Since the original article by Elkes and Elkes (1954) numerous reports have been published in the world literature on the use of chlorpromazine in chronic psychotic in-patients. The majority of these studies indicate that the drug is indeed effective in improving the behaviour of these patients; a small minority of authors is more sceptical including Mitchell (1956) using doses up to 300 mg. daily, Sarwer-Foner and Ogle (1956) with doses of 150–400 mg. daily, and Trelles and Saavedra (1954) using sleep treatment. The literature contains numerous reports of controlled and uncontrolled studies on chlorpromazine and comparisons of its effects with those of a placebo, Reserpine, Azacyclonal, etc.; attention is now turning to the effects of such drugs in various combinations.

The Day Hospital approach in adult psychiatry appears to have begun with the original conception of Cameron in Montreal. He stated (Cameron, 1958) that both the original concept and its further development sprang from growing appreciation of the possibilities of new methods of treatment and diagnosis: at this time the rapid rise of the cost of in-patient treatment took place and there was increasing realization of the importance of the treatment milieu. At the same time as Cameron was setting up his Day Hospital in Montreal, Bierer was setting up the Marlborough Day Hospital in London (Bierer, 1951) and he discussed the theory and practice of Psychiatric Day Hospitals later (Bierer, 1959). Harris (1957) also discussed the implications of Day Hospitals and Night Hospitals in psychiatry with regard to the adult patient.

It is well known that psychiatric diagnostic groupings have no claim to represent any fundamental scientific causal principle, but reflect rather the needs of administrative convenience and compromise between different theoretical orientations (Eysenck, 1960). Doubt has in fact been expressed regarding the advisability of retaining categorical divisions in a field where quantitative differences along orthogonal dimensions may be more appropriate than qualitative differences between distinct disease groups (Eysenck, 1947). The appropriate statistical method for dimensional analysis is, of course, multiple factor analysis (Eysenck, 1952) and it is possible to show relationships between factors or dimensions and psychiatric categories by giving factor scores to the subjects of the experiment and to average these scores for groups of subjects sharing a common diagnostic label (Eysenck, 1959). In this way it has been demonstrated that along the dimension of extraversion/introversion, subjects diagnosed as psychopaths tend to have particularly high extraversion scores; hysterics tend to be extraverted but not as highly as psychopaths. Patients suffering from one of the dysthymic conditions (anxiety, reactive depression, obsessional disorders), tend to have high scores on introversion. Mixed neurotics tend to be in between the other groups. All these diagnostic groups have high scores on the factor of neuroticism which is orthogonal to extraversion/introversion (Eysenck, 1957).

Much has been written about the possible somatic modifications that cardiazol, triazol and other convulsive agents bring about, and many investigations directed towards the elucidation of physical changes have been attempted. Such work in the materialist tradition of medicine is, no doubt, valuable. It would be unfortunate if it were to obscure other considerations.

The future of the psychiatric services, in particular of the mental hospital, has been the source of much speculation since the publication of the Hospital Plan for England and Wales (1962). According to the Plan there would, by 1975, be psychiatric accommodation in each Region at the level of 1·;8 beds per 1,000 population, as estimated by Tooth and Brooke (1961).

An educational history, corroborated by records where available, was obtained on 54 of the 58 adult offspring of 17 bipolar manic-depressives. The offspring were also interviewed and psychiatric status was ascertained.

Primary and other affective disorder in the offspring was not associated with a lower IQ or lower ultimate educational attainment than that of the remaining offspring. There was a trend towards increased educational failure in the offspring with primary affective disorder, but they were as likely as other offspring who had failed to have resumed their education at a later date. Ill offspring with any form of school failure had a significantly earlier onset to their psychiatric illness, although school failure could not be shown to be a part of an early symptom complex.

Jaspers' (1963) concept of delusions proper is founded on the fact that patients suffering from schizophrenic and paranoiac psychoses experience these mental events as ego alien and completely unlike previous modes of thinking, feeling and perceiving. This disruption in the continuity and quality of mental life has been taken to indicate that, in contrast to delusion-like ideas, delusions proper do not have psychological antecedents. Such a view has never been acceptable to psychiatrists who favour a developmental approach to mental pathology. According to Minkowski (1927), Katan (1954) and Ey (1969), whose writings are based on Jackson (1894), Freud (1911) and Ribot (1920), it is possible to understand and resolve this disturbance in the continuity of the content of the mental life of those who succumb to schizophrenic and paranoiac psychoses.

A descriptive study of suicides in 74 Chinese schizophrenic out-patients (43 male) is presented. The mean age at death was 31.3 years. The mean duration of illness was 8.5 years and 50 of the 74 died within ten years of onset of illness. Only five lived alone; 35 were openly employed and 20 were married at the time of death. Twenty had a history of depression, and 27 had attempted suicide previously. More females had been depressed or had attempted suicide than males. Over half were last admitted for reasons other than schizophrenic symptoms alone and ten died within one month of discharge. Eight of 71 patients followed up expressed suicidal ideas at the last psychiatric contact, but only 15 were symptomatic. Jumping was the commonest method used. Analytical studies are needed to identify risk factors in Chinese schizophrenics.

The authors assessed the relevance of clinical symptoms to genetic research in schizophrenia in the nuclear families of 65 chronic schizophrenic probands. The morbidity risk for schizophrenia and schizotypal personality (a ‘spectrum’ disorder) was markedly reduced in first-degree relatives of probands with predominant negative symptoms, as compared with relatives of probands with other symptom patterns. The data support the notion that negative-symptom schizophrenia has an attenuated genetic component.

The Quality Extinction Test was used to detect lateralised abnormalities of hemispheric functions in schizophrenic patients. Course of illness significantly affected the distribution of tactile extinctions, chronic patients showing more left-side extinctions than sub-chronic ones. Age significantly affected the number of left extinctions, and sex the number of right extinctions. The importance of clinical and epidemiological characteristics of the patients in determining the quality and degree of hemispheric dysfunction in schizophrenia was confirmed.

The main task of vocational rehabilitation facilities is to help people to return to work or, if they have never worked, to find a job for the first time. In the past seven years controversy has surfaced with regard to the role vocational rehabilitation plays in the economy. Some authors have claimed that it implicitly supports an ideology of individualism which actually acts against the interests of people with mental health problems looking for work. While accepting the need to offer a work adjustment service, these writers make a case for further socio-political intervention to help clients. The purpose of this article is to explore some of these ideas and examine their practical implications.

The incidence of tattooing is known to be high in certain selected groups.

Four circumstances—in addition to my own limitations as a historian—have determined my choice of subject for this evening. Last November this Institute celebrated its Jubilee—that is, the 50th anniversary of the recognition of the Maudsley Hospital as a School of the University of London. In the following month the one-time Medico-Psychological Association, which owed its very name to a suggestion by Henry Maudsley, and has now developed into the Royal College of Psychiatrists, moved into its new headquarters in Belgrave Square. Since then we have had to mourn the death of Sir Aubrey Lewis, one of whose outstanding contributions to the Association, and to psychiatric history, was his Maudsley Lecture of 1951, devoted to the work and influence of Henry Maudsley.† Moreover, the early ‘70s are the centenary years of Maudsley's period of office as the senior editor of the Journal of Mental Science, now the British Journal of Psychiatry, with which I myself have long been associated. So it seemed that it might be appropriate for me to tell you something about the history of the Association, about Maudsley's relations with it, and about the various ideas, proposals and actions which eventually led to the foundation of this Hospital and Institute. In doing this I hope to furnish a few footnotes, as it were, to Sir Aubrey's Maudsley and Mapother Lectures, and these will be my personal tribute to one whom so many of us have held in affectionate admiration.

Out-patient drug trials have relied largely on observer-rated improvement measures to evaluate the efficacy of psychotropic medication (4). Less frequent use (5, 7, 9) has been made of patient ratings or the combination of observer plus patient ratings. Thus a comparison of improvement ratings made by the patient and his treating doctor would be of considerable methodological interest.

Psychotherapy is the art of relieving psychiatric problems by psychological means. Which problems are psychiatric and which means of treatment are psychological could be debated at length. The boundaries of psychotherapy impinge on many areas—faith-healing, religious counselling, the many caring professions, psycho-pharmacology and neurophysiology. Numerous ideas and methods are subsumed under the term psychotherapy. Some psychotherapists confine their view of psychotherapy to a limited theory and technique, while others are more comprehensive in their practice and encompass a variety of viewpoints. In the past many different schools of thought proliferated, each claiming the superiority of its own methods and its theory, while being neglectful of other techniques and ideas. New ideas would often be treated as heresy, while pragmatism would be regarded with suspicion.

When the Plymouth Nuffield Clinic was planned it was decided to evaluate its functioning in respect of the adult psychiatric services in Plymouth. This paper reports the findings. The Nuffield Clinic project was a joint venture between the hospital service and the local authority, so that they might collaboratively discharge their respective tasks in both the spirit and the letter of the 1959 Mental Health Act. Pilkington (1966) has described the ideas and the stages leading to the creation of the clinic.