My necessarily abbreviated arguments against the continued practice of NMD are intended to be within the spirit of the debate section of the Journal. A debate necessarily requires two sides. Given that the title of the debate I was given included the term ‘mental disorder’ I am confused that an objection should be raised to my nod towards the well-recognised controversy over the modern phrenological localisation of psychiatric disorder. But I am perhaps mostly perplexed by the failure to see that the use of an irreversible surgical treatment directly applied to the brain necessarily demands much higher standards of certainty over its benefits than something like dynamic psychotherapy, particularly given the political context of a profession with obvious public image difficulties. Anyone aware of the widespread coverage that our debate received in the Scottish newspapers would be immediately impressed by this public relations context, which is precisely the area the coverage focused on.