Amesty, Osgood file bills to ban autism therapy for kids

Updated 10/31/23 to reflect Sen. Rosalind Osgood's comments. 

Republican state Rep. Carolina Amesty, on Monday filed House Bill 255, which would mandate that only physicians be allowed to perform both electroconvulsive therapy (ECT) and psychosurgical procedures and that those treatments not be available to minors. ECT has recently been shown to be highly effective for treating children and teens with severe autism, especially the one in four with extreme self-injury behaviors who are compelled to bang their heads and bite, pinch and scratch themselves until they bleed. 

Amesty, who’s been dogged by recent controversies about unpaid bills and taxes and her family’s Christian university as well as funneling $3 million to a small Hispanic Chamber of Commerce in Key Biscayne, represents District 45, including Windermere and Winter Garden.

Democratic state Sen. Rosalind Osgood, who represents parts of Broward County in South Florida, filed the identical bill in the Senate. 

"Safeguarding Florida’s families has always been my top priority,” Amesty said in an emailed statement. “After learning more about this issue from Senator Osgood and the Citizens Commission on Human Rights, I felt compelled to do my part to enact positive change in the legislature. We serve the people of Florida best by working together on bipartisan initiatives that improve the lives of children.”

The Citizens Commission on Human Rights was founded by the Church of Scientology. The anti-psychiatry nonprofit hosts the Psychiatry: An Industry of Death Museum at its Hollywood, CA, headquarters and produces videos like Therapy or Torture: The Truth About Electroshock, promoted on its site. The video is filled with hyperbolic misinformation: that ECT puts patients in restraints, uses 460 volts and causes 30-minute seizures. 

What Is ECT?

Long considered a safe, effective treatment for major depression and severe mood disorders that have not responded to treatments like talk therapy and medication, ECT involves stimulating the brain with brief pulses of low-level electricity — lower than a 9-volt battery — to induce a 30- to 90-second seizure while a patient is sedated. It’s the seizure that “corrects the biological abnormalities” that cause psychiatric disorders, according to UCLA Health. During the procedure, patients are anesthetized and given an intravenous muscle relaxant so they don’t feel the electrical pulses or the seizure. 

Initial treatment typically involves several sessions followed by a maintenance schedule to manage symptoms. Patients using ECT for depression can eventually wean off treatment, although patients using it to control self-injury often need to maintain treatments. (Researchers are looking for other modalities because they are unsure of the effects of longterm ECT on children.)

Temporary memory loss is a common side effect, although the National Institute of Mental Health (NIMH) notes that the newer “unilateral” protocol, in which electrodes are positioned on the right side and top of the head — instead of both sides— has reduced the memory loss since the right side of the brain is not associated with learning and memory.

What Does This Legislation Do?

It’s unclear what the Amesty/Osgood bill is meant to accomplish as much of what it seeks to legislate is already in practice. Here are the main points:

ECT would only be performed by physicians. 

Standard practice already dictates that ECT is done with a three-person medical team: a psychiatrist (who is an MD), an anesthesiologist (also an MD) and a nurse. Some medical centers also include a neurologist, which would make a third physician on the care team. Psychosurgeries, done for a small number of conditions, are always performed by neurosurgeons.

"While that may be standard procedure, it is not current Florida law," Osgood wrote in an email to VoxPopuli. She added that this codification was "secondary to the actual purpose of the bill, which is the ban of ECT on minors." 

ECT is unproven.

According to the legislation, ECT is “an experimental technique, the efficacy of which has not definitively been proven and which has dangerous and potentially permanent harmful or life-threatening side effects, including brain damage and memory loss, the extent of which is still unknown...”

Physicians using ECT say that is not true. “ECT has been around for 85 years, so [it] clearly is not experimental,” Randall Espinoza, MD, MPH, medical director of the ECT and Interventional Psychiatry Program at Resnick Neuropsychiatric Hospital at UCLA, wrote in an email to VoxPopuli. “ECT is one of the most researched medical procedures with studies done for over eight decades.”

A meta-analysis of studies in The Lancet and research published in New England Journal of Medicine show ECT to be effective and safe while a 2019 British study reported that “most people who experience ECT and their carers report a positive perspective."

NIMH, National Institutes of Health, American Psychiatric Association, American Medical Association, Royal College of Psychiatrists, Canadian Psychiatric Association and numerous American medical centers, including Johns Hopkins, Cleveland Clinic and Mayo Clinic, all endorse ECT.

“Electroconvulsive Therapy (ECT) is a safe and effective evidence-based medical treatment,” reads the policy statement on ECT from American Psychiatric Association, developed in 2015. “ECT is endorsed by the APA when administered by properly qualified psychiatrists for appropriately selected patients.”

ECT would require informed consent. 

"There is no such thing as ECT done against a person's will anywhere in the USA. The consent of a patient/parent/legal guardian/court-appointed decision-maker is always needed and must be sought before ECT can be administered," Espinoza said in his email. "A person who retains their ability to understand their illness and then to explain and demonstrate their choices, including the consequences of doing nothing, can also refuse to receive a treatment like ECT. " 

Espinoza said that even when patients are too incapacitated by illness to give consent, "every state has a legal process for demonstrating that the patient lacks capacity before a judge or state-defined legal review process. Ironically, it is often easier for a patient to get or be rushed to brain surgery than to get ECT in some parts of the US."

ECT would be banned for kids. 

"Families may not be given all the information regarding ECT or may not realize there is little to no studies done on the lasting effects of ECT on a developing brain," said Osgood. She told VoxPopuli she did not consult any medical experts working with ECT and severely autistic children, such as Johns Hopkins researcher and psychiatrist Irving Reti, MD, a leader in the field. Osgood did say she had "discussions with the Citizens Commission for Human Rights Florida Chapter." 

The Food and Drug Administration reclassified the devices utilized during ECT for teens 13 and older in 2018. ECT has also been shown to be, in the words of one researcher, "exquisitely responsive" for treating kids who have autism with catatonia. 

In an emailed statement to VoxPopuli, Sarah H. Lisanby, MD, director of the Noninvasive Neuromodulation Unit in the Intramural Research Program at NIMH, said, “The medical literature supports the safety and efficacy of ECT in youth with certain severe psychiatric conditions, such as severe depression, catatonia, and self-injurious behaviors associated with autism.”

Espinoza said that ECT is not “routinely done on minors,” but that with certain conditions, it can be “remarkably effective and have an important role.”

Johns Hopkins researchers found one to two sessions reduced self-injury behavior in some children with severe autism by 90 percent.

“Unfortunately, the stigma and fear surrounding ECT precludes referral and access when appropriate,” Espinoza said in his email.

Why So Much Stigma?

Stigma comes from portrayals in movies like Don’t Worry, Darling and One Flew Over the Cuckoo’s Nest, which depicts an ECT protocol that hasn’t been used since the 1950s. A 2016 Belgian study found that a majority of the 23 TV programs (72 percent) and 52 films (nearly 81 percent) that included scenes of ECT, had "a negative and inaccurate image of the treatment.” Those largely stem from older protocols, when ECT was done at higher levels of electricity without anesthesia.

“Much of language around ECT is also incorrect,” Espinoza wrote in his email. “For example, shock in medicine refers to the loss of blood flow to the major internal body organs, which does not occur during ECT.  Words like barbaric and torture derive from sensationalists and inaccurate portrayals in the movies and on TV shows. There are many examples on the internet where portrayals of ECT are wrong or insinuate nefarious practices or depict deleterious consequences.”

There may also be confusion between ECT and electric shock devices used in aversive conditioning to alter behavior. The FDA banned electric shock devices in 2020 but was overturned the following year by the DC Court of Appeasl to allow a Massachusetts school to continue using them. It's the only place in the US where the devices are used. 

"ECT is not aversive conditioning, which is a different behavioral therapy used for completely distinct purposes and indications," Espinoza said.

Espinoza is in Los Angeles, so this legislation won’t impact his patients, but he sees a slew of “negative consequences” from bills like this one, which, he said interferes with the doctor-patient relationship and “do not result in improved access to care, to better ECT practices or to better patient outcomes.”