Comment on Dr Scott's Paper

The mystery of mania and depression continues to challenge us, and among the most active in accepting the challenge is Dr Scott. Although these are psychotic states, and at times are inaccessible to psychological intervention, there is an increasing body of observations made in the psycho-analytic setting demonstrating that some patients are able to profit by psychoanalysis and indeed that something suggestive of cure may be seen with accessible patients. Of course we must be careful not to deceive ourselves, because we know that these are illnesses which are subject to remission and recurrence, and I am sure that every analyst has observed the recurrence in later years, even with analytic therapy. Nevertheless, the work has great value, for these are very often exceedingly tragic people whose lives may be ruined by the illness unless psycho-analytic intervention is attempted. As far as drugs and electroshock are concerned, they are very useful with inaccessible patients, and for bringing about a termination of the attack, but they do not solve the underlying illness out of which the attacks may grow. We are therefore justified in making what efforts we can to help these patients, and I may add that even where attacks do continue after psycho-analytic therapy, the patients are very often grateful for their increased understanding and the stability it gives them. We do well to approach the problems with this understanding, because these are essentially psychotic disorders