Latinos and electroconvulsive therapy: implications for treatment, research, and reform in Texas and beyond.

No literature exists concerning the implications of using electroconvulsive therapy (ECT) in the treatment of Latinos. Given the large and increasing Latino population in the United States, the contentious history of ECT, and the possible differences in language and cultural vantage point between the typical ECT provider and Latino client, this paucity of research is worrisome. This article identifies a number of potential problems involved in multiculturally untrained service providers treating Latinos with ECT, including invalid diagnoses, an incomplete knowledge of the strengths and resiliencies of the client, and the use of ECT rather than culturally appropriate interventions. Also discussed are Latino cultural beliefs and practices salient to mental health service providers, some of the recent mandates for multiculturally informed service provision in mental health, ideas for the constructive modification of the diagnostic and treatment protocols currently guiding the use of ECT with Latinos, and needed research relevant to the issues raised. Keywords: electroconvulsive therapy; Latinos; cultural beliefs; Texas; electroshock therapy Electroconvulsive therapy (ECT, also known as electroshock therapy) has generated an enormous amount of controversy as a psychiatric intervention. Throughout its 60 years of use, courts have routinely enacted guidelines for its use (Finch, Sobin, Carmondy, DeWitt, & Shiwach, 1999) and the psychiatric and psychological communities have sustained a wide-ranging discourse on ECT's efficacy, mode of action, adverse effects, and ethical underpinnings. While more than 5,000 articles have been written on ECT since its inception (Medline) and data are available regarding the ethnic breakdown of treatment in a handful of states (Reid, Keller, Leatherman, &. Mason, 1998), not a single study (to the knowledge of this author) has explicitly attended to the issues involved in the treatment of Latinos with ECT (searches done in 2005 on Medline, PsycINFO, PsychArticles, and Academic Search Premier refining search results for "electroconvulsive therapy" with "Latino," "Hispanic" and their plurals). While this could be the corollary of a marked trend in the field of ECT research across all demographics to focus on the treatment itself rather than the person receiving it, it is alarming that such a controversial treatment should for any reason at this point in the development of multicultural research, ethics, and awareness go on essentially unchecked in this domain. While recent meta-analytic studies continue to advance the position that ECT is safe and effective (U.K. ECT Review Group, 2003), the constructs which define efficacy remain imbedded in biological, reductionist views: "Success" often depends on continued maintenance ECT (Bourgon &. Kellner, 2000), scientific comparisons with psychotherapy are rare, the client's subjective and/or qualitative view of the experience is even rarer, and a multiculturally informed focus on the contexts, consequences, and ethicality of the treatment is absent. Thus, while the professions of care continue to debate the basic practice of ECT (with many, including this author, of the opinion that "modern" ECT remains a practice deeply imbedded in problematic sociopolitical processes), I contend that within such contexts it should be beyond debate that the use of ECT with any person of a group that is culturally and linguistically distinct from the populations portrayed by mainstream, pathologyoriented models of human problems is neither ethical nor scientific. ECT USE IN TEXAS It is important to first note that ECT is not being disproportionately prescribed to Latinos in Texas. Two archival studies done within the last 7 years utilized the data generated by the Texas law which requires that "all nonfederal clinical facilities providing electroconvulsive therapy (ECT) report every treatment to the state's mental health agency" (Reid et al. …