Examining Gender Bias and Adverse Outcomes in Psychiatric Treatment
Electroconvulsive therapy (ECT) has long been a controversial tool in the psychiatric arsenal, most commonly used to treat severe depression and other mental health conditions. But a new international survey sheds startling light on gender-based disparities in who receives ECT—and who bears its lasting consequences.
Twice as Likely to Receive ECT, Women Face Worse Outcomes
A comprehensive study led by Professor John Read of the University of East London polled 858 recipients of ECT across 44 countries. The findings are hard to ignore: women are more than twice as likely as men to be given ECT and are far more likely to experience negative outcomes. Among those surveyed, a striking 73% were women, and the vast majority of psychiatrists administering ECT (81% globally, and 88% in the USA) were men.
The gap does not end at rates of treatment. Women described higher frequencies of both short-term and long-term memory loss following ECT. Even more concerning, only 15% of women would be willing to undergo the treatment again, compared to 29% of men. The reasons, as the data and firsthand accounts reveal, encompass not only tangible adverse effects but also deeply felt emotional and psychological harm.
A Closer Look: Trauma, Consent, and Coercion
Survey participants detailed how ECT can become a source of trauma, particularly for women with histories of abuse. Many described experiences that reawakened prior trauma or left deep emotional scars. Accounts included being held down or feeling powerless during the procedure, sometimes paralleling the psychological impact of previous violations. One woman likened ECT to “another kind of rape – but of the mind,” highlighting just how profoundly the treatment can affect those already vulnerable to retraumatization.
These experiences are not isolated. Lisa Morrison, a co-author of the study and ECT recipient, reflected, “Responding to abuse with ECT, lack of informed consent, and giving this ‘treatment’ involuntarily is another violence against women.” For many, the process was compounded by a lack of clear information about the risks and alternatives before consent, as well as pressure or coercion to agree to the procedure. This was particularly striking given the dominance of male psychiatrists in delivering the treatment.
When Mental Health Care Becomes Harmful
While ECT has sometimes been hailed as a lifesaving intervention for severe depression, the new data suggest that for many women, its harms outweigh its benefits:
- More adverse effects: Women reported memory loss at rates far exceeding men, both anterograde (trouble making new memories) and retrograde (loss of prior memories).
- Lower reported benefit: Women were less likely to experience mood improvement post-ECT, and even less likely to recommend or consent to repeat treatment.
- Compounded trauma: Particularly for those with personal histories of abuse, ECT was perceived not as therapy but as a retraumatizing event.
Research co-author Sue Cunliffe emphasized the misalignment between women’s needs and psychiatric practices: “The very psychiatrists I trusted to rescue me shamed and blamed me, brain damaged me, and made me want to die.”
Systemic Gender Bias and Calls for Reform
What accounts for this stark disparity? According to the researchers, the reasons are rooted in systemic biases in mental health care. Longstanding diagnostic patterns and psychiatric practices may result in women being prescribed ECT at twice the rate of men—even though their outcomes tend to be worse.
Professor Read emphasized: “Our findings show that women not only receive ECT more often but are also more likely to suffer its most damaging effects. These patterns cannot be dismissed as coincidence. They reflect systemic biases in psychiatry and underline the urgent need for a trauma-informed, feminist perspective on mental health care.”
Dr. Lucy Johnstone, a clinical psychologist and co-author, points out, “I have had a number of women clients who were prescribed ECT for distress related to rape or domestic abuse. This is not treatment. It is re-traumatisation, and it must stop.”
Informing the Public and Mental Health Professionals
The study authors urge both clinicians and families to be aware of these differences when considering ECT for women. Ensuring truly informed consent means discussing the heightened risks, the likelihood of memory loss, and the potential for retraumatization. This transparency is crucial if mental health care is to protect, rather than further harm, its most vulnerable patients.
Concluding Thoughts
In light of these findings, a reevaluation of both psychiatric practice and clinical research is essential, particularly in how mental health care is delivered to women. ECT should not be the default response to women’s suffering, especially when the underlying causes may relate to unresolved trauma or abuse. Instead, a trauma-informed, patient-centered approach is urgently needed.
Reference
Read, J., Morrison, L., Cunliffe, S., Hancock, S., & Johnstone, L. (2024). Electroconvulsive therapy and women: An international survey. Health Care for Women International.
