'It is one thing', said John Locke (1632-1704), 'to show a man that he is in error and another to put him in possession of the truth'. I may have had the audacity to imply the first but it would be unthinkable for me to attempt the second. There are, however, several concluding observations I would like to make.
(1) A geographical transfer of patient care, a permissive scenario, a communication network such as would warm the heart of the most ardent cyberneticist, do not possess built-in panaceal properties. It would be regrettable if the inevitable social emphasis in the current preoccupation with community centred psychiatry were to overlay and conceal the volume of biological and psychodynamic work urgently awaiting attention. Psychiatry's progress would certainly be set back if social care were to be confused with medical management.
(2) There is a need for a theoretical frame of reference sufficiently versatile to unify seemingly divergent biological and psychodynamic views and with the flexibility needed to contain new ideas as they arise. Meyerian psychobiology, suitably amended by the removal of untenable hypotheses, would provide an admirable provisional framework.
(3) It is necessary to define in the clearest terms the extent to which behaviour is programmed or predetermined without conscious participation and how much results from reason and choice in a setting of clear consciousness.
(4) The priority order of requirements has assumed increasing importance with the current recession. Nunn (1981) recently pointed to the many hypotheses waiting to be tested and suggested that biological deficits should be the focus of priorities. There may be substance in his view that sociological work has received disproportionate emphasis. But why this ideological preference? There are workers in psychodynamics and other disciplines who believe that their bids for the limited resources are equally deserving. In any event research depends upon a competent worker, a sound experimental design, a problem to be solved and the availability of funds at the material time. Priorities, however, raise a point of principle which concerns how limited resources are apportioned between long and short-term research. Continuing fundamental research is vital for the progress of science, and it would be wrong to deny it the high priority it merits in favour of short-term projects, notwithstanding their possible immediate practical and political advantages.
(5) In this restless century of constant change and questioning, traditional values and longaccepted scientific theories must stand or fall on their merits. Biologists are rethinking the processes concerned with the emergence of life. They have certainly not become creationists but they are disenchanted with traditional Darwinism. Fossil records suggest that evolution proceeds by short jumps and long pauses; in the course of the former new forms appear. All this is at variance with the slow, steady, minor changes proposed by Darwin. Cladists, too, who classify organisms in accordance with a rigorous discipline, have joined issue with the Darwinian concepts.
Psychiatrists work in a limited field amidst much speculation. Like biologists, they should rethink long-accepted theories and test fresh hypotheses. There may be laws which determine the design and form of organisms. Newton enunciated a law which dealt with all forms of motion of an inanimate object in a gravitational field and by so doing exploded the view that a falling stone had directing agencies inside it. The possible influence of a biological field on the psychobiological synthesis reflected in human behaviour is exciting to contemplate; an invisible source of energy with a powerful effect on form and activity.
'I do not know', said Isaac Newton (1642-1727), 'what I may appear to the world, but to myself I seem to have been only a boy playing on the seashore and diverting myself and now and then finding a smoother pebble or a prettier shell than ordinary while the great ocean of truth lies undiscovered before me'. Undoubtedly, there are still exciting opportunities for sound clifical psychiatrists with minds free from prejudice and misconception and with the capacity to find pebbles and shells of unusual character; or to change the metaphor, with a disinclination to keep digging the same holes deeper and deeper rather than digging fresh holes in virgin soil. They are more likely to bring forth some hitherto unrecognized fact and grasp its significance for the advancement of psychiatry and the more complete comprehension of human behaviour.
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