The quintessence of fact

In the parched desert of ignorance and prejudice every established fact becomes an oasis. By ‘established fact’ I mean one that defines the field, the one that all the related and restlessly inchoate facts gather round and say ‘I belong here’, and then fall into line behind it. Every editor likes to feel they can identify these established facts as they peruse the manuscripts that flood into every journal office nowadays. Here are some from this month's issue.

1. (1) Abortion is bad for your mental health.

2. (2) Olanzapine is of no value for people with borderline personality disorder.

3. (3) Cornelia de Lange syndrome is clinically an autistic-spectrum disorder.

4. (4) Untreated phenylketonuria leads to apparently permanent and severe disability.

5. (5) CD–ROM interventions alone are limited in value for eating disorders.

Why are these likely to be strong enough to become established facts? Fergusson et al (pp. ) provide prospective data in an unselected population that mental disorder is 30% higher in those who have had abortions. He and his colleagues have no ideological axe to grind; their data dictate their paper and, after looking hard and long at all other possible confounders, they cannot account for their data in any other way. Of course, how one interprets this fact is quite a different matter, and Dingle et al (pp. ) add more grist to the mill, but despite the wide variation shown in our commentaries (Casey/Oates et al, pp. ) none disputes the essential science and the results. Olanzapine is an atypical antipsychotic drug now showing evidence of efficacy in a very large range of psychiatric disorders, not only schizophrenia and schizoaffective disorder, ^{Reference Keks, Ingham, Khan and Karcher1} those at risk of schizophrenia, ^{Reference Hoffman, Woods, Hawkins, Pittman, Tohen, Preda, Breier, Glist, Addington, Perkins and McGlashan2} bipolar and other mood disorders, ^{Reference Derry and Moore3} and anxiety disorders. ^{Reference Gao, Muzina, Gaiwani and Calabrese4} It might therefore be expected that borderline personality disorder, which manifests features of all the above conditions, would respond to this drug. But it doesn't, and please note that this publication includes many authors from a pharmaceutical company, whose contribution normally is associated with studies showing positive efficacy. ^{Reference Tungaraza and Poole5} So I judge this study to convey another essential fact that may help to put other studies into a better diagnostic and treatment perspective, ^{Reference Linehan, McDavid, Brown, Sayrs and Gallop6,Reference Kirkpatrick, Joyce, Milton, Duggan, Tyrer and Rogers7} as well as pointing our attention to the potential value of psychological treatments, including cognitive analytic therapy, the first randomised trial of which is reported by Chanen et al (pp. ).

Cornelia de Lange syndrome, a condition associated with chromosome abnormalities, was identified as having some overlap with autistic disorders many years ago ^{Reference Prior8} but Oliver et al (pp. ) show clearly that it is right in the middle of this spectrum with particularly marked compulsive features, a characteristic that separates it from some disorders showing lesser handicap. ^{Reference Bradley and Bolton9} One of the preventable forms of severe intellectual disability, phenylketonuria, has disappeared from many people's view since the recognition of the value of phenylalanine-restricted diets, and Murphy et al (pp. ) have done us a service in showing that those with the condition that preceded this advance – many fewer than they thought – are still severely handicapped despite living longer ^{Reference Jancar10} and deserve the opportunity of the randomised trial they are suggesting. And so we move on to my last established fact, now becoming clearer with every succeeding study. We are increasingly enchanted with the notion of computer as therapist in a world of exciting new technology and nearly one in five people use it for medical purposes. ^{Reference Powell and Clarke11} But computers are never personal; even their screen messages give the impression of being produced by aggressive Daleks, and it is a sad established fact that the most effective of treatments does not quite live up to its potential when given by an inanimate program. Schmidt et al (pp. ) confirm what we have suspected for some time: ^{Reference Carlbring, Gunnarsdóttir, Hedensjö, Andersson, Ekselius and Furmark12} without the human touch psychological treatments go sadly awry and lose their edge.

The primrose comic

As we come to the end of our first year of the new-look Journal it is a good time to reflect on the reaction to our revised cover and contents. I have taken the trouble to canvas as much opinion as possible and, although it may not be completely representative, here are my findings. At one extreme, some people have reacted with a sense of shock to the loss of a well-loved friend and do not like its replacement one little bit. ‘It just looks like a copy of Vogue’ said one of my colleagues, and while I am not quite sure if this should be interpreted as a compliment or an insult to either journal, it does tilt towards the negative. Others have embraced it with enthusiasm and excitement and regard the change as an advance. There is also a split in opinion by age. I was made aware of this at a dinner for honorary Fellows of the College recently when a surprisingly large number came up with comments about the new look that could be summarised in the cantankerous words of Victor Meldrew in the series One Foot in the Grave, ‘I cannot believe it’. Well, sorry, it looks as though it will be with us for some time yet.

Some years ago one of my correspondents from Australia informed me that there the British Journal of Psychiatry is often referred to as ‘the primrose comic’. I've always quite liked this. So why not celebrate our journal as the epitome of Primula vulgaris: