The Nation: The Most Common Mental Disorder

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No one knows why the treatment helps, but it usually does. Boston Psychiatrist Robert Arnot theorizes that "when an intense, hard-driving person overdrives himself, the nervous system just won't turn off; shock turns off the mind and stops the patient from thinking about whatever it is that he is preoccupied with." Other experts suggest that the shock somehow shakes up the brain so that "things fall back into their normal places." It is largely because of the lack of scientific understanding about its workings that many psychiatrists distrust the treatment.

There has been a general decline in the use of shock therapy since the 1950s, when various antidepressant drugs such as Marplan and Thorazine came into wide use. Although their effect generally takes place more slowly, they do not present the doctor with the problem of first having to combat his patient's fear of the treatment, as in the case of shock. In treating depression, psychotherapy is always used by psychiatrists, sometimes in combination with shock or drugs. Prevailing medical sentiment seems to have shifted to the idea that shock therapy ought to be only an emergency measure or one of last resort, on the theory that psychotherapy alone can get at the underlying causes of the depression, however elusive they may be. This was not as much the case in 1960, however, when Eagleton first underwent treatment, and it has still not persuaded many doctors and hospitals.

Fast. In medical circles, both St. Louis' Barnes Hospital and Minnesota's Mayo Clinic have a reputation for liberal use of shock therapy; thus the fact that Eagleton was treated by shock at those institutions does not necessarily indicate that his depression was severe. Shock is often preferred by politicians and others in the public eye because it is faster than psychiatric counseling (also cheaper: about $55 a treatment). The American Psychiatric Association claims that electroconvulsive therapy is effective in at least 90% of the depression cases in which it is carefully used, "sometimes in a matter of days and virtually always within a month."

While no psychiatrist can comment intelligently on Eagleton's case without knowing him and without the full disclosure of his records, some say he might well fit a fairly common depression syndrome: the ambitious, energetic and successful person who at moments of achievement envisions even higher goals that seem depressingly out of reach. It is, oddly, an illness of the ablest. Says Washington Psychiatrist Zigmond Lebensohn of Eagleton: "The very fact that he reached out for help is healthy." While recurrence of depression cannot be ruled out, the fact that Eagleton has gone six years without treatment and has performed effectively in office makes it less likely. Lebensohn says he treated high political figures as long as 20 years ago without noting any later ineffectiveness among them. Some psychiatrists even say that Eagleton may be less likely to break under pressure than those who have never undergone such therapy. A period of depression, the A.P.A. panel insists, does not permanently impair a person's judgment.