ECT Patients Not Asked About Causes of Their Problems

Electroconvulsive therapy [ECT] involves administering electricity to the human brain, under general anaesthetic, in order to cause grand mal convulsions. A typical course of ECT involves six to 12 treatments over three or four weeks. Although its use has reduced since its peak in the 1970s and 1980s, it is still given to approximately a million people annually, predominantly women and older people.

The first study to ask ECT patients what they thought caused the mental health problems for which ECT was prescribed has only just been published.¹ The paper also reports whether mental health services ever asked about, or therapeutically addressed, those causes.

A survey, designed by a research team of three ECT recipients and three Clinical Psychologists, including myself, was responded to by 858 ECT recipients and 286 family members and friends, from 44 countries.

Most of the ECT recipients (84%) reported childhood adversities, such as emotional neglect or physical and sexual abuse. Of those, 78% believed these adverse experiences contributed to the problems for which ECT was prescribed. Yet only 32% said mental health services had ever asked about these adversities, and only 30% felt they had been “therapeutically addressed.”

Recent stressors also went largely unrecognised. Some 81% of ECT recipients reported at least one significant stressor in the six months before treatment, most commonly loneliness or coercive/emotional abuse. 67% believed these stressors played a role in their difficulties, but only 34% were asked about them, and just 21% felt they had been addressed.

The paper¹ concludes:

“Mental health professionals should ensure that patients are asked about the life events and circumstances they believe contributed to the difficulties for which ECT is being considered and offered some help with them.”

The findings are consistent with numerous previous studies showing that, because of the dominance of a narrow biomedical approach, mental health services rarely ask about childhood adversities such as sexual abuse or neglect. My review of the research, with colleagues at the University of East London, found that between 0% and 22% of mental health service users report ever being asked about child abuse by mental health staff.²

This recent study, however, is a particularly disturbing example of what happens when human distress and despair are medicalised and seen as symptoms of a "mental illness" to be treated biologically. How can electricity and seizures possibly address child abuse and neglect, domestic violence, or loneliness?

Our findings are a stark wake-up call for a system urgently in need of a fundamental paradigm shift. The survey findings align with United Nations and World Health Organization concerns that mental health systems are neglecting social determinants such as poverty, violence, and discrimination.

My co-authors and the UK mental health charity Mind, provided comments for the University of East London’s media release about the research.

Co-author Sue Cunliffe, herself an ECT recipient, said:

“The hopelessness and entrapment caused by domestic abuse gave me just one option, suicide, to ease the pain. For that, I was given ECT and ended up so brain-damaged I had to give up my job as a doctor. In a recent report, my GP wrote ‘domestic abuse misdiagnosed and ECT given in error … causing brain damage’.”

Another co-author, Sarah Hancock, also an ECT recipient, added:

“The results of our ECT patient survey highlight the absence of routine identification and treatment of the real causes of our symptoms. These results demonstrate I am far from the only person prematurely prescribed ECT without finding out what was really going on and what I really needed.”

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Rosie Weatherley, Information Content Manager for Mind, the UK’s largest mental health NGO said:

“Mind echoes concerns raised by this research — the evidence base for ECT has never been fit for purpose, and this latest study further substantiates the need for a rethink about whether and when this treatment is offered to patients.”

We hope these findings will encourage a radical rethink of mental health support, one that moves beyond diagnosis and invasive procedures to a more holistic, trauma-informed approach to addressing the social context of distress.

The results from the survey about other ECT topics have also been published and summarised at Psychology Today, including efficacy,³ memory loss,⁴ other adverse effects,⁵ information given to patients and families,⁶ and sex differences.⁷