The massive burden of mental disorders adversely affects global health, economy and human rights situations. Yet research investments are shifting from psychiatry toward other more cost-effective fields of medicine. This editorial calls for conscious capitalism and prioritisation of mental health by reflecting on mental health disparities through the prism of justice.

While investigating the serum choline esterase activity in anxiety states, a series of successive new admissions to the Neurological Section of the Mill Hill Emergency Hospital were tested with a view to obtaining further information as to the types of cases giving abnormally high or low esterase activities.

Sera giving abnormally high esterase activity were generally found to come from patients who had been diagnosed on admission as anxiety states, but an exception was noted particularly in the case of one patient (P. M—) with the very high esterase activity of 169. This patient was described on admission as “always emotional; he feels like weeping when the National Anthem is sung; not afraid of dangers.” He complained of uncontrollable weeping in company and he had considered suicide. Both from our own observation and from that of others it appeared that he was not a particularly anxious person, but he was extremely depressed. This observation raised the question of whether anxiety is the only emotional condition in which the serum esterase activity is raised or whether it may not also be raised in severe depression.

It appeared that information on this point might be obtained by analysing the data which had accumulated in testing the new admissions, which consisted of a varied collection of patients suffering from anxiety states, depressive states, hysteria and other neurological and mixed conditions. The possibility of subsequent analytical treatment was not considered at the time when the data were collected and the diagnoses were made by more than 12 different physicians who were known to differ to some extent in their diagnostic criteria. For this reason it was hardly expected that the results would be extremely clear-cut, but in actual fact the analysis brought out surprisingly clearly the differences in serum choline esterase activity in different types of neurotics. The diagnoses were made without a previous knowledge of the esterase activities and were therefore unbiased in this respect; we are indebted to the physicians for their permission to make use of them.

Methods.—The method of estimating the serum choline esterase was the same as was described in the preceding paper (Richter and Lee, 1942), except that venous blood from the arm was used instead of capillary blood. In some of the estimations acetylcholine bromide was used instead of the chloride. The bromide ion caused a slight inhibition of the enzyme which was corrected by multiplying by the factor 1·06, which was determined empirically by carrying out estimations on the same sample of serum with the chloride and bromide at the same time. The control group consisted of the 12 normal and 12 surgical patients described in the preceding paper; the mean serum esterase activity for the 24 controls was 75 units. The various esterases occurring in blood have been described by Richter and Croft (1942).

The theory that physique and temperament are correlated remains a subject of controversy. Various workers in the field differ in their findings and, in the past, investigations on body build and its psychological correlates have been handicapped by lack of precise knowledge of the variations in body build. In recent years improved statistical methods of analysis have been applied to the study of body build, enabling the variations in physique to be analysed and assessed inductively.

Osmond and Smythies (1952) have given reasons for reviving the view originally put forward by Bleuler (1950) that schizophrenia is essentially a disorder of metabolism, and have suggested that some substance chemically related to mescaline might be the causative agent. Hoffer, Osmond and Smythies (1954) have begun an investigation of this hypothesis and have found that adrenochrome, an oxidation product of adrenaline which is probably a normal intermediate metabolite, has active hallucinogenic properties. These authors do not regard adrenochrome as being unquestionably the toxic agent in schizophrenia, but suggest that it or some closely related substance, having the indole ring and derived from adrenaline, is involved. They also advance the opinion that the metabolic fault consists of an overproduction of adrenochrome or similar substances. Such a view necessarily implies either overproduction of adrenaline or a blocking of one or more of the paths of adrenaline detoxification in the body which do not lead through adrenochrome. As adrenaline is derived from tyrosine the hypothesis is essentially one of abnormal tyrosine metabolism. From this hypothesis certain deductions can be made.

When the mental health programme of the World Health Organization (WHO) Regional Office for Europe was ‘resurrected’ in 1999, a review of the situation in the European Region of the WHO provided a surprisingly diverse picture. In this Region, which stretches from Greenland to Malta, from Ireland to Kamchatka, dramatic differences were noted in life expectancy and suicidality, income, housing, employment and social cohesion, as well as services, social support, human rights and the accessibility of basic care. In many societies, stigma and discrimination effectively excluded the mentally vulnerable from society and its basic services. Stigmatisation also hindered early intervention, rehabilitation and reintegration into society (WHO Regional Office for Europe, 1999, 2001).

Chaining of people with mental disorders, and their incarceration and abuse in prisons or mental hospitals, is an affront to psychiatry and humanity. Although mental healthcare always needs attention to cultural and social contexts, this must never be at the cost of allowing human rights violations to go unchallenged. A rights-based approach must enforce well-established international human rights conventions, and scale-up comprehensive community services around the needs and preferences of people affected by mental disorders.

People with schizophrenia have been categorised into three groups: those with full insight (aware, correct attributers); those aware of being unwell, but who misattributed their symptoms (aware, incorrect attributers); and those unaware of being ill (unaware). Cluster analysis of ‘awareness of illness' and ‘relabelling of symptoms' scores on the Schedule for the Assessment of Insight confirmed three distinct subgroups. The unaware group were impaired on executive and memory tests, whereas those in the aware, misattributing group were cognitively intact. Findings support an association between unawareness of illness and executive dysfunction, and highlight the separation of symptom misattribution from unawareness of illness.

People with depression in the workplace are less productive and at risk of losing their job. Many never work again. Intervention should ideally begin before sickness absence occurs and early return to work should be the focus of care. This will require closer integration of primary care, mental health and occupational health services.

This paper deals with some effects of family and culture on intelligence, as studied in a sample of 50 young adults who had been ascertained as educationally subnormal at school.

In this short paper I shall set out a theory of the origin of head-banging and head-rolling which I do not claim has never been advanced before (since my reading has admittedly been far from exhaustive), but which I personally have not so far encountered in the literature, and which is certainly not widely known at the present time.

Perphenazine is a phenothiazine derivative, recommended as a tranquillizer (Ayd, 1957; O'Reilly et al., 1957; Goldman, 1958; Preisig and Landman, 1958) and as an anti-emetic (Scurr and Robbie, 1958). The structural formula is 1-(2-hydroxyethyl)-4-3-(2-chloro-10-phenothiazyl)-propyl-piperazine; it has also been called Fentazin and Trilafon. Its action is similar to chlorpromazine, but it is said to be 5 or 6 times as potent, the side-effects are less severe and the potentiating effect on barbiturates is minimal. Extra-pyramidal symptoms have occurred but no serious blood-disorders or jaundice have been reported. The recommended out-patient dosage is 6 to 16 mg. daily; doses of 24 to 64 mg. daily may be used with in-patients. Autonomic side-effects such as blurred vision and dry mouth are said not to occur below 40 mg. daily, hypotension not below 150 mg. daily. The purpose of this trial was to see if perphenazine improved the symptoms of out-patients with anxiety and depression, as compared with a placebo, and also to match it with a recognized and widely used sedative, sodium amylobarbitone, in order to note any difference in effect.