Electroconvulsive therapy (ECT) remains an important treatment option for severe depressive illness, but it can have side-effects, including permanent gaps in memory. Where minimising the intellectual side-effects of treatment has priority, then treatment to only one side of the head (unilateral ECT) is preferable; where the speed of clinical improvement is paramount, then bilateral ECT may be preferred. The choice of how ECT is administered should, where possible, be part of the process of informed consent.

Psychiatry is the branch of medicine concerned with the diagnosis, treatment and study of psychological disorders. The role of the psychiatrist evolves to reflect developments in medicine, science and society. The scientific knowledge base required for the practice of psychiatry changes from generation to generation, but many of the fundamental principles of practice remain essentially unchanged. We attempt here to identify some of these (relatively unchanging) principles and explore their relevance to contemporary psychiatry. In particular, we focus on the work of some of the more reflective physicians of history (e.g. Sir Robert Hutchison, Sir William Osler) in order to identify and interpret principles of medical practice outlined in the 19th and 20th centuries and we explore the relevance of these conceptual frameworks to the practice of psychiatry in the 21st century.

It is remarkable that any of the advice given to medical students 70 years ago should still be relevant today. But none of it now makes sense without reference to the two-way relationship we share with our patients. We should be asking not what the doctor should be blessed with by the world, but what the patient should require of the doctor. This would include humanity, humility, honesty and especially wisdom.