Maintenance treatment in recurrent depression: current and future directions. The first William Sargant Lecture.

When William Sargant died in 1988 at the age of 81, he had made his mark on British psychiatry. He had exerted considerable influence on US psychiatry as well. This was especially obvious during a time when physical treatments were hardly the fashion in US psychiatry. As The Times (1988) stated at the time of his death, he had made psychiatry more respectable by keeping it close to the medical model. He did a great deal to make depression intelligible to general practitioners and, therefore, to make it a legitimate, respectable illness. Almost 25 years ago, Dr Sargant was asked to give the Watson-Smith lecture at the Royal College of Physicians. For this lecture, later published in the British Medical Journal (Sargant, 1966),hechoseas his subject psychiatric teaching in the general teaching hospital. His primary goal in this lecture was to re-establish the clinical unity of psychiatry and general medicine through examples of the treatment possibilities beginning to open up in both general medicine and psychiatry, which he hoped could be pursued jointly. Included in this broad discussion was the treatment of depression. Dr Sargant stressed that treatment for depression could now be conducted for much shorter periods than previously. He described the experience that he and his colleagues had had since the late 1950s in prescribing antidepressant drugs. He finished this lecture on a fairly optimistic note. “¿ Now with all physical treatments combined if necessary, practically all cases of depression in good previous personalities can be helped, and recurrences often prevented or greatly modified. Chronicity should by now become a very rare occurrence indeed.―That may have been the case in the UK, but, unfortunately, it was not yet the case in the US. It is interesting to note that this lecture at the Royal College of Physicians was considered sufficiently important for a commentary on it to be published in The Times six months later (1966). The commentary, entitled “¿ Psychotherapy in Its Widest Sense―, concluded that current clinical research in medicine and psychiatry was now becoming impressive. It made three major points: (a) with all the exciting work now going on with pharmacotherapy, we might begin to understand more about the underlying patho physiology of mental disorders (b) medications should not be considered the end all or be-all of our armamentarium (c) the mentally and emotionally afflicted can be restored to a useful and satisfying role in society only if the term †̃¿ psychotherapy' is used in the widest possible sense to include all the tools now available to physicians, family doctors, and clergymen alike, each performing their particular art to aid the mentally disturbed.