Despite its acknowledged efficacy and safety in the treatment of patients with severe affective and psychotic illnesses, as well as extensive efforts at professional and public education, electroconvulsive therapy is a neglected treatment, its use in the U.S. being mainly restricted to academic and private hospitals. Widespread use between 1935 and 1960, a rapid decline following the introduction of psychoactive drugs, and a slow resurgence in clinical interest since 1975 characterizes its history. The use of ECT has been encouraged by repeated favorable evaluations and by new procedures which improve both its efficacy and its safety. The experience in the United States provides a lesson for other nations where its use is inhibited.