Prior to the 1930s, the prime mode of treatment for psychiatric outpatients was psychoanalysis. Little could be done for inpatients, other than provide sedation and social support. In the 1930s, four major somatotherapies, all interventionist in technique, were developed: insulin coma therapy, Metrazol convulsive therapy, lobotomy (psychosurgery), and electroconvulsive therapy (ECT), the only one of these therapies still in use today. This paper focuses on the development of ECT by Ugo Cerletti and Lucio Bini at the Clinic for Nervous and Mental Disorders in Rome in 1938. The first electro-shock treatment with humans is discussed in detail and the export of ECT to North America is described. Fifty years after the first treatment, ECT remains a controversial method of psychiatric treatment.