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PSYCHOACTIVE DRUGS AND THE CREATIVE URGE
1143 NUCLEAR WAR
from the
Sm,—Your welcome editorial on the threat of nuclear war (Nov. 15) mentioned that a British group is being planned along the lines of Physicians for Social Responsibility in the United States, whose
ductivity,
inform the medical profession and the public about the foreseeable medical consequences of nuclear war. You added that it is vital that these activities be rapidly developed and sustained. Such a group whose aims are essentially similar has been formed under the title Medical Campaign against Nuclear Weapons. The following is the text of a letter which will shortly be sent over signatures to other medical journals in Britain. I would be grateful if you would meanwhile accept it over my signature, as chairman, alone: "So long as deterrence implied the threat to use strategic nuclear weapons against cities, the possibility of their actual use was so unthinkable as to be dismissed by most ofus. Now that the deployment of and readiness to use ’tactical’ nuclear weapons is proclaimed NATO policy, and civil defence against nuclear war is officially discussed and encouraged, the unthinkable has evidently become thinkable. "Doctors of medicine and scientists in related fields are in a position to know that nuclear weapons would be so destructive of human life and health that they must never again be used. Prevention of nuclear war offers the only possibility for protecting people from its medical consequences. "We have therefore initiated an organisation under the title Medical Campaign against Nuclear Weapons to heighten the awareness of the medical profession and of those concerned with public policy about the medical implications of nuclear war. We invite all who are interested in joining us or in our aims to apply for further information to Medical Campaign against Nuclear Weapons, c/o 120 Edith Road, London W14." aim is
to
17 Mortimer Crescent, London NW6
point of view of both patient and physician, artistic pro-
on a qualitative-quantitative basis, seems to be increased much more frequently than decreased during the administration of lithium prophylaxis as a safeguard against uncontrollable mood-
swings. As far as Van Gogh is concerned, the question is moot; his genius lives with us, and neither lithium nor the tranquillisers were in use at the time of his illness and final hospital admission. I should, however, like to remind fellow physicians of the need to be alert to possible undesired side effects of treatment, including the suppression of the creative urge, during this era of widespread, long term use of very potent psychoactive drugs. Department of Psychiatry, College of Medicine, Upstate Medical Center, Syracuse, N.Y. 13210, U.S.A
RICHARD H. PHILLIPS
DOPE TESTS FOR DOCTORS?
SIR,-It impression, as senior registrars tutoring M.R.C.P. (U.K.) candidates, that there is a growing tendency amongst doctors to take tranquillisers and other drugs, such as beta-blocking agents, in an attempt to reduce anxiety during the examination. Since a competent physician is routinely expected to make decisions during stressful situations in clinical practice, we are concerned at this apparent trend towards the increased use of drugs by doctors at an early stage of their careers, and believe that this merits further study, both as regards the assessment of true clinical ability and the possible implications for future drug abuse. is
our
University Department of Medicine, Royal Infirmary, Glasgow G4 0SF
HOWARD COHEN IGNAC FOGELMAN
J. H. HUMPHREY ACCESS TO PSYCHIATRIC CASE-RECORDS
PSYCHOACTIVE DRUGS AND THE CREATIVE URGE
SIR,-As an enthusiastic follower of the current BBC television series The Shock of the New, a series devoted to modern art and artists, my attention became focused on some remarks made during the programme entitled "Expressionism and the death of Romanticism" (Oct. 26, 1980).’ "Van Gogh’s paintings", said Mr Robert Hughes, "were not the work of a madman; they were done by an ecstatic who was also a great artist. Today the doctors would give him lithium and tranquillisers, and we would probably not have the paintings: had the obsessions been banished, the exorcising power of the art could well have leaked away ..." Now, being an artist myself as well as a psychiatrist, I am exquisitely sensitive to all medical manoeuvres, physical, pharmaceutical, or psychotherapeutic, which may negatively influence creative expression. Mr Hughes seems to suffer, just here, from what has been called the "lumping syndrome". First he lumps doctors together, as though we would all handle a condition in the same fashion-a false, and in this case, pejorative generalisation. He also seems to lump lithium together with the tranquillisers, as though their pharmacological properties were identical. This is an obvious, although perhaps understandable misconception, on the part of an intelligent and interested layperson who has no experience with the use of
psychotropic drugs. While there is much
empirical evidence that the major tranquillisers commonly prescribed in quantities sufficient to suppress not only aberrant thoughts and behaviour, but also motivation, including that toward creativity, my own experience, strongly substantiated by the work of Schou,indicates quite a different picture in the relationship between creativity and lithium. Considered are
1. Hughes R. The shock of the new. Listener 1980; 104: 569-71. 2. Schou M. Artistic productivity and lithium prophylaxis in manic-depressive illness. Br
J Psychiat 1979; 135:
97-103
SIR,-I thought your readers might like to be aware of an ominous development in this part of Scotland with regard to the confidentiality of medical records on psychiatric patients. The heads of the following paramedical departments-dietetic, physiotherapy, social work, clinical psychology, occupational therapy, pharmacy, and chiropody-are demanding that a hospital policy is officially introduced whereby any fully qualified member of these departments, concerned in the management of a case, may have unrestricted access to the medical records of Angus psychiatric patients, past and present. As a consultant psychiatrist one is under fire because the present policy on access to medical records is seen, by paramedical personnel, to be restrictive and not in accord with practice elsewhere in Britain. While I have had good working relationships with paramedical personnel throughout my career as a psychiatrist, I have never considered automatic access to medical records of my patients by a variety of hospital workers an essential tenet of good patient care. I would certainly be interested to know what is the usual practice adopted by psychiatrists elsewhere. Sunnyside Royal Hospital, Montrose DD109JP
K. M. G. KEDDIE
SERVICES FOR THE MENTALLY HANDICAPPED
SiR,-In your Nov. 1 issue (p. 987) you note a report from the Campaign for the Mentally Handicapped entitled Even Better Services? favouring closure of mental handicap hospitals and transfer of resources to local services. The Development Team for the Mentally Handicapped has recognised that 30-35% of patients in mental handicap hospitals have specialist needs. The rest are there because they need care and asylum, an unpopular notion today, which is not available anywhere else. At the same time there are mentally handicapped people in the
from the
Sm,—Your welcome editorial on the threat of nuclear war (Nov. 15) mentioned that a British group is being planned along the lines of Physicians for Social Responsibility in the United States, whose
ductivity,
inform the medical profession and the public about the foreseeable medical consequences of nuclear war. You added that it is vital that these activities be rapidly developed and sustained. Such a group whose aims are essentially similar has been formed under the title Medical Campaign against Nuclear Weapons. The following is the text of a letter which will shortly be sent over signatures to other medical journals in Britain. I would be grateful if you would meanwhile accept it over my signature, as chairman, alone: "So long as deterrence implied the threat to use strategic nuclear weapons against cities, the possibility of their actual use was so unthinkable as to be dismissed by most ofus. Now that the deployment of and readiness to use ’tactical’ nuclear weapons is proclaimed NATO policy, and civil defence against nuclear war is officially discussed and encouraged, the unthinkable has evidently become thinkable. "Doctors of medicine and scientists in related fields are in a position to know that nuclear weapons would be so destructive of human life and health that they must never again be used. Prevention of nuclear war offers the only possibility for protecting people from its medical consequences. "We have therefore initiated an organisation under the title Medical Campaign against Nuclear Weapons to heighten the awareness of the medical profession and of those concerned with public policy about the medical implications of nuclear war. We invite all who are interested in joining us or in our aims to apply for further information to Medical Campaign against Nuclear Weapons, c/o 120 Edith Road, London W14." aim is
to
17 Mortimer Crescent, London NW6
point of view of both patient and physician, artistic pro-
on a qualitative-quantitative basis, seems to be increased much more frequently than decreased during the administration of lithium prophylaxis as a safeguard against uncontrollable mood-
swings. As far as Van Gogh is concerned, the question is moot; his genius lives with us, and neither lithium nor the tranquillisers were in use at the time of his illness and final hospital admission. I should, however, like to remind fellow physicians of the need to be alert to possible undesired side effects of treatment, including the suppression of the creative urge, during this era of widespread, long term use of very potent psychoactive drugs. Department of Psychiatry, College of Medicine, Upstate Medical Center, Syracuse, N.Y. 13210, U.S.A
RICHARD H. PHILLIPS
DOPE TESTS FOR DOCTORS?
SIR,-It impression, as senior registrars tutoring M.R.C.P. (U.K.) candidates, that there is a growing tendency amongst doctors to take tranquillisers and other drugs, such as beta-blocking agents, in an attempt to reduce anxiety during the examination. Since a competent physician is routinely expected to make decisions during stressful situations in clinical practice, we are concerned at this apparent trend towards the increased use of drugs by doctors at an early stage of their careers, and believe that this merits further study, both as regards the assessment of true clinical ability and the possible implications for future drug abuse. is
our
University Department of Medicine, Royal Infirmary, Glasgow G4 0SF
HOWARD COHEN IGNAC FOGELMAN
J. H. HUMPHREY ACCESS TO PSYCHIATRIC CASE-RECORDS
PSYCHOACTIVE DRUGS AND THE CREATIVE URGE
SIR,-As an enthusiastic follower of the current BBC television series The Shock of the New, a series devoted to modern art and artists, my attention became focused on some remarks made during the programme entitled "Expressionism and the death of Romanticism" (Oct. 26, 1980).’ "Van Gogh’s paintings", said Mr Robert Hughes, "were not the work of a madman; they were done by an ecstatic who was also a great artist. Today the doctors would give him lithium and tranquillisers, and we would probably not have the paintings: had the obsessions been banished, the exorcising power of the art could well have leaked away ..." Now, being an artist myself as well as a psychiatrist, I am exquisitely sensitive to all medical manoeuvres, physical, pharmaceutical, or psychotherapeutic, which may negatively influence creative expression. Mr Hughes seems to suffer, just here, from what has been called the "lumping syndrome". First he lumps doctors together, as though we would all handle a condition in the same fashion-a false, and in this case, pejorative generalisation. He also seems to lump lithium together with the tranquillisers, as though their pharmacological properties were identical. This is an obvious, although perhaps understandable misconception, on the part of an intelligent and interested layperson who has no experience with the use of
psychotropic drugs. While there is much
empirical evidence that the major tranquillisers commonly prescribed in quantities sufficient to suppress not only aberrant thoughts and behaviour, but also motivation, including that toward creativity, my own experience, strongly substantiated by the work of Schou,indicates quite a different picture in the relationship between creativity and lithium. Considered are
1. Hughes R. The shock of the new. Listener 1980; 104: 569-71. 2. Schou M. Artistic productivity and lithium prophylaxis in manic-depressive illness. Br
J Psychiat 1979; 135:
97-103
SIR,-I thought your readers might like to be aware of an ominous development in this part of Scotland with regard to the confidentiality of medical records on psychiatric patients. The heads of the following paramedical departments-dietetic, physiotherapy, social work, clinical psychology, occupational therapy, pharmacy, and chiropody-are demanding that a hospital policy is officially introduced whereby any fully qualified member of these departments, concerned in the management of a case, may have unrestricted access to the medical records of Angus psychiatric patients, past and present. As a consultant psychiatrist one is under fire because the present policy on access to medical records is seen, by paramedical personnel, to be restrictive and not in accord with practice elsewhere in Britain. While I have had good working relationships with paramedical personnel throughout my career as a psychiatrist, I have never considered automatic access to medical records of my patients by a variety of hospital workers an essential tenet of good patient care. I would certainly be interested to know what is the usual practice adopted by psychiatrists elsewhere. Sunnyside Royal Hospital, Montrose DD109JP
K. M. G. KEDDIE
SERVICES FOR THE MENTALLY HANDICAPPED
SiR,-In your Nov. 1 issue (p. 987) you note a report from the Campaign for the Mentally Handicapped entitled Even Better Services? favouring closure of mental handicap hospitals and transfer of resources to local services. The Development Team for the Mentally Handicapped has recognised that 30-35% of patients in mental handicap hospitals have specialist needs. The rest are there because they need care and asylum, an unpopular notion today, which is not available anywhere else. At the same time there are mentally handicapped people in the