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SETTING UP A THERAPEUTIC COMMUNITY
220 be alive in the year 2000 A.D., it does not seem to me to be a valid reason for curtailing a class of people who form the meat and substance, the wealth and strength, of a nation. None of these patients has come from that huge, feckless, and fecund class of unskilled labour who breed endlessly, either because they are too lazy or stupid to avoid repeated pregnancies, or because they follow the archaic practice of providing an insurance for themselves in their old age. It seems to me that the system now being worked out in India, where the latter order of citizen is paid a sum of money to have the operation, is worth consideration here, where at present the practice is to limit the alpha and beta people, and to encourage the gamma class of the unskilled and uninstructable masses to further fecundity. There is a valid criticism of my comments-that it is not for a doctor to concern himself with social problems, and that his preoccupation should be with his individual patients. But I feel that the present trickle of vasectomies will in a few years widen to a very broad stream, and that the stream should be controlled as to quality as well as to quantity if the end-result is not to be a grave reduction in number of the best elements in this country. In conclusion, the ultimate idiocy was reached for me a few days ago in the form of a letter from the medical officer " of a Military Organisation asking if I would undertake vasectomy on a number of his personnel who " desired vasectomy for contraceptive purposes ". GEOFFREY PARKER. London W 1. to
MENTAL DEFICIENCY NO GROUND FOR DIVORCE SIR,-Following on my letter (Jan. 7, p. 49), I was particularly pleased to read your legal correspondent’s account last week (p. 154) of the position with regard to subnormality and unsoundness of mind. He rightly emphasises the importance of this issue and sets out very fully the reasons for the divergence of opinion on this matter between two of Her Majesty’s judges. There is, however, one point which requires clarification. Your correspondent states: " In the Matrimonial Causes Act, Parliament included the mentally defective specifically in the provisions relating to nullity; but no mention is made of mental deficiency in the divorce provisions of that Act." It should be made clear that with regard to the 1965 Matrimonial Causes Act, not only is the expression mental deficiency (or subnormality) not mentioned in the divorce provisions of the Act, but in actual fact it is also not specifically included in the
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PSYCHE SUBMERGED SIR,-In your issue last week (p. 162) Dr. Hoenig takes you to task, with laboured facetiousness, for publishing an excellent article by a journalist, Brian Inglis. A certain complacency and myopia tends to afflict our profession; as a psychiatrist working with children I must say that I find more understanding of the emotional factors in illness among laymen than among doctors. ALAN S. CLARK.
SETTING UP A THERAPEUTIC COMMUNITY SIR,-Dr. Edwards and his co-authors1 describe the work of a hostel for alcoholics in South London. The need for such accommodation is shown by the progress of 75 male alcoholics after mental-hospital treatment in the Liverpool region. The patients were assessed between 3 and 27 months after discharge, using the simple criterion of success or failure in maintaining complete abstinence; out of those classed as returning to a home the greater number went back to their wives, but a few returned to parents or siblings or to their own children. Of the 51 alcoholics who went home, 33 drank again and 18 remained dry. Of the 24 who did not return to a domestic environment, 22 resumed drinking and only 2 kept abstinent. The difference is significant: y2=4.7(with Yates’ correction); 0.05. At least theoretically, the alcoholic who has acquired or retained domestic links has a more stable personality and is therefore more responsive to the usual treatments than his peer without social bonds, while the latter also has practical difficulties in finding companionship and recreation outside drinking situations. The necessity of a hostel to supplement therapy is recognised by the Merseyside Council on Alcoholism, but shortage of funds has so far prevented this development. The above figures show the inutility, from the long-term aspect, of inpatient treatment for most of these alcoholics who lack family ties, so it is hoped that local authorities will become able to budget for hostel accommodation to reduce the relapse-rate in such patients. Addiction Unit, Moston Hospital, Chester. J. S. MADDEN. 1. Edwards, G, Hawker, A., Hensman, C. Lancet, 1966, ii, 1407.
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provisions relating to nullity. Finally, on a more general
note, one cannot help being the absurd mixture of medical and legal terms, relating to the mind, contained in Section 9 of that Act, which reads in part: A marriage shall be voidable on the ground that at the time of the marriage either party to the marriage: (i) was of unsound mind; or (ii) was suffering from mental disorder... ; or (iii) was subject to recurrent attacks of insanity or epilepsy." It is little wonder that learned judges differ in their interpretation of the medicolegal terms in this Act. What a pity it is that the persons responsible for drafting the Matrimonial Causes Act of 1965 did not fully take into account the words and the spirit of the Mental Health Act of 1959. Monyhull Hospital, A. I. ROITH. Birmingham 30.
astonished
at
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TRIALS AND TRIBULATIONS
SIR,-In your article based on discussions with some medical advisers in the pharmaceutical industry last week (p. 152) you write, in connection with the arranging of clinical trials of drugs, that " there may be difficulties... certain hospitals may get a reputation for doing work for one company ". The implication would seem to be that an association between a hospital and a pharmaceutical company on other than a temporary, ad-hoc basis is undesirable, if not worse. The corrupting hand of commerce must be kept away from the profession. Articles appearing on the same date in two of your contemporaries are relevant. The British Medical Journal1I pleads for a greater number of clinical pharmacologists, working in hospital. Are they, in your view, to be itinerant? If not, and if each is to work in a single hospital, is it not inevitable that he will form strong and continuing links with individual drugs firms ? And will this be wrong? And in the Pharmaceutical Journal2 Prof. 0. L. Wade writes: I would like to see a closer and a more adult relationship between the pharmaceutical industry and the medical profession. Only the industry, not doctors, can make drugs; only doctors, not the industry, can use drugs. The best interests of our patients require intelligent co-operation ". That is a hopeful, realistic approach; and one that in the past has been mooted in your own columns. Your article contains another statement on which I should like to comment: " The [pharmaceutical] industry itself is very conscious of constant surveillance-and it already has two committees on its shoulders and a third is even now investigating it. But while these problems will sort themselves out...." I see no sign that the problems of the industry will sort themselves out. It is not, in my experience, a habit that problems have. (I speak of worth-while problems.) Action is required; more particularly, in this context, action leading to fuller cooperation between industry and profession, an overt cooperation that would benefit both sides, not to speak of patients. "
1. Br. med. J. Jan. 21, 1967, p. 125. 2. Wade, O. L. Pharm. J. 1967, 198, 71.
MENTAL DEFICIENCY NO GROUND FOR DIVORCE SIR,-Following on my letter (Jan. 7, p. 49), I was particularly pleased to read your legal correspondent’s account last week (p. 154) of the position with regard to subnormality and unsoundness of mind. He rightly emphasises the importance of this issue and sets out very fully the reasons for the divergence of opinion on this matter between two of Her Majesty’s judges. There is, however, one point which requires clarification. Your correspondent states: " In the Matrimonial Causes Act, Parliament included the mentally defective specifically in the provisions relating to nullity; but no mention is made of mental deficiency in the divorce provisions of that Act." It should be made clear that with regard to the 1965 Matrimonial Causes Act, not only is the expression mental deficiency (or subnormality) not mentioned in the divorce provisions of the Act, but in actual fact it is also not specifically included in the
"
PSYCHE SUBMERGED SIR,-In your issue last week (p. 162) Dr. Hoenig takes you to task, with laboured facetiousness, for publishing an excellent article by a journalist, Brian Inglis. A certain complacency and myopia tends to afflict our profession; as a psychiatrist working with children I must say that I find more understanding of the emotional factors in illness among laymen than among doctors. ALAN S. CLARK.
SETTING UP A THERAPEUTIC COMMUNITY SIR,-Dr. Edwards and his co-authors1 describe the work of a hostel for alcoholics in South London. The need for such accommodation is shown by the progress of 75 male alcoholics after mental-hospital treatment in the Liverpool region. The patients were assessed between 3 and 27 months after discharge, using the simple criterion of success or failure in maintaining complete abstinence; out of those classed as returning to a home the greater number went back to their wives, but a few returned to parents or siblings or to their own children. Of the 51 alcoholics who went home, 33 drank again and 18 remained dry. Of the 24 who did not return to a domestic environment, 22 resumed drinking and only 2 kept abstinent. The difference is significant: y2=4.7(with Yates’ correction); 0.05. At least theoretically, the alcoholic who has acquired or retained domestic links has a more stable personality and is therefore more responsive to the usual treatments than his peer without social bonds, while the latter also has practical difficulties in finding companionship and recreation outside drinking situations. The necessity of a hostel to supplement therapy is recognised by the Merseyside Council on Alcoholism, but shortage of funds has so far prevented this development. The above figures show the inutility, from the long-term aspect, of inpatient treatment for most of these alcoholics who lack family ties, so it is hoped that local authorities will become able to budget for hostel accommodation to reduce the relapse-rate in such patients. Addiction Unit, Moston Hospital, Chester. J. S. MADDEN. 1. Edwards, G, Hawker, A., Hensman, C. Lancet, 1966, ii, 1407.
p <
provisions relating to nullity. Finally, on a more general
note, one cannot help being the absurd mixture of medical and legal terms, relating to the mind, contained in Section 9 of that Act, which reads in part: A marriage shall be voidable on the ground that at the time of the marriage either party to the marriage: (i) was of unsound mind; or (ii) was suffering from mental disorder... ; or (iii) was subject to recurrent attacks of insanity or epilepsy." It is little wonder that learned judges differ in their interpretation of the medicolegal terms in this Act. What a pity it is that the persons responsible for drafting the Matrimonial Causes Act of 1965 did not fully take into account the words and the spirit of the Mental Health Act of 1959. Monyhull Hospital, A. I. ROITH. Birmingham 30.
astonished
at
"
TRIALS AND TRIBULATIONS
SIR,-In your article based on discussions with some medical advisers in the pharmaceutical industry last week (p. 152) you write, in connection with the arranging of clinical trials of drugs, that " there may be difficulties... certain hospitals may get a reputation for doing work for one company ". The implication would seem to be that an association between a hospital and a pharmaceutical company on other than a temporary, ad-hoc basis is undesirable, if not worse. The corrupting hand of commerce must be kept away from the profession. Articles appearing on the same date in two of your contemporaries are relevant. The British Medical Journal1I pleads for a greater number of clinical pharmacologists, working in hospital. Are they, in your view, to be itinerant? If not, and if each is to work in a single hospital, is it not inevitable that he will form strong and continuing links with individual drugs firms ? And will this be wrong? And in the Pharmaceutical Journal2 Prof. 0. L. Wade writes: I would like to see a closer and a more adult relationship between the pharmaceutical industry and the medical profession. Only the industry, not doctors, can make drugs; only doctors, not the industry, can use drugs. The best interests of our patients require intelligent co-operation ". That is a hopeful, realistic approach; and one that in the past has been mooted in your own columns. Your article contains another statement on which I should like to comment: " The [pharmaceutical] industry itself is very conscious of constant surveillance-and it already has two committees on its shoulders and a third is even now investigating it. But while these problems will sort themselves out...." I see no sign that the problems of the industry will sort themselves out. It is not, in my experience, a habit that problems have. (I speak of worth-while problems.) Action is required; more particularly, in this context, action leading to fuller cooperation between industry and profession, an overt cooperation that would benefit both sides, not to speak of patients. "
1. Br. med. J. Jan. 21, 1967, p. 125. 2. Wade, O. L. Pharm. J. 1967, 198, 71.