Depression
It would enhance the scientific respectability of this branch of neurology, as Professor Miller describes it, if a neurologist were to give his results in a form which made possible comparison with results obtained by others.
Abstract
if we had had to rely on internal medicine and neurology ? The next point concerns the physical aspects of psychiatric illness. It is ludicrous for psychiatrists to waste their time acquiring an exhaustive knowledge of all the " several hundred pathophysiological disturbances" that can cause a confusional state; what should be expected of them is skill in diagnosis and treatment of psychiatric disorders together with the ability to pick out those mental syndromes that may be organic in origin and need investigation. Moreover, physical examination is standard practice in psychiatry; while in medical departments assessment of mental state is not, even todaydespite the risk of overlooking depression and of compounding iatrogenic illness by overzealous investigation. Indeed there is a very strong case for all aspirants to consultant status in medicine to undergo some postgraduate training in psychiatry, since as Professor Miller observes psychiatry covers the whole of medicine. His own involvements in this field have occasioned great interest. Yet one could have wished for a rigorous clinical analysis based on his 2,000 personal cases, instead of the textbook description of classical endogenous depression actually given. In psychiatric practice the typical endogenous form is relatively uncommon, response to antidepressant drugs is often incomplete, and relapse is rather frequent ; consequently much effort has been and is being expended on clarifying the nosology of the affective disorders and defining indications for the various treatments. It would enhance the scientific respectability of this branch of neurology, as Professor Miller describes it, if a neurologist were to give his results in a form which made possible comparison with results obtained by others. Since no original article on depression or on any other major aspect of " neurology at its highest level," excepting only epileptic experiences,' has appeared in its last 20 volumes, it is to be hoped that the long silence will be broken by publication in Brain.-I am, etc., Newcastle upon Tyne 1. D. W. K. KAY.