What has not ended

The first large study of memory was done in 2007. The method has been in use since 1938.

The paper opens with its own admission, verbatim: "Despite ongoing controversy, there has never been a large-scale, prospective study of the cognitive effects of electroconvulsive therapy". That was written in 2007. ECT had by then been in use for sixty-nine years.

Of 751 patients referred, 347 took part in at least one post-treatment evaluation, across seven New York facilities. The conclusion, verbatim: "adverse cognitive effects were detected 6 months following the acute treatment course".

Specifically: bilateral electrode placement produced "more severe and persisting retrograde amnesia" than right unilateral; sine wave stimulation produced pronounced slowing of reaction time, both immediately and six months later. And: "advancing age, lower premorbid intellectual function, and female gender were associated with greater cognitive deficits".

And what happened next. The damage had been measured by the field itself and published in a leading journal. The method carried on being used — and being imposed on people who do not consent. No critic is needed to say this: they measured it themselves, and they did not stop.

[64] Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. "The Cognitive Effects of Electroconvulsive Therapy in Community Settings", Neuropsychopharmacology 2007;32:244-254, DOI 10.1038/sj.npp.1301180

In use since 1938. Placebo-controlled evidence: 224 patients.

The only way to show that a treatment works beyond expectation is comparison against a sham — for ECT, anaesthesia without the current. There are eleven such trials. They are all earlier than 1986. Between them they cover 224 patients who received ECT and 187 controls.

The five meta-analyses the literature relies on draw on between one and seven of those eleven. The 2019 quality review concluded that the research as a whole "barely supports short-term benefit" and contains no indication of long-term benefit, of suicide reduction, or of greater effectiveness in older people. Its authors called for the method's immediate suspension until properly designed trials are done.

That concession is what counts. It does not come from the critics; it comes from the man defending the method. Eighty-seven years after its introduction, both sides agree that there is almost no evidence about what remains once the treatment stops. They disagree only on whether that is enough to carry on.

This page's position, without hedging. A method in use for eighty-seven years; whose entire body of controlled evidence is 224 patients from trials that stopped in 1986; whose own advocates measured persisting memory damage at six months; and whose defender concedes that we do not know what remains once it stops — has not proved what it claims. And it continues to be imposed on people who do not consent.

This is not an open scientific question. It is a practice unjustified by its own evidence.

[65] Read J, Kirsch I, McGrath L. "Electroconvulsive Therapy for Depression: A Review of the Quality of ECT versus Sham ECT Trials and Meta-Analyses", Ethical Human Psychology and Psychiatry 2019;21(2):64-103 · [66] Anderson IM. "Electroconvulsive therapy (ECT) versus sham ECT for depression: do study limitations invalidate the evidence?", BJPsych Advances 2021;27(5):285-291

There is no "UK" framework. There are three.

England and Wales: under s.58A of the Mental Health Act 1983, ECT may not be given to a patient aged 18 or over who is capable of consenting and does not consent — except where s.62 applies, that is, treatment immediately necessary to save life or, not being irreversible, to prevent serious deterioration.

Scotland: a separate and stricter regime applies under the Mental Health (Care and Treatment) (Scotland) Act 2003, where a capacitous refusal is binding and cannot be overridden. Northern Ireland differs again.

Greece: we located no ECT-specific statute; the general provisions of Articles 95–99 of Law 2071/1992 on involuntary hospitalisation apply.

And the finding that is not a number: we searched for official statistics on how often ECT is administered without consent. We found none, in any of the three countries. That a practice of this weight is not systematically recorded is itself the finding.

[48] Mental Health Act 1983, ss. 58A and 62 · [49] Mental Health (Care and Treatment) (Scotland) Act 2003 · Greek Law 2071/1992, arts 95–99 · [50] Kaliora SC et al., J ECT 2013;29(3):219-224

Chemical restraint: drugs for behaviour, not for illness

In 2007 the US HHS Office of Inspector General reviewed six months of Medicare claims and found that 14% of elderly nursing home residents had a claim for an atypical antipsychotic — 304,983 people out of 2.1 million. That 51% of those claims were erroneous, amounting to $116 million. And that 22% of the drugs claimed were not administered in accordance with the standards on unnecessary drug use.

In October 2009 a report to the responsible minister at the UK Department of Health estimated that around 180,000 people with dementia were being treated with antipsychotics each year, and that up to 36,000 would derive some benefit. The cost, verbatim: «an additional 1,620 cerebrovascular adverse events, around half of which may be severe, and an additional 1,800 deaths per year on top of those that would be expected in this frail population». That last clause matters: these are deaths in addition to the expected number, not total deaths.

And the trend line, with equal weight: both reports preceded national reform programmes, and prescribing has since fallen substantially in both countries. 2007 is not 2026.

The distinction from the sister site: psychdrugs.org covers the FDA's mortality warnings. Here the angle is restraint — a drug given to control behaviour rather than to treat illness.

[51] HHS Office of Inspector General, OEI-07-08-00150, May 2011 (review period 01.01–30.06.2007) · [52] Banerjee S, "The use of antipsychotic medication for people with dementia: Time for action", 2009

Residential programs for "troubled teens" — and why the title says non-medical

In October 2007 the Government Accountability Office testified to the House Committee on Education and Labor that it had found thousands of allegations of abuse, some involving death, at residential programs for troubled youth in the United States and at American-owned facilities abroad, between 1990 and 2007. It examined 10 closed civil or criminal cases from 1990 to 2004 in which a teenager died while enrolled in a private program.

GAO states itself that it did not verify the allegations, and that allegations should not be confused with proof of abuse. It also states that no federal agency collected comprehensive nationwide data.

The programs were wilderness therapy programs, boot camps and academies. Contributing factors GAO identified: the hiring of untrained staff and a lack of adequate oversight.

Why it appears here with an asterisk: these are largely residential settings, not psychiatric clinics, and it is a purely American matter. It is given as one exhibit, not as a pattern.

[53] US GAO, GAO-08-146T, "Residential Treatment Programs: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth", testimony 10.10.2007