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
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
