 recipients has delivered stark findings relating to women’s experiences){kind=link}
A new international survey of 858 electroconvulsive therapy (ECT) recipients has delivered stark findings relating to women’s experiences of this controversial procedure. The paper explicitly demonstrates that the widespread use of ECT on women needs to be understood from a trauma-informed perspective.
I am a co-author of this paper, a woman who has received ECT multiple times and a survivor of abuse. It has been devastating to learn how other women have been harmed, but I am grateful that our voices are being heard. The survey reveals that 73% of participants who received ECT were women. We cannot hear these stories without being compelled to act. And while people also report positive, even life-saving experiences of ECT, psychiatry continues to ignore those harmed and fails to prevent future harms.
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.
The Disproportionate Use on Women
Why this disproportionate use? While higher rates of depression in women are often cited as an explanation, the study found that women were more often given ECT across all diagnostic groupings, including bipolar disorder and psychosis/schizophrenia. The explanation that women have higher rates of depression may lie in long-established evidence about the root causes of women’s distress often not addressed by traditional psychiatry:
- A major explanation for the sex difference in depression is that women are subjected to more stressors and depressing events and circumstances than men (Burton, 2025).
- Gender inequality and heightened exposure to severe adversity, particularly childhood sexual abuse and violence, are strongly linked to the gender gap in depression rates (Kuehner, 2017).
- Older women – the largest group of ECT recipients – are among the most marginalised in society. For example, people aged 60 to 65 in the UK have the highest poverty rates among adults of any age (2023, Centre for Ageing Better).
In this context, the study found a striking power dynamic, with 81% of psychiatrists giving ECT being men. A male psychiatrist treating a female patient was 13 times more likely than a female doctor treating a male patient (a figure that soared to 25 times more likely in the USA). The research paper provides further context for these figures. While there is no implication of conscious sexism on the part of prescribers, this finding raises uncomfortable questions about the replication of power imbalances and abuses.
One participant, aged 50 from the UK, said she felt “Retraumatised. Held down and body ‘done to’ against my will”. As a survivor myself of both abuse and ECT, these women’s voices haunt me. I don’t want anyone else to feel this way. More quotes describing participants’ actual experience of ECT are given below.
This has been my experience. I could not have given informed consent because I wasn’t given accurate information. NICE (2003; 2022) guidelines stipulate various steps which must be taken if a person hasn’t responded well to ECT previously. And yet I had my fourth, fifth and sixth course (12 sessions each time) despite becoming increasingly unwell and continuing to be suicidal. When I was most vulnerable, my rights were not protected.
ECT as Retraumatisation
The study found that for ECT recipients, particularly women with histories of being subjected to violence, the procedure can feel like another violation.
“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).
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”.
An Urgent Call for Change
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!”
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 hasn’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.
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.
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, https://www.psychologytoday.com/gb/blog/hide-and-seek/201205/the-7-reasons-why-depression-is-more-common-in-women?eml
Centre for Ageing Better (2023) https://ageing-better.org.uk/sites/default/files/2025-03/The-State-of-Ageing-2025-interactive-summary.pdf
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) https://www.nice.org.uk/guidance/ta59/resources/guidance-on-the-use-of-electroconvulsive-therapy-pdf-2294645984197
Morrison, L., Cunliffe, S., Hancock, S. P., Harrop, C., Johnstone, L., & Read, J. (2025). Electroconvulsive therapy and women: An international survey. Health Care for Women International, 1–29. https://doi.org/10.1080/07399332.2025.2568222
NICE Guidelines on the use of ECT (2022) https://www.nice.org.uk/guidance/ng222/chapter/recommendations#electroconvulsive-therapy-for-depression
Royal College of Psychiatrists UK Patient Information Leaflet https://www.rcpsych.ac.uk/docs/default-source/mental-health/treatments-and-wellbeing/ect-files/electroconvulsive-therapy-information-resource—3-march-2022.pdf?sfvrsn=ffb14a24_2
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) https://www.un.org/en/about-us/universal-declaration-of-human-rights
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Mad in the UK hosts blogs by a diverse group of writers. The opinions expressed are the writers’ own.