LETTERS

TO

THE

Am

EDITOR

There are other interesting correspondences and links between Piaget’s work and what may be happening in dreams. For example, the process ofcoordinating sensorimotor schemata (both in the sense of Piaget’s theories and in the physiological sense) with the visual world is extremely important.

concede

This

by

is an

area

of intense

interestingly

enough,

coordination

is being

investigation

much

of this

traced

in physiology

sensorimotor

to brain

stem

and,

and

neuronal

visual

activity.

For example, some of the motoric ‘action schemata” (simple motor acts such as walking) described by Piaget have been shown to have a clear physiological substrate, and the concept of a motor pattern generator for these acts is a most useful one. Some ofthcsc physiological motor pattern generators may bear an interesting isomorphic relationship to the cognitive representations that the infant in the sensorimotor stage is working to develop. Piaget speaks of play as useful in development and of dreams as often showing processes cognitively analogous to those in play. Viewed from the physiological side, it may be that the activation ofmotor pattern generators and the visual system in D sleep is functionally important in furthering development and coordination of these systems, just as Piaget sees dreams as important in furthering the development of possibly isomorphic cognitive It is clear

that

links

between

isomorphic

this

is a rich

area

physiology

for investigation

and

of

psychology.

1. Gazzaniga

MS. LeDoux JE, Wilson DH: Language, praxis, and hemisphere: clues to some mechanisms of consciousness. Neurology 27:1144-1147, 1977 2. McCarley RW, Hobson JA: The form ofdreams and the biology of sleep. in Handbook of Dreams: Research, Theory, and Applications. Edited by Wolman W. New York. Van Nostrand, Rein-

right

hold Co

(in press)

3. Greenwood P. Wilson DH, Gassaniga MS: Dream report ing commissurotomy. Cortex 13:311-316, 1977 4. Piaget J: Biology and Knowledge. Chicago, University cago

Press,

followof Chi-

1971

5. Robbe-Grillet

when

to legal

am currently

representing

readmission

after

not a simple

prejudice

courts

that

admission unreliable

they

testing.

against

should

be

Piaget WW

denied

J: Play, Norton

&

W.

MCCARLEY,

School

Admission

Psychiatrists

Screening

by Psychiatrists

not

excluded

have

been

M.D.

H0BSON,

Mass.

from

medical

,

,

‘

‘

embarrassment

over

the

extravagance

of their

claims

of expertise and the dearth of data supporting such claims. Both of these faults also affect Drs. Klein and Mumford’s paper.

The

authors less

school

Perhaps

more

substantial

,

number

fessors

Alan

of psychiatric

Stone

and

Alan

studies

collected

Dershowitz

which

by

are ‘ ‘not failure or (1). It is

quite clearly that psychiatrists and psychologists especially qualified to prognosticate the success, risk of a college, graduate school orjob applicant”

worth noting that the and Dershowitz were Orthopsychiatric

views expressed by Professors Stone officially endorsed by the American

Association.

Drs. Klein and Mumford provide absolutely contradict this conclusion. Although their paper references, only one is even arguably relevant that

Pro-

demonstrate

psychiatrists

screen

and it apparently concludes the fact-who has committed

medical

no data that is filled with to their pro-

school

that psychiatrists suicide.

applicants,

can tell-after

would instead deprive the medical profession of many sensitive and humane people who would have been exactly the type of doctor that Drs. Klein and Mumford want. REFERENCE I . Stone A, Dershowitz A: Brief for amicus curiae American Orthopsychiatric Association, Glassman v. NY Medical College, in Legal Rights of the Mentally Handicapped. Edited by Ennis B, Friedman P. New York, NY, Practising Law Institute, 1974, pp 77-100

suggest sensitive,

CHRIS

New

HANSEN

York,

N.Y.

that

because

psychiatric

medical and

students

psychological

An

Explanation

for

Seasonality

of Births

in Schizophrenia

M.D.

school admission screening because of the newness of the art, the isolation of the practitioners, or the advocacy of the practitioners. as Henriette Klein, M.D. and Emily Mumford, Ph.D. suggest in ‘The Bent Twig: Psychiatry and Medical Education’ (March 1978 issue). If psychiatrists have been excluded, it is because of their medical col-

coming

medical

1962

Co.

Boston,

leagues’

is

that are demonstrably subject to misuse. important for readers of the American JourDrs. Klein and Mumford totally ignore the

Last Year at Marienbad. Translated by HowGrove Press, 1962 Dreams, and Imitation in Childhood. New York,

J. ALLAN

SIR:

vulnerability

but a recognition

AL:

ROBERT

Medical

I

not.

denied

on the basis of decisions and invalid and therefore

nal ofPsychiatry

posal

testing

arc

student

That

psychiatrists

1978

such

points

school

ard R. New York, 6.

that

as grade

one medical

person

November

acknowledge

challenges,

psychiatric

no

/35:/I,

Although the goal of more humane and sensitive physicians is one we all support, psychiatric screening of medical school applicants will not achieve this goal. I suspect it

REFERENCES

the

point

is vulnerable

‘

systems.

this

J Psychiatry

are betesting

should be used to screen applicants for medical school. Such screening is almost surely made illegal by the Federal Rehabilitation Act of 1974. Drs. Klein and Mumford essentially

SIR: disorder

A large American was recently

study published

of season of birth in the Archives

and

mental

of General Psychiatry (1), and a similar study was published in the British Journal ofPsychiairy in 1974 (2). Both studies showed a highly significant excess of births in the first quarter of the year for people who later became schizophrenic. The excess was approximately April. The American

8% for January, study corrected

February, for small

March, differences

and in

month of birth for the general population and provided a comprehensive literature review. Both articles listed a number of explanations for this finding, but they seem to have missed the simplest and most plausible explanation. The schizophrenic patients in both studies were born between 1920 and 1955. During that period, a large number of schizophrenics schizophrenic

tab hospital two years. ophrenics population, patients

of childbearing age were institutionalized. psychosis at that time probably meant

admission Although

A a men-

lasting from at least three months to the sexual activity ofhospitalized schiz-

is probably less than that of the nonhospitalized it certainly is not nonexistent. Male and female were on different wards but were permitted ground

1434

A

Am

J Psychiatry

privileges

/35:/I,

in good

November

weather.

1978

It is well

LETTERS

known

to the

staff

of

most mental hospitals that in the private areas ofthe grounds a fair amount of sexual activity takes place in good weather. In such cases, given the distribution ofdiagnoses in hospitalized patients, both, would

at least one ofthe two have had a schizophrenic

The excess births of January, February,

procreating disorder.

adults,

patients in the months April could easily be ac-

counted for by the offspring of only thousands of hospitalized patients. take place during the warm months

a small percentage of the If conception did indeed (June, July, August, and

September) next

then for

winter

a transmission

the

excess

and

early

rate

number

of only

3%-5%

of schizophrenics

would born

the

spring.

I. Torrey EF, Torrey BB, Peterson MR: Seasonality of schizophrenic births in the United States. Arch Gen Psychiatry 34:1065-1070, 1977 2. Hare E, Price J, Slater E: Mental disorder and season ofbirth: a national sample compared with the general population. Br J Psychiatry 124:81-86, 1974 F. DAWSON,

On!.

M.D. ,

also

whether

on Attitudes

In their

Toward

article

the

Mentally

Ill

Fear of the Mentally Support for the Common Man’s Response” issue) John M. Lagos, Ph.D. , and associates SIR:

able,

concise

gerousness attitudes

for

‘ ‘

discussions of the mentally community

that the original been performed

of

the

ill and treatment.

empirical study more rigorously.

literature the

Ill: Empirical (October 1977

provided admiron the dan-

implications One wishes,

presented

of public however,

in the article

had

First, descriptions of violent activity were based on the admissions records of 400 patients, apparently with no checks on their validity in cases where the alleged violent behavior did not occur in the presence of the admitting physician. Then, assuming without demonstrating that the notes

were reasonably accurate the authors concluded that

descriptions of actual behavior, perhaps the public has reason to

fear mental patients as a class because a significant percentage of the sample was found to have been violent before admission to a hospital. However, there was no control group,

an elementary necessity in a study that attempts implicitly to compare one class of persons (the mentally ill) with another (normal individuals). The degree to which the public fears any that

group must depend in part the public may have reason

on base to fear

rates, and the mentally

the

notes

violent

claim ill is an

unwarranted interpretation. More than a third (36%) of the mental patients committed one form of violence or another, but an even higher percentage of nonpatients may also behave violently. If so, the appropriate conclusion would be that all of us have great rcason to fear many people and even more reason to fear nonpatients than patients. Studies on the dangerousness of the mentally ill have immediate relevance to the politicized debates about civil commitment. At a time when psychiatry is often attacked as being unscientific and insufficiently concerned with civil biberties, this study can only add power to the critiques. One wishes the authors had added a control group or simply limit-

J.D..

MORSE.

PH.D. Calif.

Angeles,

Once

that

acts

no control

arc

again

equably

group

was

prevalent

he is correct.

used

in the

However,

to

gener-

we did not

suggest that patients were more violent than the general popubation. We categorically stated, ‘These data . . . cannot substantiate the proposition that ex-mentab patients are more violent than the general population.” It seems to mc that Dr. Morse has not gotten our point. What we tried to say was that the research to date has been so narrowly focused that the twin issues of patient violence and community fear have been denied full scientific scrutiny. were assembled paradigm for

Research

and discussion

SIR: Dr. Morse points out that the design ofour study did not include a check on the validity of the reports of violent acts found in the hospital charts. This is true, and it constitutes a definite limitation that further studies would do well

We did not claim

Canada

EDITOR

Dr. Lagos Replies

al population.

Hamilton,

J.

Los

show REFERENCES

THE

of the literature

STEPHEN

to avoid. Dr. Morse

DAVID

review

often

of schizophrenic March, and

account

ed the paper to a fuller of its implications.

TO

new

approach

lence

among

to have

settled

anything.

Rather,

inadequacy violence

of the reigning and to suggest

ofcommunities

in which

to illustrate the research on patient

to the education mental

Dr. Morse concern for

patients

implies

is an

that

our

the data a

vio-

issue.

article

reflected

insufficient

the civil liberties of psychiatric patients. Undoubtedly, the interests of patients will best be served by understanding them better. Our work has introduced a new dimension to the study of violence among psychiatric patients as webb as to the education of communities regarding patient violence. It is my belief that this is constructive and that in the long run this work will contribute more to the liberation than to the confinement of psychiatric patients.

M. LAGOS,

JOHN

Newark,

Peptidergic

Influences:

PH.D. N.J.

Tip of the Iceberg?

to make a few comments in response to ‘The Opiate Receptor and MorphineLike Peptides in the Brain’ ‘ by Solomon H. Snyder, M.D. (June 1978 issue). Dr. Snyder calls particular attention to the somewhat surprising density of enkephabin-containing ncurons in the globus pallidus, along with evidence for a pathway arising from cell bodies in the caudate nucleus whose terminals in the gbobus pallidus release enkephalin on neuronab populations in that site. The caudate, putamen, and globus pallidus arc usually viewed somewhat narrowly as regulators ofmotor behavior, which seems to make puzzling the

SIR: I would like excellent article

the

observation

kephalin

zance

than

ofthe

and emotion pendent on states, such pleasure.

There shares

that any

almost

globus part

pallidus

ofthe

inextricable

brain.

relationship

contains Ifone

more takes

between

(1-3), it is apparent that such responses and coordinated with a whole range as attention, motivation, pleasure,

is good rich

the

other

evidence

connections

that with

the

the

extrapyramidab

ncocortex

as well

en-

cogni-

motion are deof CNS and dis-

system as with 1435