MHM Magazine

electrode placement. Beyond depression, ECT remains a frontline intervention for catatonia, severe mania, and psychotic depression - situations in which delaying effective treatment can endanger life through malnutrition, dehydration, or suicide. Side effects exist, of course, but they are often misrepresented. Short-term memory problems around the time of treatment are common, but most patients recover cognitive function fully within weeks. Long-term memory loss is possible but far less common than public perception suggests. For many patients, the benefits - rapid, sometimes dramatic improvement in function and mood, outweigh these risks. Attitudes Among Health Professionals A recent study conducted by myself and Dr. Y Nel, at the Wits Department of Psychiatry explored how psychiatrists and clinical psychologists perceive ECT. Unsurprisingly, psychiatrists - who work directly with the treatment - reported more accurate and positive views. Clinical psychologists, on the other hand, often mirrored broader public hesitations, voicing concerns about memory loss, patient trauma, or lingering perceptions of ECT as outdated. This gap matters. Patients and families don’t only ask psychiatrists about ECT, they ask their GPs, their therapists, even their neighbours. And if the first professional they consult shares the same misconceptions they’ve absorbed from pop culture, patients may never consider ECT at all. For healthcare workers, being equipped with balanced, evidence- based knowledge is crucial. Even if you never administer or directly refer for ECT, your voice can either close the door or gently open it. Common Myths — and How to Debunk Them “ECT is painful and traumatic.” Modern ECT is performed under anaesthesia with muscle relaxants. Patients are asleep, feel no pain, and the seizure is carefully controlled and monitored. Most describe the procedure as far less distressing than expected. “ECT causes brain damage.” There is no evidence that ECT causes structural brain damage. While temporary memory problems are common, the overwhelming majority of patients recover fully. Many experience improved cognitive function as their depression lifts. “It’s a last resort when nothing else works.” ECT is often used when medications fail, but it is also the first-line treatment in life- threatening situations: severe suicidality, refusal to eat or drink, or catatonia. In these cases, waiting for antidepressants to take effect can be too risky. The Health Professional’s Role: Guiding Conversations General practitioners and many other mental health professionals don’t prescribe ECT, but they are key in shaping patients’ early attitudes. Imagine this scenario: A middle-aged woman with severe depression sits in your consulting room. She has tried multiple antidepressants with little effect. Her psychiatrist is recommending ECT, but she turns to you first. “Doctor, is it true they still use shock therapy? Isn’t that dangerous?” In that moment, your words matter. A dismissive shrug or a cautious “Well, it’s controversial” could reinforce her fears. Instead, a calm, factual response can make all the difference: “Yes, ECT is still used today, but it looks nothing like what you’ve seen in movies. It’s done under anaesthesia, very safe, and for many patients, it works when nothing else does. It can sometimes be the fastest way out of severe depression. If your psychiatrist thinks it’s appropriate, it’s worth considering.” That reassurance doesn’t mean you oversell the treatment — just that you give it a fair chance against decades of stigma. Shifting the Narrative The persistence of myths about ECT is not just a cultural curiosity, it’s a barrier to care. For some patients, those myths can literally be the difference between life and death. As health professionals, shifting the narrative starts with being well-informed. It involves challenging outdated images, reframing ECT as a medical treatment rather than a punishment, and recognising when it may be the right option. Think of ECT not as an archaic relic, but as a specialised tool in modern psychiatry’s toolkit. For the right patient, at the right time, it can restore function, relieve suffering, and give families back their loved one. Looking Ahead Medicine is always evolving, and ECT is no exception. Researchers are exploring refinements such as ultra-brief pulse stimulation, as well as alternatives like transcranial magnetic stimulation (TMS) and ketamine infusions. Yet for now, ECT remains one of the most well-studied and effective interventions for severe, treatment-resistant mood disorders. Despite decades of evidence confirming its safety and efficacy, ECT remains one of psychiatry’s most misunderstood treatments. Myths about memory loss, trauma, or “outdated” practice persist, influencing both patients and healthcare professionals. Timely ECT, however, can be life-saving, especially for severe depression, catatonia, and other acute psychiatric conditions. For further reading see the article “Knowledge of and Attitudes Towards Electroconvulsive Therapy Among Psychiatrists and Clinical Psychologists at the University of the Witwatersrand,” which examines psychiatrists’ and clinical psychologists’ knowledge of and attitudes toward ECT, highlighting how direct experience and education can transform fear and uncertainty into informed, confident care decisions. After all, stigma is powerful, but so is reassurance from a trusted health professional. References available on request. MHM | 2025 | Volume 12 | Issue 4 | Electroconvulsive Therapy: Knowledge, Attitudes and the Future of an Old Treatment MHM Issue 4 | 2025 | MENTAL HEALTH MATTERS | 29 MHM