The San Bernardino County Department of Behavioral Health is paying just under a quarter of a million dollars per year to have a limited subset of county residents receive electroconvulsive therapy.
Somewhere on the order of seven to eleven of what are deemed psychiatric patients within the county are subjected to the controversial process, which is basically intended to assist in recovery from cases of severe mental illness but has also been utilized as a form of punishment, per year.
At the time the county entered into an arrangement with the Loma Linda University Behavioral Medicine Center for the provision of electroshock therapy, former San Bernardino County Department of Behavioral Health Director Georgina Yoshioka described the treatment in question as involving vectoring electrical charges into the brains of subjects, resulting in “a brief painless seizure which causes changes in brain chemistry that can quickly reverse symptoms of certain severe mental health conditions, such as depression, schizophrenia, and bipolar disorder, which have not responded to reasonable pharmacological treatment. It is an evidence-based, safe and effective alternative that may provide relief.”
According to available literature put out by the American Psychiatric Association, electroconvulsive therapy, also referred to by its acronym ECT, is a psychiatric treatment consisting of passing an electrical current through the brain for the purpose of causing a generalized seizure. Electroconvulsive therapy has been used as an intervention for mental disorders when other treatments are inadequate. Conditions responsive to electroconvulsive therapy include major depressive disorder, mania, and catatonia, according to the association.
Modern electroconvulsive therapy, having evolved from earlier seizure-inducing treatments, was advanced in the 1930s into a formal procedure with the development of equipment designed to deliver electrical currents to the brain using either unilateral or bilateral telectrodes positioned on the scalp to stimulate one or two of the brain’s hemispheres. Electroconvulsive therapy became widely used in the 1940s, 1950s and into the 1960s. It use declined by the 1970s in reaction to negative publicity, untoward side effects, misuse extending into abuse and safety concerns.
A significant minority of psychiatrists by that point had expressed concerns about both short-term and long-term impacts on cognition and memory, application of the treatments as a means of behavioral modification or punishment, abuse. less than fully regulated and uneven standards in its application, failure in multiple cases or generally to document outcomes and other issues.
Despite the widespread use of electroshock therapy the American Psychiatric Association did not complete and publish a comprehensive evaluation of the practice until 1978’s “Electroconvulsive Therapy: Report of the Task Force on Electroconvulsive Therapy of the American Psychiatric Association.” The report endorsed the use of electroconvulsive therapy in the treatment of depression.
The use of electroconvulsive therapy declined until the early 1980s, after the National Institute of Mental Health and National Institutes of Health made overt recognition that it had, in certain tightly circumscribed instances therapeutic value, culminating in a consensus expressed by psychiatrists at a 1985 conference on electroconvulsive therapy that despite drawbacks and significant side-effects, electrical stimulation of brain tissue had been shown to be effective for a narrow range of severe psychiatric disorders.
Electroconvulsive therapy under typical circumstances involves multiple administrations given two or three times per week until the patient no longer has symptoms, which is referred to as remission. The return of depression is labeled as relapse. Electroconvulsive therapy can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. Differences in these parameters affect symptom remission and adverse side effects. Electroconvulsive therapy can be administered bilaterally or unilaterally, with high-dose unilateral application matching efficacy of bilateral application but causing fewer cognitive effects.
Psychiatric professionals gravitate toward the use of electroconvulsive therapy in the treatment of severe depressive disorder or in those cases where patients’ conditions have proven resistant to other forms of treatment. Psychiatric patients commonly show improvement with the application of certain therapies but the efficacy of treatmens are as frequently undercut by relapse in which the patient returns to a disturbed state. Electroconvulsive therapy is commonly reported or represented to have high efficacy and remission rates of around 50 percent to 60 percent. Advocates of electroconvulsive therapy tout its effectiveness in mitigating major depressive disorder, where it is statistically demonstrated to reduce suicide risk, and outperforming alternatives such as antidepressants in this regard, though relapse is common without maintenance treatment.
While Canadian psychiatric professionals differ and have suggested that electroconvulsive therapy can and should in many cases be used as a first line treatment, American psychiatrists generally hold that electroshock therapy be resorted to when one or other treatments have failed, or in emergencies, such as imminent suicide. Electroconvulsive therapy has also been used in selected cases of depression occurring in the setting of multiple sclerosis, Parkinson’s disease, Huntington’s chorea, developmental delay, brain arteriovenous malformations, and hydrocephalus.
Electroshock therapy is generally considered a second-line treatment for people with catatonia who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia. There is substantial evidence for its efficacy in treating catatonia, although evaluations reaching that conclusion are plagued by a dearth of randomised controlled trials.
Electroconvulsive therapy is used to treat people who have severe or prolonged mania. The National Institute for Health and Care Excellence recommends it only in life-threatening situations or when other treatments have failed and as a second-line treatment for bipolar mania.
Electroshock therapy is widely used internationally in the treatment of schizophrenia. In North America and Western Europe, however, its use is generally limited to treatment-resistant schizophrenia in which symptoms are not mitigated by antipsychotics.
There has been little attention paid in scientific literature as to what longterm damage might result from continuous, repeated and constant passage of an electrical current though the brain is and no such longterm studies were found in the search of a comprehensive research paper database.
In 2019, Dr. Bennet Omalu, the forensic neuropathologist who first identified Chronic Traumatic Encephalopathy (CTE) in National Football League players, without citing any empirical data, stated that functional injuries resulting from electroconvulsive therapy should be considered as both repetitive traumatic brain injury and repetitive electrical injury.
While it has for decades been acknowledged that side effects of electroconvulsive therapy include an impact on cognitive function and memory along with the generation of confusion in those subjected to it, defenders of the therapy have asserted that in most cases those effects are fleeting, transient and temporary. That is controverted by the claims of a number of electroconvulsive therapy treatment patients, including the late actress Gene Tierney and the late author Ernest Hemingway, who complained, bitterly, that they had suffered severe and lasting memory impairment. Tierney, who underwent ECT to alleviate severe depression, claimed it had destroyed significant portions of her memory. Hemingway received electroconvulsive therapy to counteract severe depression, anxiety and what is now diagnosed as bipolar disorder. He later wrote to a friend, “What is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient.”
Within the last year, an analysis of the downside of electroconvulsive therapy was published in the International Journal of Mental Health. The study, bearing the title “The adverse effects of electroconvulsive therapy beyond memory loss: an international survey of recipients and relatives,” was written by John Read, Sue Cunliffe, Sarah Price Hancock, Chris Harrop, Lucy Johnstone & Lisa Morrison and published on November 19, 2025.
The abstract of the paper begins, “Research into the safety of electroconvulsive therapy (ECT) usually focuses on memory loss. Studies asking patients directly reveal a broader range of adverse effects. This paper reports the responses of 747 ECT recipients and 201 relatives/friends, from 37 countries, to a question about 25 possible adverse effects, in an online survey. Seventeen of the 25 were reported by more than half of both the ECT recipients and the relatives/friends. Eight were reported by more than 67 percent of both groups: losing train of thought, difficulty concentrating, fatigue, emotional blunting, relationship problems, loss of independence, difficulty navigating and loss of vocabulary. The first four of these were described as ‘severe’ by at least 30 percent of both groups.”
By the numbers, 87 percent said they had lost their train of thought; 86 percent complained of difficulty concentrating; 86 percent said they suffered from fatigue; 78 percent complained of having difficulty reading; 76 percent said they experienced emotional blunting; 72 percent remarked on a loss of vocabulary; 68 percent they experienced relationship problems and 67 percent were burdened with a loss of independence.
The paper reported that the patients and their family members/friends reported, with far less frequency, other effects.
Those ranged from 4.5 percent reporting pain to 4 percent reporting trauma/post-traumatic stress/flashback to 3.9 percent reporting anxiety and nervousness to 3 percent reporting depression, despair and crying to 2.7 percent reporting anger, rage and fury to 2.4 percent reporting confusion to 2 percent expressing new or intensified inclination toward suicide to 1.9 percent reporting issues with self-esteem and confidence to 1.9 percent reporting problems sleeping to 1.7 percent reporting emotional dysregulation and irritability to 1.6 percent reporting eye or vision problems to 1.6 percent reporting nausea and/or vomiting to 1.6 percent reporting distrust of others to 1 percent reporting dizziness or vertigo. Tinnitus or ringing in the ears, loss of balance, incontinence, loss of identity, loss of creativity and nerve damaged were expressed but in each case by less than 1 percent of those surveyed.
Most respondents found the information given to them with regard to the electroconvulsive therapy they received to be inadequate.
Most respondents reported, on several different measures, that ECT either made no difference or made matters worse for them.
Most respondents reported memory loss that lasted more than three years.
The survey found that women are more likely to be given electroshock therapy and to suffer more memory loss.
While electroshock treatments are promoted by the psychiatric profession as therapeutic, passing an electrical current through brain tissue has been used as a form of punishment and as a means of behavior modification. The use of electroconvulsive therapy in this fashion was far more common in the 1940s, 1950s and 1960s in the context of psychiatric institutions and asylums than it is today. Well into the 1960s and in some institutions during the 1970s, ECT was administered without anesthesia or muscle relaxants, which would result in the patient experiencing violent convulsions that were extremely traumatic and on occasion resulted in fracture or dislocation of the long bones and or fractured vertebrae. While far less widespread today than was the case in the past, administering electroshocks serve as a form of control or punishment for misbehavior, non-compliance, disobedience, or actions/activities deemed to be immoral, reprehensible or depraved.
Generally, when administered for therapeutic purposes, electroconvulsive therapy is administered under anesthesia with a muscle relaxant. In some cases, this involves minute doses of curare, the muscle-paralyzing South American poison, or a safer synthetic alternative to curare, succinylcholine, to modify the convulsions. The use of anesthetics is done for multiple purposes, one of which is that patients would be less willing to submit to the treatment if they were not anesthetized.
Under normal conditions, convulsions, which are a disruption of normal brain function and manifest as sudden, uncontrolled muscle contractions, are undesirable and dangerous because they entail a loss of physical control, and in some cases can cause serious injury, including unrecognized internal harm. During a convulsion, a person may lose consciousness, fall or exhibit violent or uncontrolled movements. This can lead to bruising and organ trauma, broken bones, concussions with bleeding in the brain. During a seizure, a person may fall or not be able to stop shaking or protect himself or herself. Convulsions can manifest in breathing and airway problems by stopping the person experiencing them to discontinue breathing temporarily or inhale vomit, leading, potentially, to aspiration pneumonia or other respiratory complications. A seizure can induce further seizures. Brain damage can proceed from prolonged or severe seizures
While brief, controlled seizures usually do not cause Long-lasting, prolonged or repeated seizures that continue for five minutes or more or which occur in clusters can cause permanent neurological injury. A long convulsive seizure, known as status epilepticus, is considered a medical emergency.
People with epilepsy or frequent seizures have a higher overall risk of dying earlier than the general population.
Nevertheless, inducing a controlled seizure is considered therapeutic primarily for certain severe, treatment-resistant mental health conditions.
The theoretical rationale behind using controlled seizures for therapy includes making a rapid neurochemical reset in which the brain-wide electrical surge alters neurotransmitter levels. Repetitive brain stimulation triggers an increase in inhibitory signals, primarily through enhanced production and/or release of gamma-aminobutyric acid, the primary inhibitory neurotransmitter in the central nervous system, which can reduce neuronal excitability, calm overactive neural networks and promote calm and relaxation. The biological stress of a seizure is also likely to stimulate neuroplasticity by causing structural alterations in the brain, including the release of a substance – brain-derived neurotrophic factors – which serves to regrow brain cells and improve connectivity.
According to ECT advocates, when medications, psychotherapy, and brain stimulation fail, electroconvulsive therapy is considered the single most effective treatment for severe, suicidal, or psychotic depression, with claimed remission rates ranging from 70 percent to 90 percent in treatment-refractory patients. There have been successes using electroconvulsive therapy in broader psychiatric contects beyond depression, and therapeutic seizures are used to remedy conditions like schizophrenia, schizoaffective disorder, and catatonia.
Under the standards that are in wide use today, measures are taken to safely apply a relatively minute electrical charge to a patient’s brain. With the patient placed under general anesthesia and given muscle relaxants, a carefully measured, brief electrical or magnetic stimulus is applied to the scalp to induce a generalized seizure. Advocates of the process claim that because the patient is sedated and relaxed, he or she does not experience the physical convulsions or distress associated with a traditional epileptic seizure.
Though there is a general consensus within the psychiatric community, even among those who are opposed to the use of ECT that electroconvulsive therapy achieves at least some of the results its advocates claim for it, the exact mechanism of action of ECT has eluded scientists, despite decades of research to come to an understanding of the force they are wielding.
There are several hypotheses in this regard, some of which are complementary and others of which are contradictory.
One theory is that the seizure triggers changes in brain chemistry, including modulation of neurotransmitters such as serotonin, dopamine, and norepinephrine, which are critical for mood regulation.
Along this tangent is the belief that ECT also promotes neurogenesis and brain plasticity, potentially restoring neural connections disrupted by depression or other psychiatric disorders
It is also believed by some that the electrically-triggered seizures influence hormonal and immune systems, including the hypothalamic-pituitary-adrenal axis, toward a therapeutic effect.
A more recently arrive-at theory is that electoconvulsive stimulation alleviates depression symptoms by increasing aperiodic activity, a type of electrical activity in the brain that doesn’t follow a consistent pattern and is generally considered what is described as being cerebral background noise.
Modern electroconvulsive therapy, having evolved from earlier seizure-inducing treatments, was advanced in the 1930s into a formal procedure with the development of equipment designed to deliver electrical currents to the brain using either unilateral or bilateral electrodes positioned on the scalp to stimulate one or two of the brain’s hemispheres. Electroconvulsive therapy became widely used in the 1940s, 1950s and into the 1960s. It use declined by the 1970s in reaction to negative publicity, untoward side effects, misuse extending into abuse and safety concerns.
A significant minority of psychiatrists by that point had expressed concerns about both short-term and long-term impacts on cognition and memory, application of the treatments as a means of behavioral modification or punishment, abuse. less than fully regulated and uneven standards in its application, failure in multiple cases or generally to document outcomes and other issues.
Despite the widespread use of electroshock therapy, the American Psychiatric Association did not complete and publish a comprehensive evaluation of the practice until 1978’s “Electroconvulsive Therapy: Report of the Task Force on Electroconvulsive Therapy of the American Psychiatric Association.” The report endorsed the use of electroconvulsive therapy in the treatment of depression.
The use of electroconvulsive therapy declined until the early 1980s, after the National Institute of Mental Health and National Institutes of Health made overt recognition that it had, in certain tightly circumscribed instances therapeutic value, culminating in a consensus expressed by psychiatrists at a 1985 conference on electroconvulsive therapy that despite drawbacks and significant side-effects, electrical stimulation of brain tissue had been shown to be effective for a narrow range of severe psychiatric disorders.
Electroconvulsive therapy under typical circumstances involves multiple administrations given two or three times per week until the patient no longer has symptoms. Electroconvulsive therapy can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. Differences in these parameters affect symptom remission and adverse side effects. Electroconvulsive therapy can be administered bilaterally or unilaterally, with high-dose unilateral application matching efficacy of bilateral application but causing fewer cognitive effects.
Psychiatric professionals gravitate toward the use of electroconvulsive therapy in the treatment of severe depressive disorder or in those cases where patients’ conditions have proven resistant to other forms of treatment. Psychiatric patients commonly show improvement with the application of certain therapies but the efficacy of treatments are as frequently undercut by remission in which the patient returns to a disturbed state. Electroconvulsive therapy is commonly reported or represented to have high efficacy and remission rates of around 50 percent to 60 percent. Advocates of electroconvulsive therapy tout its effectiveness in mitigating major depressive disorder, where it is statistically demonstrated to reduce suicide risk, and outperforming alternatives such as antidepressants in this regard, though relapse is common without maintenance treatment.
San Bernardino County has had an arrangement with Loma Linda University Medical Center at least since 2017 for the Loma Linda University Behavioral Medicine Center to provide electroconvulsive therapy to patients designated for treatment by the e San Bernardino County Department of Behavioral Health.
In 2022, the county entered into a $1,237,500 for the period of July 1, 2022 through June 30, 2027 with the Loma Linda University Behavioral Medicine Center for those services. At that time, according to Yoshioka, it was anticipated physicians and medical staff in Loma Linda would provide up to 165 therapy sessions annually in both inpatient and outpatient settings, at a cost of $1,500 per session with an average of 20 sessions per client at an average cost of $30,000. In 2023, the county agreed to assign the rights and obligations relating to the Loma Linda University Behavioral Medicine Center’s provision of those services to the Loma Linda University Medical CenterSan Bernardino County Department of Behavioral Health .
There is at least marginal concern with regard to how electroshock administrations at the disposal of San Bernardino County officials are to be applied. The declared intent is that the technology is to be used in medical/mental health contexts for therapeutic designs. The San Bernardino County Department of Behavioral Health often works with the San Bernardino County Sheriff’s Department in what is generally described as an effort to combat homelessness. Tactics sometimes used by sheriff’s deputies in an effort to persuade elements of the homeless population living on the streets, sidewalks, in alleyways, in parks, in riverbeds or on riverbanks, flood control channels, beneath railroad trestles or under road and freeway overpasses, in abandoned buildings and elsewhere that they should take leave of the county have included physically abusing or assaulting them into submission. Given that approach, there is concern that the sheriff’s office will request the employment of unmodified ECT, which can be very painful, as a form of punishment or behavior modification on individuals who have proven intransigent or defiant in the face of demands that they should comply with what the orders to move along and discontinue their loitering.
The Sentinel on June 23 sought from San Bernardino County that it lay out in general terms by which electroconvulsive therapy is being provided to patients?.
San Bernardino County Deputy Public Information Officer Janelle Needham on June 29 responded that “The San Bernardino County Department of Behavioral Health reimburses electroconvulsive therapy [costs] provided by contracted treatment partners following a comprehensive clinical evaluation. ECT is approved for reimbursement when the individual meets established clinical criteria, including documented treatment resistance, a prior positive response to ECT, the need for a rapid response due to a potentially life-threatening psychiatric condition, or when medications are not appropriate because of documented intolerable adverse effects.
Needham said that the county department of behavioral health reimburses the Loma Linda San Bernardino County Department of Behavioral Health for the electroconvulsive treatment it provides when, “following a comprehensive evaluation, the individual meets one or more of the following clinical criteria:
• A history of poor response to two medications indicated for the existing psychiatric condition;
• A history of an effective response to ECT for the same condition in the past;
• A need for rapid response due to the potentially life-threatening nature of the individual’s condition; or
• ECT is an effective alternative because the individual has a documented history of intolerable adverse effects from indicated medications.”
Needham said, “Treatment is provided by contracted clinical partners in accordance with applicable clinical standards and legal requirements.”
The Sentinel further inquired as to what guardrails are in place to ensure that someone who does not want to be subjected to electroconvulsive therapy can avoid be subjected to it and whether aor any individual[s] who are receiving services from the San Bernardino County Department of Behavioral Health had been subjected to electroconvulsive therapy against his/her/their will. The Sentinel asked what the standard is for obtaining the consent of those who undergo electroconvulsive therapy provided by the San Bernardino County Department of Behavioral Health and, if an individual being treated by the San Bernardino County Department of Behavioral Health or someone subject to the care or authority of the Department of Behavioral Health did not want to undergo electroconvulsive therapy, what means of registering that objection are open to him/her
Needham responded, “For individuals who have the capacity to consent to treatment, informed consent is required before electroconvulsive therapy may be administered. Consent is obtained by the treating contracted provider as part of the clinical treatment process. An individual may decline ECT or withdraw previously provided consent at any time, either verbally or in writing, and such withdrawal is effective immediately.”
Needham did indicate, however, that an individual might be subjected to electroshock therapy against his or her will if those in positions of authority deem the individual to be treated to be incapable of or resistant to making a decision that would have a bearing on his or her best interest.
“ECT without a patient’s consent may occur only when an individual lacks the capacity to consent and only in accordance with the requirements and protections established under California Welfare and Institutions Code section 5326.7,” Needham said. “Accordingly, individuals who have the capacity to consent may object to ECT by declining treatment or by withdrawing consent at any time. The department of behavioral health does not have additional information to provide regarding individual patient treatment due to applicable privacy protections.”
-Mark Gutglueck