I am grateful for the opportunity of commenting on a recent article by Dr Paul Bridges, ‘Psychosurgery and the Mental Health Act Commission’ (Bulletin, August 1984, 8, 146–48). It may be useful to clarify the areas where we agree with him and to put into context matters in which he is critical. In the latter case I wish to consider whether his criticism is accurately directed at the Commission's policies.

Once it was generally supposed that people were afraid of psychiatrists. The fear of insanity, that ultimate loss of control, made people joke about psychiatrists as they joked about other fearsome things such as death and sex. Now it seems there are fewer jokes but much more open suspicion and hostility and there is much to suggest that over the years psychiatrists have become afraid of people. We have been so preoccupied with the clinical and heuristic aspects of our profession that we have not recognized the emergence of damaging paranoid forces, let alone made any adequate or appropriate response to them. This failure has created formidable problems for the mentally ill and their families and has been a significant factor in promoting one of the vicious backward swings in the pendular history of psychiatry.

During some recent research for a project in the history of psychiatry, I had the opportunity of studying the first hundred years' Annual Reports of Glasgow's Gartnavel Royal Mental Hospital dating from 1814. I was struck at how applicable some of the comments were in modern psychiatry and was interested in some of the phraseology used and ideas expressed. Some were quaint, some entertaining and surprisingly few abstruse.

I have just spent 18 months searching for a job to continue higher psychiatric training in the London area. In connection with this quest, I wrote many letters, made numerous telephone calls, spoke with more than 50 consultant psychiatrists in 11 teaching hospital settings, investigated and considered 23 advertised posts, applied for 16, was shortlisted for 12, withdrew from one and was interviewed for 12, before finally being offered a job which I was happy to accept.

A Conference on the above topic took place at the Institute of Psychiatry, London, on 17 and 18 July 1984. The Conference was sponsored by the Department of Health and Social Security and was organized by the General Practice Research Unit. Over 100 invited clinicians, research workers and policy-makers took part. The majority of the participants were either psychiatrists or general practitioners, but representatives of all relevant disciplines attended.