No evidence was found for any relationship between degree of fear of ECT (as determined from analysis of ratings based on clinical interview and observation and of responses to two projective tests: the Word-Chain Association Test and the Fisher Thematic Apperception Test) and psychiatric improvement with the treatment. Nor was there any evidence linking improvement with notions of guilt and punishment or death-rebirth fantasies. Some fear of ECT was universal in the patients, the level of fear remaining relatively constant from beginning to end of treatment. The role of fear in electroconvulsive treatment was studied in a group of 96 hospitalized male veteran psychiatric patients given a course of real or simulated ECT.