Frank Fish's paper, published in The Journal of Mental Science in September 1961, pp. 978–985, deals with issues which are fundamental for psychiatry. He examines the different approaches used in existential psychology and especially the philosophical basis of existential psychiatry. In his conclusion, he denies its value. His paper demands a reply, since it contains misrepresentations.

In view of the reports of Mendigutia et al. (6), Delay et al. (3), Kamphausen (5), Harenko et al. (4), Alleva (1), that haloperidol was very effective in controlling manic states, it was decided to treat a number of cases with this diagnosis using this new preparation.

Thioproperazine is a phenothiazine compound with a piperazine nucleus in the side chain. The pharmacological investigations of Courvoisier et al. (1958) indicate that it is much less sedative than other phenothiazines and that it has weak anti-adrenaline, anti-histamine and anti-serotonin activity. Clinical reports by Delay et al. (1958), Perrin et al. (1958), Denber et al. (1959), Levy and Maarek (1960) and Perret et al. (1961) indicate improvement in schizophrenic patients, but their papers described trials of this drug in which both recent and long-term cases or other diagnostic groups were included. Denham and Carrick (1961) reported the total remission of symptoms in 32 of 58 chronic schizophrenics treated by the discontinuous method with significant improvement in a further 25. Their acceptance of the view that improvement was correlated with the occurrence of hypertonic syndromes and that failure of treatment was likely if anti-parkinsonism drugs were used to suppress the hypertonicity, excludes the possibility of the type of continuous treatment employed with other phenothiazines. Denber et al., however, advocated the suppression of these drug effects and Perret et al. reported 47% improvement using the continuous method in another mixed group of chronic patients.

At the International Symposium on Niamid (nialamide)—1-/21—(benzylcarbamyl) ethyl/2-iso-nicotinoyl hydrazine—a mono-amine oxidase inhibitor, held in Lisbon in November, 1959, T. S. Davies reported that a 35-year-old mongol of imbecile grade, who had previously been inert and who had never spoken, gradually began to speak in monosyllables and, after two months on the drug, was able to converse in short sentences, showed increased physical activity and was able to undertake simple domestic tasks. It is not clear exactly what dosage of Niamid this patient received, but it was within the range of 30 mgm to 75 mgm daily. This report received wide publicity, out of its context, in the lay press, with its inevitable tendency to give the impression that a treatment of mongolism had been discovered, an impression which it is perhaps unnecessary to say Davies had certainly not intended to give.

Since its introduction in 1938, electroconvulsive therapy (E.C.T.) has shown itself to be a dramatically effective, unusually safe treatment for severe depressive states (“melancholias”, “endogenous” or “psychotic” depressions). Nevertheless, it is repugnant to many patients and psychiatrists, produces a troublesome, if transient, amnesia—especially in older individuals—and is occasionally complicated by fractures and dislocations as well as by anaesthetic and relaxant misadventures. Worst of all, as early studies showed, of the 80–90 per cent. of severe depressives who respond to E.C.T., some 30 per cent. relapse (Huston and Locher, 1948 a, b). Recent work suggests that the rate of relapse may often be higher still—thus of 94 per cent. of a group of patients who had responded to E.C.T., Kiloh and Ball (1961) reported that 46 per cent. had relapsed during the six months following the cessation of treatment. For these reasons, the trend to chemotherapy initiated by the advent of effective antidepressant compounds in 1957 continues to develop, and signs are becoming manifest that within a few years E.C.T. may be replaced by pharmacotherapy.

Death due to barbiturate overdosage has been an increasing problem, rising steadily in England and Wales from a death rate of 2 per million population in 1949 to 5 per million in 1958 (1). Of 2,044 consecutive fatal poisonings studied in Denmark between 1953 and 1959, over a quarter were due to barbiturates (2). 300 tons of barbiturate are consumed in the U.S.A. every year and acute poisoning with it in that country accounts for 1,500 deaths per year (3).