Patients' fear of and objection to electroconvulsive therapy (ECT) have complicated the administration of this modality since its inception. Despite modifications in technique and pretreatment education over the years, these problems have not disappeared. The author discusses the literature on fear of convulsive therapy and provides three case examples from his clinical experience. The review suggests that some patients gradually develop a pathological fear of ECT over the course of treatment, which creates a significant obstacle to compliance and in some cases leads to refusal of treatment. The author suggests that this clinical phenomenon, described during the 1950s but often underrecognized today, merits further study.