Tom Trevelyan, describes his impression of a debate for which he was considered too reasonable.

If one is to believe the histrionic and sensationalist media coverage that preceded the release of Oliver Stone's satirical film Natural Born Killers, and which ironically paralleled events in the film, a busy time may be expected for our colleagues working in forensic psychiatry. It would not be surprising if viewing of the film was to be adduced by a desperate defence lawyer as an incitement to commit acts of violence. Hopefully, no such argument would be deemed admissible as the film's formal qualities deliberately militate against audience identification with on-screen characters and incidents.

Clozapine is well known to be an effective treatment for neuroleptic-resistant schizophrenia. However, its use is complicated by a variable and delayed response and by a range of troublesome adverse effects. Current practice is usually to increase the dose initially to around 450 mg/day and then by small increments to a maximum of 900 mg/day according to response and tolerability. While this method is often successful, it has been suggested that a better way of optimising the dose of clozapine might be to monitor plasma concentrations of the drug.

Femi Oyebode and Christina Pourgourides show how Greek tragedy tests established morality and helps an audience resolve its own emotional conflicts.

Over the past four years I have visited a number of special care wards (also known as locked/intensive care/secure wards) and interviewed many staff and patients, both as a Mental Health Act Commissioner and as a second opinion appointed doctor. It has been suggested to me that my observations may be of some interest. The points are not exhaustive nor are they research based. Before continuing I must also declare that I have no special knowledge or expertise in the care or treatment of patients in this setting.

Magical thinking co-exists with rational, logical thought. It may be eclipsed by reason, but not extinguished. Magical thinking is an ever-present component of the mind's activity.

Albert Ellis formulated what is now known as rational emotive behaviour therapy (REBT) in 1955. The Institute for Rational Emotive Therapy (IRET), a not-for-profit organisation chartered by the Regents of the University of the State of New York, opened in its current mid-town Manhattan site in 1965.

One of the most enduring images of the BBC2 Horizon States of Mind: ‘Hearing Voices' was of an exercise used by Ron Coleman from the Hearing Voices Network. Dividing his audience of mental health professionals into groups of three, he asked two to hold an ordinary conversation while the third whispered comments, repeated sentences or gave orders to one of those trying to talk.

Concerns about the use of high doses of neuroleptic medication prompted an audit of prescriptions of these drugs in a large psychiatric hospital. Following an initial audit in 1991 of 196 patients, a follow-up of 192 patients was undertaken in 1993. A significant reduction in levels of neuroleptic medication was found, although doses still tended to remain high.

Jack London's autobiographical account of his long struggle with alcoholism was first published in 1913, three years before he committed suicide by taking an overdose of drugs; he was 40 years of age.

Prolactin, a protein hormone synthesised and released by the anterior pituitary, promotes mammary tissue development and lactation and suppresses gonadotrophin secretion. Dopamine is the natural inhibitor of prolactin release and so standard antipsychotics, which block dopamine receptors, will cause prolactin levels to rise. This hyperprolactinaemia can lead to gynaecomastia, galactorrhoea, menstrual disturbances, a reduction in sperm count, erectile dysfunction, failure of ejaculation and reduced libido. Prolactin-related adverse effects are frequently encountered in patients on antipsychotics and are a cause of substantial morbidity.

At present there is a somewhat damaging ‘splitting’ occurring within the NHS ‘reforms’ – assisted by the media. Consultant psychiatrists, who are regarded as intrusive and paternalistic, administer treatments (mostly medication and ECT) to patients who are not consulted, and are generally thought to know what is best for themselves. General management, which overtly sets out to ‘change the culture’, appears to sustain this irrational harmful and pseudo confrontation.

The preliminary report on homicides committed by mentally ill people was published on Wednesday, 17 August 1994. The decision to present some of our findings ahead of the more comprehensive report to be published in 1995 was made by the Steering Committee after it became clear that some information coming from our collection of data might usefully be made more widely known. The media reaction which had followed individual cases over the previous months made it important to provide some perspective into the frequency of homicides by psychiatric patients, to indicate that the respondents to our questionnaire often saw these tragic episodes as unexpected and unconnected with shortage of services and to point to the finding that several of the cases showed that the individual patient had somehow removed himself or herself from supervision or from regular medication in the weeks or months before the homicide.

The Health and Safety Executive (1992) defines violence against staff as “any incident in which an employee is threatened or assaulted by a member of the public in circumstances arising out of the course of his or her employment”. Verbal abuse and threats are, as the Health and Safety Executive notes, the most common types of incidents, and staff have the common-law right to be protected from such incidents in the course of their work. While the literature on physical violence against mental health professionals is quite large and expanding (see, for example, Health and Safety Commission, 1987; Shepherd, 1994; Wykes, 1994), comparatively little emphasis has been placed on verbal assaults, although these may be extremely distressing.

‘Welcome To Reality’ announces the bright orange graffito, in English, on the perimeter wall of The City Psychiatric Hospital Number 3. A superfluous arrow points to the gate house. This is a large general psychiatric hospital of 2150 beds serving a population of 1.7 million people and also providing my first experience of Russian psychiatry. The buildings, some wooden, date from 1870 onwards and are set in a large area of mature woodland enclosed by a high wall in the northern suburbs of the city.

In the Amazon rainforest there grow two plants: the mariri (Banisteriopsi caapi) and the chacrona (Psychotria viridis), which have been used by native Indians for hundreds of years to make an infusion. The infusion, known as ‘hoasca tea’, is no ordinary herbal brew but one with psychoactive properties. The leaves of these plants contain dimethyltryptamine (DMT), which has hallucinogenic effects, and beta-carbolines, which are monoamine oxidase inhibitors that prevent the degradation of DMT in the gastrointestinal tract. The preparation and consumption of these substances are legal in Brazil; although the Federal Council for Narcotics (CONFEN) states that they can only be used during recognised rituals.