By John Read, Sarah Price Hancock, Lisa Morrison, Lucy Johnstone, Chris Harrop, and Sue Cunliffe
Electroconvulsive Therapy
Electroconvulsive Therapy [ECT] is still used on at least a million people annually. It involves six to 12 administrations of electricity to the brain, under general anaesthesia, over several weeks, to produce grand mal seizures. It is used predominantly on women over 60 years old.
Our ECT research team comprises three English clinical psychologists, and three survivors of ECT, from England, Northern Ireland and the USA. Chris, John and Lucy have been researching ECT for years. Meanwhile, Lisa, Sarah and Sue have been publicising the damage done by ECT to themselves and many others.
Studies based on psychiatrists’ assessment of efficacy and risks invariably conclude (and often begin) with ‘ECT is safe and effective’. Studies that directly ask ECT recipients, however, produce very different outcomes.
An international survey
These patient-oriented studies are often small and easily ignored. In 2024, therefore, we ran the largest ever international survey of ECT involving over 1,100 recipients and relatives. It focussed on efficacy* and adverse effects but included questions about what information people had been given.
Patient information
We had already conducted audits on information leaflets provided by ECT clinics in England and the rest of the UK, finding minimization of risks and exaggeration of benefits. In England, most of the 36 clinics failed to tell potential recipients of the cardiovascular risks, the higher risks of memory loss for women or the lack of evidence for any long-term benefits. Most leaflets also minimized memory loss and falsely claimed that ECT corrects biological deficits that cause depression. A similar audit in Australia found similar inaccuracies.
In the first of ten papers from our online survey, just published in the Journal of Medial Ethics, we report what patients had been told. Of the 735 ECT recipients who answered ‘Were you given adequate information about ECT before having it’, 24% said ‘yes’, 59% ‘no’ and 17% were ‘not sure’.
The data relies on memory, sometimes for events many years ago, and memory loss is one of the major risks involved in ECT. So, comparing rates about different items of information may be more informative than the specific rates themselves. For example, while most (63%) recipients remembered been told ‘ECT can cause temporary memory problems’, only 17% were told ‘ECT can cause long-term or permanent memory problems’, 12% that ‘ECT can cause heart problems’, and 28% that there are ‘Risks from repeated general anaesthesia’.
Similarly, most (63%) were told ‘ECT is the most effective treatment for severe depression, (despite there not having been a single placebo-controlled trial since 1985), but only 12% were told that there is ‘No evidence ECT has any long-term benefits’ About half of both recipients and relatives reported being told ‘Depression is caused by a chemical imbalance in the brain’ (58% and 53% respectively) and ‘ECT corrects chemical imbalance or other brain abnormality’ (42% and 41%). Both statements have little or no research support. Only 21% of ECT recipients recall being told their legal rights.
Why are patients not being given a full picture of the potential risks of ECT?
Efforts to enhance practice in this domain might be facilitated by research exploring why it is that patients and their families are so often not given comprehensive, evidence-based information.
One hypothesis worth exploring is that some clinicians might not know about, or believe, the information. If so, cognitive dissonance may be a partial explanation. We are all subject to this powerful human inclination to only absorb information consistent with our existing views. As someone once said, ‘A man hears what he wants to hear and disregards the rest’ (Simon, P. 1969).
A second hypothesis is that some psychiatrists sometimes downplay ECT’s adverse effects from an understandable fear that fully informed patients and their families might decline a treatment that the psychiatrist believes is very effective, even life-saving (for which there is little robust evidence).
Finally, it might be useful to research the possible effects of financial incentives to clinicians, who may be no less susceptible to such influence than researchers.
The first two hypotheses might be explored with in-depth interviews, with absolute anonymity guaranteed. One way the third could be tested could be by comparing the information provided in countries where ECT is primarily provided free and does not impact the income of clinicians (such as in the British National Health Service) with countries where it is provided via private practice (such as the USA, where a single administration of ECT can cost $660).
The principle of Informed Consent
While awaiting such research, however, we must note that none of these hypothesised reasons justifies contravening the core ethical principle of informed consent, as stated by the World Psychiatric Association’s Code of Ethics:
‘In pursuing informed consent, psychiatrists should offer patients accurate information about their diagnoses, proposed treatments, risks, potential benefits and alternatives’.
A 2023 joint report by the World Health Organisation and United Nations stated:
‘People being offered ECT should be made aware of all its risks and potential short- and long-term harmful effects, such as memory loss and brain damage’.
The World Health Organisation’s latest guidance document on mental health has just reiterated:
‘In countries where electroconvulsive therapy (ECT) is used, this intervention must only be administered with the written or documented, free and informed consent of the person concerned’
We agree, and, therefore, end our paper with:
‘If efforts to persuade hospitals and clinics to comply with the ethical principle of informed consent by providing comprehensive evidence-based information are unsuccessful, professional, regulatory and government organizations should intervene.’
*In the same week, another paper from the survey was published:
Read J, Johnstone L, Hancock S, Harrop C, Morrison L, Cunliffe S. (2025). A Survey of 1144 ECT recipients, family members and friends: Does ECT work? International Journal of Mental Health Nursing.
Efficacy was measured in five ways. On all five, most recipients, and most relatives, reported that ECT either made no difference or made things worse.
Paper title: Why Are Patients And Families Not Told The Truth About Electroconvulsive Therapy?
Authors: John Read1, Sarah Price Hancock2, Lisa Morrison3, Lucy Johnstone4, Chris Harrop4, Sue Cunliffe4
Affiliations:
1 Department of Psychology, University of East London, UK
2 Ionic Injury Foundation
3 Lisa Morrison Training and Consultancy
4 Independent Researcher
Competing interests:
JR has been a paid expert witness in ECT legal cases in the USA, Canada and New Zealand.
Social media accounts of post author(s):
John Read:
X: @ReadReadj
Bluesky: @profjohnread.bsky.social
Sarah Price Hancock:
LinkedIn: https://www.linkedin.com/in/sarahpricehancock
X: @PsychRecovery
Facebook: https://www.facebook.com/PsychRecoveryandRehab
YouTube: @SarahPriceHancock
Lisa Morrison:
X: @LisaTMSA,
Bluesky: @lisatmsa.bsky.social
LinkedIn: www.linkedin.com/in/lisatmorrison
Chris Harrop:
X: @Chris_E-Harrop