In 2005 King's College London and the Oral History Society are hosting a conference on the oral history of the Second World War (http://www.oralhistory.org.uk). The conference will bring together research that starts with the verbal testimonies of both combatants and civilians involved in the conflict. But note that I write ‘starts with’ those oral testimonies. I doubt that any of the presenters will argue that these testimonies are the only source of information we have on what happened during the war. All will agree on the importance of listening carefully to the stories told, but also of interpreting, analysing and supplementing them with information from other sources. Many of the papers to be presented also look at how narratives have changed over time. Testimonies of the war from the former East Germany, for example, have changed dramatically since the fall of the Berlin Wall, a process that has happened in all of the countries of the former Soviet bloc, albeit in different ways. War stories change according to who is doing the telling, who is doing the listening, and why the story is being told now.

The assessment of body build as an integral part of the total personality is now accepted as an important procedure in the practice of clinical psychiatry. Body build has been found to influence symptomatology, mental status, course and prognosis in neurotic and psychotic disorders (Betz, 1942; Mauz, 1930; Kisselew, 1931; Freudenberg, 1941; Rees, 1945, 1947). Whereas the delineation of physical types has now become an objective procedure by the use of anthropometric indices (Rees, 1949), it has long been recognized that the differentiation of physical types in women is much more difficult. Kretschmer (1921) pointed out that the types of physique described by him were less easily diagnosed in women, and Sheldon (1940) pays comparatively little attention to the variations of female body build.

The World Health Organization has developed training material to support its QualityRights Initiative. These documents offer excellent strategies to limit coercion. However, the negative portrayal of psychiatry, the absolute prohibition on involuntary treatment and the apparent acceptance of the criminalisation of individuals with mental illness are causes for concern.

The present paper is based on the study of the drinking habits of British seamen interviewed during a recent journey.

At the beginning of the war part of the Maudsley Hospital moved to Mill Hill School, and a neurosis centre of 550 beds was established. During the six years of war some 20,000 neurotic patients, both forces and civilian, were treated at this centre. Within the centre a special unit for the study of Forces patients with effort syndrome (E.S.) was set up. This unit was in existence from 1939 to 1945, and during this period 2,324 cases of E.S. were treated. The writer was associated with this unit throughout, working in association with a cardiologist (Paul Wood (1)), and with other psychiatrists (Lewis (2), Guttmann (3), Gillespie (4)). Much of the material brought together in this thesis has already been published (Jones (3, 5, 6, 7, 8, 9, 10, 11, 12, 38, 43)). During most of the war years the writer was in receipt of a Medical Research Council grant.

At the International Symposium on Niamid (nialamide)—1-/21—(benzylcarbamyl) ethyl/2-iso-nicotinoyl hydrazine—a mono-amine oxidase inhibitor, held in Lisbon in November, 1959, T. S. Davies reported that a 35-year-old mongol of imbecile grade, who had previously been inert and who had never spoken, gradually began to speak in monosyllables and, after two months on the drug, was able to converse in short sentences, showed increased physical activity and was able to undertake simple domestic tasks. It is not clear exactly what dosage of Niamid this patient received, but it was within the range of 30 mgm to 75 mgm daily. This report received wide publicity, out of its context, in the lay press, with its inevitable tendency to give the impression that a treatment of mongolism had been discovered, an impression which it is perhaps unnecessary to say Davies had certainly not intended to give.

In 1906 Alzheimer reported the case of a woman, æt. 51, who, in addition to the expression of ideas of suspicion and jealousy, failed mentally to such an extent that she was unable to find her way about her own home. During her hospital residence she was perplexed, disoriented for time and place, and had difficulty in understanding and in expressing her thoughts. There were delirious phases, during which she was hallucinated. Her power of retention was greatly impaired. She showed paraphasia and perseveration. The illness persisted for a period of four and a half years, and at the time of her death she suffered from contractures. The post-mortem examination showed a striking alteration of the neurofibrils: “In an otherwise normal cell there appear at first one or more fibrils, which on account of increased thickness and increased stainability stand out prominently. In the further course of the alteration many neighbouring fibrils are similarly affected. These then form thick bundles, which gradually come to the surface of the cell. Finally the nucleus and cell disintegrate, and only a tangled bundle of fibrils remains to indicate the site of a former ganglion cell.” In addition, throughout the entire cortex, especially in the outer layers, there were many miliary foci or plaques.

Depressive illness is a major medical problem among psychiatric out-patients (Davies, 1964). Most of the recent investigations of depression have been related to the use of antidepressive drugs and electroplexy, but a deeper understanding of the condition quite apart from the efficacy of treatment is necessary (Lewis, 1964). The importance of cultural factors in mental illness is well recognized (Myers and Roberts, 1959), but their study has been neglected in Britain in spite of the variety of ethnic groups in many British cities, especially London. Many of the cultural groups in London consist of recent immigrants in whom the factors connected with immigration are difficult to separate from cultural influences. However, Anglo-Jews form a long established though distinct group which has been fully accepted in Britain for over a hundred years (Roth, 1964). They are predominantly British-born and English-speaking and number about 450,000, more than half of these living in London (Brotman, 1964). One of the older areas of settlement is the East End of London, but with economic advancement there has been a drift away from there to better class areas (Krausz, 1964). It was felt that a cross-cultural study in the East End of London comparing Jewish and non-Jewish patients suffering from depression might provide some insight into intercultural differences as well as the dynamics of depressive illness.

The introduction of the new psychopharmacological agent haloperidol (R 1625, “Serenase”R) to psychiatric therapy provides an interesting supplement to the chemotherapeutic outfit available for the treatment of psychoses. It seems to be the first compound possessing neuroleptic powers of at least the same degree as the drugs used so far, in spite of a chemical structure quite different from reserpine and the drugs of the phenothiazine group.

A feature of the recent history of medicine has been the introduction of treatments whose costs are orders of magnitude higher than doctors are used to justifying. Having previously been left almost untouched by these developments, psychiatrists are beginning to find themselves in the position previously occupied by renal physicians, transplant surgeons, and oncologists – having to face uncomfortable decisions about costs versus benefits and the rationing of medical care. To a considerable extent this is a consequence of the launch of the new, ‘atypical’, and ‘superior’ neuroleptic, clozapine.

In his review of psychotherapeutic practice today, Marks (1971) has pointed out that there is a decreasing tendency to make dogmatic assertions of universal applicability of one or other form of psychotherapy to all neurotic states. There is an increasing readiness among psychotherapists of different schools to recognize that genuine therapeutic potential may be found in a variety of techniques with widely differing underlying assumptions about the nature of neurosis. It seems increasingly probable that psychotherapists of the future will need to be conversant with many techniques and the clinical indications for each, for it is becoming unrealistic to expect all neurotic problems to be solved by one technique alone.

Abnormal sexual behaviour in pre-pubescent children is uncommon even in a psychiatrically referred population. Among 516 referrals there were 6 boys and 10 girls, the girls starting younger. The boys differed little in history or background from other conduct-disordered boys, but the girls were more commonly victims of sexual abuse and lacking a father in the home. The personalities of the girls suggested continued risk of sexual experimentation and possible development of personality disorder.

A case of Capgras syndrome associated with extreme violent behaviour is described. The patient's psychodynamics support the belief that the Capgras delusion initially arises from an altered affective response towards one or more others and proceeds to intolerable ambivalent feelings. This ambivalence is neutralised through the imagined existence of doubles.

Sixteen consecutive patients with anorexia nervosa were studied and compared with a control group of other patients coming to an adolescent service, matched for sex and admission status. The anorexic group were not significantly different from the controls in social class and I.Q., and had a male-to-female ratio of one to four. However, they were significantly more likely to have perfectionistic personality traits and to profess to be happy with their families; these families had few external stresses, were very close, and had a high degree of exclusivity.

Complete recovery of phantom limb pain of five years' duration occurred in a 71-year-old man following treatment with fluoxetine. There was no coexisting affective disorder. Further research is indicated in view of the postulated role of lowered central 5-hydroxy-tryptamine activity in the genesis and maintenance of chronic pain.

British Journal of Psychiatry (1993), 163, 105–106

Therapeutic community principles have in recent years become increasingly and often enthusiastically applied. They have also attracted an extensive literature, including, among many, studies by Maxwell Jones (1952 and 1962), Cumming and Cumming (1962), and the contributions to two symposia: in Boston, edited by Greenblatt, Levinson, and Williams (1957) and in this country by Freeman (1965).

Red blood cells (RBCs) from normal volunteers were incubated in vitro at four different extracellular lithium concentrations. Extracellular lithium concentration affected RBC lithium accumulation in several ways. As extracellular lithium concentration increased, the inter-individual variability of RBC lithium accumulation increased. Furthermore, the ratio of RBC lithium concentration to extracellular lithium concentration (lithium ratio) increased in relation to increasing extracellular lithium concentration. A lack of agreement among the authors of recent reports dealing with the significance of the lithium ratio as a psychobiological measure has been noted. It is suggested that this lack of agreement may be due, in part, to the study of patients with differing levels of extracellular lithium.

It is generally accepted that any appreciable lack of intelligence precludes the possibility of successful psychological treatment along verbal lines. It is also widely believed that individuals with a lifelong character disorder, commonly described as “psychopathic”, whatever their degree of intelligence, are relatively inaccessible or unresponsive to group or individual psychotherapy. It follows that in individuals where intellectual defect is coupled with psychopathic character, the difficulties of psychotherapy are multiplied. A review of the literature supports this general impression.