Tackling the voice within
Your article on the need for psychiatrists to accept that hearing voices can be a positive as well as a negative experience (Speaking out, January 9) concludes with the statement that "such talk is unlikely to be heard in the London corridors of the Institute of Psychiatry". On the contrary, such talk can frequently be heard within our corridors.
Research from the institute has shown that about 4% of the general population hear voices and that voices can be seen on a brain scanner as emanating from that part of the brain that normally produces verbal thoughts or "inner speech".
Nevertheless, many people who hear voices are tormented by them. Therefore, together with the Maudsley hospital, we run a Hearing Voices clinic for such people who want help, whether or not they consider that they suffer from an illness. We can provide advice about the pros and cons of different medications.
However, medication is rarely enough, and cognitive behaviour therapy, a talking treatment, often facilitates an understanding of the psychological origins of the voices and how to best cope with them.
In short, many people without a diagnosis of schizophrenia hear voices, while many people with such a diagnosis can manage their experiences well with appropriate help. The dividing line between those regarded as normal and abnormal is not as clear cut as is often believed.
Robin Murray
Professor of psychiatry, Institute of Psychiatry
· Your article mentions our report, Recent Advances in Understanding Mental Illness and Psychotic Experiences. Readers may be interested to know that it is available from the society at £15 (0116-254 9568) or can be downloaded at: www.understandingpsychosis.com
Jonathan Calder
Communications officer, British Psychological Society
Foyer enlightenment
While acknowledging the support needs of teenage asylum seekers (Nervous hosts, January 9), we should not overlook the positive contribution they can make within existing supported housing projects for young people, such as foyers.
Many of the UK's 114 foyers already accommodate significant numbers of young asylum seekers. Their presence can open the eyes to the wider world of local young people who may never have travelled further than five miles from home. Their motivation to learn and work can be a source of challenge and inspiration.
The clash of expectations can be very positive - one London foyer manager described the dynamics of a residents' meeting, where asylum seekers were incredulous that anyone would put their hard-earned shelter at risk by falling behind with their rent!
We would urge housing managers to talk to their local foyers about young asylum seekers. Those without foyers might like to explore the development of one that could meet the needs both of local young people and those from further afield.
Carolyn Hayman
Chief executive, Foyer Federation
Worthy honour
I take great exception to your sideswipe at an environment agency employee (Eco soundings, January 9). Geoff Bateman and his team did a marvellous job during the foot and mouth crisis.
But for them, the backlog of undisposed carcasses would have vastly multiplied and the outbreak consequently could have been far longer and more extensive. But for them, we would today be facing serious environmental pollution from inappropriate or badly conducted burial and burn.
Geoff's recognition in the new year's honours list for his environmental achievements is thoroughly well deserved, and your ungracious and dismissive comments are entirely misplaced.
Sir John Harman
Chairman, Environment Agency
Puff and nonsense
It is nonsense to say that, until the start of the NHS smoking cessation programme, "most smokers wanting help with kicking the habit had nowhere to turn except to an unregulated private sector"(Gasps of disbelief, January 2).
As the 1998 white paper, Smoking Kills, states: "GPs, practice nurses, etc, are the people to whom we all look to advise us about our health". Each day, nearly 250,000 smokers visit their doctors and practice nurses about health concerns and many want to stop smoking and want help in doing so.
Over the past 20 years, there has been much research evidence of the effectiveness of even brief advice in primary care, and also of the useful additional effect of nicotine replacement products and Zyban, both of which are prescribable on the NHS.
As a GP for nearly 40 years, I can vouch for this valuable role. I, too, am concerned that NHS smoking cessation services should continue, but these are and always will be only supplementary to general practice.
Godfrey Fowler
Emeritus professor of general practice, University of Oxford
Clipped wings
Malcolm Dean (January 9) writes about reform of self-regulation in the medical profession, introducing a bar on ability to practise unless you are regularly subject to scrutiny of your competence. He asks: "Can you name a single profession where such a system operates?"
The answer is Yes: airline pilots are subject to a six-monthly health and competence check throughout their career. Failure can mean an end to their job.
Barry Tomlinson
Bedford
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