{"id":4688,"date":"2025-08-15T09:00:51","date_gmt":"2025-08-15T08:00:51","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4688"},"modified":"2025-11-03T01:56:25","modified_gmt":"2025-11-03T00:56:25","slug":"why-are-patients-and-families-not-told-the-truth-about-electroconvulsive-therapy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/08\/15\/why-are-patients-and-families-not-told-the-truth-about-electroconvulsive-therapy\/","title":{"rendered":"Why are patients and families not told the truth about electroconvulsive therapy?"},"content":{"rendered":"<p>By John Read, Sarah Price Hancock, Lisa Morrison, Lucy Johnstone, Chris Harrop, and Sue Cunliffe<\/p>\n<p><strong>Electroconvulsive Therapy<\/strong><\/p>\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=wRWT_UZus94\">Electroconvulsive Therapy<\/a> [ECT] is still used on at least <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22741102\/\">a million people annually<\/a>. 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 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29052308\/\">women over 60 years old<\/a>.<\/p>\n<p>Our ECT research team comprises three English clinical psychologists, and three survivors of ECT, from England, Northern Ireland and the USA. <a href=\"https:\/\/www.sciencegate.app\/document\/10.1891\/ehpp-d-21-00003\">Chris<\/a>, <a href=\"https:\/\/www.uel.ac.uk\/about-uel\/staff\/john-read\">John<\/a> and <a href=\"https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/09638239917652\">Lucy<\/a> have been researching ECT for years. Meanwhile, <a href=\"http:\/\/www.lisamorrison.co.uk\/\">Lisa<\/a>, <a href=\"https:\/\/sdsu.zoom.us\/rec\/play\/PbJgcGVjLQb6Vo-0cJCC2k-9bJRk7-aG7lEJzicnvAyCSy1GQk8xXyD9c3C_k_pFoR-yFPeveOL2S48-.27JB29lR8Eh1xvGZ?fbclid=IwZXh0bgNhZW0CMTEAAR3c-2PLadePYGVPp4kG54JxJ72ElH8cQnVK3LDv2qmcZSpYV2fzXpGr4Sw_aem_1fKhK0Yh6FV98_vdHId8XA\">Sarah<\/a> and <a href=\"https:\/\/youtu.be\/lFBZ9Ukc71I?si=1XknsI9r9sZPWTfR\">Sue<\/a> have been publicising the damage done by ECT to themselves and many others.<\/p>\n<p>Studies based on psychiatrists\u2019 assessment of efficacy and risks invariably conclude (and often begin) with \u2018ECT is safe and effective\u2019. Studies that directly ask ECT recipients, however, produce <a href=\"https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/09638237.2020.1739244\">very different outcomes<\/a>.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>An international survey<\/strong><\/p>\n<p>These patient-oriented studies are often small and easily ignored. In 2024, therefore, we ran the <a href=\"https:\/\/www.psychologytoday.com\/gb\/blog\/psychiatry-through-the-looking-glass\/202401\/international-survey-of-electroconvulsive-therapy\">largest ever international survey<\/a> 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.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Patient information<\/strong><\/p>\n<p>We had already conducted audits on information leaflets provided by ECT clinics in <a href=\"https:\/\/www.sciencegate.app\/document\/10.1891\/ehpp-d-21-00003\">England<\/a> and <a href=\"https:\/\/bpspsychub.onlinelibrary.wiley.com\/doi\/full\/10.1111\/papt.12481\">the rest of the UK<\/a>, finding minimization of risks and exaggeration of benefits.\u00a0 In England, most of the 36 clinics failed to tell potential recipients of <a href=\"https:\/\/www.psychologytoday.com\/gb\/blog\/psychiatry-through-the-looking-glass\/202409\/electroconvulsive-therapy-has-significant-cardiac\">the cardiovascular risks<\/a>, the <a href=\"https:\/\/www.nature.com\/articles\/1301180\">higher risks of memory loss for women<\/a> or the <a href=\"https:\/\/repository.uel.ac.uk\/download\/6f15f49c4021ee397aef1abbb71a8fac6d4fac1347ae4eab733d3ccaedf9a30d\/892186\/ECT%20REVIEW%20RESUBMISSION.pdf\">lack of evidence for any long-term benefits<\/a>. Most leaflets also minimized <a href=\"https:\/\/www.nature.com\/articles\/1301180\">memory loss<\/a> and falsely claimed that ECT corrects biological <a href=\"https:\/\/www.cambridge.org\/core\/journals\/psychological-medicine\/article\/abs\/depression-why-drugs-and-electricity-are-not-the-answer\/3197739131D795E326AE6913720E6E37\">deficits that cause depression<\/a>. <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/inm.13318\">A similar audit in Australia<\/a> found similar inaccuracies.<\/p>\n<p>In the first of ten papers from our online survey,<a href=\"https:\/\/jme.bmj.com\/content\/early\/2025\/06\/03\/jme-2024-110629\"> just published in the Journal of Medial Ethics<\/a><strong>,<\/strong> we report what patients had been told. Of the 735 ECT recipients who answered \u2018Were you given adequate information about ECT before having it\u2019, 24% said \u2018yes\u2019, 59% \u2018no\u2019 and 17% were \u2018not sure\u2019.<\/p>\n<p>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 \u2018ECT can cause temporary memory problems\u2019, only 17% were told \u2018ECT can cause long-term or permanent memory problems\u2019, 12% that \u2018ECT can cause heart problems\u2019, and 28% that there are \u2018Risks from repeated general anaesthesia\u2019.<\/p>\n<p>Similarly, most (63%) were told \u2018ECT is the most effective treatment for severe depression, (despite there <a href=\"https:\/\/www.psychologytoday.com\/gb\/blog\/psychiatry-through-the-looking-glass\/202008\/80-years-do-we-know-if-electroconvulsive-therapy\">not having been a single placebo-controlled trial since 1985<\/a>), but only 12% were told that there is <a href=\"https:\/\/connect.springerpub.com\/content\/sgrehpp\/21\/2\/64\">\u2018No evidence ECT has any long-term benefits\u2019<\/a> About half of both recipients and relatives reported being told\u00a0 \u2018<a href=\"https:\/\/www.nature.com\/articles\/s41380-022-01661-0\">Depression is caused by a chemical imbalance in the brain\u2019<\/a> (58% and 53% respectively) and \u2018ECT corrects chemical imbalance or other brain abnormality\u2019 (42% and 41%). <a href=\"https:\/\/www.nature.com\/articles\/s41380-022-01661-0\">Both statements have little or no research support<\/a>. Only 21% of ECT recipients recall being told their legal rights.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Why are patients not being given a full picture of the potential risks of ECT?<\/strong><\/p>\n<p>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.<\/p>\n<p>One hypothesis worth exploring is that some clinicians might not know about, or believe, the information. If so, <a href=\"https:\/\/www.psychologytoday.com\/gb\/basics\/cognitive-dissonance\">cognitive dissonance<\/a> 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, \u2018A man hears what he wants to hear and disregards the rest\u2019 (Simon, P. 1969).<\/p>\n<p>A second hypothesis is that some psychiatrists sometimes downplay ECT\u2019s 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 <a href=\"https:\/\/www.youtube.com\/watch?v=JrT3G_utaD8&amp;t=537s\">(for which there is little robust evidence)<\/a>.<\/p>\n<p>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 <a href=\"https:\/\/www.bmj.com\/content\/326\/7400\/1167\">researchers.<\/a><\/p>\n<p>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 <a href=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/fiscal-year-2025-medicare-inpatient-psychiatric-facilities-prospective-payment-system-ipf-pps-and\">cost $660<\/a>).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>The principle of Informed Consent<\/strong><\/p>\n<p>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\u2019s Code of Ethics:<\/p>\n<p>\u2018In pursuing informed consent, psychiatrists should offer patients accurate information about their diagnoses, proposed treatments, risks, potential benefits and alternatives\u2019.<\/p>\n<p><a href=\"https:\/\/www.who.int\/publications\/i\/item\/9789240080737\">A 2023 joint report<\/a> by the World Health Organisation and United Nations stated:<\/p>\n<p>\u2018People 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\u2019.<\/p>\n<p>The World Health Organisation\u2019s <a href=\"https:\/\/www.who.int\/news\/item\/25-03-2025-new-who-guidance-calls-for-urgent-transformation-of-mental-health-policies\">latest guidance document on mental health<\/a> has just reiterated:<\/p>\n<p>\u2018In 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\u2019<\/p>\n<p>We agree, and, therefore, end <a href=\"https:\/\/jme.bmj.com\/content\/early\/2025\/06\/03\/jme-2024-110629\">our paper<\/a>\u00a0with:<\/p>\n<p>\u2018If 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.\u2019<\/p>\n<p>&nbsp;<\/p>\n<p>*In the same week, another paper from the survey was published:<\/p>\n<p>Read J, Johnstone L, Hancock S, Harrop C, Morrison L, Cunliffe S. (2025). <a href=\"http:\/\/dx.doi.org\/10.1111\/inm.70109\">A Survey of 1144 ECT recipients, family members and friends: Does ECT work?<\/a> International Journal of Mental Health Nursing.<\/p>\n<p>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.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Paper title: <\/strong><a href=\"http:\/\/Why Are Patients And Famiies Not Told The Truth About Electroconvulsive Therapy\">Why Are Patients And Families Not Told The Truth About Electroconvulsive Therapy?<\/a><\/p>\n<p><strong>Authors<\/strong>: John Read<sup>1<\/sup>, Sarah Price Hancock<sup>2<\/sup>, Lisa Morrison<sup>3<\/sup>, Lucy Johnstone<sup>4<\/sup>, Chris Harrop<sup>4<\/sup>, Sue Cunliffe<sup>4<\/sup><\/p>\n<p><strong>Affiliations: <\/strong><\/p>\n<p>1 Department of Psychology, University of East London, UK<\/p>\n<p>2 Ionic Injury Foundation<\/p>\n<p>3 Lisa Morrison Training and Consultancy<\/p>\n<p>4 Independent Researcher<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Competing interests: <\/strong><\/p>\n<p>JR has been a paid expert witness in ECT legal cases in the USA, Canada and New Zealand.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Social media accounts of post author(s): <\/strong><\/p>\n<p>John Read:<\/p>\n<p>X: @ReadReadj<\/p>\n<p>Bluesky: @profjohnread.bsky.social<\/p>\n<p>&nbsp;<\/p>\n<p>Sarah Price Hancock:<\/p>\n<p>LinkedIn:\u00a0 https:\/\/www.linkedin.com\/in\/sarahpricehancock<\/p>\n<p>X: @PsychRecovery<\/p>\n<p>Facebook: https:\/\/www.facebook.com\/PsychRecoveryandRehab<\/p>\n<p>YouTube: @SarahPriceHancock<\/p>\n<p>&nbsp;<\/p>\n<p>Lisa Morrison:<\/p>\n<p>X: @LisaTMSA,<\/p>\n<p>Bluesky: @lisatmsa.bsky.social<\/p>\n<p>LinkedIn: www.linkedin.com\/in\/lisatmorrison<\/p>\n<p>&nbsp;<\/p>\n<p>Chris Harrop:<\/p>\n<p>X: @Chris_E-Harrop<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/08\/15\/why-are-patients-and-families-not-told-the-truth-about-electroconvulsive-therapy\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":503,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8053,8078],"tags":[],"class_list":["post-4688","post","type-post","status-publish","format-standard","hentry","category-consent","category-psychology"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Why are patients and families not told the truth about electroconvulsive therapy? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/08\/15\/why-are-patients-and-families-not-told-the-truth-about-electroconvulsive-therapy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Why are patients and families not told the truth about electroconvulsive therapy? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"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. 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It involves six to 12 administrations of electricity to the brain, under general anaesthesia, over several weeks, to produce grand mal seizures. 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