Ethical Implications of Electroconvulsive Therapy: A Review

This article examines in depth whether electroconvulsive therapy (ECT) satisfies bioethics’ four healthcare provision principles: nonmaleficence, beneficence, justice, and autonomy. Treating patients ethically implies protecting them from damages, working to ensure their well-being, and respecting their decisions once they have been correctly informed. Although most of the medical literature states that ECT is an effective and safe technique, there is no conclusive evidence of long-term effectiveness. The frequent and sometimes persistent side effects such as amnesia that imply a profound disturb of lived experience, or the difficulties regarding the informed consent process, allow us to conclude that the bioethical debate about ECT is not currently closed, and the information provided to patients needs to be revised.

How Accurate are ECT Patient Information Leaflets Provided by Mental Health Services in England and the Royal College of Psychiatrists? An Independent Audit

BackgroundThe aims of this paper were to assess the accuracy of patient information leaflets about electroconvulsive therapy (ECT) in England, and assess compliance with National Institute for Health and Care Excellence (NICE) recommendations, and the principle of informed consent.MethodsFreedom of Information Act requests were sent to 51 National Health Service Trusts for a copy of their information leaflet. These, and three Royal College of Psychiatrists (RCPsych) leaflets, were scored on a 40-item accuracy measure.ResultsThirty-six Trusts (71%) provided leaflets. The number of accurate statements, from a possible 29, ranged from four to 20, with a mean of 12.8. The most commonly omitted accurate statements included: that previous treatments, including psychological therapy, should be tried first (mentioned by 12 Trusts); cardiovascular side effects (6); lack of long-term benefits (6); patients’ right to take 24 hours to consider giving consent (1); memory loss higher in women and older people (0). The number of inaccurate statements averaged 5.8, out of 11, and ranged from two to nine. The most common inaccurate statements included: ECT corrects biological deficits (28); misleading claims of very low mortality risk (28); minimization of memory loss (23); claims that ECT saves lives (22); claims of very high improvement rates (19). The current (2020) RCPsych leaflet contained seven inaccurate statements and scored worse than two previous RCPsych leaflets.ConclusionsInformation leaflets about ECT comply neither with NICE recommendations nor the principle of informed consent. Patients are being misled about the risks they are taking and the limited nature of ECT’s benefits.

Szasz Under Friendly Fire: Damned With Faint Praise

This essay is a critical review of recent collections of articles by friends and colleagues of Thomas Szasz. Apart from the usual misunderstandings and wilful misinterpretations of Szasz's social psychology generally and critique of mental illness specifically, his friends and colleagues add a new dimension to Szaszian criticism by damning him with faint praise. Ignoring his indebtedness to social psychologist, George Herbert Mead, they interpret his work as an ideological defence of libertarianism, rather than as a logical critique of mental illness. A defence is, therefore, especially indicated.

Cultural Differences in the Use of Covert Coercion Among Mental Health Professionals of Latin Culture: A Focus Group Study

Coercion in Mental Health is related to sociocultural contexts. The purpose of this study is to examine whether the uses and perceptions of covert coercion on the part of professionals from four Latin-culture countries (Spain, Italy, Mexico, and Chile) differ between them and from those described in the literature.We conducted a qualitative research, using focus groups with professionals, with targeted sampling and an iterative process for thematic analysis.Several differentiating categories were found: the use of alternative strategies of covert coercion (deception, emotional blackmail, and directiveness); the role of family and socioeconomic differences; and cultural aspects such as the unique role religion plays in Mexico, a relatively greater toleration of threat as a means of coercion.

The Biopsychosocial Model: The End of a Reign of Error

Four decades after the publication of the concept of Engel's “biopsychosocial model” for medicine and its subsequent enthusiastic embrace by psychiatry, it is widely accepted as a valid alternative to the reductionism of biological psychiatry. However, unlike models in mainstream science, the original model has not been developed or expanded. Despite widespread efforts to “talk it up,” Engel's “biopsychosocial model” has failed to have any lasting impact on psychiatry. The reason is simply that it doesn't exist. The logical flaws in Engel's original concept are explored, and some consequences noted.

Manipulations and Spins in Attention Disorders Research: The Case of ADHD and COVID-19

This article raises awareness to manipulations and “spins” that occur in Attention Deficit/Hyperactivity Disorder (ADHD) research. An in-depth inspection was conducted on a high-profile study that suggested that ADHD is a risk factor for infection with COVID-19 and that stimulants reduce that risk (Merzon et al., 2020b). Two additional studies by the same first author were inspected as well, one that was published in the same journal and one that relied on the same dataset. Seven manipulations and spins were identified, including inappropriate operational definitions, misrepresentations, and omissions that produced bogus results and might have concealed potential adverse effects of medications. These distortions illustrate how biased science can contribute to the ethically problematic phenomena of overdiagnosis and overmedication.

Are Antidepressants Overprescribed? Patients' Experiences of the Prescribing Process

An online survey was completed by 1,829 New Zealand adults prescribed antidepressants. Only 43% were experiencing self-reported “severe” depression when first prescribed antidepressants. Thus, most prescriptions were for depression that was self-reported as mild or moderate, despite studies suggesting that antidepressants are no more effective than placebo at these levels. General practitioners (GPs) prescribed at lower depression levels than psychiatrists and spent less time with patients. Thirty-five percent of GPs and 42% of psychiatrists reportedly gave no information about adverse effects. Almost no prescribers gave information about adverse effects in the personal and interpersonal domains, or about withdrawal effects. Closer adherence to evidence-based prescribing and to the principle of informed consent may lead to a reduction in unnecessary, ineffective, and potentially harmful prescribing.

Reflections on Type III Error: Ethical Implications for Mental Health Research, Public Policy, and Population Health

This reflection comments on Type III error—how the misrecognition of causal factors shaping the onset, acuity, and duration of mental health symptoms may lead to the design of interventions that compromise the health of populations. Type III error reveals the ethical challenges of research designs that answer the wrong question. The argument offered by Schwartz and Carpenter in their 1999 article, “The right answer for the wrong question: consequences of Type III error for public health research,” is used as a foil to discuss ethical implications for population mental health.