and possibly hundreds of thousands of other North Americans, never having a real opportunity to get well.
Many early survivors of lithium and other shock therapies suffered permanent brain damage. Some medical staff even judged that was an “improvement,” because at least the patients showed “loss of tension and hostility.” The death rate for those who had lithium shock treatment was up to five per cent.
Harold’s ward notes do not suggest staff were cruel for the sake of it. Apparently desperate to do something, anything, they followed the psychiatric procedures of their era. Indeed, some were observant: Their descriptions resonate with how I experienced my father.
During his almost two offand-on decades in Riverview, which ended in 1973 when he was transferred to a B.C.government-funded boarding home in Kitsilano, Riverview staff noted how he would “rarely look directly at the person who was speaking ” and often seemed “vague” and “unconcerned.”
The notes of the presumably well-meaning staff at Riverview, which had more than 4,000 patients in those days, also captured how Harold’s “personal hygiene and grooming are good” and how, about a year after his shock treatments ended, he “plays a good game of badminton and is slightly more cheerful.”
A few empathetic phrases even show up, including about how Harold “suffered” during his shock treatments. That fits with my recent discovery, via Yale University’s medical historian Deborah Doroshaw, that many North American staff who had earlier taken part in lithium shock therapies “are often ashamed.”
There were, however, signs of vindictiveness. In March 1956, a Dr. R. Parkinson, writing about Harold, referred to how this “schizophrenic university graduate continues in his lazy attitude. … He cannot be considered recovered; he is in fact flat, apathetic and lacks initiative. His wife is inquiring concerning his discharge, and my feeling is that if she really wants him, she can have him.”
Parkinson sometimes put my father in a locked ward as “a form of punishment” when he was reluctant to work in the hospital laundry.
As for the staff ’s judgment on the effectiveness of their shock therapy, there was a fleeting note in the first few weeks suggesting an “improvement.” Such hope was not to be repeated. By November 1955, one psychiatrist blandly concluded: “This patient does not seem to have gained any real improvement following his course of coma insulin.”
By then, long-term damage appears to have been done to my father’s mind — and I’ll probably never know whether it was caused by the condition itself, the shock therapies, the stress of war and life, the grim institutionalization or some combination of it all. He passively lived out his last decades in the boarding home, where I continued my Sunday visits.
One psychiatrist would eventually describe Harold as a “chronic burnt-out schizophrenic case,” who had no overt psychotic symptoms (such as delusions). Instead, Harold simply exhibited what are known as the “negative” symptoms of schizophrenia, which the psychiatrist aptly described as “withdrawal and confinement to his own small world.”
What is the point of dwelling on Harold’s awful past? On the treatments that could well have ruined any chance he had of a brighter future?
I don’t really want a government apology or financial compensation, even while many in the West have adopted that approach in regard to the way their loved ones were mistreated. Politicians’ apologies seem to be growing increasingly frequent and even cynical, especially in Canada.
The former head of the University of B.C.’s Centre for Applied Ethics, however, encourages me to forge on. Michael McDonald says, even if many North Americans are developing fatigue about apologies, they can have value for some aggrieved communities, such as the country’s Aboriginals.
He also sees benefit in telling my father’s story — in being a public “witness” to an injustice that harmed many.
Two quotes come to mind. The first is Spanish philosopher George Santayana’s: “Those who cannot remember the past are condemned to repeat it.” The second is Danish Christian existentialist Soren Kierkegaard’s aphorism: “Life can only be understood backwards; but it must be lived forwards.”
In understanding my father’s treatment at Riverview, I don’t think it’s fruitful to focus on individuals’ behaviour: Most of the medical staff were following procedures of the era. It’s also not overly helpful to attack the authoritarian manner in which Riverview was run. The legacy of the Second World War, as McDonald says, was alive then: Most institutions, including schools, followed rigid rules.
What may be worthwhile, however, is, as McDonald says: “To keep asking, ‘Have we got it right?’ ”
That question applies across many fields. For instance, for several decades in the early 20th century, good people in Canada believed in eugenics, which aimed to improve the human species by discouraging reproduction by persons presumed to have inheritable undesirable traits. But then the Nazis picked up the idea.
In regard to this era, there is also a high probability we will be judged extremely harshly for our failure to reduce the fossil fuels that cause climate change. And, as McDonald says, most people are relatively sanguine about losing their privacy to those who control the internet. Maybe we will soon wake up.
What would be the present-day medical issues that most relate to the use and abuse of shock therapy treatments in the 1950s? There have been significant advances since then in humanely and effectively treating people with mental health difficulties. But the field remains fluid and inexact — and many grey areas remain.
While lithium coma treatment has been entirely discredited, electro-convulsive therapy continues — using more refined methods, which include the use of anesthetics. Even though views still vary widely on the technique, many psychiatrists firmly believe it can be beneficial for certain kinds of severe depression.
Instead, the hottest issue in mental health today, arguably, focuses on what many maintain is an over-reliance on drugs as the primary way to deal with a psychiatric diagnosis.
The enthusiasm about lithium shock therapy that prevailed six decades ago manifests itself in new ways today.
“When many treatments first come out, they’re suddenly the thing that’s going to fix everything,” says Vancouver psychiatrist Carl Wiebe.
“We should have a lot of humility,” Wiebe says. “We should be careful about criticizing what people did in the past, because even though they made mistakes they did their best. Or we hope they did. And we also need to be humble about what we’re doing today. We can’t just say we’ve got the best thing since sliced bread and it’s going to fix everything. Because it’s not.”
The most burning controversies in psychiatry today revolve around how to respond to the shocking upsurge in diagnoses of mental illness, especially clinical depression and related conditions. Many in the mental health profession believe that in response, to put it bluntly, too many pills are being pushed.
This is not the place to attempt to resolve the complex social, psychological and scientific debates over drugs, which my father used into his 60s, before his psychiatrist tapered them down to nothing — which was, amazingly, when he responded to a therapist’s urging to try his hand at painting. The main thing to point to is that a wave of critics within the mental health community are raising alarms about over-medication.
Numerous books, such as Anatomy of An Epidemic, warn of a startling rise in North Americans being diagnosed as mentally ill. Among children the rate has catapulted by 35 times. And most are automatically being given medications. Marcia Angell, former editor of the New England Journal of Medicine, is among those who have written about the crisis. And she has been criticized for it, particularly by those tied to pharmaceutical companies.
Just as physicians often overprescribe antibiotics for physical conditions that may not be serious enough to warrant them, Wiebe says too many health professionals over-prescribe drugs that affect the minds and behaviour of people who aren’t really mentally ill, but who are just going through difficult periods. Most such drugs not only have deleterious side-effects, many, as recent news stories are revealing, are highly addictive.
While Wiebe is the first to acknowledge it’s not easy to treat psychosis and other conditions, he urges medical professionals to be exceedingly leery of the glitzy billion-dollar marketing campaigns pharmaceutical companies are aiming at them, which often come with free dinners and trips.
Finally, if there is a specific mental health lesson to learn from my father’s past (mis) treatment, it may be that many patients could benefit from a more gentle approach and more talk-oriented therapy.
Harold’s ward notes show he appreciated the psychiatrist who listened to him. But even in the 21st century, most physicians and psychiatrists, with notable exceptions, are mainly handing out more medications, while understanding less about counselling.
As Johns Hopkins University’s Dean MacKinnon says in Trouble in Mind: “Medical students who go into psychiatry often have relatively little education in psychology, compared to their education in biochemistry, anatomy, genetics and physiology. … All of these factors render psychology seemingly inessential in the treatment of mental disorder.”
What’s more, many Western governments don’t offer the public access to subsidized psychological therapy. Wiebe, McDonald and others say we should be taking seriously advances in Britain, which is providing half a million people a year with treatments such as cognitive behavioural therapy. Billions of dollars are being saved, including in workplace absenteeism.
Just as there was too much faith put in shock therapies in the 1950s, today there is too much trust being put in drugs, as well as a general social reluctance to provide struggling people with evidence-based psychotherapy.
What might have happened if, by good fortune, Harold had received better treatment? We’ll never know.
But maybe he would have had a chance at a decent life. Maybe my brother and I would have had a father.
The hottest issue in mental health today, arguably, focuses on what many maintain is an overreliance on drugs as the primary way to deal with a psychiatric diagnosis.