Electroconvulsive Therapy (ECT) in the News: "Balance" Leads to Bias.

M any reports of electroconvulsive therapy (ECT) in the news media try to achieve journalistic balance by dedicating a sizable portion of their content to anti-ECT views.We suggest that such practice is, in fact, biased, and effectively perpetuates misinformation and stigma about ECT. Recently, Nicholas Kristof of the New York Times argued that uncritically presenting both sides of an issue for the sake of journalistic “balance” can lead to distortion rather than an accurate portrayal of truth. His examplewas the current US presidential election in which unchecked news reporting on a candidate has led to “normalizing lies and extremism.” Kristof's argument applies equally to news reporting on electroconvulsive therapy (ECT). Despite its widespread acceptance in the medical community, ECT remains surrounded by “controversy.” For years, journalists have paired factual reporting on ECTwith sensationalized anecdotes and unsubstantiated claims. In an attempt to intrigue readers and avoid partisanship, many news outlets have inadvertently given a sizable, unchecked platform to antipsychiatry proponents. For example, 2013 BBC Health News coverage on ECT included a patient success story, a history of the procedure, and potential theories ofmechanism of action. However, it paired thesewith the story of a patient who blamed ECT for erasing years of her memory, with no discussion of her psychiatric condition or response to treatment, and quotes from a psychologist comparing ECTwith “lobotomies and surprise baths.”A2016 article in STAT gave equal weight to a patient narrative on how ECT resolved her severe depression and claims from an anti-ECT proponent, who blamed ECT for ending her marriage. A 2016 New Scientist article discussing the efficacy of ECT still included terminology such as “tainted treatment” and “brutal and archaic.” In their effort to capture readers' attention, all of these articles referenced the movieOne Flew Over the Cuckoo's Nest, the ubiquitous archaic image of ECT that is conflatedwithmodern practice. Even informationalmaterial from the psychiatric profession includes language promulgated by the antipsychiatry movement. For example, the ECT informational leaflet from the Royal College of Psychiatrists has a section entitled “what do those against ECT say,” which states that “some see ECTas a treatment that belongs to the past...permanently damages both the brain and mind...[and] would want to see it banned.” An article that presents one success story and one patient who reports catastrophic memory loss implies that both outcomes are equally likely. This is not an accurate portrayal of the clinical reality; approximately three quarters of patients have a good response to ECT and a positive attitude about it. Inaccurate or overblown statements without adequate commentary perpetuate the apprehension and stigma surrounding ECT. By presenting dramatized memory loss claims side by side with physician expertise and factual studies, the media is doing a huge disservice to thousands of individuals experiencing treatable mental illness. It is empowering antipsychiatry organizations, such as the Citizens Commission on Human Rights, an arm of the Church of Scientology, who insist that ECT is used for physician financial profit and patient torture. The reality is that there are more than 15,000 citations on PubMed about ECT, and it has support from medical associations, including the American Psychiatric Association and Royal College of Psychiatrists, as well as support from patient advocacy groups such as National Alliance on Mental Illness. Its undeniable sole intention is to provide relief and improve the quality of life of individuals experiencing psychiatric illness. This is a particularly important time for ECT to be accurately represented to the public. The US Food and Drug Administration recently proposed a rule that will limit the indications of ECT to treatment-resistant depression in adults, which may have the chilling effect of making the other generally accepted indications for ECT “off-label.” Although it may be too late to change the Food and Drug Administration's course of action, it must be noted that the public-hearing process allowed a disproportionate amount of antipsychiatry propaganda to be publicized. It is high time to insist that balanced reporting on ECT consist of accurate descriptions of the procedure as a modern medical intervention with known efficacy rates, benefits, and risks. Journalists have a responsibility to correct misperceptions and