Diagnosis of inflammatory bowel disease.

SIR,-As an outsider to both psychiatry and psychology I have been looking forward for some time to finding a serious professional comment on G Baruch and A Treacher's Psychiatry Observed,' which I read on its appearance earlier this year with mixed feelings of enjoyment and irritation. The review which eventually appeared in the BM7(16 September, p 821) over the name of Dr Henry R Rollin was a poor reward for my patience. I am far from being a revolutionary and am not even a socialist in any serious sense, but the fact that I have no enthusiasm for the "socialist transformation of society" sought by Baruch and Treacher does not blind me to the possible validity of some of the points they make. To spend a major part of a fairly long review doing little but carp at their distasteful ideology is a poor substitute for the substantive discussion of their actual arguments and the sober evaluation of the evidence they adduce to support them. No reader of Dr Rollin's notice would be likely to gather a clear impression (favourable or otherwise) of what the book actually asserts, beyond a few themes which your reviewer has chosen to attend to for no better reason than that he is irritated by what the authors say. As it happens I agree with Dr Rollin's implication that Baruch and Treacher often write as though the mere fact that they would have approached specific clinical problems in a different way from that adopted by consultant psychiatrists should be enough in itself to satisfy the reader that the consultants were wrong. But this is exactly the assumption that Dr Rollin makes in his own disagreements with the authors on such matters as the relation of politics to medicine and psychiatry, the role of consultants relative to that of psychologists and other paramedical workers, the value to be placed on drugs and other physical methods of treatment, and the social dimensions of psychiatric illness. Dr Rollin, like the authors he attacks, appears to believe that he has only to state his disagreement for the matter to be at an end. This is precisely the mandarin style that arouses so much antipathy (certainly not just among radicals) against the medical Establishment (Dr Rollin's word and capitalisation) as well as against the equally self-righteous mandarins of the left. Particularly silly are Dr Rollin's remarks about the Soviet Union. Those who inhabit what he calls "the Marx, Trotsky, Mao triangle" are among the last people on earth to hold up Russia as a model for human society and it is culpably naive of your reviewer not to know this. I believe that the far left are themselves culpably naive in imagining that the terrible history of communism lacks major and appalling significance for any kind of revolutionary marxism and no doubt Dr Rollin and I would be in agreement here. But it is pointless to use "that vast prison camp, the USSR" as a stick to beat the Trotskyists with. Some of them would regard that designation as rather mild. Dr Rollin is so obsessed by the politics of his authors that it is enough for them to advocate any kind of change for your reviewer to condemn it. One does not need to be socialist, one hardly needs to be even a liberal, to believe (and to be able to argue one's belief) that there is room for far greater democracy in our health services. But because Baruch and Treacher want "democracy" (which admittedly they might define in rather strange ways) Dr Rollin must call it "anarchy" and finish his notice with a final tilt at Vanessa Redgrave's dismal little sect. I had hoped that debates in the medical profession were more informatively and relevantly conducted. Meanwhile neither Baruch nor Treacher, I think, need lose much sleep over this angry but intellectually vacuous review. IAN HAMNETT