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A Socratic Dialogue to Unsettle an Entire Field… and the Foundations of Institutional Knowledge

Socrates at Oxford

By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.

Essay substantially revised on 1 September 2026.

When I taught medical students at Oxford, I would often employ the Socratic method, and ‘play Socrates’. Rather than spoon-feed them the curriculum, or tell them what to think, I would question what they thought they knew, and follow their answers wherever they happened to lead. These were among my most lively and memorable tutorials.

In this piece, I try to reconstruct one such dialogue, with a newly qualified doctor, Phaedrus, preparing for an interview for an academic post in psychiatry.

The Dialogue

Socrates: Congratulations, Phaedrus, on your recent graduation.

Phaedrus: Please don’t mention it, Socrates. Graduating serves only myself—or, in fact, my parents. I have not yet done anything for the world.

Socrates: But you have, at least, seen through it. Now that you are a physician, what are you going to do?

Phaedrus: I am applying for a research post.

Socrates: In which specialty?

Phaedrus: Psychiatry, the healing of the soul—of course! I have my job interview tomorrow. Will you help me prepare for it?

Socrates: Very well, my young friend. I shall play the eminent professor of psychiatry. As you know, I have my own hierarchy of madness.

Phaedrus: What, with love being the highest form?

Socrates: Are you ready?

Phaedrus: I am!

Socrates: Mr Phaedrus, our university has a large and highly rated department of psychiatry. How much money do you suppose it spends on research each year?

Phaedrus: I really don’t know. Many millions, certainly.

Socrates: And how many comparable departments are there in this country?

Phaedrus: Dozens.

Socrates: And throughout the world?

Phaedrus: Hundreds, perhaps thousands.

Socrates: And for how many decades have they been conducting psychiatric research?

Phaedrus: Many decades.

Socrates: So it would be fair to say that, collectively, we have spent many billions on psychiatric research?

Phaedrus: Without question.

Socrates: Does that include the research budgets of pharmaceutical companies?

Phaedrus: No, not at all.

Socrates: Very well. Then name me one important breakthrough in psychiatry in all the decades since the Second World War.

Phaedrus: SSRI antidepressants. I heard one in six adults are now on them.

Socrates: Many perfectly competent people, including within psychiatry, argue that SSRIs are no more effective than a placebo.

Phaedrus: Some studies show that they work. Other studies show that they don’t. The consensus is that they are slightly more effective than a placebo.

Socrates: Who sponsored the studies?

Phaedrus: You raise a valid point, Socrates. We’d have to look at it carefully on a case-by-case basis.

Socrates: SSRIs have disturbing adverse effects, whereas inert placebos do not. Could it be that these adverse effects are increasing their placebo effect?

Phaedrus: OK, forget SSRIs. What about second-generation antipsychotics like risperidone and olanzapine? They have fewer disturbing adverse effects than first-generation antipsychotics like chlorpromazine. Surely, they must count as an important breakthrough.

Socrates: It has been argued that much of the difference between the old and the new is simply that the new are administered at much lower doses—though even they have disturbing adverse effects.

Phaedrus: Yes, they remain very dirty drugs. Theodorus says they only work insofar as they sedate you.

Socrates: Phaedrus, are you saying that, despite having spent many research billions, there has not been a single breakthrough in psychiatry in all these decades?

Phaedrus: What about mindfulness meditation?

Socrates: Phaedrus, you know that was invented in India, more than two thousand years ago.

Phaedrus: That was a long time before peer review.

Socrates: And yet, you wish to pursue a career in psychiatric research. Perhaps you fancy that you, of all people, will be the one to make the breakthrough?

Phaedrus: In the cold light of what we have said, my chances do seem rather slim. But perhaps medical science is more about making small steps than giant leaps, you know, working in a large team to make small steps.

Socrates: Small steps forwards or small steps backwards?

Phaedrus: How do you mean!

Socrates: When do researchers make small steps backwards rather than small steps forwards?

Phaedrus: When they publish misleading research. There is a saying, is there not, that to do the wrong thing is worse than to do nothing at all.

Socrates: Do the researchers put out misleading research because they are lacking in intelligence?

Phaedrus: No, it’s more that they are under a silent pressure to publish.

Socrates: In what way?

Phaedrus: Researchers need to publish results to appear successful and advance their careers—and perhaps also to justify themselves to themselves. Positive results are more likely to be published than negative results, and so there may be a tendency, however subconscious, to arrive at results that are slightly positive.

Socrates: If positive results are published while negative results are hidden from view, we may be deceived into thinking that a particular phenomenon is present when it is not, or that a particular treatment or intervention is effective when it is not.

Phaedrus: And that gives rise to false theories, false constructs, and false paradigms: blind alleys in which other researchers lose themselves.

Socrates: Not just other researchers, Phaedrus, but also physicians, science writers, journalists…

Phaedrus: Not to forget the patients themselves.

Socrates: Quite. Now tell me, Phaedrus, who pays for all this research?

Phaedrus: Universities, governments, charities…

Socrates: Anyone else?

Phaedrus: Pharmaceutical companies.

Socrates: And do pharmaceutical companies have any particular interest in the results?

Phaedrus: Well, naturally. They want to sell their drugs.

Socrates: Might that influence the research?

Phaedrus: It might.

Socrates: How?

Phaedrus: They might be more inclined to publish favourable results than unfavourable ones.

Socrates: How do you mean?

Phaedrus: Well, for example, there are pharmaceutical companies that have been known to selectively publish research with positive findings, while spinning, doctoring, or suppressing any research with negative findings. This creates the impression that their products are more effective than they are.

Socrates: Or even, that their products are effective when they are not.

Phaedrus: Yes, it misleads the research community, who create or adjust explanatory models to fit the ‘findings’.

Socrates: Which creates even more confusion.

Phaedrus: On top of all this, pharmaceutical companies spend large sums of money promoting their products to physicians and end consumers.

Socrates: How do they promote their products to physicians?

Phaedrus: By meeting with them and ‘educating’ them about a particular product or range of products, sponsoring their conferences, contracting them as speakers or consultants, and such like. They target the most influential physicians, so-called ‘key opinion leaders’.

Socrates: So the physicians they target are those in leadership positions.

Phaedrus: Yes, just those who are driving the research!

Socrates: Tell me, Phaedrus, when a researcher sets out to conduct a study, does he begin again from first principles?

Phaedrus: Of course not. He begins with what is already known.

Socrates: And how does he know what is already known?

Phaedrus: From the existing research.

Socrates: Including the research we have just been discussing?

Phaedrus: I see what you mean.

Socrates: Suppose an early finding is mistaken, but is accepted and built upon by other researchers. What happens to the mistake?

Phaedrus: I suppose it becomes embedded in the literature.

Socrates: And if enough further research is built upon it?

Phaedrus: It might eventually come to be regarded as established knowledge.

Socrates: Even though it was never knowledge in the first place?

Phaedrus: Yes.

Socrates: Well then, Phaedrus, if, after all this, you still wish to pursue a career in psychiatric research, you must take great care to avoid all these pitfalls and make small steps forwards rather than small steps backwards. Otherwise, you will have thrown away your education. You will have wasted your life. And you will leave this world, to which you owe so much, having done it more harm than good.

Phaedrus: Socrates, if I mention any of this in my interview, they won’t take me.

Socrates: No, they won’t.

Phaedrus: And if they take me, and I try to do the right thing, they will punish me.

Socrates: They will.

Phaedrus: Socrates, you meant to help me prepare for my interview.

Socrates: I have.

Phaedrus: What else can I do with myself, or for the world?

Socrates: Be brave.

Continue Exploring

If this essay spoke to you, you might look into The Meaning of Madness.

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Freud and the Discovery of the Unconscious

Portrait of Sigmund Freud
Sigmund Freud in 1921, photographed by Max Halberstadt.

By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.

Essay substantially revised on 8 September 2026.

People with a high level of anxiety have historically been referred to as ‘neurotic’. The term ‘neurosis’ derives from the Ancient Greek neuron (‘nerve’) and loosely means ‘disease of the nerves’.

The core feature of neurosis is anxiety, but neurosis can also manifest in more distinct forms such as phobias, panic attacks, irritability, depression, perfectionism, and obsessive-compulsive tendencies. Whatever form or forms it takes, neurosis can prevent us from living in the moment, adapting usefully to our environment, and developing a richer, more nuanced, and more fulfilling outlook on life.

Neurosis and the Loss of Meaning

For Carl Jung, neurosis often reflected a crisis of purpose and meaning. In Memories, Dreams, Reflections, he noted that the majority of his patients consisted ‘not of believers but of those who had lost their faith’.

Yet he also believed that neurosis could, in some cases, benefit the sufferer.

In Two Essays on Analytical Psychology, he wrote:

The reader will doubtless ask: What in the world is the value and meaning of a neurosis, this most useless and pestilent curse of humanity? To be neurotic—what good can that do? … I myself have known more than one person who owed his whole usefulness and reason for existence to a neurosis, which prevented all the worst follies in his life and forced him to a mode of living that developed his valuable potentialities. These might have been stifled had not the neurosis, with iron grip, held him to the place where he belonged.

Freud and the Birth of Psychoanalysis

The most original, influential, and controversial theory of neurosis is that of Sigmund Freud.

Freud studied medicine in Vienna from 1873 to 1881 and, after a time, decided to specialise in neurology. In 1885–86, he spent the best part of a year in Paris, where he was impressed by the neurologist Jean-Martin Charcot’s use of hypnosis in the treatment of ‘hysteria’ (Greek, hysterikos, ‘of the womb’), an outdated and inherently sexist construct involving the conversion of psychological distress into physical and psychological symptoms.

Freud returned to Vienna and opened a private practice, but gradually abandoned hypnosis in favour of ‘free association’, which involved asking the patient to relax on a couch and say whatever came into her mind.

In 1895, inspired in particular by Josef Breuer’s treatment of Bertha Pappenheim (better known as Anna O.), Freud and Breuer published the seminal Studies on Hysteria. Following the publication of The Interpretation of Dreams (1899) and The Psychopathology of Everyday Life (1901), Freud was appointed professor at the University of Vienna and began to gather a devoted following.

He remained a prolific writer throughout his life. Some of his most influential works include Three Essays on the Theory of Sexuality (1905), Totem and Taboo (1913), and Beyond the Pleasure Principle (1920).

Following the Nazi annexation of Austria in 1938, Freud fled to London, where, in the following year, he died of cancer of the jaw. His daughter Anna became a distinguished psychoanalyst in her own right and did much to develop and systematise his account of the ego defence mechanisms.

The Talking Cure

In Studies on Hysteria, Freud and Breuer argued that neurotic symptoms could originate in traumatic experiences that had been excluded from consciousness. Treatment involved helping the patient to recover these experiences and give expression to the emotion attached to them, leading to a sudden and dramatic outpouring of feeling (‘catharsis’) and, ideally, to the disappearance of the symptom.

Freud later moved beyond this early ‘cathartic method’, placing ever greater emphasis on free association, dream interpretation, and the patient’s relationship with the analyst. By remaining relatively passive and inscrutable, the analyst became a kind of blank canvas onto which the patient could project thoughts and feelings carried over from important earlier relationships—a process called ‘transference’.

In the course of analysis, the patient might display ‘resistance’ by changing the topic, blanking out, falling asleep, arriving late, or missing appointments. Such behaviour was only to be expected: it indicated that the patient was approaching repressed material but remained afraid of confronting it.

Routes into the Unconscious

Freud famously called dreams ‘the royal road to a knowledge of the unconscious’. Dreams, he believed, are disguised fulfilments of repressed wishes. Their surface story, or ‘manifest content’, conceals a deeper ‘latent content’ that has been distorted to make it more acceptable to the sleeping mind. The task of dream interpretation is to work backwards from the manifest content to the hidden wish beneath it.

Besides dreams and free association, Freud identified two further routes into the unconscious: parapraxes and jokes.

Parapraxes, better known as ‘Freudian slips’, are ‘faulty actions’ that occur when unconscious thoughts and desires suddenly parallel and then override conscious thoughts and intentions. Examples include calling a partner by the name of an ex-partner, substituting one word for another that rhymes or sounds similar (‘I would like to spank/thank you’), or combining two words into a single one (‘He is a very lustrous [illustrious/lustful] gentleman’).

Although parapraxes often manifest in speech as ‘slips of the tongue’, they can also manifest as misreadings, mishearings, forgettings, and the mislaying of objects. In Freud’s world, even a joke was never only a joke—and an accident might not be entirely accidental.

The Architecture of the Mind

In The Interpretation of Dreams, Freud presented and elaborated upon his ‘topographical model’ of the mind, distinguishing between the conscious, the unconscious, and an intermediary layer called the preconscious, which, although not presently conscious, could readily be accessed by consciousness.

He later became dissatisfied with the topographical model and supplemented it with the ‘structural model’, according to which the mind is divided into the id, ego, and superego.

The id, which is wholly unconscious, contains our drives and repressed emotions. Governed by the ‘pleasure principle’, it seeks immediate gratification regardless of circumstance or consequence.

Opposing it is the partly unconscious superego, a sort of moral judge arising from the internalisation of parental figures and, by extension, of society itself.

Caught in the middle is the ego, which, unlike the id, has both conscious and unconscious parts. Governed by the ‘reality principle’, it mediates between the id, the superego, and the demands of reality, postponing gratification and enabling the person to function in the world.

Neurotic anxiety arises when the ego is overwhelmed by these competing demands. To protect itself, it deploys various defence mechanisms (‘ego defences’) that block or distort impulses from the id, making its outrageous demands seem more acceptable, tolerable, and manageable.

Freud’s topographical and structural models of the mind
Freud’s topographical model (the ocean) and structural model (the iceberg) superimposed. Only the tip of the iceberg is conscious.

Sex, Death, and the Oedipus Complex

For Freud, human behaviour is driven above all by instinct. The life instinct, or Eros, seeks survival, propagation, pleasure, and creation, and draws its energy from the libido or sex drive. Opposed to it is the death instinct, the unconscious urge towards aggression, destruction, and, ultimately, the peace of non-existence.

Human life is shaped by the tension between these two elemental forces: the impulse to bind and build, and the impulse to break apart and return to nothingness.

Even in childhood, the libido is the primary motivating force. As children mature, they pass through a series of psychosexual stages—oral, anal, phallic, latent, and genital—each centred upon a different source of pleasure and conflict. If a conflict is not adequately resolved, part of the personality may remain ‘fixated’ at that stage, contributing to neurotic symptoms and patterns of character in later life.

The most notorious of these conflicts is the Oedipus complex, named after the mythological king who unwittingly killed his father and married his mother. In Freud’s account, the young boy takes his mother as his first love-object and comes to regard his father as a rival. But since his father is stronger and more powerful, he eventually relinquishes his claim upon his mother and identifies with his father instead.

Freud’s corresponding account of female development is even more controversial and, like much of his sexual theory, is better understood as a mythology of the mind than as literal science. Even so, the Oedipus complex captures something profound: that we do not enter society directly, but through the triangle of the family, by learning that we cannot possess everything—or everyone—that we desire.

Freud’s stages of psychosexual development

Freud’s Enduring Influence

Although derided in his time and still today, Freud is without question one of the deepest and most original thinkers of the twentieth century.

Many of his specific theories are unscientific, unfalsifiable, or simply wrong. Yet his larger vision—that much of mental life takes place outside awareness, that we are divided against ourselves, that childhood shapes adulthood, that symptoms have meanings, and that human beings are strangers in their own minds—has become so deeply embedded in our culture that we can no longer easily perceive its influence.

Despite being disowned or disdained by physicians, Freud is, ironically, the most famous of all physicians, and the only physician to have become a household name. He is credited with discovering—or at least mapping—the unconscious and inventing psychoanalysis, and had a colossal impact not only on psychiatry but also on art, literature, and the humanities.

He may have been thinking of himself—he often did—when he noted that ‘the voice of intelligence is soft, but it does not die until it has made itself heard.’

Continue Exploring

I revisit Freud in The Meaning of Madness and Hide and Seek: The Psychology of Self-Deception.

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