How to treat the mentally ill :LETTER

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The Independent Online
From Professor Ernest Gellner

Sir: Dr Phil Thomas's letter ("Medication and madness", 16 June) is a sad case of question-begging prejudgement of tragically important matters. He asserts that the issue concerning the relative merit of drugs and of "understanding" is a matter of "values". Those who disagree with him evidently suffer from false values.

The problem hinges above all on matters of fact. There is, alas, little evidence that "understanding" is available or, if it were, that it is therapeutically effective. There is a fair amount of evidence to suggest that the information or theory marketed as a means to such understanding is of logically dismal quality, and can actually do harm.

It is, of course, inherently desirable and important that patients, once sufficiently stabilised to be able to benefit from it, should be given as much social and personal help as possible, and it is reasonable to suppose that this will help them re-establish their lives. That is not in dispute.

Dr Thomas is right in suggesting that drugs do not help all patients, that the biological basis of mental illness has not been convincingly demonstrated (almost nothing has, in the field of human conduct), that drugs are liable to have side effects which need to be monitored and weighted against possible benefits, and that drugs do not (at any rate, as yet) go to the heart of the matter. But to slide from this to an implied condemnation of the use of drugs is to try irresponsibly to deprive many sufferers of the only available (as yet) escape from an anguished condition.

Dr Thomas asks rhetorically how would we like to be treated, should we develop schizophrenia. Answer: by someone who would choose the method most likely to help us, in the light of available evidence. Not by someone whose choice is decided by whether or not the method gives him or her psychic satisfaction.

Yours faithfully,


King's College