'I just, you know, can't really see the point, doc, you know?" I know how he feels. I think I'm losing my faith in psychiatry. Especially with depressed people. Because apart from the drugs - and they do work, so don't even try and take that away from me - today it seems like it's all theatre, and I hate the theatre.

There's this guy I see every month. Like most inexperienced psychiatrists, I see my depressed patients more frequently than I need to, mainly because of a magical belief that this will prevent them from killing themselves. But this guy thinks he's missing something: and I wonder sometimes if he is really depressed. His life, to be fair, is pretty miserable.

We have a thing called the bio-psycho-social model, which we all buy into. The bio bit is drugs. The social bit is changing the concrete stuff in your life, and that usually means firing off a few letters for the benefits agency to ignore.

But the psychological stuff: this might come as a shock, but nobody really teaches you about it. You get a bit about how to listen to people, but psychoanalysts we are not, and really it's like anything in medicine, you just pile in and have a go.

So a few months ago with this person, I found myself thinking: I completely buy into the idea that people buy the stuff they see on the telly to make themselves feel better; but maybe it goes deeper than that. Maybe all the happy people on telly make folk think they ought to be a bit happier than they can ever hope to be. It's like all those worries people had about novels 100 years ago: you wouldn't want the servants reading them, in case they started getting funny ideas.

I wanted to tell him all this, but obviously I didn't. What I did was, in my own flaky way, try and show him how people can learn coping strategies, and be as happy as they can manage. I also wanted to maybe, you know, recommend some improving literature. Which obviously I also didn't do. The worst thing was, because I like him, and because he is a bit like my friends, I wanted to tell him about stuff, maybe show him that my life was a bit crap too. It would have been vastly inappropriate, of course, because depression is irrational, and because he is feeling real pain to an extent that I don't: but I challenge you to show me a psychiatrist alive who hasn't had the same thought flicker across their mind at least once.

I'm so glad I didn't. Because today, after six months of seeing me, and after three years of seeing psychiatrists, he decides to tell me something he has never told anyone: his uncle used to fiddle with him. He giggles, and then he won't even look at me.

His uncle didn't used to fiddle with him: he used to take him into a room, pull his trousers down, and do unspeakable, horrific things to him. Things that he couldn't tell his wife about, or his friends - and he has good friends - or his doctors.

And it wasn't because I am any good as a psychiatrist - I'm not. It was partly time, and it was partly because I never told him about my life, or my friends, or my favourite bands. To him I'm just a guy in a room who tells him about the side effects of quaxipram and listens while he talks. To him, I'm a blank slate. He didn't want my approval or respect, so he could tell me anything, and finally he told me everything. It was only a start, but at last I can understand why we have ground rules about not talking about ourselves, and also why psychiatry can do some small good: maybe the drugs were just a good excuse for two people to sit in a room talking without it having to be called therapy. Now tell me what to do with the other nine people I'm seeing today.