It was fully anticipated that the Mental Health Act Commission would take special interest in psychosurgery, and Section 57 is clearly intended to supervise this form of therapy. The Chairman of the Commission, Lord Colville, considerately arranged a visit to our Unit shortly after the implementation of the Act, and this proved to be a most useful meeting. Obviously we were ready to give any help or advice needed, based on our experience of over 1,100 operations carried out over about 20 years. Our world-unique unit has eight beds specifically for the assessment and treatment of patients referred for psychosurgery, although intensive antidepressant medication is sometimes used successfully in order to avoid psychosurgery.

The Mental Health Act 1983 stimulated discussion on all aspects of compulsion in psychiatry. It has been the practice at St. Mary Abbots Hospital to use the powers granted by Section 39 of the 1959 Act and Section 17 of the 1983 Act as a means of compelling a small number of seriously ill patients to take medicines in the community, and I described this practice briefly in a recent article.

In spite of the vast strides forward made by the brain sciences this century, the gap between our understanding of the brain and our understanding of the mind remains uncomfortably wide. At one end of the scale, physical scientists scratch patiently away at the chemistry of receptor sites on cell membranes, at the other, clinicians make brilliant deductions by sheer intuition, and in between is a hazy land. As the pendulum now swings back towards a biological approach to psychiatry, we hear again the old assertion that the only true knowledge can be obtained by objective observation; subjective intuition must therefore be suspect, an unreliable and intangible entity. What validity is there in this argument?

The current trend towards community care for mentally handicapped people means that general practitioners have greater opportunities to meet mentally and multiply handicapped people living in the family home or in small units in the community. In addition, an increasing number of large long-stay mental handicap hospitals have delegated the reponsibility for primary care to local GPs, frequently employed as clinical assistants for this purpose. This is having the welcome effect of allowing the psychiatrist and the trainee in psychiatry to follow their particular interests and develop their own treatment skills.

The British approach to administrative problems is often to accumulate more and more evidence for changes which are obsolete before enaction. Such a fate seems likely to happen to plans for the management of the psychiatrically disturbed offender following several reports. It was interesting, therefore, this summer to work as a locum consultant in a Saskatchewan forensic psychiatric hospital.