Recent guidance from the World Health Organization (WHO) and American Psychiatric Association (APA) has finally acknowledged the risks of electroconvulsive therapy (ECT). These organizations focus on ensuring that patients receive informed consent, acknowledging the risks of long-term memory loss and other health concerns due to the procedure, and recommend against the use of ECT in children.
But this has stirred up ECT promoters like Joseph Cooper and colleagues, who published a recent opinion piece in The Lancet Psychiatry defending ECT. Yet according to other researchers (published the same day, also in The Lancet Psychiatry), Cooper et al. cherry-pick data and ignore the large body of research on ECT’s harms. Worse, Cooper et al. “directly oppose” the principle of informed consent, according to their critics.
The critics were led by Michelle Funk, a key figure in WHO’s mental health policy, and also included ECT survivors like Sarah Price Hancock, and researchers like John Read.
“Denying people full information and the right to make autonomous decisions not only violates their rights but also reinforces stigma and disempowerment. We stand by the guidance developed with the input of leading experts and its call for legislation grounded in human rights,” write Funk et al.
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ECT, or “electroshock,” is a controversial procedure that involves electrocuting the brain to deliberately induce seizures. There is no consensus on how this might reduce mental health problems. The procedure results in adverse cognitive effects that can last for years, including persistent memory loss in over a third of patients. Life-threatening cardiac problems are also common, even in those with no history of heart problems.
Although opinion pieces claim that ECT is a life-saving procedure, the data to support its effectiveness simply isn’t there. Instead, studies show that after receiving treatment, people who receive ECT are 45 times more likely to die by suicide than the general population. When compared to those with the same severity of mental health problems, a study of over 70,000 veterans found no difference between those who received ECT and those who did not.
Researchers have noted that only 11 placebo-controlled studies of ECT’s effectiveness for depression have ever been conducted, and all took place prior to 1985. None were double-blind. Fewer than half (4 out of 11) of these small, old, biased studies found ECT to beat placebo.
In a 2020 study, researchers including Read as well as renowned Harvard researcher Irving Kirsch concluded that “there is no evidence that ECT is effective for its target demographic—older women, or its target diagnostic group—severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or adolescents.”
Funk et al.’s Response to Cooper et al.
According to Funk and colleagues, Cooper et al. cite a misleading 1994 paper to suggest that ECT does not cause brain damage. Yet, Funk et al. write, “the study provides no direct support for this claim, shows no improvement in brain function, and in fact reports structural brain changes that might be maladaptive, contradicting the authors’ interpretation of these changes as inherently beneficial.”
Cooper et al. also cite a single study with no control group to suggest that people are overwhelmingly happy with receiving ECT, even when forced to receive it without informed consent. However, Funk et al. note that the majority of research debunks this claim—for instance, a systematic literature review combining various studies that found long-lasting dissatisfaction, side effects, and trauma as a result of ECT.
Beyond cherry-picking single studies to make their case, while ignoring the majority of ECT research, Cooper et al. also rail against WHO’s ethical complaints. Funk et al. note that the APA and the UK’s NICE are particularly concerned about the effects of electrocuting and causing seizures in the developing brains of children; evidence suggests this can be even more detrimental than it is for adults. Cooper et al. disagree, trotting out the old unsupported notion that ECT saves children from suicide.
Another moral issue: WHO guidance has compared forced treatment to torture and suggested that individuals have the right to a say in their own medical care and should be told of potential risks and benefits. Again, Cooper et al. disagree, taking the paternalistic attitude that doctors should not provide informed consent and should not give patients a say in what they do to their bodies. Instead, ECT should be forced and patients should not be warned of potential risks, lest they try to avoid the procedure.
Funk et al. write, “The safety, ethics, and effectiveness of ECT remain contested around the world and among top authorities in the field. We call on Cooper and colleagues to align their position with the scientific evidence and human rights standards. Informed consent, safeguards, and respect for autonomy are not barriers, they are the foundation of ethical care.”
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Funk, M., Drew, N., Pathare, S., Encalada, A. V., McGovern, P., Hancock, S. P., & Read, J. (2025). Electroconvulsive therapy: reaffirming the case for caution, consent, and rights. The Lancet Psychiatry. Published on June 23, 2025. DOI: 10.1016/S2215-0366(25)00192-0 (Link)
