Once upon a time the depressed were idle, the psychotic were possessed, and those suffering with any form of mental illness were punished, exorcised, ridiculed, confined, excluded or criminalised.

Thankfully, as a result of investment in research, there have been significant advances in the understanding of the brain and the biological underpinnings of mental disorders, emotions and behaviours, including aggression. To advocate the omission of the scientific study of aggression from that of the rest of the brain would be anomalous, to say the least.

Aggression can indeed lead to ‘bad behaviour’, as indicated by Dr Mushtaq, but to conclude that they are synonymous is inaccurate and is missing the point. Many individuals are extremely distressed by the impact of their own propensity to extreme anger or aggression. Many seek help, but often little is available. Without research into the efficacy and safety of potential interventions, be they medical, psychological or social, there would be no evidence to guide practice. Effective help is needed, not ostracism.

Dr Mushtaq makes a thoughtful point about medicalising conditions that do not fall within accepted norms. This is indeed a problem of the traditional medical model, in which there is a demand to dichotomise continuous symptoms or physio-biochemical measures (such as those of anxiety, mood, blood pressure, or haemoglobin concentration) into ‘health’ or ‘disease’. Such a blunt approach is often arbitrary, and unsatisfactory, but the medical community seems to demand it. After all, how can you treat something unless it is an illness? Without clear boundaries between health and disease, fears of chaos and uncertainty abound, as Dr Mushtaq describes. Deciding on a threshold and giving it a label certainly has its place, but from an individual's perspective, it is the serious impact those symptoms have on their lives that is of most concern, and a desire to obtain relief. Health and illness of the human brain are more complex than dichotomies, and research is required to elucidate this subtlety and to identify and improve treatments. Without research, psychiatry would still be in the dark ages.