ABSTRACT
If Winnicott were alive and practising today as a paediatrician (or a child psychiatrist) he would most probably ®nd himself in hot water. Having recourse in his treatment of depression almost exclusively to a talking cure, direct observation and case management, he would be deemed highly eccentric by his colleagues armed as they are nowadays with the DSM-IV and a battery of state-of-the-art antidepressants. For him the brain, particularly the child brain, was less the organ that required `tweaking' in the service of cure than the natural developmental pathway, that with the right setting in place could be coaxed back on track. He made his views absolutely plain in his attacks on shock therapy, or `treatment by ®ts' as he scathingly called it, when asserting that emotional disorders like depression were essentially independent of brain tissue disease. No one could claim to know, he insisted, how ECT worked in depression, and this implied a turning by doctors to magic instead of science ± a view that ®ts perfectly with the present-day controversial use of antidepressant medication for children and adolescents. The magic in this instance lies in assuming that the successful experiments on the adult brain automatically confer bene®t for the developing brain. In general, Winnicott made a habit of championing
the `positive' qualities of depression, both in children and adults, about which he wrote from a mass of clinical experience with considerable authority and enthusiasm. Yet he often used the term `depression' inconsistently, referring to both health and pathology thereby giving the impression of straddling a political divide (see entry on `Depression' in Abram 2007).
