approximately 1 million patients receive ECT per year. Exact numbers of how many persons per year have ECT in the United States are unknown due to the variability of settings and treatment. Researchers' estimates generally range from 100,000 to 200,000 persons per year. Some persons receiving ECT die during the procedure (ECT is performed under a general anaesthetic, which always carries a risk). Leonard Roy Frank writes that estimates of ECT-related death rates vary widely. The lower estimates include: 2–4 in 100,000 (from Kramer's 1994 study of 28,437 patients) 1 in 10,000 (Boodman's first entry in 1996) 1 in 1,000 (Impastato's first entry in 1957) 1 in 200, among the elderly, over 60 (Impastato's in 1957) Higher estimates include: 1 in 102 (Martin's entry in 1949) 1 in 95 (Boodman's first entry in 1996) 1 in 92 (Freeman and Kendell's entry in 1976) 1 in 89 (Sagebiel's in 1961) 1 in 69 (Gralnick's in 1946) 1 in 63, among a group undergoing intensive ECT (Perry's in 1963–1979) 1 in 38 (Ehrenberg's in 1955) 1 in 30 (Kurland's in 1959) 1 in 9, among a group undergoing intensive ECT (Weil's in 1949) 1 in 4, among the very elderly, over 80 (Kroessler and Fogel's in 1974–1986). Political abuse of psychiatry Psychiatrists around the world have been involved in the suppression of individual rights by states in which the definitions of mental disease have been expanded to include political disobedience. Nowadays, in many countries, political prisoners are sometimes confined and abused in mental institutions. Psychiatry possesses a built-in capacity for abuse which is greater than in other areas of medicine. The diagnosis of mental disease can serve as proxy for the designation of social dissidents, allowing the state to hold persons against their will and to insist upon therapies that work in favour of ideological conformity and in the broader interests of society. In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials. Under the Nazi regime in the 1940s, the "duty to care" was violated on an enormous scale. In Germany alone 300,000 individuals that had been deemed mentally ill, work-shy or feeble-minded were sterilized. An additional 200,000 were euthanized. These practices continued in territories occupied by the Nazis further afield (mainly in eastern Europe), affecting thousands more. From the