The survey’s findings demand greater awareness of sex differences in risks, seizure thresholds, and outcomes, which must be explicitly communicated to female patients. Critically, we must prioritize evidence and rights-based supports for helping people heal from trauma and address the societal stressors, violence, and inequalities causing women’s distress. We must stop subjecting them to treatments that can replicate and compound existing trauma. “First, do no harm!”

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.

We also need to challenge systemic power imbalances that legitimise certain voices whilst diminishing and marginalising others. Women are disproportionately affected.

ECT does not meet modern standards of evidence-based medicine and people’s rights are being ignored.

In the UK, the Royal College of Psychiatrists state in their patient information leaflet about ECT that whilst they do their best to provide accurate information, they “can make no representations, warranties, or guarantees, whether express or implied, that the content in this resource is accurate, complete or up to date”. And yet they can give a treatment that induces a seizure in the brain, with no consensus about dosage and no definitive explanation for how it works.

They acknowledge that ongoing research is needed to understand more. In 2003, NICE demanded urgent research. This has not been done. Anybody who values evidence-based medicine should be strongly advocating for a series of randomised placebo-controlled studies, which haven’t happened for over 40 years. Leading UK clinical psychologist and researcher Professor Richard Bentall has repeatedly offered to run such a study. (Read more in Chris Harrop’s blog post).

Is this an acceptable standard for people who could potentially be left with permanent memory loss and brain damage, careers thwarted, and families torn apart? A ‘treatment’ that can be given involuntarily with life-altering consequences? Women, like me, not getting the help and support needed to heal from rape and abuse; retraumatised.

People have a right to life, safety and freedom from degrading treatment (Universal Declaration of Human Rights, Article 5). Yet a participant, 47 years old, from Sweden says she has “Severe trauma from the experience” whilst another, 26, from Denmark, reports “Trauma due to compulsory ECT”. Psychiatry and other governmental and regulatory bodies are failing to provide those in significant states of distress the same standard of healthcare as those with other health problems, with women disproportionately affected. There is an ethical duty on prescribers to ensure their patients are fully informed of all risks and benefits and to advocate for parity in standards of care and treatment.

Healthcare professionals often assume superior knowledge, pathologizing experiences in ways that foster paternalistic behaviour and erode autonomy

In the context of power and privilege, it’s interesting that the survey’s findings have been outright dismissed or deemed a “low form of evidence,” by some professionals who argue ECT is a completely safe, effective and life-saving treatment. Patient voices are purportedly integral to mental health service design and delivery, as is person-centred care and treatment. But we know that those who have more difficult experiences and are critical of services are often excluded (Beresford, 2020). People labelled as “mentally ill” have historically been undermined by professional and academic disciplines (Sapouna, 2024). Healthcare professionals often assume superior knowledge, pathologizing experiences in ways that foster paternalistic behaviour and erode autonomy (Ho, 2011). Structural oppression and dehumanising systems affect those working in and those needing services. But those deemed ‘mentally ill’ hold the least power. Dismissing the experiences of those harmed is yet another form of silencing that so many survivors of abuse know only too well.

The study acknowledges its limitations, for example that we may not have achieved a representative sample of participants with positive, mixed, and negative ECT experiences. However, it is one of the very few studies, and certainly the largest, which provides hundreds of participants the opportunity to share more negative experiences, which are often not asked about. As someone who has spent over thirty years as a patient in the mental health system, I know that at the time, my voice lacked the credibility of the “professionals” who treated me. Involving those who have actually lived what is being studied adds value on multiple levels, but too often power inequalities perpetuate and compound harm from past experiences (Holland et al., 2025). As such I am deeply grateful for the opportunity to have been an equal partner in this research team, alongside two other women who have also had ECT, and three clinical psychologists.

This work is part of my journey as I continue to make sense of and heal from what happened to me. It has been lifesaving to have had the choice to understand my suffering not as an illness, but as an understandable response to traumatic events. But while ECT continues in its current form, with only the positive experiences being listened to (valid as they may be) and the ‘evidence’ used selectively, women will continue to be disproportionately harmed. As one of the study participants said, “I live in fear of this happening to me again. Just 2 years ago I narrowly missed being detained by psychiatry and my GP was saying she thought I should have ECT. I was terrified” (31, Australia).

Violence, abuse and inequality remove choice and destroy lives. We cannot allow a system that is meant to help and support people to instead continue to ignore their rights. And yet it does.

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)