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NORTH AMERICAN PSYCHIATRY
1176 now wishes to set free the insane, and that the world in which it lives is dominated by the need to open the locked barrier of the Iron Curtain. For the macrocosm is the mirror of the microcosm, and the locked doors of prisons and mental hospitals are mirror-images of what man has had to do with the evil and madness within himself that he dares not release. We have become obscurely aware of this, and it is a creditable impulse of our time that impels us to open these long-locked doors. Nevertheless, we should pause, with our hand on the key. Are we ready yet Has the generation that created Belsen and dropped the Hiroshima bomb so controlled its inner impulses of evil and insanity that it can dare to do this thing ? For every door opened in the external world opens a door in the mind. The primitive, who in some strange way comprehended the catastrophic power of the inner world, placed taboos on certain doors Modern which he knew he was not ready to enter. Science has no such qualms : not because it is braver than in the past, but because it has turned its back on the warning wisdom of the antique world. To unlock the gates of mental hospitals and prisons is not merely to create new problems of staffing and technique : it is also to open, by the smallest perceptible chink, that gateway of the mind behind which throng the grim phantoms of archaic fear. Man is only just able Twice in our lifetime it to hold this gateway closed. has burst open, and at any moment it may do so again. Tampering with this particular lock at this particular time is more dangerous than it looks. On the other hand, to cry halt is no answer. Risks have to be taken. And at the last every door must be opened "’ else a great Prince in prison lies." But we - should know what we are about ; when committing ourselves to action we should at least be capable of anticipating its inner as well as its outer consequences. The almost comical dismay of Homo, sapiens on discovering the facts of life has lost its charm. ALAN MCGLASHAN. London, W.1.
prisons,
NORTH AMERICAN PSYCHIATRY
SiR,-Signs are not lacking that in America, despite warnings from the sage of Baltimore, the precise and exclusive dogma of psycho-analysis has gained ascendancy over the common-sense psychiatry of Adolf Meyer. The same tendency, if not so pronounced, is present in this land : and it is a sombre reflection that psychiatrists of the future, if they are to prevail in medical psychology, may find themselves constrained to accept the Freudian obedience, and to aver the oecumenical significance of psychic determinism, sexuality, and phallic symbolism. The lesson from America would seem to be : pious .negations are not enough. London, W.I.
MURDO MACKENZIE.
SIR,-Although in the United States commitment and admission procedures vary and differ from one State to another, in that they are determined by the individual State governments, all the States have at least one thing in common-the patient retains all civil rights, including the right to the writ of habeas corpus, and the right to post a sealed and uncensored communication to any This aspect of the mental-health person whatever. services of the United States surely bids us pause to reflect on the enormity of the crime of interfering with the liberty of those who, owing to their illness, are unable to protest-the regrettable state still prevailing in
our own
country.
We realise and appreciate that because of his crimes the criminal forfeits certain civil rights, that his letters .are censored ; but by what authority do we dare to meddle with the strictly private affairs of our sick ? By what authority, and under which Act, do we read, censor,
delay, and/or confiscate the private property
mentally
of
our
ill?
broadly, the neuroses account for some 85% of mentally ill, the psychoses for 15%. And since (again broadly) psychotics do not write letters, it can safely be assumed that the letter-writers in our mental hospitals are intelligent people who, although subject to periodic phases of abnormal thought and behaviour. resent such interference with their private affair... strongly Let us not deceive ourselves by pretending that such censorship is an aid to diagnosis, lest we find ourselves without a diagnosis of those who never write letters at all. Rather let us come to realise-and quickly-that such unwarranted interference does no more than heap Put
our
frustration upon the very frustration that has landed the
patient
in
a
mental
hospital,
Edzell, Angus.
instead of a general one, H. G. WOODLEY.
SEX CHROMATIN IN UNCOMPLICATED OVARIAN APLASIA
Barr and his associatesshowed that it to visualise the sex chromatin in the interpossible phase nucleus of females, this method has come into use2 in order to determine the chromosomal sex of individual:)
SIR,-Since
was
where sex differentiation on morphological grounds was doubtful. Dr. Polani and his colleagues, in their preliminary communication in your issue of July 17, have shown that in three cases of Turner’s syndrome with coarctation of the aorta the chromosomal sex as determined by examination of skin biopsies was male in all three. Prompted by these observations and by the fact that results have not hitherto been reported in uncomplicated ovarian aplasia,3 we here report for the first time the presence of sex chromatin in this condition. The term aplasia seems preferable to agenesis since most investigations have shown that some connectivetissue remnants persist in the gonad site. We have reviewed4 the reports of agenesis and aplasia in the literature. From our own case we concluded that primary sex differentiation is under genetic control and that hormones govern continued differentiation : the sex of this patient was decided on morphological grounds to be female. Re-examination of sections of skin and brain in this of the characteristic sex case showed the presence chromatin both in the cells of the epidermis and in the neurones, thus confirming the morphological findings. This material gave a positive Feulgen reaction. In view of the fact that there are so few reported cases of uncomplicated ovarian aplasia it would be a long time before an extended series could be examined for sex chromatin. The present case is therefore important from a theoretical point of view since it demonstrates that not all cases of uncomplicated ovarian aplasia are genetic males and that a decision as to sex can be made on morphological grounds. The question arises as to the chromatin (apart altogether from the individual in cases of morphologically indeterminate sex since other factors must be taken into account-namely, hormonal and psychological factors. Can the sex of the individual be recognised purely by the presence or absence of sex chromatin! These are questions which could be investigated at the present time. Meanwhile, since it is possible by a simple technique to select segments of individual chromosomes and expose them to ultraviolet irradiation without injury to other parts of the nucleus,5 one of us (C. A. E.) is investigating
part played by the its direct
sex
function) in
1. Barr, M. L., Bertram, L. F., Lindsay, H.A. Anat. Rec. 1950. 107, 283. 2. Ham, A. W. Histology. Philadelphia, 1953 ; p. 65. 3. See Lancet, Sept. 25, 1954, p. 638. 4. Arch. Path. 1946, 42, 381. 5. Uretz, R. B., Bloom, W., Zirkle, R. E. Science, 1954, 120, 19
prisons,
NORTH AMERICAN PSYCHIATRY
SiR,-Signs are not lacking that in America, despite warnings from the sage of Baltimore, the precise and exclusive dogma of psycho-analysis has gained ascendancy over the common-sense psychiatry of Adolf Meyer. The same tendency, if not so pronounced, is present in this land : and it is a sombre reflection that psychiatrists of the future, if they are to prevail in medical psychology, may find themselves constrained to accept the Freudian obedience, and to aver the oecumenical significance of psychic determinism, sexuality, and phallic symbolism. The lesson from America would seem to be : pious .negations are not enough. London, W.I.
MURDO MACKENZIE.
SIR,-Although in the United States commitment and admission procedures vary and differ from one State to another, in that they are determined by the individual State governments, all the States have at least one thing in common-the patient retains all civil rights, including the right to the writ of habeas corpus, and the right to post a sealed and uncensored communication to any This aspect of the mental-health person whatever. services of the United States surely bids us pause to reflect on the enormity of the crime of interfering with the liberty of those who, owing to their illness, are unable to protest-the regrettable state still prevailing in
our own
country.
We realise and appreciate that because of his crimes the criminal forfeits certain civil rights, that his letters .are censored ; but by what authority do we dare to meddle with the strictly private affairs of our sick ? By what authority, and under which Act, do we read, censor,
delay, and/or confiscate the private property
mentally
of
our
ill?
broadly, the neuroses account for some 85% of mentally ill, the psychoses for 15%. And since (again broadly) psychotics do not write letters, it can safely be assumed that the letter-writers in our mental hospitals are intelligent people who, although subject to periodic phases of abnormal thought and behaviour. resent such interference with their private affair... strongly Let us not deceive ourselves by pretending that such censorship is an aid to diagnosis, lest we find ourselves without a diagnosis of those who never write letters at all. Rather let us come to realise-and quickly-that such unwarranted interference does no more than heap Put
our
frustration upon the very frustration that has landed the
patient
in
a
mental
hospital,
Edzell, Angus.
instead of a general one, H. G. WOODLEY.
SEX CHROMATIN IN UNCOMPLICATED OVARIAN APLASIA
Barr and his associatesshowed that it to visualise the sex chromatin in the interpossible phase nucleus of females, this method has come into use2 in order to determine the chromosomal sex of individual:)
SIR,-Since
was
where sex differentiation on morphological grounds was doubtful. Dr. Polani and his colleagues, in their preliminary communication in your issue of July 17, have shown that in three cases of Turner’s syndrome with coarctation of the aorta the chromosomal sex as determined by examination of skin biopsies was male in all three. Prompted by these observations and by the fact that results have not hitherto been reported in uncomplicated ovarian aplasia,3 we here report for the first time the presence of sex chromatin in this condition. The term aplasia seems preferable to agenesis since most investigations have shown that some connectivetissue remnants persist in the gonad site. We have reviewed4 the reports of agenesis and aplasia in the literature. From our own case we concluded that primary sex differentiation is under genetic control and that hormones govern continued differentiation : the sex of this patient was decided on morphological grounds to be female. Re-examination of sections of skin and brain in this of the characteristic sex case showed the presence chromatin both in the cells of the epidermis and in the neurones, thus confirming the morphological findings. This material gave a positive Feulgen reaction. In view of the fact that there are so few reported cases of uncomplicated ovarian aplasia it would be a long time before an extended series could be examined for sex chromatin. The present case is therefore important from a theoretical point of view since it demonstrates that not all cases of uncomplicated ovarian aplasia are genetic males and that a decision as to sex can be made on morphological grounds. The question arises as to the chromatin (apart altogether from the individual in cases of morphologically indeterminate sex since other factors must be taken into account-namely, hormonal and psychological factors. Can the sex of the individual be recognised purely by the presence or absence of sex chromatin! These are questions which could be investigated at the present time. Meanwhile, since it is possible by a simple technique to select segments of individual chromosomes and expose them to ultraviolet irradiation without injury to other parts of the nucleus,5 one of us (C. A. E.) is investigating
part played by the its direct
sex
function) in
1. Barr, M. L., Bertram, L. F., Lindsay, H.A. Anat. Rec. 1950. 107, 283. 2. Ham, A. W. Histology. Philadelphia, 1953 ; p. 65. 3. See Lancet, Sept. 25, 1954, p. 638. 4. Arch. Path. 1946, 42, 381. 5. Uretz, R. B., Bloom, W., Zirkle, R. E. Science, 1954, 120, 19