To summarise then, in 1962 RET displayed important features still current. These include the inter-relatedness of cognitive, emotive and behavioural processes, the important role that cognition plays in psychological problems, its humanistic view of the self, and the futility and dangers of self-rating. The emphasis on perpetuation rather than acquisition processes of emotional disturbance holds good now as it did then, and the core view of therapeutic change is essentially the same now as it was in 1962, despite further, more recent elaborations.

Significant change has occurred in RET since 1962 that updates several of Ellis' original ideas. These include the distinction between interpretations (or inferences) and evaluations, the primary of musts in accounting for psychological disturbance, the clear distinction between healthy and unhealthy negative emotions and the greater role according to force and energy in the change process. In addition, a greater emphasis is placed on biological aspects of emotional disturbance now than 30 years ago. Finally, a greater range of cognitive, imaginal, emotive and behavioural methods are found in current RET literature than in Reason and Emotion in Psychotherapy, where Ellis restricts himself to illustrating a few cognitive and behavioural techniques.

RET, then, has grown and developed over the past 30 years. In large part, this reflects the theory's flexibility and the competent people who have worked to make RET one of the most viable and widely used cognitive-behaviour therapies.

The clinical and cost-effectiveness of collaborative care for improving outcomes in people with mental and physical comorbidities is well established. However, translating these models into enduring change in routine care has proved difficult. In this editorial we outline how to shift the conversation on collaborative care from ‘what are we supposed to do?’ to ‘how we can do this’.

The diagnostic criteria of descriptive psychiatry inevitably vary between the generations and even from decade to decade. New hypotheses imply new selections from the quite illimitable mass of data which may be collected from any patient. Hence new pictures may emerge whose relation to the old may be only partial, and whose inclusion under traditional rubrics may give rise to confusion, or pose problems which are verbal rather than clinical.

Anxiety, either manifest or in the form of non-specific emotional disturbance, has been widely accepted as an operative factor in the personality structure of delinquent subjects (Aichhorn, 1; Burt, 5; Friedlander, 17; Stott, 53), and at present it appears that cognitive factors have little or no bearing upon the problem (Marcus, 43; Woodward, 61). By regarding anxiety or activated stress as a stimulus producing response (Hull, 24, 25; Miller, 45), delinquent behaviour has been postulated as learned responsiveness to anxiety or stress, which also functions as a learnable drive (Tong, 55). Previous investigations using Rorschach, persistence and galvanic skin response indices of anxiety or emotional disturbance have shown that there are significant variations according to both the nature of the conduct disorder (sex, violence, larceny, etc.), and ratings of stability (Tong, 54, 55). Different forms of conduct disorder are also known to carry different relapse potentialities, so that sex offenders, for example, are less likely to relapse than are larceny offenders (Mannheim and Wilkins, 42; Tong and Mackay, 60), although it is possible that different methods of treatment or disposal influence the likelihood of relapse for different sex offenders (Radzinowicz, 48). Prediction tables have been constructed for the purpose of more accurately assessing the most unstable offenders (42), and although such systems carry an encouraging degree of reliability it is apparent that greater reliability in prediction will only follow more accurate personality assessment than is possible by the use of impressionistic methods alone (58). Only knowledge of the relevant personality variables will lead to accurate assessment of change in subjects for whom the significant historical factors necessarily remain fixed. Furthermore, assessment techniques must be relatively unaffected by intelligence, education and rapport factors.

Recent interest in the problems of long-stay mental hospital populations has led to a number of studies which have been concerned with rehabilitation and particularly the re-activation of chronic, deteriorated patients by deliberate and systematic modification of their environment. In some of these studies, attention has been focused on the hospital ward itself, both as the background against which personal and social deterioration may be assessed, and as the means of re-building desirable patterns of behaviour (Cameron, Laing and McGhie, 1955; May, 1956). Another group of rehabilitation studies has been concerned with the value of specific work programmes. Industrial-type workshops in Dutch mental hospitals have been discussed by Carstairs et al. (1955), and the value of industrial and productive work in hospitals in this country, as well as some of its therapeutic effects, have been described in other publications (Baker, 1956; Stern, 1959; Collins, Fynn, Manners and Morgan, 1959). Considerable developments in the rationale and organization of sheltered as well as financially viable industrial workshops or factories for chronic mental patients have been made more recently (Wadsworth, Scott and Tonge, 1958; Early, 1960; Cooper and Early, 1961; Wadsworth et al., 1961).

There is evidence of unduly high frequencies of alcoholism, psychopathy and criminality among the relatives of alcoholics. Åmark (1951) found a frequency of alcoholism among the brothers and fathers of 645 Swedish alcoholics to be about 25 per cent. (Fremming's estimate of alcoholism among 1,730 males from the Danish population being 3·4 per cent.). In a more recent study of family data on 1,000 patients admitted to a Canadian mental hospital that included 56 patients with alcoholism, the present author (Gregory, 1959) found a recorded history of excessive drinking among 23·2 per cent. of the fathers of the alcoholics, among 1·8 per cent. of the mothers, and among 4·2 per cent. of their siblings. Allowing for the age and sex of these siblings, it would appear that there was a lifetime expectancy of excessive drinking of at least 14 per cent. among the brothers of these alcoholic patients. These figures compare with a minimal estimated lifetime expectancy of alcoholism amounting to 1·6 per cent. of the total population, or at least 2·7 per cent of the corresponding male population of Ontario.

Reaction to the death of a closely related person is characterized by a period of shocked disbelief, a period of acceptance and suffering, during which time the libidinal attachment to the internalized object is gradually withdrawn, and a prolonged period of readjustment. The first two phases usually last a number of months and correspond to the state of acute grief described by Lindemann (1944), Wretmark (1959) and Parkes (1965). The third phase involves the adjustment to a life without the lost person and in some individuals may persist for a number of years.

Kallmann (1953) studied the differences between uniovular twins discordant for schizophrenia and found there to be a definite superiority in physical strength and body weight in the unaffected twin. This paper is concerned with some aspects of the growth of psychotic boys, to determine if the inferiority noted by Kallmann is generally detectable.

A considerable amount of work has been done on the physiology of sleep (Wolstenholme and O'Connor, 1961; Oswald, 1962) and on psychological functions—reaction time, imagery, etc., in relation to sleep and sleep deprivation (Oswald, 1962). But there have been no systematic investigations of the relationship between sleep and personality differences. The purpose of the present study was to test predictions concerning such relationships generated by general theories and by clinical observation.

The case is presented of a twelve-year-old boy suffering simultaneously from Tourette Syndrome (TS) and a manic episode. The problems of this unique clinical association are discussed from the point of view of differential diagnosis, treatment, and possible biochemical basis. The case also illustrates the usefulness of the expanded concept of TS as a neuropsychiatric disorder with dys-regulation of perceptual, motor, and cognitive functioning.

Unusually frequent sinistral motor and sighting dominance have sometimes been reported in schizophrenics, although the majority of patients are still dextral. In this study, assessment of lateral dominance also included a measure of grip strength—a potentially more sensitive index of dominance or lateralised impairment; schizophrenics, non-schizophrenic patients (affective disorder), and normal controls were studied. There were no differences in handedness or sighting dominance. Affective patients, particularly bipolar psychotics, had greater right-handed grip superiority than normals or non-paranoid schizophrenics. Paranoid schizophrenics were similar, being significantly greater in right-sided dominance than non-paranoids, who tended toward a smaller value than normals. Hand grip asymmetry was highly correlated with handedness in normals, but not in patients. The possibility is discussed that these results may reflect asymmetrical patterns of cerebral impairment or attentional bias.

The career of the diagnosis of conversion hysteria is reviewed at a time when it is threatened with expulsion from classifications of psychiatric disorder. Criticism of its face validity has not led to adequate diagnostic alternatives, and has been insensitive to its unusual form as a category as well as the contribution it has made to the stability of the classificatory system around it.

Basal serum cortisol and dexamethasone suppression test (DST) results were studied in 21 pathological gamblers who varied on the Beck Depression Inventory and selected scales of the Minnesota Multiphasic Personality Inventory, which had previously been shown to be related to depression in gamblers. All subjects were suppressors on the DST. There was a significant relationship between fluctuation in 08.00 h and 16.00 h basal cortisol levels and the psychological measures, suggesting a subtype of pathological gambler with potential clinical significance.

Six cases of Gilles de la Tourette's syndrome are discussed in the light of conflicting views on the aetiology of the condition. It is hypothesized that the onset of coprolalia in patients with persistent childhood tics indicates a disturbance of the normal balance between a need for tension relief by swearing and a capacity to control such vocal activity. Some conclusions are drawn on the management of the syndrome by the use of butyrophenones, massed practice of tics, and the promotion of personality development. A flexible approach geared to the individual patient's particular needs is recommended.

Some conclusions are drawn on the management of the syndrome by the use of butyrophenones, massed practice of tics, and the promotion of personality development. A flexible approach geared to the individual patient's particular needs is recommended.