© 2008 The Royal College of Psychiatrists
COLUMNS |
From the Editor's desk
Different perspectives
We sometimes forget that retinas reverse optical images and our view of the
world is upside down. There is now quite a fashion in upside-down world maps
in which Spain and France are `down under' and New Zealand tops the living
world. These maps do not just constitute an exercise in raising the confidence
level of the Antipodean psyche, which to many is already far too confident,
but invites more critical thinking. The value of looking at psychiatric
problems from a different perspective is illustrated by several of the papers
in this issue. Cannabis is the accepted bad boy on the pathway to
schizophrenia1,2
but it is equally well recognised that many people can use, and misuse,
cannabis without getting a whiff of psychosis. There could be several reasons
for this, the most prominently flagged being genetic differences in those who
are susceptible (but this is now receiving less
support),3 as well
as differences in brain
anatomy.4 Morgan
& Curran (pp.
306–307) now
offer an exciting, but hairy, explanation: some cannabis contains more of the
cannabinoid called cannabidiol, a substance that is not only harmless but has
some antipsychotic properties, whereas other forms, particularly the more
concentrated form called `skunk', contain more 
9-tetrahydrocannabinol
(9-THC), that leads the consumer down the bumpy road to
schizophrenia.
The popular perspective of skinny fashion models illustrating the exact meaning of the behavioural term `modelling' in generating eating disorders in a susceptible public, perhaps best shown in an elegant study published some years ago in the Journal,5 also has another side: the influence of the need to be thin on the models themselves (Treasure et al, pp. 243–244). This seems likely to include not only frank eating disorders but many additional morbidities (Patton et al, pp. 294–299). There is also another behavioural concept, habituation, that has a different perspective shown by Kessing (pp. 290–293). Repeated exposure to many noxious influences leads to a reduction in response as we adapt; this does not seem to be true of depression, which remains highly prevalent in the elderly6 and, once linked to adversity, tends to persist,7 so appears to be more related to kindling than habituation.
But the best example of the influence of perspective comes from the study by Freeman et al (pp. 258–263) in their novel use of virtual reality in testing the generation of paranoid symptoms. My immediate reaction was disbelief at their description of `a virtual reality train ride populated by neutral characters'. How on earth can all those strange people sitting opposite me in an average journey on the London underground be described as `neutral' in character? But of course they are. The computer `avatars' (a word which I note describes the incarnation of a Hindu deity in human or animal form) are created to be quite aggressively neutral; is it me, being male with my `worry style and cognitive inflexibility', that makes them into threatening individuals? I must try to change my mental set when travelling.
Why not write a letter?
Writing letters in this age of instant communication seems to have gone out of fashion, or at least it appears so in the British Journal of Psychiatry. I cannot accept that either our knockabout debate section (Luty/Carnwath, pp. 245–247) or `From the Editor's desk', despite its lofty erudition, satisfies all the questions that you undoubtedly have burning to be answered after you read the Journal. I also hope that the pathological influence of the impact factor, which does not credit letter writers, is not inhibiting your correspondence, or, as Ernest Hemingway put it, `it's such a swell way to keep from working and yet feel you've done something'. To stimulate those who have temporarily lost their corresponding facility we are now allowing letters to be sent directly (not just as eLetters) for consideration for publication in the print Journal to bjpletters{at}rcpsych.ac.uk, and have amended our authors' instructions accordingly.
We are also keen on expanding contributions to our `Extras' section in the Journal. Please remember, we rely on you for material for `Psychiatry in pictures' and the other items that show to our readers what diverse and interesting people we are. It is these pieces that give us a more human face to the world and, in the politician's language, `put us in touch with our constituents'. As an avid consumer of all confectionery I have always felt a special affinity with Jane Austen, not specifically for her novels, which of course are absolutely magnificent, but through her letters, especially the apparently mundane but highly resonant `you know how interesting the purchase of a sponge-cake is to me'. So let us have a few more sweetmeats for the Journal table and increase our splendid fare.
REFERENCES
-
1
- Arseneault L, Cannon M, Witton J, Murray RM. Causal association
between cannabis and psychosis: examination of the evidence. Br J
Psychiatry 2004; 184: 110
-17.
[Abstract/Free Full Text] 2 - Hides L, Dawe S, Kavanagh DJ, Young RM. Psychotic symptom and
cannabis relapse in recent-onset psychosis: prospective study. Br J
Psychiatry 2006; 189: 137
-43.
[Abstract/Free Full Text] 3 - Zammit S, Spurlock G, Williams H, Norton N, Williams N, O'Donovan
MC, Owen MJ. Genotype effects of CHRNA7, CNR1 and COMT in
schizophrenia: interactions with tobacco and cannabis use. Br J
Psychiatry 2007; 191: 402
-7.
[Abstract/Free Full Text] 4 - Szeszko PR, Robinson DG, Sevy S, Kumra S, Rupp CI, Betensky JD,
Lencz T, Ashtari M, Kane JM, Malhotra AK, Gunduz-Bruce H, Napolitano B, Bilder
RM. Anterior cingulate grey-matter deficits and cannabis use in first-episode
schizophrenia. Br J Psychiatry 2007;
190: 230-6.
[Abstract/Free Full Text] 5 - Becker AE, Burwell RA, Herzog DB, Hamburg P, Gilman SE. Eating
behaviours and attitudes following prolonged exposure to television among
ethnic Fijian adolescent girls. Br J Psychiatry 2002; 180: 509
-14.
[Abstract/Free Full Text] 6 - Castro-Costa E, Dewey M, Stewart R, Banerjee S, Huppert F,
Mendonca-Lima C, Bula C, Reisches F, Wancata J, Ritchie K, Tsolaki M, Mateos
R, Prince M. Prevalence of depressive symptoms and syndromes in later life in
ten European countries: the SHARE study. Br J
Psychiatry 2007; 191: 393
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[Abstract/Free Full Text] 7 - Fergusson DM, Boden JM, Horwood LJ. Recurrence of major depression
in adolescence and early adulthood, and later mental health, educational and
economic outcomes. Br J Psychiatry 2007;
191: 335
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[Abstract/Free Full Text]
Related articles in BJP:
- Models as a high-risk group: the health implications of a size zero culture
- Janet L. Treasure, Elizabeth R. Wack, and Marion E. Roberts
BJP 2008 192: 243-244.[Abstract] [Full Text] - Specialised alcohol treatment services are a luxury the NHS cannot afford
- Jason Luty and Thomas Carnwath
BJP 2008 192: 245-247.[Abstract] [Full Text] - Virtual reality study of paranoid thinking in the general population
- Daniel Freeman, Katherine Pugh, Angus Antley, Mel Slater, Paul Bebbington, Matthew Gittins, Graham Dunn, Elizabeth Kuipers, David Fowler, and Philippa Garety
BJP 2008 192: 258-263.[Abstract] [Full Text] - Severity of depressive episodes during the course of depressive disorder
- Lars Vedel Kessing
BJP 2008 192: 290-293.[Abstract] [Full Text] - Prognosis of adolescent partial syndromes of eating disorder
- George C. Patton, Carolyn Coffey, John B. Carlin, Lena Sanci, and Susan Sawyer
BJP 2008 192: 294-299.[Abstract] [Full Text] - Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis
- Celia J. A. Morgan and H. Valerie Curran
BJP 2008 192: 306-307.[Abstract] [Full Text]
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