Criticisms of ECT Laid Bare: Dr. Gergel's Commentary in BJP

In the British Journal of Psychiatry is this commentary:

The pdf is here.

And an excerpt from from the text:

The first question must surely be motivation. Around 1.4 million people worldwide receive ECT annually.1 In psychiatric terms, ECT is relatively costly and complex, involving general anaesthesia in most countries, with estimates of annual treatment costs that ‘can exceed $10 000’. 14 If, after 80 years of ECT, there really was no evidence for effectiveness, why would healthcare providers continue funding ECT and what would psychiatrists stand to gain, especially in the face of such acrimonious criticism? 

Moreover, claiming that psychiatry knowingly inflicts an invasive medical treatment with potentially serious side-effects and no evidence of substantive therapeutic benefits implies a global breach of core medical ethical principles. Not only would this violate both beneficence and nonmaleficence, but also justice, through allocating limited resources to expensive and ineffective treatments. Moreover, deliberately misleading patients about therapeutic benefits would surely negate ‘informed’ consent and autonomous decision-making concerning treatment. Although psychiatry may sometimes involve errors of clinical judgement, the idea that so many medical practitioners are complicit in breaching fundamental professional ethics seems implausible and devoid of apparent motivation.

This is a wonderful commentary that carefully debunks the major criticisms of anti-ECT activists. Tania Gergel, PhD, is a Wellcome Trust Senior Research Fellow at King's College, London. Her main area of interest is mental health ethics and law. She has published widely about patient capacity, advanced directives and involuntary treatment.

An accompanying brief editorial in BJP will be the subject of another blog post.

My only (minor) critique of this commentary is the reliance on UK statistics for the discussion of involuntary treatment; absolute numbers of ECT treatments in the UK are so small compared to many other countries that using the UK as an example may not be generalizable. But it is the British Journal of Psychiatry....

I strongly recommend a full and careful read of this piece to all healthcare professionals involved in ECT, ~15 minutes.