The stigma associated with mental health problems leaves many feeling they have to ‘hide’ their difficulties. Supporting them in making disclosure decisions can potentially improve well-being, reduce self-stigma and support recovery processes. In this editorial we discuss the case for interventions designed for this purpose and present one prominent programme: Honest, Open, Proud.

In the world of mental diseases schizophrenia may well be termed “the sickness that destroyeth in the noonday.” Although the replacement of Kraepelin's nomenclature of “dementia praecox” by Bleuler's term, “schizophrenia,” has carried with it a general recognition that the chance of recovery is better than had been originally anticipated, the doom of those who do not recover is amongst the most dreadful meted out by any disease. It so frequently means a body apparently fully alive with a mind permanently impaired or virtually dead. Despite the obvious desirability of assessing the prognostic chances of the individual case, the statistical works published up to date have failed to establish agreement as to how this may be done. The object of this paper is to combine a detailed examination of the literature with a personal study of the histories of over 100 cases of schizophrenia in an effort to reach a definite conclusion in this matter. The paper will be divided into the following parts: I, a detailed survey of the literature; II, the outcome of 120 cases studied by myself; III, a comparison of remission rates and prognostic factors in cases treated by cardiazol.

The Geriatric Mental State Examination (GMS), a standardised psychiatric interview, and its computerised diagnostic system, AGECAT, have been applied to a large (1070) sample of subjects aged over 65 in Liverpool. In a split-half study of this sample, diagnostic scales within the GMS and a diagnostic index derived from them were tested for efficacy in cases of organic and early organic illness (mostly various stages of dementia) and depressive illness. Results demonstrated high levels of sensitivity and specificity, and positive predictive values were within the expected range when applied to these disorders, given their low prevalence in the community. The GMS, when used in this way, is a flexible and effective case-finding instrument.

Repetitive transcranial magnetic stimulation (rTMS) has been investigated as treatment for major depressive episodes since the early 1990s. Using data from a recent meta-analysis, we show that most patients included in randomised trials display relatively high degrees of treatment resistance. This might have unfavourably biased the clinical reputation of rTMS.

Schizophrenia is characterised by generalised cognitive impairment that is both a risk factor and a predictor of outcome. Recent research into human intelligence supports the view that, in schizophrenia, poor performance on disparate cognitive tasks can be explained by dysfunction of a frontoparietal neural network thought to support fluid intelligence.

Several research trends in contemporary psychiatry would benefit from greater emphasis on detailed assessment, modelling dynamic change, and micro-level analysis. This may assist with clarifying nosological and pathoaetiological issues. We make this case by referring to three areas: psychopathology and nosology; prediction research; and ‘big N’ data sets.

Most of the classical reviews of narcolepsy were written in the decade from 1925 (Kinnier Wilson, 1928; Redlich, 1931; Thiele and Bernhardt, 1933; Daniels, 1934, and others). The clinical picture was well established by these writers and does not need discussion. In addition to narcoleptic seizures, other symptoms are common, the most frequent being attacks of loss of tone and power, variously called cataplexy, “Lachschlag,” “Tonusverlust.” Night sleep is often disturbed by periods of wakefulness and bad dreams. During the phases of going to sleep or waking up, temporary paralysis of the muscles, without disturbance of consciousness, and hallucinatory episodes of all sense modalities sometimes occur. The generally accepted explanation of these various phenomena is that they represent a dissociation of the motor, sensory and central components of sleep. There are, however, three controversial points: firstly, the relationship of the patho-physiology of the seizures to epilepsy; secondly, the “somatic constitution “of the narcoleptic patient; and thirdly, the nosological status of narcolepsy.

Headache is a common problem (Rangell, 1953). Cohen (1939) concluded that relatively few cases were organically based and Shapiro (1955) in an American series found that only four out of a hundred cases presenting with headache could be explained on an organic basis, even though there are fifty odd causes of the symptom (Harris, 1936).

The importance of psychotherapy, as one of the commonest and most distinctive methods of treatment used by psychiatrists, is hardly disputed, although the definition, theoretical basis and effectiveness of its various forms are subject to much debate. In the present article we are concerned with psychotherapy only as a form of service available to N.H.S. patients. Our aims are: (1) to calculate the numbers of patients, living in an area with relatively good services, who are receiving two operationally-defined types of psychotherapy, (2) to estimate the numbers of local patients already attending out-patient clinics who might be referred to a specialized psychotherapy department if certain rules of selection were applied, and (3)to discuss the relevance, if any, of these data for planning local psychotherapy services. The limitations of the material will be obvious and the calculations crude, but they should be adequate to open the subject to realistic discussion.

In depression alteration in mood is accompanied by pronounced physical and behavioural changes. Characteristically there is a decline in appetite, weight and libido, insomnia and a disturbance of diurnal rhythm. A slowing of thought and movement to the point of severe retardation or even stupor may occur. Anxiety is often present and in agitated depression is accompanied by restless psychomotor activity. As lesions in the hypothalamus may produce disturbances in appetite, weight, libido and sleep, it has been suggested that hypothalamic dysfunction may play a part in the aetiology of those depressions in which physical symptoms predominate (Pollitt, 1965).

Increased spontaneous fluctuations in skin conductance (SC) in adult schizophrenics have been associated with high expressed emotion (EE) in their relatives. This is the first study in children where parental EE, parental psychopathology, and autonomic activity, indexed by SC levels and reactivity, have been assessed. The subjects were children and adolescents with disruptive behaviour disorders (DBD, n = 35), a psychiatric contrast group with obsessive–compulsive disorders (OCD, n = 42) and normal controls (NC, n = 45). Children living in homes with two high-EE parents had higher SC activity during rest period and slower adaptation to relaxation. Fathers' EE and maternal psychiatric diagnosis were related to higher SC activity, especially for the OCD group.

Few psychiatrists now take a lively interest in the social sciences, and few social scientists listen to what psychiatrists have to say. For the handful who do, the widening gap between the two fields of knowledge is regrettable, for we have much to learn from each other. The gap seems to have grown for two reasons: psychiatrists, increasingly occupied with pharmacotherapy, have drawn closer to general medicine, and there is comparatively little interest in the social therapies which seemed to offer so much promise back in the 1950s. The open-door system was a success, and so was the idea of community care, even if the practice left much to be desired. Incidentally, these developments destroyed many of the interesting experiments in group dynamics which were at one time a feature of mental hospital life. Social workers, once seen as allies, went off on their own in the new, powerful and largely incomprehensible Social Services Departments, where they had many other tasks to occupy them. Sociologists became shrill and hostile. Many psychiatrists ceased to read sociology after the publication of Goffman's Asylums (Goffman, 1961) because it seemed that sociology was off on some kind of egotrip which was deeply antithetical to their own professional experience. People who talked about “madness” instead of “mental illness”, rejected diagnosis as labelling, and regarded mental patients as victims of a capitalist plot were (and are) difficult to talk to. One of the distinguishing features of mental health reform over the past 200 years has been its apolitical nature—people of all political views could agree on what seemed essentially a matter of common humanity. Suddenly it became highly politicized, both in theoretical terms, since the new analysis was basically neo-Marxist, and in the action of pressure groups in the Civil Liberties lobby. Confused by the Right to Treatment, the Right to Refuse Treatment, the Right to Information and the Right to Confidentiality, most psychiatrists have (wisely in the circumstances) kept their heads down and got on with the job.

In the course of time the term “porencephaly” has come to mean a condition characterized by any large circumscribed defect in the substance of the brain. Because of the unmyelinated state of the centrum semiovale in early life traumatic, vascular, anoxic or infective processes are likely to lead to a much more massive resorption of the tissues than occurs in the adult. Parts of the wall of the hemisphere may be converted into a semi-translucent membrane separating the lateral ventricle from the sub-arachnoid space. This thin sheet of neuroglial tissue usually represents the residual stretched out molecular layer of the cortex, and is a finding common to many varieties of infantile and foetal encephalomalacia (Wolf and Cowan, 1956).