Letter

To the Editor:

In Dr. Levi's review (Psychoanalytic Books, 2, 339-343) of our book Development and Psychopathology, there are errors of fact that cannot be allowed to stand. All the psychotic patients described were treated with appropriate medication, and it is hard to see on what basis Dr. Levi questioned this. It is clearly stated in our introduction that treatment is not discussed in the book, which is concerned with the psychological understanding of common psychiatric disturbances. In this respect, Dr. Levi's doubts are particularly unfortunate: Dr. Freeman, in his book The Psychoanalyst in Psychiatry, emphasises the importance of medication; Dr. Wiseberg is well known for his advocacy of the diligent use of prophylactic medicinal treatment in manic depressive states; and Dr. Yorke has published a forceful argument urging the complementary nature of all relevant viewpoints, including the biological, in any sound psychiatry.

Thomas Freeman, M.D., Stanley Wiseberg, M.D., Clifford Yorke, FRCPsych., D.P.M. United Kingdom

Reply

I am pleased to know that the psychotic patients were treated with appropriate medication. To me it seemed they might not have received medication because none was mentioned in describing the courses of illness of several of the patients. Psychopharmacologic treatment implies functional brain disorder while the authors' intensive focus on metapsychologic formulation and psychological development omitted clarification of how a possibly dominant biologic factor interacts with, or may cause, the regressions and disharmonies delineated. If I were treating such patients with medication, I would feel it necessary to include how the changes in their illnesses related to the medications as well as to the psychologic vicissitudes the authors describe.

L. David Levi, M.D. Washington, D.C.