Electroconvulsive therapy (ECT) is an important treatment modality in psychiatry, considered to be the most effective option for pharmaco-resistant affective and psychotic disorders. Despite its great efficacy, it still remains a rather controversial method, which hinders its full potential. It is feasible to say that in part, this controversy is caused by a largely negative image of ECT displayed through media. The depiction of ECT in movies has been studied and well documented in the past. The aim of our study was to provide an overview of how ECT is represented in video games - a form of media where ECT representation has been overlooked in scientific literature so far. As with movies, most of these portrayals are negative, depicting ECT as an obsolete, aggressive or torturous treatment method.

Department of Psychiatry 1st Faculty of Medicine of Charles University and General University Hospital Prague Czechia

Department of Psychiatry Faculty of Health Studies Krajska zdravotni a s Jan Evangelista Purkyne University and Masaryk Hospital Usti nad Labem Czechia

Department of Psychiatry Faculty of Medicine Masaryk University and University Hospital Brno Brno Czechia

Faculty Hospital Královské Vinohrady Prague Czechia

Grammar School Bilíkova Bratislava Slovakia

Institute of Clinical and Experimental Medicine Prague Czechia

Tatra Defence Vehicle Kopřivnice Czechia

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Sackeim HA. Modern electroconvulsive therapy: vastly improved yet greatly underused. JAMA Psychiatry. (2017) 74:779–80. doi: 10.1001/jamapsychiatry.2017.1670, PMID: PubMed DOI

Peterchev AV, Rosa MA, Deng ZD, Prudic J, Lisanby SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT. (2010) 26:159–74. doi: 10.1097/YCT.0b013e3181e48165, PMID: PubMed DOI PMC

Mádlová K, Kališová L, Zajícová M. Public stigma of electroconvulsive therapy (ECT) in the Czech Republic. Eur Psychiatry. (2016) 33:S554–4. doi: 10.1016/j.eurpsy.2016.01.2046 DOI

McFarquhar TF, Thompson J. Knowledge and attitudes regarding electroconvulsive therapy among medical students and the general public. J ECT. (2008) 24:244–53. doi: 10.1097/YCT.0b013e318168be4a, PMID: PubMed DOI

Sienaert P. Based on a true story? The portrayal of ECT in international movies and television programs. Brain Stimul. (2016) 9:882–91. doi: 10.1016/j.brs.2016.07.005, PMID: PubMed DOI

Buday J, Neumann M, Heidingerová J, Michalec J, Podgorná G, Mareš T, et al. . Depiction of mental illness and psychiatry in popular video games over the last 20 years. Front Psych. (2022) 13:967992. doi: 10.3389/fpsyt.2022.967992, PMID: PubMed DOI PMC

Finances Online (2020). Available at: https://financesonline.com/number-of-gamers-worldwide/ (Accessed December 3, 2023).

Shapiro S, Rotter M. Graphic depictions: portrayals of mental illness in video games. J Forensic Sci. (2016) 61:1592–5. doi: 10.1111/1556-4029.13214, PMID: PubMed DOI

Ferrari M, McIlwaine SV, Jordan G, Shah JL, Lal S, Iyer SN. Gaming with stigma: analysis of messages about mental illnesses in video games. JMIR Mental Health. (2019) 6:e12418. doi: 10.2196/12418, PMID: PubMed DOI PMC

UK Games Charts . Ukiepedia. (2021). Available at: https://ukiepedia.ukie.org.uk/index.php/UK_Games_Charts

UK Annual Report . (2021). Available at: https://www.gamesindustry.biz/articles/2021-01-08-43-million-games-sold-in-the-uk-in-2020-uk-annual-report (Accessed December 3, 2023).

Thomas DR. A general inductive approach for analyzing qualitative evaluation data. American journal of evaluation. (2006) 27:237–46.

Stone R. China reins in Wilder impulses in treatment of ‘internet addiction’. Science. (2009) 324:1630–1. doi: 10.1126/science.324_1630, PMID: PubMed DOI

The New York Times . (2017). Available at: https://www.nytimes.com/2017/01/13/world/asia/china-internet-addiction-electroshock-therapy.html (Accessed December 3, 2023).

Kühn S, Kugler D, Schmalen K, Weichenberger M, Witt C, Gallinat J. Does playing violent video games cause aggression? A longitudinal intervention study. Mol Psychiatry. (2019) 24:1220–34. doi: 10.1038/s41380-018-0031-7, PMID: PubMed DOI PMC

The UK ECT Review Group . Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. (2003) 361:799–808. doi: 10.1016/S0140-6736(03)12705-5, PMID: PubMed DOI

Hořínková J, Bartečků E, Kališová L. The practice of electroconvulsive therapy in children and adolescents in the Czech Republic. J ECT. (2021) 37:112–8. doi: 10.1097/YCT.0000000000000726, PMID: PubMed DOI

Dominiak M, Antosik-Wójcińska AZ, Goetz Z, Sikorska O, Stefanowski B, Gorostiza D, et al. . Efficacy, safety and tolerability of formula-based unilateral vs bilateral electroconvulsive therapy in the treatment of major depression: a randomized open label controlled trial. J Psychiatr Res. (2021) 133:52–9. doi: 10.1016/j.jpsychires.2020.12.002, PMID: PubMed DOI

Takamiya A, Bouckaert F, Sienaert P, Uchida T, Kudo S, Yamagata B, et al. . Electroconvulsive therapy for patients with depression who lack capacity for consent: doing good and doing no harm. J ECT. (2021) 37:171–5. doi: 10.1097/YCT.0000000000000764, PMID: PubMed DOI

Lloyd JR, Silverman ER, Kugler JL, Cooper JJ. Electroconvulsive therapy for patients with catatonia: current perspectives. Neuropsychiatr Dis Treat. (2020) 16:2191–208. doi: 10.2147/NDT.S231573, PMID: PubMed DOI PMC

Suleman R. A brief history of electroconvulsive therapy. Am J Psychiatr Resid J. (2020) 16:6. doi: 10.1176/appi.ajp-rj.2020.160103, PMID: PubMed DOI

Koh AH, Tan XW, Tor PC, Chatterton ML, Martin DM, Loo CK. The association between outpatient continuation/maintenance electroconvulsive therapy, readmission risk and total direct cost in patients with depressive, bipolar and psychotic disorders: a naturalistic retrospective cohort study. J Affect Disord. (2023) 338:289–98. doi: 10.1016/j.jad.2023.06.016, PMID: PubMed DOI

Gaynes BN, Rush AJ, Trivedi MH, Wisniewski SR, Spencer D, Fava M. The STAR* D study: treating depression in the real world. Cleve Clin J Med. (2008) 75:57–66. doi: 10.3949/ccjm.75.1.57, PMID: PubMed DOI