In another paper in collaboration with Reiss and Taylor (1944) I have described and classified the state of testis function in schizophrenia, mental defect, and the common mental illnesses from an examination of specimens obtained by biopsy from 115 representative subjects, selected for adequate physical health and development. It was found convenient to classify all material in five grades according to the histological appearances. These have been fully described in our paper. In brief they indicate (1) complete normality, (2) normality with slight defects, (3) moderate atrophy, (4, 5) severe and very severe atrophy amounting in the worst cases to total loss of normal function. While we have regarded a Grade 3 specimen as significant in young subjects, it is probably not necessarily outside the normal expectation from the fourth decade upwards. Grades 4, 5 are, of course, indicative of a severe atrophying process at any age. In analysing the defects we noted and described degeneration of the seminiferous elements with changes in the tubular capsule. The basement membrane was affected first and principally, and underwent a form of hyaline degeneration. This, we felt, was the underlying cause of the atrophy of the seminiferous epithelium, and eventually led in many instances to complete destruction of lengths of the affected tubules. The interstitium was not subject to important change.

A 13–year-old boy developed severe kleptomania after a depressive illness. This was a response to psychological trauma, and appeared in the context of a probable ‘lethargic’ encephalitic process.

My first duty is to thank you for having elected me President of this Section. I am conscious that this is one of the greatest honours which can come to a psychiatrist and I shall do my very best, within my limitations, to prove worthy of it. It is customary for the presidential address to deal with a topical problem of common concern, and one on which the President can speak with authority based on personal experience. I have chosen to talk about the teaching of psychiatry. I have called my address “Reflections” in order to make it clear that I cannot offer you more than some personal observations on a subject on which I feel deeply.

Much confusion has resulted in recent years from the use of the word “community” to mean merely “outside hospital”. Community psychiatry is not just extramural work or a means of avoiding hospitalization. A community mental health service is a comprehensive psychiatric service of care and treatment for a defined population, including full hospital facilities (Freeman, 1963). The hospital is in fact part of the community, and provides one of its services. The size of population base that can most efficiently support a comprehensive service is probably between 150,000 and 200,000 in urban areas, judging by experience in Lancashire (Smith, 1965). This is large enough to contain all the basic services that are needed, and small enough to allow all key professional workers to remain in constant face-to-face contact. Within its defined area, the service must have continuous and final responsibility, whatever the clinical state of individual patients. It must offer a continuous spectrum of integrated services, from full-time, permanent care in an institution on the one hand, to occasional support for a patient or family at home on the other. Since the demand for services is potentially infinite, an essentially ideological choice must be made in assessing priorities for the resources that exist. I believe that if we try to act primarily on the basis of human needs within the total community, the first call on these resources must be for the three great problems of schizophrenia, subnormality and old age. Concentration on psychotherapy would make it more likely that these greater social needs remained unmet, and it may well be that any large-scale treatment of neurosis or personality problems would have to be outside psychiatric—or even medical—channels (Ryle, 1967).

Biological rhythms exist in a rich variety and almost bewildering profusion to attend and equilibrate the physiology of man. Such dynamic phasic activity appears not only to be intimately concerned with the phenomenology of life and biological processes in general, but is also to be found in purely chemical systems (Hedges and Meyers, 1926). Modalities of the periodicities associated with life can be divided into those external to the organism—including diurnal and climatic variation, sun-spot activity, etc., and into those inherent within the individual such as the respiratory and cardiac rhythms, the menstrual cycle, sleep and awakening. Only less well marked are certain psychological periodicities such as “cyclothymic “variations in mood and personality. In the course of the present century much painstaking research has attempted to link external with internal rhythmic activities, significant correlations being adduced between seasonal variation and, for example, the incidence of psychiatric disorder (Huntington, 1915), immunity from disease (Spencer and Melroy, 1943, Webster, 1944), temperament and behaviour (Petersen, 1934-36; Mills, 1942), and an impressive array of biochemical and physiological variables ranging from blood pH, lactic acid and protein to breath-holding time, plethysmography, tests of hand strength and fatigability, dark adaptation time and various tests of urinary function (Petersen, 1947).

All scientific communities must keep themselves intellectually alive. It is important that we should attempt sometimes to tackle intriguing questions that are, strictly speaking, beyond the reach of robust, achievable, scientific methodologies. The small, flawed and inconclusive literature on the relationship between creativity and mental disorder, which includes contributions from some scientific heavyweights (e.g. Andreason, 1987; Post, 1994) represents a respectable attempt to use empirical methods to explore one such intriguing question. The fact that these matters are unlikely ever to be resolved does not discredit the effort.

Recent advances in attachment-informed relational neuroscience point to possible mechanisms of action of psychological therapies, with implications for effective practice.