Comment: Right of Reply; Simon Wessely

The professor of psychological medicine at King's College, London, responds to Joseph Schwartz's article in praise of psychoanalysis in the treatment of mental illness
ONE OF the problems with being a psychiatrist is that everybody has an opinion about it - when surgical colleagues here tell taxi-drivers what they do for a living they are greeted by a respectful silence. When I do, I am subject to a range of opinions ranging from the "I bet you can read my mind then doctor," to "do you really connect people up to the national grid?"

Joseph Schwartz's piece on Freud was the equivalent of a two-hour taxi ride. Freud's invention of psychoanalysis was a landmark in the history of modern thought, and it is difficult to overstate his impact on culture and literature. But there is one gap - his influence on how we see mental disorder, which was never profound in this country, continues to dwindle.

As a way of understanding human behaviour and motivation, psychoanalysis is like great literature: one reads it for insights into the human condition, but not for advice on how to help an agoraphobic solicitor use the Underground, a cancer patient to think that there is still a purpose in life, or a student to overcome an attack of mania, all of which I have done in the last week.

Yes, psychiatrists do prescribe medication to treat mental disorder - because it works. Well over 1 000 studies now show that if you are depressed, for whatever reason, antidepressants are safe and effective. They are far from perfect and have side effects - both of which are also true of analysis - but are a great deal cheaper.

What Schwartz is saying is the old line of "talking good, drugs bad". Back in the 1960s we used to have those debates, but they are frankly tedious now. We now know that the reality is, "talking good, drugs good", and, as a result of modern trials, "talking plus drugs best of all".

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