By any standards many of us will probably look back on 2025 as among the world’s worst ever years. These days, when asked ’How are you doing, John?’ I feel obliged to respond not with the traditional British riposte of ‘Not too bad,’ but with a list of all the political horrors of the year, which I shall leave unnamed here.
Sometimes I feel lucky to be living in the UK. But then our government just caved in to threats from the pharmaceutical companies and the manchild and signed a ‘deal’ doubling NHS expenditure on pills and weakening our already questionable drug accreditation standards.
But the year has, nevertheless, somehow ended on a high for our little ECT research team, composed of three women who have had ECT, Sarah Hancock (USA), Sue Cunliffe (England) and Lisa Morrison (Northern Ireland) and three British clinical psychologists, Lucy Johnstone, Chris Harrop and me.
In 2024, 858 ECT recipients and 286 family members and friends, from 44 countries, responded to our online survey about their experiences of ECT. In the past two months we have managed to publish six research papers emanating from our international ECT survey. Chris and Lisa have written blogs about the first five, which are summarised in the table below.
Read J et al (2025) A large exploratory survey of ECT recipients, family members and friends: What information do they recall being given? Journal of Medical Ethics
60% of ECT recipients reported they had not been given ‘adequate information.’
Only 17% were told that ‘ECT can cause long-term or permanent memory problems’;12% ‘ECT can cause heart problems’; 28% ‘Risks from repeated general anaesthesia.’
58% of recipients (53% of relatives) were told ‘Depression is caused by a chemical imbalance in the brain.’
42% of recipients (41% of relatives) were told ‘ECT corrects chemical imbalance or other brain abnormality.’
Read J et al (2025) A survey of 1144 ECT recipients, family members and friends: Does ECT work? International Journal of Mental Health Nursing
On five different measures, 55% to 71% reported either no benefit or a negative outcome.
Percentages reporting some benefit were: helped the problem for which ECT was given, 45%; improved mood, 41%; helpful, 41%; improved quality of life, 29%; reduced suicidality, 33%.
Read J et al (2025) A survey of 1144 ECT recipients, family members and friends: Incidence, severity and duration of memory deficits. Ethical Human Psychology and Psychiatry
On four different measures, memory loss reported by 61% to 84% recipients.
65% of those reporting anterograde amnesia said it lasted for more than three years.
81% of those reporting retrograde amnesia said it lasted more than three years.
Read J, et al (2025) The adverse effects of electroconvulsive therapy beyond memory loss: An international survey of recipients and relatives. International Journal of Mental Health
17 of 25 adverse effects reported by more than half of both the ECT recipients and relatives.
8 reported by more than 67% of both groups: Losing train of thought, Difficulty concentrating, Fatigue, Emotional blunting, Relationship problems, Loss of independence, Difficulty navigating, Loss of vocabulary.
More recent ECT not associated with fewer adverse effects.
Morrison L, et al (2025) Electroconvulsive therapy and women: an international survey. Health Care for Women International
Women receive ECT more often than men.
Women suffer more memory loss and other adverse effects than men.
Women’s depression is improved less than men’s.
82% of ECT psychiatrists are men (88% in USA)
Read J et al (2025) A survey of ECT recipients, family members and friends: Are the self-reported reasons for their problems being addressed? International Journal of Mental Health Nursing
84% of recipients reported childhood adversities
Of those, 78% believed these experiences contributed to the problems for which ECT was prescribed.
Only 32% said mental health services had asked about these adversities.
Only 30% felt the adversities had been therapeutically addressed.
Similar results for recent stressors.
Paper Number Six
The most recent paper, published at the beginning of December asked, of ECT recipients and relatives, ‘Are the self-reported reasons for their problems being addressed?’
Respondents were first asked: ‘To what extent do you think the problem for which ECT was prescribed (e.g., depression) was caused by biological factors (chemical imbalance, brain disorder, genetics, etc.) vs. psychological/social factors (e.g., loneliness, stress, loss/bereavement, abuse, neglect, poverty, violence, discrimination, etc.)’. Fifty-one percent of recipients (48% of relatives) thought the causes were mostly psychosocial. Only 29% of recipients (36% of relatives) thought they were mostly biological.
Childhood Adversities
More specifically, 84% reported one or more adverse childhood adversities (including emotional, physical and sexual abuse and emotional neglect). Of those reporting childhood adversities, 78% felt that the adversities contributed to the problems for which ECT was prescribed to treat.
Crucially, however, only about a third (32%) reported ever having been asked about childhood adversities by mental health services prior to being given ECT. Furthermore, only 30% felt that the adversities had been addressed therapeutically. The only good news here is that the minority who were asked did seem to get some help for the adversities.
Recent Stressors
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 coercive/emotional abuse and loneliness. Sixty-seven percent of these believed their stressors played a role in the development of their difficulties, but only 34% were asked about them. Just 21% felt the stressors had been addressed.
Seventy-one percent of relatives concurred that recent stressors had helped to cause the problem for which ECT was prescribed (they were not asked the other questions because we thought they would not know the answers).
Psychological Therapy
Guidelines suggest that other treatments, including psychological therapy, should be tried before ECT. One in four (26%) had not tried therapy.
Recency
Results suggest that clinical practice is improving over time. On all five clinical practice variables (asking about and addressing childhood adversities ACEs and recent stressors, and psychological therapy having been tried) the mean year of last ECT was significantly more recent for affirmative responses than for negative ones.
This is good news. But it is not the same as the adverse events of ECT reducing over time, as is often claimed by that small and dwindling number of psychiatrists who still believe in the healing powers of electricity and seizures. The findings in our paper on the ‘Incidence, severity and duration of memory deficits’ found no reduction in time in the damage being done.
Methodology
An obvious potential limitation of a convenience sample like ours is that the sample may have been biased towards those with a negative view of ECT, those ‘with an axe to grind’. This is quite possible, and ECT proponents are, understandably, quick to raise this issue. They are less eager to point out that the bias could equally be in the other direction, against those with a negative experience. First, people for whom ECT had not alleviated the severe depression for which it is often prescribed might be unable to complete surveys. Second, people whose suicidality was not prevented by ECT could not participate. Third, patients who died during or soon after treatment due to a cerebral or cardiovascular event did not participate. Finally, some of those in whom ECT caused severe cognitive damage may have been unable to participate.
I would like to take this opportunity (one doesn’t mention such things in scientific journals) to reassure those ECT psychiatrists and other ECT advocates who tried to sabotage and undermine the survey on social media, by proudly announcing that they had filled out the survey several times themselves and had not been stopped from doing so, that their responses, and other duplicate responses, were, of course, deleted.
Paradigm Shift
Our finding that respondents were rarely asked the social causes of their problems is far from unique. Multiple previous studies have found that the majority of users of mental health services, internationally, are neither asked about adverse or traumatic events nor have them adequately addressed if they do disclose them.
Our findings are, however, a uniquely disturbing example of what happens when you medicalise human distress. How can electricity possibly address child abuse, or domestic violence? 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 survey findings certainly align with United Nations and World Health Organization concerns that because of the dominance of the ‘medical model,’ mental health services around the world are neglecting social determinants:
‘Mental health and well-being are strongly associated with social, economic, and physical environments, as well as poverty, violence, and discrimination. However, most mental health systems focus on diagnosis, medication, and symptom reduction, neglecting the social determinants that affect people’s mental health.’
Co-author Sue Cunliffe (England), herself an ECT recipient, comments:
‘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.”’
Co-author Sarah Hancock (USA), 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.’
Rosie Weatherley, Information Content Manager from 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 re-think about whether and when this treatment is offered to patients.’
GRATITUDE
I want to end the year by saying a huge thank you to:
The hundreds of people all over the world who took the time to fill out our survey, even
when it was distressing to recall some of the experiences.
Mind, the UK’s wonderful mental health NGO, for helping with the design and dissemination of the survey.
The many other NGOs and mental health organisations who disseminated the survey.
Everyone, anywhere, engaged in the struggle to create more humane, evidence-based, human rights oriented, trauma informed help for when we are distressed or desperate.
Everyone at Mad in America and all the other ‘Mad ins’ around the world.
The other members of our amazing little ECT group: Chris, Lisa, Lucy, Sarah and Sue.
Thank you all, for being you.
Merry Christmas and Happy Hanukkah.
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.