The study found that for ECT recipients, particularly women with histories of being subjected to violence, the procedure can feel like another violation.

Note from the author: It has been difficult to write this blog, which includes my own experiences, and I invite you to consider if now is a good time for you to read this.

“I felt violated in a way that shouldn’t be possible... Over time I came to see that this was just another rape, but of my mind. Part of me was stolen, violently. ECT was abuse.” (35, Australia).

“Triggered past experiences of abuse” (48, UK).

Women also reported significantly more Adverse Childhood Experiences (ACEs) than men, notably sexual abuse (44.6% of women vs. 22.4% of men) and emotional neglect. Women did not report more recent stressors than men overall but did report the specific stressor ‘rape/sexual assault’ at 6.8% vs 1.1% for men.

“As someone with a history of childhood abuse and rape, knowing I was given ECT so many times without proper facts and other options for addressing the cause of my depression, self-harm and suicidality, feels like being raped all over again” (42, UK).

Although 59% of women believed their adversities contributed to the issues for which they received ECT, only one in four felt these were “therapeutically addressed” by mental health services. This fits with my personal experience of spending thirty years in services with multiple diagnoses before learning that what had happened to me could be the primary cause of my distress and ‘symptoms’; rather than an illness in me. My ‘treatments’ were predominantly medically focused, further reinforcing in me the incorrect, though common feeling of many survivors, that ‘I’m to blame. I’m bad. This is my shame’. In many ways I was subtly blamed for the extremes of my ‘symptoms’; told I needed to stop dwelling on the past.

The mental health system often fails to respond in ways that support survivors to heal. Women deserve non-medicalised evidence-based options and choices, not retraumatisation. Some of the participants’ descriptions of ECT explicitly fall under the category of “Abuse/Violated/Traumatised,” with one woman stating, “The abuse at the hospital was extremely triggering and worsened my PTSD” (26, Canada). And another saying “I woke up in one session not able to breathe or move. Terrifying” (68, USA).

Greater Harm, Less Consent

Women consistently reported worse outcomes than men, finding ECT significantly more harmful. They also experienced more memory loss, including both anterograde (inability to recall recent events) and retrograde (loss of memories from before treatment) amnesia. Previous research confirms women are more likely to suffer memory loss from ECT (Sackeim et al., 2007; Martin et al., 2024a; Brus et al., 2017).

Despite these heightened risks, women reported receiving less adequate information before the procedure and were less likely to give voluntary consent.

We also know that women are at greater risk of harm because of their lower seizure thresholds, which may account for their reported worse outcomes. This is a fact recognized for over 30 years and recently reaffirmed by the American Psychiatric Association (2025). As a result, the same electrical dose is likely to cause more cognitive damage in women. Additionally, women’s smaller skulls and thinner skull bones may intensify the electrical field during ECT, further increasing cognitive risks. Despite these heightened risks, women reported receiving less adequate information before the procedure and were less likely to give voluntary consent. One participant explained it was a “Trauma. Because I was scared to, but did it under pressure” (38, Australia).

• Only 49.9% of women described their involvement as “voluntary,” compared to 63.5% of men.

• More women (36.8% vs. 22.4% of men) reported giving consent under pressure.

With low reported efficacy (women were less likely to report improved mood) and high rates of adverse effects, coercion, and inadequate information, it’s unsurprising that only 15% of women, compared to 29% of men, would choose ECT again. A 28-year-old participant from Canada expresses her “Terror of experiencing it again”.

Thanks to Mad in The UK for allowing us to republish this blog.

References

American Psychiatric Association. (2025). The Practice of ECT: A Task Force Report (3rd edition). Washington, DC: A.P.A.

Beresford, P. (2020) PPI or User Involvement: Taking stock from a service user perspective in the twenty first century. Research Involvement and Engagement, 6 (36).

Brus, O., Nordanskog, P., Båve, U., Cao, Y., Hammar, Å., Landén, M., Lundberg, J., & Nordenskjöld, A. (2017). Subjective memory immediately following electroconvulsive therapy. Journal of ECT, 33, 96-103.

Burton, N. (2025) The 7 reasons why depression is more common in women. Psychology Today

Centre for Ageing Better (2023)

Chris Harrop’s Blog Post ECT: New Studies Detail Harms, Lack of Efficacy, Lack of Informed Consent - Mad in the UK

Ho, A. (2011) Trusting experts and epistemic humility in disability. International Journal of Feminist Approaches to Bioethics, 4 (2), 102-123.

Holland, S., Cook, L., Harris, C., Liennard, S.L., Malik, S., Price, Z., Rodrick, L., Speyer, E., Vaughan, R. and Williams, J. (2025) Critical reflections on public involvement in research: Involving involuntary recipients of social services to improve research quality. British Journal of Social Work, 00, 1–19.

Kuehner, C. (2017). Why is depression more common among women than among men? Lancet Psychiatry, 4, 146-158.

Martin, J., Strawbridge, R., Christmas, D., Fleming, M., Kelly, S., Varveris, D., & Martin, D. (2024a) Electroconvulsive therapy: A Scotland-wide naturalistic study of 4826 treatment episodes. Biological Psychiatry Global Open Science, 5, 100434.

NICE Guidelines on the use of ECT (2003)

NICE Guidelines on the use of ECT (2022)

Royal College of Psychiatrists UK Patient Information Leaflet

Sackeim, H., Prudic, J., Fuller R., Keilp, J., Lavori, P., & Olfson, M. (2007). The cognitive effects of ECT in community settings. Neuropyschopharmacology, 32, 244-254.

Sapouna, L. (2024) Critically unlearning about madness and distress: Reflections on social work education and activism in Ireland. International Mad Studies Journal, 2 (1).

Universal Declaration of Human Rights (Article 5)