A RECENT documentary shown on BBC2, The Mind of a Murderer, reflected the problems of diagnosis and treatment faced every day by psychiatrists, social workers, the police and the courts when dealing with violent patients. The two cases highlighted in the programme displayed classic symptoms, in one case of schizophrenia and in the other of psychopathy. Both conditions can lead to violence, and in both instances the patients’ disorders led them to commit particularly horrific murders. There must be few doctors who have not had similar discussions with disturbed patients, albeit few with such extreme behaviour.

In both cases shown in the programme the psychiatrists made mistakes in diagnosis and in prognosis that contributed to the homicide. In neither instance was this for lack of dedication, but the handling of the patients demonstrated that all doctors make mistakes, and mistakes can be particularly disastrous in psychiatry.

Overworked doctors may not always have the endless hours necessary to take the good case history on which a reliable diagnosis depends, but some techniques are making accurate diagnosis more likely. One of them is the MRI scan that not only displays the anatomy of the brain and any physical abnormalities, but also demonstrates its physiological activity. When any part of the brain is stimulated during the scan, whether by emotion, thought or cognition, it lights up. The way in which this activity differs in those with psychiatric disease from the mentally healthy may in future provide a means of subjective diagnosis.

A GUY walks into the Human Resources department of a large company and hands the executive his application. The executive begins to scan the sheet, and notices that the applicant has been fired from every job he has ever held.

“I must say,” says the executive, “your work history is terrible. You’ve been fired from every job.”

“Yes,” says the man.

“Well,” continues the executive, “there’s not much positive in that.”

“Hey!” says the guy as he pokes the application. “At least I am not a quitter!” — Dawn\Syndication Service