Sexual drive of patients in psychiatric hospitals.

We are all indebted to Dr Elizabeth M Bryan for her contributions to our knowledge of the social and psychological effects of twinning and to Dr Manny Lewis for his studies of the need for mourning in relation to stillbirth -their latest joint paper (19 November, p 1327) being no exception. I wonder, however, whether they have sufficiently emphasised the conflict in a mother between mourning for the dead baby and taking pleasure in the rearing of a live one in the case of the death of one of a pair of twins. Either she postpones her mourning, repressing the feelings that go with it, or she indulges her grief at the expense of the survivor, depression being incompatible with the lively communication, based on primary maternal preoccupation, that Murray has shown to be so important for a baby's emotional and intellectual development.' Many of your readers will have personal or professional experience of the problem that this presents to families; and it is difficult to know how to cope with what on the face of it is an insoluble dilemma. Perhaps the best answer would be for the mother to be helped to get over her mourning before taking up the care of the second baby, bonding in our species being almost certainly a postponable if necessary process but susceptible to permanent wrecking. JOHN A DAVIS