Why electroconvulsive therapy still carries a stigma

Summary

Electroconvulsive therapy is a highly effective treatment in psychiatry but still carries a stigma. One possible explanation is that it can be seen as a threat to personal autonomy.

The paper by Tania Gergel is an excellent literature review on the efficacy and side-effects of electroconvulsive therapy (ECT) as well as a gripping tale of personal experiences with mental illness.¹ This positive verdict on ECT has been supported for decades.^2,3 More recent data have consistently come to the same conclusion, which clearly represents a medical consensus.⁴ This view is also shared by the vast majority of patients who have received ECT – including a psychiatrist who successfully recovered from depression after receiving the treatment.⁵ Moreover, patients who benefit from the treatment are likely to change their minds in its favour.⁶ Add to that the fact that ECT is highly cost-effective when prescribed for people with severe depression who have failed to benefit from antidepressants.⁴ Yet a survey of practitioners found that biases against ECT were among the factors restricting its availability.⁷

Why is ECT so often vilified?

How can we explain why one of the most effective treatments in all of psychiatry has been attacked so bitterly and frequently? We cannot look for an answer from the research literature, which consistently refutes the concerns of the critics. Rather, we have to frame these issues within a larger issue: the stigma of mental illness and the threat it represents to the autonomy of our minds.⁸ In this scenario, what experts recommend can be seen as a further threat to personal autonomy.⁹ Since this sense of threat can be even more intense when the problem lies in the mind, there will probably always be some degree of stigma associated with mental illness. But as more and more people seek mental health treatment, it could eventually decrease.

Stigma has to be understood in the same way as the anti-psychiatry movement⁹ and the critical psychiatry movement,¹⁰ which both reject a long-standing medical consensus about the value of medication for severe mental illness. Here, instead of focusing on the loss of autonomy related to mental disorders, psychiatric diagnosis and treatment are seen as making matters worse by offering ‘prescribed harm’.⁹ There is also opposition from some mental health professionals, who focus on the possible harm of biological treatments, but are less critical of risks associated with psychotherapies.

What can we do about it?

In the meantime, how can we combat the stigma associated with ECT? There have been reports of the use of educational videos to change the minds of patients,¹¹ but this procedure has not been widely tested. For now, psychiatrists will bear the responsibility to educate patients who suffer from severe forms of depression, as well as their family members, about a full range of options for managing their illness.