Sir : As an editor, Hugh Freeman will appreciate that covering a century's sweep risks giving hostages to fortune on specific details. I focused on how therapy establishments have a habit of blaming the disease and not the treatment. Professor Freeman does not disagree that this is what the psychoanalytical establishment did. An article in the Psychiatric Bulletin in 1981 predicted a similar dynamic would develop within biological psychiatry. My contention is that it has. Whether Eli Lilly were the first to formulate'a blame the disease not the drug' defence for therapeutic failure is not established, but I have documented in detail that this did happen (Reference HealyHealy, 2000).

In the Colorado shootings, the lead teenager was taking fluvoxamine. The emotional indifference that selective seretonin reuptake inhibitors (SSRIs) can cause may have contributed to this tragedy. I do not claim that it did so, but the response of the American Psychiatric Association to deny the possibility is based on neither research nor decency.

As regards perceptions that SSRI use is being aimed at personality transformation rather than simply the treatment of disease, there is a recent series of articles on this issue (Reference Elliott, Kramer and HealyElliott et al, 2000). There is also growing concern that many preschool children in America and Britain are receiving SSRIs (Reference Zito, Safer and DosreisZito et al, 2000). What disease is being treated here ?