Skip to main content Accessibility help

Controversial treatments in psychiatry

  • Jason Luty


Psychiatry uses some of the most controversial treatments in medicine. This may be partly because several are administered under coercion and opposed to the patient's expressed will, under the protection of the relevant mental health legislation. Electroconvulsive therapy (ECT) is perhaps the archetypal controversial treatment; although it is considered to be effective, the research supporting it is much less impressive than one would expect. The prescription of stimulant drugs for childhood attention-deficit hyperactivity disorder (ADHD) and substitution therapy (such as methadone maintenance) in addictions treatment remain topical and appear to be subject to political interference. ‘Treatment’ for homosexuality and psychosurgery were common in the past but are now rare. These issues are discussed to give insight into how once common controversial treatments can decline and become obsolete. However, seclusion and covert medication remain in practice and are highly scrutinised.

Learning Objectives

• Recognise that many controversial treatments, such as psychosurgery, have been superseded by psychotropic drugs used since the 1950s

• Be aware of the limitations of evidence supporting controversial treatments, such as stimulants for childhood ADHD and ECT for depression in adults

• Be aware that controversial treatments are highly emotive and may be viewed negatively by the public or politicians, despite evidence for their safety and effectiveness

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Controversial treatments in psychiatry
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Controversial treatments in psychiatry
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Controversial treatments in psychiatry
      Available formats


Corresponding author

Correspondence Dr Jason Luty, Borders Addiction Service, The Range, Tweed Road, Galashiels TD1 3EB, UK. Email:


Hide All

Declaration of Interest




Hide All
Amato, L, Minuzzi, S, Davoli, M, et al (2011) Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database of Systematic Reviews, 3: CD005031.
Amato, L, Davoli, MVS, Akli, R, et al (2013) Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database of Systematic Reviews, 2: CD003409.
Angold, A, Erkanli, A, Egger, HL, et al (2000) Stimulant treatment for children: a community perspective. Journal of the American Academy of Child and Adolescent Psychiatry, 39: 975–84.
Banaschewski, T, Coghill, D, Santosh, P, et al (2006) Long-acting medications for the hyperkinetic disorders. A systematic review and European treatment guideline. European Child & Adolescent Psychiatry, 15: 476–95.
Barraclough, BM, Mitchell-Heggs, NA (1978) Use of neurosurgery for psychological disorder in British Isles during 1974–6. BMJ, 2: 1591–3.
BBC (2009) Cannabis row drugs adviser sacked. BBC News, 30 October ( Accessed 6 Sept 2016.
Berrios, GE (1997) The origins of psychosurgery: Shaw, Burckhardt and Moniz. History of Psychiatry, 8: 6181.
Bridges, PK, Bartlett, JR, Hale, AS, et al (1994) Psychosurgery: stereotactic subcaudate tractotomy an indispensable treatment. British Journal of Psychiatry, 165: 599611.
Byford, S, Barrett, B, Metrebian, N, et al (2013) Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction. British Journal of Psychiatry, 203: 341–9.
Clinical Research Centre, Division of Psychiatry (1984) The Northwick Park ECT trial. Predictors of response to real and simulated ECT. British Journal of Psychiatry, 144: 227–37.
Crossley, D (1993) The introduction of leucotomy: a British case history. History of Psychiatry, 4: 553–64.
Department of Health (2003) Electro Convulsive Therapy: Survey Covering the Period from January 2002 to March 2002, England (Bulletin 2003/08). Department of Health.
Department of Health (2015) Mental Health Act 1983: Code of Practice. TSO (The Stationery Office).
Gossop, M, Marsden, J, Stewart, D (2003) The National Treatment Outcome Research Study (NTORS): 4-5 year follow-up results. Addiction, 98: 291303.
Gregory, S, Shawcross, CR, Gill, D (1985) The Nottingham ECT study. A double-blind comparison of bilateral, unilateral, and simulated ECT in depressive illness. British Journal of Psychiatry, 146: 520–4.
Haldeman, D (1991) Sexual orientation conversion therapy for gay men and lesbians: a scientific examination. In Homosexuality: Research Implications for Public Policy (eds Gonsiorek, J, Weinrich, J): 149–60. Sage.
Heller, AC, Amar, AP, Liu, CY, et al (2006) Surgery of the mind and mood: a mosaic of issues in time and evolution. Neurosurgery, 59: 720–33.
Higgins, ST, Wong, CJ, Badger, GJ, et al (2000) Contingent reinforcement increases cocaine abstinence during out-patient treatment and 1 year follow-up. Journal of Consulting and Clinical Psychology, 68: 6472.
Government, HM (2010) Drug Strategy 2010. Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life. Home Office.
Home Affairs Select Committee (2002) Drugs: Breaking the Cycle. Written evidence submitted by Charlie Lloyd and Neil Hunt (DP156). House of Commons ( Accessed 23 December 2016.
Home Office (2003) The impact of Drug Treatment and Testing Orders on Offending: Two-Year Reconviction Results (Home Office Report 184). Home Office.
Hough, M, Clancy, A, McSweeney, , et al (2003) Impact of Drug Treatment and Testing Orders on Offending: Two-Year Reconviction Results. Home Office.
Independent Working Group on Drug Consumption Rooms (2006) Drug Consumption Rooms – Summary Report of the Independent Working Group. Joseph Rowntree Foundation.
Ingram, A, Saling, MM, Schweitzer, I (2008) Cognitive side effects of brief pulse electroconvulsive therapy: a review. Journal of ECT, 24: 39.
Johnstone, A (2005) The Decision of the House of Lords in Munjaz (Mental Health Law Briefing 94). RadcliffesLeBrasseur.
Kaplan, SL (2011) Child bipolar disorder imperiled by conflict of interest: will the credibility of child bipolar disorder be undermined? Psychology Today, 11 July (blog).
Kendall, T (2013) Paying people with psychosis to improve adherence. BMJ, 347: 9.
King, S, Griffin, S, Hodges, Z, et al (2006) A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents. Health Technology Assessment, 10: iiiiv, xiii–146.
Krafft-Ebing, R (1886) Psychopathia Sexualis. Reprinted by Bloat Books, 1999.
Lewis, R (2005) Walter Freeman's psychosurgery and biological psychiatry: a cautionary tale. Neurology Today, 5 (4): 70–2.
Lisanby, SH, Maddox, JH, Prudic, J, et al (2000) The effects of electroconvulsive therapy on memory of autobiographical and public events. Archives of General Psychiatry, 57: 581–90.
Mashour, GA, Walker, EE, Martuza, RL (2005) Psychosurgery: past, present and future. Brain Research Reviews, 48: 409–19.
Matthews, K, Eljamel, MS (2003) Status of neurosurgery for mental disorder in Scotland: selective literature review and overview of current clinical activity. British Journal of Psychiatry, 182: 404–11.
McCarthy, S, Wilton, L, Murray, ML, et al (2012) The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care. BMC Pediatrics, 12: 78.
Mental Health Act Commission (2008) Twelfth Biennial Report. TSO (The Stationery Office).
Mental Welfare Commission for Scotland (2006) Covert Medication. Legal and Practical Guidance. Mental Welfare Commission for Scotland.
Mental Welfare Commission for Scotland (2014) Good Practice Guide: The Use of Seclusion. Mental Welfare Commission for Scotland.
Michelson, D, Allen, AJ, Busner, J, et al (2002) Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. American Journal of Psychiatry, 159: 1896–901.
Mind, (2015) Making Sense of Neurosurgery for Mental Disorder. Mind (
Molina, BS, Hinshaw, SP, Swanson, JM, et al (2009) The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48: 484500.
Moncrieff, J, Timimi, S (2013) The social and cultural construction of psychiatric knowledge: an analysis of NICE guidelines on depression and ADHD. Anthropology & Medicine, 20: 5971.
Monynihan, R (2011) A new deal on disease definition. BMJ, 342: d2548.
National Audit Office (2004) The Drug Treatment and Testing Order: Early Lessons (HCC 366). NAO.
National Centre in HIV Epidemiology and Clinical Research (2009) Return on Investment 2: Evaluating the Cost-Effectiveness of Needle and Syringe Programs in Australia 2009. Australian Government.
National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction (1998) Effective medical treatment of opiate addiction. JAMA, 280: 1936–43.
National Records of Scotland (2016) Drug Related Deaths in Scotland 2015. National Records of Scotland ( Accessed 23 December 2016.
National Treatment Agency for Substance Misuse (2012) Medications in Recovery: Re-Orientating Drug Dependence Treatment for Substance Misuse. NTA.
NICE (2003) Electroconvulsive Therapy (ECT): The Clinical Effectiveness and Cost Effectiveness of Electroconvulsive Therapy (ECT) for Depressive Illness, Schizophrenia, Catatonia and Mania (TA59; modified 2009). National Institute for Health and Care Excellence.
NICE (2007) Drug Misuse in Over 16s: Psychosocial Interventions (CG51). National Institute for Health and Care Excellence.
NICE (2008) Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults (CG72; modified 2013). National Institute for Health and Care Excellence.
NICE (2009) Depression: The Treatment and Management of Depression in Adults (CG90). National Institute for Health and Care Excellence.
NICE (2016) Attention Deficit Hyperactivity Disorder: Diagnosis and Management – Updated 2016 (CG72). National Institute for Health and Care Excellence.
Norcross, JC, Koocher, GP, Garofalo, A (2006) Discredited psychological treatments and tests: a Delphi poll. Professional Psychology: Research and Practice, 37: 515–22.
Nosyk, B, Sun, H, Evans, E, et al (2012) Defining dosing pattern characteristics of successful tapers following methadone maintenance treatment: results from a population-based retrospective cohort study. Addiction, 107: 1621–9.
Petry, NM, Martin, B (2002) Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. Journal of Consulting and Clinical Psychology, 70: 398405.
Pliszka, S, AACAP Work Group on Quality Issues (2007) Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46: 894921.
Ramsay, S (2001) UK nurses receive guidance on covert medication of patients. Lancet, 358: 900.
Rasmussen, KG (2009) Sham electroconvulsive therapy studies in depressive illness: a review of the literature and consideration of the placebo phenomenon in electroconvulsive therapy practice. Journal of ECT, 25: 54–9.
Reed, J (2013) Why are we still using electroconvulsive therapy? BBC News ( Accessed 14 April 2016.
Riddle, MA, Yershova, K, Lazzaretto, D, et al (2013) The Preschool Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) 6-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 52: 264–78.e2.
Rose, D, Fleischmann, P, Wykes, T, et al (2003) Patients' perspectives on electroconvulsive therapy: systematic review. BMJ, 326: 1363.
Royal College of Psychiatrists (2000) Neurosurgery for Mental Disorder (Council Report CR89). Royal College of Psychiatrists.
Royal College of Psychiatrists (2004) College statement on covert administration of medicines. Psychiatric Bulletin, 28: 385–6.
Russell, G, Rodgers, LR, Ukoumunne, OC, et al (2014) Prevalence of parent-reported ASD and ADHD in the UK: findings from the Millennium Cohort Study. Journal of Autism and Developmental Disorders, 44: 3140.
Satcher, D (2001) The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. Office of the Surgeon General.
Sees, KL, Delucchi, KL, Masson, C, et al (2000) Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA, 283: 1303–10.
Simpson, DD, Joe, GW, Rowan-Szal, GA (1997) Drug abuse treatment retention and process effects on follow-up outcomes. Drug and Alcohol Dependence, 47: 227–35.
Sonuga-Barke, EJ, Brandeis, D, Cortese, S, et al (2013) Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170: 275–89.
Strang, J, Metrebian, N, Lintzeris, N, et al (2010) Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial. Lancet, 375: 1885–95.
Strohl, MP (2011) Bradley's benzedrine studies on children with behavioral disorders. Yale Journal of Biology and Medicine, 84: 2733.
Swayze, VW (1995) Frontal leukotomy and related psychosurgical procedures in the era before antipsychotics (1935–1954): a historical overview. American Journal of Psychiatry, 152: 505–15.
Treloar, A, Beats, B, Philpot, M (2000) A pill in the sandwich: covert medication in food and drink. Journal of the Royal Society of Medicine, 93: 408–11.
Turnbull, PJ, McSweeney, T, Webster, R (2000) Drug Treatment and Testing Orders: Final Evaluation Report. Home Office Research, Development and Statistics Directorate.
UK ECT Review Group (2003) Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet, 361: 799808.
Van der Merwe, M, Bowers, L, Jones, J, et al (2009) Seclusion: A Literature Review. City University (
Verkuijl, N, Perkins, M, Fazel, M (2015) Childhood attention-deficit/hyperactivity disorder. BMJ, 350: h2168.
Visser, SN, Danielson, ML, Bitsko, RH, et al (2014) Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child and Adolescent Psychiatry, 53: 3446.
Young, S, Amarasinghe, JM (2010) Practitioner review: non-pharmacological treatments for ADHD: a lifespan approach. Journal of Child Psychology and Psychiatry, 51: 116–33.
Ward, J, Hall, W, Mattick, RP (1999) Role of maintenance treatment in opioid dependence. Lancet, 353: 221–6.
Wodak, A, Cooney, A (2004) Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS among Injecting Drug Users. World Health Organization.
Wright, NM, Tompkins, CN (2004) Supervised injecting centres. BMJ, 328: 100–2.
Yoshino, K (2002) Covering. Yale Law Journal, 111: 769.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Controversial treatments in psychiatry

  • Jason Luty
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *