LETTERS

TO

programs

THE

EDITOR

present

hospitalization

the patient

demarcating”)

with only two choices-continued

or commitment-before

discharge

will

be con-

trum

such

diverse

of the corpus

structures

callosum,

as the

pyriform

septal

cortex,

nuclei,

ros-

and “various

ol-

sidered. Under these circumstances, it is debatable how voluntary the patient’s hospitalization really is (I). The recommendations considered by our task force on AMAs include the following: I. Using the AMA category only when the patient is not

factory pathways” have “particular

under the rubric “septal region” is that they functional qualities.” Since the septal region

refers

tissue

committable,

animals,

i.e., dangerous

to himselfor

to others.

2. Not using the AMA designation for patients who drop out and leave without telling the staff and who cannot be traced or returned to the facility after repeated attempts. 3.

Using

have

been

not

making

the

term

only

informed

plications

of the

patient

and

cons

that

they

and/or

prevent

practicing

know

the

(i.e.,

the possible

com-

only when, in addition to considerations or countersigns the order. One hopes that

a nonphysician

without

question

of AMA

ership in this area by defining ignation before nonclinicians

or terms

nate,

the

to deal

situation

to define

with

in which

mary if not sole therapists, charge decisions are made

in man

the

midline with

changed

to include

gyrus

rectus, which

are

it, the art

more ventrally, the (or septal) nucleus

the boundaries do this for

the outpatient therapeutic

heterogeneous

ofthe We

club,

es-

reentry its

lead-

AMA desalso need a

clinicians

their non

for

to termiare

communities

the

pri-

where

dis-

etc.

in voluntary

mental

D, Haven,

hospi-

M.D. Conn.

how many helped by

in the time they spent working on this material. invasion of bureaucracy into medical practice destroy the physician-patient relationship and, of medicine.

I. HARRIS, Cambridge.

M.D. Mass.

of Anatomy

132:3,

March

1975

aspect

ofthe

In a

large

(2) and, include

the

rostral

sites

of the

of

head

of

Dr.

sheet

may very and

of tissue

and

separating

not contain

small and the diagonal

Heath

this

the

is lacking in man. is used to denote

or may

the possibility

demarcating

are the fiber

the

septum).

is a thin

which

preclude

rigidly

poorly band

associates

nerve defined (4). The

include

of an anatomical

in

crite-

area.

connections

between

the septal

region

and

other parts of the brain? Figure 1 in Dr. Heath and associates’ article diagrams them on a human brain. I know of no studies demonstrating such anatomical connections in man. Possibly,

the arrows experiments

on this diagram to the human

represent an extrapolation of animal case. However, there is no published

anatomical evidence of connection between the septal region and ventral lateral thalamus, between the fastigial nucleus of the cerebellum and the hippocampus, or between the interpeduncular nucleus and the septal region by way of the medial neetion

bundle.

The

only

is in a publication

evidence that

ever, the photographs authors were capable

Dr.

of Heath

a

fastigio-septal

con-

coauthored

(5).

in that article do not convince of distinguishing experimental

How-

me that the (degener-

ating) their

axons from normal axons not sufficiently suppressed by staining technique. Finally, figure 1 in their article in the Journal shows the amygdala existing in isolation. This structure thalamus

prepare this material. One wonders have been treated or administratively

which

and

structures

definitions

What

who wishes

nonphysician collectively,

us.

sensi-

special section “PSRO and Other Peer (December 1974 issue) gives one pause. specialists devoted the time and thought

Am J Psychiatry

part

cells and, parolfactory

SIR: One ofthe disturbing features of”Brain Activity During Emotional States” by Robert G. Heath, M.D., and associates (August 1974 issue) is its tenuous anatomical rationale. For example, the “previously defined” septal region the authors refer to occupies 2 pages in the 619-page book they cite as a reference (I ). In that book, the criterion for grouping (“rigidly

298

not

pellucidum,

HERBERT

A Question

also

ventricles

be reviewed.

not

accumbens, medial

the lateral

to

and

other

septal Brain

parts

of

region Activity

the

brain,

but

not

as Dr. Heath and During Emotional

to

rate

presentation

of the neuroanatomy

the

sensory

associates States”

I feel that responsible article from an anatomical point ofview. apparent that Dr. Heath and associates were not whether one of their central arguments incorporated “

with

nucleus ventral

the septum

and legal

does

Such an obvious and well-defined structure In its place, the broader term “septal region”

is connected

these specialists The increasing may eventually

the

medical

Bureaucracy?

to could

the

and

charged

must

ofanimals. denotes

subdivisions

nuclei,

are

is diffi-

I have listed that are part of Dr. Heath and associdefinition (in a later article [3J, Dr. Heath’s definition

being

New

necessary patients

septal

giving

discharges

that

nucleus”

identifiable

the

from

ANT0NI0J.

The impressive Mechanisms” highly trained

readily

of

region

structures

forebrain

SIR:

with

so unlike

it is

criteria

the septal

“septal

(i.e.,

1. Szasz TS: Involuntary hospitalization tals. N EngI J Med 287:277-278, 1972

Review Twenty

because term

exception

anatomical

In fact,

clinician

REFERENCE

An Unnecessary

function

term.

restricted

structure the

--not the

a license

The use of the AMA discharge may be a not-so-subtle pecially when it is coupled with barring the patient’s into the treatment process. The American Psychiatric Association can exercise

term

in defining

caudate,

medicine

entire

cult

ates’

family

situation

advice and signing discharge orders). In this day of rising consumer consciousness tivity,

the

of the

or consequences).

would

with

the

pros

the assumption

4. Using this term I -3, a physician signs this

when

to nervous

necessary

imply. is an ir-

It is sadly concerned an accu-

involved.

R F FE REN C F 5

1. Heath RG, and and Neurology: University Press, 2. Andy J. Stephan

Charles

C Thomas,

the Tulane University Department of Psychiatry Studies in Schizophrenia. Cambridge, Harvard 954 H: The Septum of the Cat. Springfield. Ill.

1964

3.

Paul SM, Heath RG, Ellison iT: direct pathway from the fastigial Neurol 40:798 805. 1973

4.

Crosby

EC. Humphrey

T, Laues

Histochemical demonstration nucleus to the septal region.

EW: Correlative

Anatomy

of a Exp

of the

Nervous System. New York. Macmillan Publishing Co. 1962 5. Harper JW, Heath RG: Anatomic connections of the fastigial cleus to the rostral forebrain in the cat. Exp Neurol 39:285 I973

BlAIR

H.

TURNER,

Pu.D.

Washington.

D.C.

nu-292,