The article "Take Gains From Placebo Effect More Seriously, Psychiatrists Urged," in the May 5 issue presented references to psychotherapy. It quoted Walter Brown, M.D., as saying, "What patients probably get from placebo treatment are the effective elements of psychotherapy," but there was no discussion of what are or are not the effective elements of psychotherapy.

The authors quoted in the article were using scientific statistical methods, but these methods have limitations in approaching the truth about mental illness. Scientific statistical methods compare one group of people under certain circumstances with another group of people. These methods, obviously, cannot be applied to the study of one unit, one event, or one patient. They require at least more than one patient. Scientists using statistical methods cannot know all of the truth or all of the reality of one patient’s mental illness.

In contrast, psychodynamic psychotherapy helps fill this gap by its method of studying, understanding, and treating one patient. The method is basically a comparison of a patient at one point in time with himself or herself at various other times. A therapist compares and connects a patient’s reports of past incidents, fantasies, dreams, statements, feelings, behaviors, and relationships with those currently in the life of the patient, as reported by the patient and as observed by the therapist in the sessions. There are several points of comparison that are correlated by the therapist: What the patient says that another person says about him or her and their relationship is compared with what the patient says about himself or herself and the relationship to the other person. What the patient says and does in sessions and in relationship to the therapist is compared with what the patient says that he or she says and does at home or at work in relationship to other people. What the patient says is compared with what the patient expresses nonverbally.

From reports and observations, a therapist identifies patterns and variations and develops hypotheses about their meanings. A therapist looks for consistencies and inconsistencies and for logical connections that qualify and refine the hypothesis of cause and effect and the development of mental disorders.

Medical science, with statistical methods, has made significant contributions to knowledge about the causes and the cures of "physical" diseases and mental disorders and freed us from many medieval superstitions. Few people, if any, would deny this or suggest that we stop doing medical research. Nonetheless, awareness of its limitations may help keep more doors open in the search for the truth about mental disorders and their cures.

James M. Murphy, M.D.

New York, N.Y.