It is agreed with your correspondent that certainty may often be preferred to confusion. We plead guilty to one nosological omission: the patient described had no history of classical catatonia (akinesis, mutism and waxy flexibility). Your correspondent's own cited review from 1999 (Clark & Rickards) admits there were no randomised controlled trials of treatment in catatonia. It is to be hoped that our article will have refreshed clinicians' awareness of this condition, as it is indeed often iatrogenic.