This book is subtitled Guide for Patients and their Families, so my first impulse was to get the opinion of a user. However, I changed my mind after reading it.

I have met Max Fink in the past and he is given to bullish statements, so I was not surprised at the tenor of the book. However, I cannot suggest to my patients or their relatives that they should read a book that states that a course of electroconvulsive therapy (ECT) usually takes at least 6 months and that appears to condone using ECT to treat patients without informed consent. Fink describes the mechanism whereby treatment can be given without written consent in the USA, pointing out that it can be slow and expensive. He then describes several case histories in which this mechanism was circumvented and treatment appears to have been given without either informed consent or the appropriate order from a State Court. We must be grateful that the current Mental Health Act procedures in the UK provide an effective mechanism to allow appropriate timely treatment of these very ill people. On behalf of these vulnerable individuals we must be vigilant regarding proposals for reform.

This is a small, slim and eminently readable volume, but I cannot recommend it to patients and families. I did find it instructive in terms of practice and attitudes in the USA and I urge psychiatrists who prescribe ECT to read it and to reflect upon our own practice in the UK. Those who campaign against the stigma associated with psychiatry might also find it interesting. ECT in the USA has faced relentless opposition from anti-ECT groups, and there is always a temptation to combat extremism by going to the other extreme. The real challenge, of course, is to recognise legitimate concerns at both poles of opinion and to negotiate a middle course.