Governments and non-governmental organisations are increasingly adopting a ‘zero-suicide’ goal, but what such a goal precisely involves is unclear. Ostensibly it strongly prioritises the prevention and elimination of all suicide. We argue that, so understood, a societal goal of zero suicide risks contravening several ethical principles. In terms of beneficence and non-maleficence, a ‘zero-suicide’ goal risks being inefficient and may burden or harm many people. Autonomy-wise, a blanket ban on all suicide is excessive. As regards social justice, zero suicide risks focusing on the symptoms of social malaise instead of the structures causing it. With respect to transparency, a ‘zero’ goal that cannot be met makes these authorities look detached and risks frustration, distrust and, worse, stigmatisation of suicide and of mental health conditions. Instead, we propose a middle path for suicide prevention, founded on harm reduction, ‘soft group paternalism’ and efforts directed at increased quality of life for disadvantaged groups. Although soft group paternalism respects autonomy, this approach permits coercive interferences in certain circumstances. We hope that the justificatory framework tying together these largely familiar elements is novel and sensible.

Tumours of the corpus callosum (C.c.) are known to be a difficult diagnostic problem. Intellectual and mental disturbances and rapid deterioration in the course of the illness have been observed in most of these cases and are considered by many authors to indicate an involvement of this body (Lévy-Valensi, 1910; Mingazzini, 1922; Ironside and Guttmacher, 1929; Alpers and Grant, 1931; Voris and Adson, 1935; Schlesinger, 1951, Bremer et al., 1956). However, a similar picture may also occur in tumours of other sites; moreover, tumours of the C.c. tend to infiltrate the hemispheres, particularly the cingulum and the frontal lobes, and this might well account for the mental picture. A sign which seems to be more specific for damage of the C.c. is dyspraxia restricted to the left limbs in right-handed persons. Although this dyspraxia has been reported only in a small minority of cases concerned, it has not been observed in lesions other than those of the C.c.

With the coming of the National Health Service, there seemed a real chance of establishing fuller psychotherapy in Out Patients. This is not to imply that psychotherapy was not given before; but in most hospitals it was necessarilly limited except in special cases, and there was a tendency to leave it a good deal to junior staff who had the time and wanted the experience.

In abreaction under any of the methods in use, a phase of cortical excitation is followed by a phase of temporary cortical inhibition with rupture of pre-existing patterns of conditioned reflexes and behaviour, a phase in which new modes of behaviour are easily adopted, the ultra-paradoxical phase (Pavlov, 1934). In this phase the patient is extremely suggestible, and this corresponds to psychological transference always found in post-abreactive states (Shorvon and Sargant, 1947).

For the past twenty years we have been studying methods of teaching and their effectiveness in changing the behaviour of medical students and doctors. At the Massachusetts General Hospital our work was concerned primarily with teaching psychotherapy to medical students, residents and younger physicians. During these years we have practised and taught many kinds of psychotherapy, including situational therapy, relationship therapy such as catharsis, support, reassurance, suggestion and persuasion, and the various types of insight therapy from the verbalization and understanding of simple correlations to more extensive Freudian psychoanalysis. The patients we treated in Boston were primarily those with psychoneuroses and psychosomatic disturbances. In these groups of patients insight therapy was the method of choice. It was only when insight therapy was impracticable or too disturbing to the patient that other methods such as relationship therapy were used. During these years we used insight therapy whenever possible, often with limited effectiveness. The treatment for any given hospital admission required from 20 to 40 interviews, occasionally more. It was our practice to use the vis-à-vis interview method.

It is a fact in Psychiatry which has by no means been sufficiently recognised, that attacks of mental disease have early symptoms that are often not mental in character; and it is equally true that in Neurology the fact has not attracted sufficient attention, that all sorts of sensory, vasomotor and motor symptoms may be the mere preludes to an attack of insanity and not of themselves the real disease. Such prodromata of so serious an event as an attack of insanity are exceedingly well worthy of careful study for many reasons, most notably because the recognition of their true character and their explanation might enable us in many cases to anticipate and possibly to ward off the mental attack. The neurologist who is called in to see a woman suffering from an unusual form of headache, with anorexia, insomnia, and obscure paræsthetic sensations, often misses the real point of the case because he does not realise that such symptoms are, in this particular patient, higher-cortical in origin, and may mean an attack of acute mania in a week if nothing can be done to arrest their course. The psychiatrist often considers a mental attack as being sudden in origin, and puts it down as an unled-up-to mental explosion, when in reality there had been sensory and motor symptoms, sleeplessness, and other indications which would have pointed to the existence of previous auto-intoxication, nerve exhaustion, or other disturbance.

The brief summary of the results stated in this paper is based upon an examination of thirty-five cases of general paralysis and seventy-seven cases of psychoses other than general paralysis.

Those who were present at the Glasgow meeting of the British Medical Association will remember that our Scotch members, especially Dr. Turnbull, endeavoured to get up an excursion to Kennoway. It was hoped that at least twenty would avail themselves of the opportunity, but the hope was not fulfilled; then ten, but this also failed; lastly five, but I am sorry to say there were not even five righteous men found in the Psychology Section of the British Medical Association. The excursion was therefore abandoned.

Frenquel, α-(4-piperidyl) benzhydrol hydrochloride, generically known as Azacyclonal hydrochloride was introduced commercially into this country in the early part of 1957 although it had already been available in the United States of America for several months previously. Sargant (1956) obtained a supply of Azacyclonal from America and in his paper on Chemical Tranquillizers he refers to Azacyclonal as “an interesting drug”. Azacyclonal was thought to be the first drug to possess a specific anti-hallucinatory effect.

It is indeed a true saying that to be successful in the treatment of disease clinical observation must be accompanied by biological and bio-chemical research. Yet the practice of medicine in times not so very remote was chiefly based on careful observation and common sense. In by far the majority of diseases the ætiology was not understood, and this was strikingly true of the acute forms of mental derangement. Still, devoted workers and searchers after truth continued their investigations on the dead and their experiments on the living. Gradually appliances were improved and new methods pursued, and with such brilliant results that at last the true cause of infective disease was discovered. One by one bacteria were isolated and studied, and thus a great world of medical research was opened out and results obtained which have already wrought untold blessings to humanity.

The speech faculty of the epileptic has hitherto received very little attention, though passing references to it have been made from time to time by several writers, viz. Kussmaul, Ross, Wylie, and others. Wylie has stated the well-known fact that temporary aphasia appears sometimes as the “aura,” sometimes as an immediate consequence of a fit. Kussmaul confirms this, and Ross writes, “In some cases the warning of an epileptic attack consists of a sudden inability to speak, and it is very probable that word-deafness and word-blindness are by no means uncommon auræ.” While saying so much, Ross admits what is certainly true, that motor aphasia is the more readily noticed, and, as obscuring the question of aphasic auræ, he admits the mental confusion attending the onset of unconsciousness, a factor of some importance. Bradylalia (slow speech) and echolalia (echo speech) have also been noticed by observers at home and abroad. They are, however, so frequently observed in developmental speech, and in other nervous and mental diseases, that too much may be made of their significance.

The incidence of schizophrenia among admissions to mental hospitals has been variously estimated at from 12% to 16%. These statistics ignore the pre-psychotic states and all those schizoids who have, in these modern times, been assisted to exteriorize or readjust themselves without the invocation of the Lunacy Laws.