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.

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:

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.

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).

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.