The use of electroconvulsive therapy in Latin America and the Caribbean

Sixty years after its introduction into psychiatry (1), the use of electroconvulsive therapy (ECT) still fuels scientific, ideological, and ethical debate. One well-informed proponent has observed that ECT is probably more enshrouded in myth than any other procedure in medicine (2). Among the population at large, and especially patients and their family members, ECT may be the psychiatric intervention that arouses the most anxiety (3, 4)—although some authors dispute this assertion (5). ECT has specific indications, and objective standards and principles guide appropriate admin-istration. In the United States of America, for exam-ple, the American Psychiatric Association has issued such standards (3). In that country, efforts have been made to study ECT’s indications and effects and to safeguard the rights of patients, but it is interesting to note that the use of ECT has varied over time and geographically. These frequently reported discrepancies underscore ECT’s still-precarious and controversial status in psychiatric care (6–8). Geographical variation in ECT use has also been identified in Great Britain, where it is more common in Ireland than in England (9). Similarly, reports in Uruguay indicate that it is used more in the capital city than in the country’s interior (10). This paper reports the results of a mail survey conducted in 1995 to obtain precise and authorita-tive data concerning the use of ECT in Latin Amer-ica and the Caribbean. The objective was to facili-tate the identification of psychiatric, administrative, and bioethical issues that will provide, if needed, the basis for action to ensure that ECT is used appropriately. METHODS Directors of the mental health divisions or departments of the ministries of health throughout Latin America and the Caribbean (with the excep-tion of Haiti) were contacted through the Represen