Sir: The efficacy of barbiturate-facilitated abreaction in the investigation and treatment of mental disorders has been well documented since 1930, when Bleckwenn carried out his pioneer work. Dysken et al (Reference Dysken, Chang and Casper1979), reviewing the North American literature, cited 52 studies in which the procedure was found to be useful, and there have been no reports of permanent harm. If this valuable technique were to disappear from the therapeutic armamentarium, as suggested by the results of the Wilson survey (Psychiatric Bulletin, February 2002, 26, 58-60), it would be a most unfortunate development.
An explanation for the disuse of abreaction may be found in the nature of the procedure as it is usually performed. Psychiatrists are unskilled in parenteral administration and lack confidence in their ability to cope with respiratory depression or laryngospasm. These hazards are eliminated if the necessary drugs are given by mouth.
We have found that the oral administration of up to 300 mg of amobarbital with 80 mg of methylphenidate produces an abreactive state in which the patient can talk freely about sensitive issues and release the corresponding emotions. Addition of the stimulant to the barbiturate combats somnolence and promotes a smooth flow of speech. Employing this method we have enjoyed a number of successes in the treatment of post-traumatic stress disorder.
We believe that abreaction is a unique therapeutic instrument that should be preserved and used more widely than at present.
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