From ward round discussions in which I was present, the main criteria were severity of a person's mental health condition and whether all other options had been explored. It would usually be that a person had tried a number of medications and not had any noticable improvement. Also, it depended on what the patient wanted to happen next and, the concerns of family members.

Ok, you are much closer to this issue than I am. It comes up in the news sometimes where someone is court ordered (approved???) to be treated by ECT and have to appeal against it. Cases where the person is judged incompetent to make the decision themselves.
From my perspective it's hard to find the line between science or professional advocacy of a procedure. There are definitely negative side effects.

I'm not sure you're seeing what I'm seeing, that in short for shock therapy there are no criteria. Or, that is, what the patient reports or wants. Or for the real wackos, just zap 'em; nothing else works!

Is that a fair if blunt assessment?

It is far more complex. In the immediacy of the moment , like when aggressive behaviour is taking place, immediate decisions about medication, have to be made amongst a team. Safety is a key issue, but any decisions have to be justifiable and are accountable by law. It may be that the patient is not always the one who has the ultimate say, but they can appeal against decisions and put in complaints. Generally, most decisions about ECT are carefully thought out though, although I believe that many years ago this was less so. But, medication and injections are more frequently given against individuals' wishes, often as a preventative risk measure.

I think that you in your post you are touching upon one of the main areas which is involved in the ethics of psychiatry, which is capacity to consent, which has to be assessed fully and carefully.

I get all of that. My point, though, which you write and then cross-write over, is that no one knows anything about what ECT does. Some results are noted and interpreted with who-knows-what scientific validity. But at the moment ECT has about the same quality of justification as administering doses of mercury or bloodletting did in the 18th century and prior.

That is, doctors in a group, being supposed to know, suppose that they know, forget that they don't and congratulate themselves on agreeing on a "scientific" basis on a course of treatment that is not much more than voodoo. Or has some real science come into evidence?

I am not really an advocate of ECT and certainly I didn't enjoy taking patients to ECT. But, it was often the patients themselves who said how they felt that they benefitted from it, so hopefully it was not 'voodoo'. Even with medication, no one knows exactly how it works in many cases but hopefully neuroscience will give us more answers in time. There is, of course, the whole placebo effect, but it don't think that it can come down to that because people notice major differences between different medications, so it is probably mostly about neurotransmitters.

I was thinking 1955 was about the peak of the lobotomy era. — Mark Nyquist

Oh! I didn't know that. All I know about 1955 is that Albert Einstein died that year. I guess God lobotomized the human race. :rofl: Makes sense since dear Albert was proving to be an intractable nuisance with his E = mc² which flagged off the nuclear arms race. The doomsday clock has been ticking ever since. We can't put the genie back in the bottle. Might as well make our 3 wishes.

Advocates of Electroconvulsive Therapy claim memory loss is caused by depression, not ECT itself. — Mark Nyquist

I concur. My memory has never been the same since I had melancholia for as long as I can "remember." It's a vicious cycle: sadness -> memory loss -> sadness -> memory loss ->.... I wonder if the ouroboros is allowed to complete the process of eating itself what would happen? A broken heart can't learn by heart!

I agree with you 'if you're not feeling the blues there's something wrong with you.' — Jack Cummins

I would've preferred it if I were wrong but, for better or worse, I'm not. One only needs to look at the two greatest role models of the world, one western, Jesus, and the other eastern, the Buddha to realize this. Both gentlemen were deeply concerned with suffering, one (the Buddha) was probably certifiable as reeling under bouts of major depression. The point? That people consider these two as ideals to be emulated leaves no room for doubt that people all over the world want us to feel the world's agony. The duo were later upgraded to divine beings and that's as big as hints get - empathy at that level no mere mortal can achieve.

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Here is my version of how psychiatry research is funded. The big pharma company donates to a reputable philanthropic organization but with earmarks and donor restrictions attached. The philanthropic organization then awards grants to approved research organizations. That way the recipient can claim funding from some great philanthropy without mentioning big pharma. Wink, wink. And if you or I would like to find out who really funded such and such study we would dead end in the philanthropies financial statement. It wouldn't be there and they wouldn't tell you if you asked. This is probably all wrong and just my version but if anyone knows please correct me. That just doesn't seem like real science.