The advent of the various tranquillizing drugs during the past few years and their increasing use in mental hospitals have had the effect of drastically decreasing the number of lobotomies performed. At our hospital, e.g., the last lobotomy was performed in November, 1954; previous to that time 131 such operations had been done in seven years. To all intents and purposes lobotomy is a therapeutic procedure no longer used for psychiatric purposes. This may change, of course—it may be decided that for certain patients a lobotomy is still the treatment of choice. Or, it may be that in the years to come lobotomy will be of interest chiefly to medical historians.

A patient experienced an organic affective psychosis on three separate occasions after taking recommended doses of non-prescription cold/sinus preparations. The possible underlying pharmacological mechanisms of this clinical reaction lend support to the cholinergic-adrenergic balance hypothesis of affective disorders. Recognition of this acute drug-induced state can lead to appropriate short-term pharmacotherapy and can prevent misdiagnosis of a major affective disorder or schizophrenia.

Two papers have recently appeared in the Journal indicating a causal relationship between indoxyluria, alimentary toxæmia, and melancholia. One paper, published by Arthur A. D. Townsend in January, 1905 (Journal of Mental Science, 1905, p. 51), is entitled “Mental Depression and Melancholia, considered in regard to Auto-intoxication, with Special Reference to the Presence of Indoxyl in the Urine and its Clinical Significance”; the other paper, published by Lewis C. Bruce in July, 1906 (Journal of Mental Science, 1906, p. 501), bears the title “The Clinical Significance of Indoxyl in the Urine.”

Since there is little general agreement either on the nature of psychopathic personalities or on how to deal with the problems within organized society which their behaviour creates, we are justified in any attempt to present these problems in a new light and to examine the impact of recent work upon them. There is, moreover, an urgent need to clarify our own ideas on the subject in the hope that we can present them in practical form to those social agencies who so frequently meet with the psychopath as a perplexing hindrance to the smooth working of the State's affairs, whether in the schools, the courts, in industry, in the services or in any part of our national life in which planned co-operation is desirable. The psychopathic misfit for whom the increasing complexity of society has allowed no place, and for whom as yet science has found no certain remedy, often manifests his disability at least as much in a disorder of citizenship as in one of personal adjustment, and in no field of our work are we so constantly reminded that it is impossible to consider the patient in isolation from the milieu in which he must live. While the brain is a part, and the controlling, communicating part of the somatic mechanism, the concept of the mind of an individual is not so confined. In that the individual is a member of a group, part of his mental life belongs to that group and plays a part in forming its characteristics. In favourable circumstances this contribution is repaid by the guidance and support which membership of a group can provide. When an individual is so constituted that he is without the inward mechanisms necessary for the efficient working of this process of interchange, the result may be unhappiness for him or loss of harmony in the group. Thus, although it is to medical science that the appeal for an explanation or a remedy is most often made, the psychopathic personality is a responsibility which we must always share with the social sciences. Since the defect of personality is usually a constitutional one, the problems it creates are as likely to be solved by manipulation of the environment of the psychopath than by any effort to change his spots. This is not to say that the leopard in our kraal is not to be rendered more tame, or that he cannot be afforded the help of psychotherapeutic cosmetics, so long as the therapist in his preoccupation with the spots does not forget the savage heart that lies beneath them.

A case of mania subsequent to the addition of lithium in unsuccessful treatment by antidepressants is presented. It is suggested that lithium might potentiate some properties of antidepressants which affect their capacity to induce mania.

Hysterical stupor is rare, and indeed some authorities are sceptical of its existence. There are few references to it in English, either in standard text-books or papers. Oppenheim and Bleuler refer to it in passing, but with little clinical detail. Hoch's benign stupors, in spite of their name, are really psychotic reactions. He refers to invariable intellectual retardation and preoccupation with ideas of death being present, and actually a follow-up has shown that most of these cases were really schizophrenic. Millais Culpin, Hubert, and others writing of war neuroses describe hysterical stupors, but they have been the result of terrifying experiences at the front. The case described below showed features which would appear to justify a diagnosis of hysterical stupor, occurring in an individual subject to little external strain. This, in conjunction with a failure to improve over some weeks, but with rapid recovery after cardiazol treatment would seem to warrant reporting it.

The co-occurrence of physical and mental ill health means there is considerable overlap between the patients that geriatric medicine and old age psychiatry serve. In this editorial we detail similarities between the specialisms, highlight the common challenges facing them and argue that closer alignment holds the potential to improve patient care.

The diagnostic process in a case of dementia associated with physical and emotional dependence is described. The utility of sodium amylobarbitone abreaction is considered. The role of both psychodynamic and organic factors are emphasised in the aetiological work-up. The organic factors discussed include alcohol, sedative tranquillisers, solvents, and metals. The term ‘pseudodementia’ is not favoured, and the phrase ‘dementia syndrome of dependency’ is proposed.

Accounts of the parallel psychiatric treatment of identical twins are relatively rare. This case is especially unusual in two respects, first in the uncommon nature of the particular problem which they presented as their major symptom (i.e. homosexual attraction to elderly men), and secondly because they were treated together as a family group.

The object of my study was an attempt to discover what social factors might be said to contribute to either mental health or mental ill-health in old age. I studied the histories of four groups of 50 aged in four different settings which in retrospect might be said to form a spectrum. That is to say that each subsequent social background seemed to be more conducive to normal ageing than the preceding one. The actual sequence of the whole investigation, for technical reasons, was, however, as follows: In the first place I made contact with patients in Tooting Bec Mental Hospital; as a second group I chose people in a Club for Old Age Pensioners in Streatham; thirdly, I visited old people living by themselves in Fulham; and finally, 1 interviewed a group who are living on an Estate at Mill Hill, the Estate being maintained by the Society of Linen and Woollen Drapers. In all but the last sample I studied the cases of 25 men and 25 women.

Most psychiatrists who have made a study of abnormal psychosexual development accept Money's postulate as to the manner in which heredity and education determine sexual development. This assumes that genetical and hormonal factors influence psychosexual development only through bodily shape, while sexual behaviour is learned like the native language. Nevertheless, Money himself raises the question as to whether patterns of sexual play, activity and distractibility in the two sexes are not elements of a strong genetical determinism.

The notion of transcultural psychiatry is an attractive one. It creates visions of palm-lined beaches and tropical abundance in the midst of which energetic epidemiology leads to aetiological revelations. Nissl commented to his friend Kraepelin (1904), about to embark on his journey to Java, that his research was only a scientific cloak to hide his enthusiasm for travel—a jest that all subsequent transcultural workers have had to suffer. It is unfortunate that not only are the palms and beaches overrated but the differences in culture and morbidity found are often scarcely greater than those existing between sections of one's own society, where even communication may be as great a problem. Even if the contribution made to the understanding of our own illnesses is meagre, transcultural studies can still be justified because they allow us to evaluate the needs of the peoples studied and, we may hope, permit us to indicate how they may be helped. The view sometimes expressed, particularly by anthropologists, that one should endeavour to observe without changing is unacceptable to doctors. Help is indeed required—there are no noble savages nowadays.