546 546..546


GIVING VOICE TO CONTRARYGIVING VOICE TO CONTRARY
OPINIONSOPINIONS

We, like all learned journals, are de-We, like all learned journals, are de-

termined to be as objective as possible intermined to be as objective as possible in

selecting articles that rely on data insteadselecting articles that rely on data instead

of opinion. But data are only part of theof opinion. But data are only part of the

story; it is how they are interpreted thatstory; it is how they are interpreted that

leads to argument and controversy, andleads to argument and controversy, and

we must make sure we cover all this debatewe must make sure we cover all this debate

in an appropriate manner. I have had toin an appropriate manner. I have had to

learn this since a school report at the agelearn this since a school report at the age

of 11 commented on my debating skills:of 11 commented on my debating skills:

‘at present he interrupts rudely without‘at present he interrupts rudely without

giving others the chance to speak and,giving others the chance to speak and,

when admonished, spends his time mutter-when admonished, spends his time mutter-

ing at the back of the class’. A better methoding at the back of the class’. A better method

of expressing contrary opinion is shown byof expressing contrary opinion is shown by

our supplement (no. 49) this month, whichour supplement (no. 49) this month, which

examines the subject of dangerous and severeexamines the subject of dangerous and severe

personality disorder from many differentpersonality disorder from many different

angles, and which is relevant to much ofangles, and which is relevant to much of

the debate that is going on at present in thethe debate that is going on at present in the

UK parliament over a new Mental HealthUK parliament over a new Mental Health

Act. There is much else to stimulate contraryAct. There is much else to stimulate contrary

opinions in this issue. Depression knocksopinions in this issue. Depression knocks

hard on the morbidity door after physical ill-hard on the morbidity door after physical ill-

ness, particularly after myocardial infarctionness, particularly after myocardial infarction

(Mayou(Mayou et alet al, 2000) and it might be expected, 2000) and it might be expected

that its removal might reduce prematurethat its removal might reduce premature

death too. Van Melledeath too. Van Melle et alet al (pp. 460–466)(pp. 460–466)

finds it does not and, while this finding isfinds it does not and, while this finding is

in general supported by Carney & Freedlandin general supported by Carney & Freedland

(pp. 467–468) they point out that the sample(pp. 467–468) they point out that the sample

size needed to demonstrate such an effectsize needed to demonstrate such an effect

would be impossibly large unless a high-riskwould be impossibly large unless a high-risk

group were selected.group were selected.

There continues to be controversy overThere continues to be controversy over

the long-term effects of trauma and its mea-the long-term effects of trauma and its mea-

surement (Fruehsurement (Frueh et alet al, 2005) and Ikin, 2005) and Ikin et alet al

(pp. 475–483) set a benchmark for good(pp. 475–483) set a benchmark for good

methodology in their 50-year follow-upmethodology in their 50-year follow-up

study; it will be interesting to see whetherstudy; it will be interesting to see whether

modern ways of preventing post-traumaticmodern ways of preventing post-traumatic

stress lead to better results in more recentstress lead to better results in more recent

conflicts. Browneconflicts. Browne et alet al (pp. 484–489) add(pp. 484–489) add

to the debate by their findings suggestingto the debate by their findings suggesting

that post-traumatic stress in reservists isthat post-traumatic stress in reservists is

created not by problems of war but thosecreated not by problems of war but those

at home, which yet again makes me shakeat home, which yet again makes me shake

my head sadly when I turn to ruminatingmy head sadly when I turn to ruminating

about the value of the post-traumatic stressabout the value of the post-traumatic stress

disorder construct (Moldisorder construct (Mol et alet al, 2005; Tyrer,, 2005; Tyrer,

2005). Depression at least seems a more2005). Depression at least seems a more

stable condition, but now we are seeing dif-stable condition, but now we are seeing dif-

ferential responses to treatment in those offerential responses to treatment in those of

different personality adjustment (Newton-different personality adjustment (Newton-

HowesHowes et alet al, 2006; Joyce, 2006; Joyce et alet al, pp. 503–, pp. 503–

508) and different levels of depression508) and different levels of depression

(Luty(Luty et alet al, pp. 496–502); it is clear that, pp. 496–502); it is clear that

the recognition of additional pathology isthe recognition of additional pathology is

important in choosing treatment. Whereimportant in choosing treatment. Where

transcranial magnetic stimulation willtranscranial magnetic stimulation will

finish in the treatment stakes is far fromfinish in the treatment stakes is far from

clear (Andersonclear (Anderson et alet al, pp. 533–534) but it, pp. 533–534) but it

is unlikely to be for simple depressionis unlikely to be for simple depression

alone. But perhaps I ought to be thinkingalone. But perhaps I ought to be thinking

more about my choice of treatment any-more about my choice of treatment any-

way, for as a predictably premature mono-way, for as a predictably premature mono-

zygotic twin I am clearly at greater risk ofzygotic twin I am clearly at greater risk of

depression if Raikkonendepression if Räikkönen et alet al’s findings’s findings

(pp. 469–474) are correct.(pp. 469–474) are correct.

With all this controversy about, weWith all this controversy about, we

would like to see a little more of it gettingwould like to see a little more of it getting

into our correspondence columns. Pleaseinto our correspondence columns. Please

do not be put off by the need to submitdo not be put off by the need to submit

all letters as eLetters in the first instance.all letters as eLetters in the first instance.

Those that are going to spark good debateThose that are going to spark good debate

will get into the main journal readily andwill get into the main journal readily and

we hope will develop Samuel Johnson’swe hope will develop Samuel Johnson’s

‘agitation of contrary opinions’ rather‘agitation of contrary opinions’ rather

better than his crushing ‘Sir, I have foundbetter than his crushing ‘Sir, I have found

you an argument; but I am not obliged toyou an argument; but I am not obliged to

find you an understanding’.find you an understanding’.

AVE GASKELLAVE GASKELL

No, this is not a Lancastrian support ofNo, this is not a Lancastrian support of

Samuel Gaskell’s legacy to the College withSamuel Gaskell’s legacy to the College with

the ‘h’ suppressed, but a more sombrethe ‘h’ suppressed, but a more sombre

goodbye. Samuel Gaskell of Warrington,goodbye. Samuel Gaskell of Warrington,

despite his impressive legacy of removingdespite his impressive legacy of removing

the handcuffs and leg-locks of patients atthe handcuffs and leg-locks of patients at

Lancaster County Lunatic Asylum and re-Lancaster County Lunatic Asylum and re-

placing them with dances with one of theplacing them with dances with one of the

patients accompanying on the violin (Free-patients accompanying on the violin (Free-

man & Tantam, 1991), is best known forman & Tantam, 1991), is best known for

giving his name to the Gaskell series ofgiving his name to the Gaskell series of

books published by the Royal College ofbooks published by the Royal College of

Psychiatrists and for the gold and bronzePsychiatrists and for the gold and bronze

medals that bear his name (even though itmedals that bear his name (even though it

was his sister, Elizabeth, who made thewas his sister, Elizabeth, who made the

benefaction to the Royal Medico-Psycholo-benefaction to the Royal Medico-Psycholo-

gical Association after Samuel died ingical Association after Samuel died in

1886). One of Samuel’s other relatives, Eli-1886). One of Samuel’s other relatives, Eli-

zabeth Gaskell, the novelist who broughtzabeth Gaskell, the novelist who brought

the city of Manchester to the attention ofthe city of Manchester to the attention of

the literary world in much the same waythe literary world in much the same way

as Jane Austen did the city of Bath, con-as Jane Austen did the city of Bath, con-

tinues to have considerable impact. Buttinues to have considerable impact. But

the Gaskell imprint has now drawn to athe Gaskell imprint has now drawn to a

close and the new title RCPsych Publica-close and the new title RCPsych Publica-

tions has replaced it. This was not an easytions has replaced it. This was not an easy

decision, but we are in a world in whichdecision, but we are in a world in which

the internet is king and RCPsych, despitethe internet is king and RCPsych, despite

its intrinsic lack of euphony, is a title thatits intrinsic lack of euphony, is a title that

is instantly recognisable. So as we bid a col-is instantly recognisable. So as we bid a col-

loquial farewell to Samuel – ‘time to cumloquial farewell to Samuel – ‘time to cum

in, lad, tha’s ’ad a good innings’ – we hopein, lad, tha’s ’ad a good innings’ – we hope

for an equally successful career for the newfor an equally successful career for the new

bright kid on the block.bright kid on the block.

Freeman, H. & Tantam, D. (1991)Freeman, H. & Tantam, D. (1991) Samuel Gaskell.Samuel Gaskell.
InIn 150 Years of British Psychiatry: 1841^1991150 Years of British Psychiatry: 1841^1991 (eds(eds
G. E.Berrios & H. Freeman), pp. 445^451.Gaskell.G. E.Berrios & H. Freeman), pp. 445^451.Gaskell.

Frueh, B.C., Elhai, J. D.,Grubaugh, A. L.,Frueh, B.C., Elhai, J. D.,Grubaugh, A. L., et alet al (2005)(2005)
Documented combat exposure of US veterans seekingDocumented combat exposure of US veterans seeking
treatment for combat-related post-traumatic stresstreatment for combat-related post-traumatic stress
disorder.disorder. British Journal of PsychiatryBritish Journal of Psychiatry,, 186186, 467^472., 467^472.

Mayou, R. A., Gill, D.,Thompson, D. R.,Mayou, R. A., Gill, D.,Thompson, D. R., et alet al (2000)(2000)
Depression and anxiety as predictors of outcome afterDepression and anxiety as predictors of outcome after
myocardial infarction.myocardial infarction. Psychosomatic MedicinePsychosomatic Medicine,, 6262,,
212^219.212^219.

Mol, S. S. L., Arntz, A., Metsemakers, J. F. M.,Mol, S. S. L., Arntz, A., Metsemakers, J. F. M., et alet al
(2005)(2005) Symptoms of post-traumatic stress disorder afterSymptoms of post-traumatic stress disorder after
non-traumatic events: evidence from an opennon-traumatic events: evidence from an open
population study.population study. British Journal of PsychiatryBritish Journal of Psychiatry,, 186186,,
494^499.494^499.

Newton-Howes, G.,Tyrer, P. & Johnson,T. (2006)Newton-Howes, G.,Tyrer, P. & Johnson,T. (2006)
Personality disorder and the outcome of depression:Personality disorder and the outcome of depression:
meta-analysis of published studies.meta-analysis of published studies. British Journal ofBritish Journal of
PsychiatryPsychiatry,, 188188,13^20.,13^20.

Tyrer, P. (2005)Tyrer, P. (2005) From the Editor’s desk.From the Editor’s desk. British Journal ofBritish Journal of
PsychiatryPsychiatry,, 186186, 552., 552.

B R I T IS H J O UR N AL O F P SYC HI AT RYBR I T IS H J O URN A L O F P SYC HIAT RY ( 2 0 0 7 ) , 1 9 0 , 5 4 6 . d o i : 1 0 .11 9 2 / b j p .1 9 0 . 6 . 5 4 6( 2 0 0 7 ) , 1 9 0 , 5 4 6 . d o i : 1 0 .11 9 2 / b j p .1 9 0 . 6 . 5 4 6

From the Editor’s deskFrom the Editor’s desk

PETER TYRERPETER TYRER

5 4 65 4 6

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