At times the balance between understanding patients’ experiences of ill health and the biological models of disease processes can be difficult to achieve. Most healthcare professionals recognise the importance of both the scientific theories of disease and abnormal functioning, but also of ethical issues and the subjective experience of illness. Evidence-based medicine highlights the importance of taking into account three elements: the evidence, patient particulars and patient preference (Reference Haynes, Devereaux and GuyattHaynes, 2002). To ignore any one of these aspects would lead to an approach to care which cannot be patient-centred.

Professor Cawley suggested that ‘psychiatry is more than a science’ (Reference CawleyCawley, 1993), containing an ‘undefined something extra’ in addition to its scientific knowledge and practice. Psychiatry's concern with the uniqueness of each individual, empathy and communication with patients is ‘inevitable and everpresent’.

This is especially important for patients undergoing electroconvulsive therapy (ECT), who not only face the stigma of the treatment but also the potential disempowerment of such a technique, particularly in those cases where it is carried out against the wishes of the patient. The study carried out by Kershaw et al (Reference Kershaw, Rayner and Chaplin2007) was potentially able to address this issue, but unfortunately the researchers did not report whether the patients were being treated voluntarily, nor their attitudes towards ECT before receiving treatment.