If our psychiatric treatments are, indeed, based on the results of research, how, then, are we to account for the wide variability in ECT treatment in the United States? Despite the data, it appears that there continues to be ambivalence among American psychiatrists toward this efficacious and safe treatment. One reason may lie in its history of unmodified administration and the resultant side effects. Certainly films such as Shock Corridor,One Flew Over the Cuckoo's Nest, and Frances cannot have helped its reputation. However, there may be another more central reason for this ambivalence. With a few notable exceptions, there is little ECT research being conducted in major American psychiatric centers compared with research on pharmacological treatments. Many of the efficacy studies are one or more decades old. Rigorously designed multisite collaborative studies, using modern research techniques, of ECT's efficacy and predictors and correlates of response, relapse, and maintenance do not exist.