“Blackout”, a confusing term sometimes denoting amnesia and at other times unconsciousness, has come in the alcoholism literature to designate memory loss associated with drinking alcohol. That alcoholics frequently experience amnesic episodes has been recognized since Bonhoeffer's time, and more recently Jellinek (1952) and others have popularized the notion that blackouts are an important predictor of alcoholism, a conclusion based on questionnaire data indicating that blackouts occur early in the course of alcoholism, well before the appearance of other alcoholic symptoms. Jellinek also believed that alcoholics often had blackouts after ingestion of modest, subintoxicating amounts of alcohol.

Psychotropic drugs used in mental depressions or acute psychoses have been shown to interfere with monoaminergic transmission in the brain. Since it is impossible to study the metabolism of these monoamines directly in the human brain, many studies have been made on the urinary excretion of these amines and their metabolites in various mental conditions. However, few conclusive results have been obtained, because only a very small part of the urinary monoamines and their metabolites derive from the central nervous system.

The diagnosis of pre-senile dementia is a clinical one and implies a state of intellectual and/or emotional impairment due to organic cerebral change.

The association of mental disorders with reduced thyroid function has been recognized for many years, the thyroid disturbances concerned falling into two distinct categories. The first involves a gradual reduction in the output of thyroid hormone over a period of months, or years due, for example, to Hashimoto's disease. Clinically recognizable myxoedema may eventually appear, and in some cases—one-third of Jellinek's (1962) series—it is associated with mental disorders of almost any type and degree (Akelaitis, 1936; Asher, 1949). Two reports (Logothetis, 1963; Pomeranze and King, 1966) make it clear that major mental illness, often clinically indistinguishable from what might be called the normal run of schizophrenias, affective disorders and dementias, can be caused by hypothyroidism even before any clinical evidence of thyroid disorder appears.

George A. Kelly graduated in engineering with psychology as a subsidiary subject at the time when the boom of the ‘twenties in the United States was collapsing into the depression of the early ‘thirties. He found it impossible to obtain employment as an engineer and went to practise psychology in an impoverished, inaccessible area on the border of the dust-bowl. There he had to do the best he could to diagnose and treat the peculiar psychological problems of his patients by himself without the advice or assistance of any medically qualified psychiatrist or other psychologist within reach for consultation. He found little help in the popular psychologies of the period, behaviourism and psychoanalysis. Through trying many experimental approaches he gradually developed a homespun psychology which he expounded in a two-volume book, The Psychology of Personal Constructs (1955) and elaborated in a very large number of other publications after he entered the academic world.

This paper reports a study of first admissions to psychiatric facilities in Dublin. It forms part of a survey whose objects were to investigate the extent and characteristics of hospitalized psychiatric illness in Dublin, to make comparisons between mental illness in Dublin and in other cities, to observe the outcome of a first-admitted cohort of patients followed up for five years and to examine the differences, on admission and in outcome, between those receiving Local Authority and those receiving private care.

Controversy over the classification of depressive phenomena has been a prominent feature of the psychiatric scene for about forty years and the issues involved have been reviewed on a number of occasions (Partridge 1949; Grinker et al. 1961; Kiloh 1965; Rosenthal and Klerman 1966; Mendels and Cochrane 1968). Briefly it may be stated that a number of attempts have been made to support or refute the validity of classifying depressions into those which are “endogenous” and those which are “reactive” or “neurotic”; using a variety of statistical methods which have included factor analysis, principal component analysis and multiple regression analysis.

Folklore has had more to say than science about the relation between the outcome of a pregnancy and the psychological history of the parturient: our culture interprets a legitimate stillbirth as the sign of a sick marriage. And sceptics may think that accretions of folklore are with us yet in the form of facile psychoanalytic explanations. Helene Deutsch (1945) ably expounds the case: spontaneous abortion differs from induced abortion, she tells us, in that “the inducing agent is the psyche, and the pregnant woman who resorts to the help of this agent does not act from conscious will or in accordance with conscious wishes”.

Psychotherapists, who by temperament are likely to be tender-minded, have up to now largely failed to devote “attention to the problems of quantitative assessment” (Sutherland et al., 1967), and have perhaps been too prone to regard the complaints of tough-minded critics as manifestations of unconscious resistance. If, as most therapists do, one retains the conviction that patients are altered by the experience of psychotherapy, it should be possible to demonstrate and measure such alteration. The fact that attempts to measure change are often unconvincing is probably a function of the crudity or irrelevance of many of the measuring instruments used.

The relationship of electroencephalographic (EEG) differences to personality measures aroused early interest (see Hill, 1963). For example, Adrian (1935) considered that EEG variations between subjects might correspond to differences in emotional constitution, and contrasts have been found in the personalities of patients with high and those with low alpha indices (McAdam and Orme, 1954).

The pressures and difficulties of the clergyman's life are in many ways similar to those to which the doctor is subject (a'Brook, Hailstone and McLauchlan, 1967). Like the doctor, the clergyman occupies a special role in the community and is “surrounded by a sacred aura which sets him apart from his fellow man” (McAllister and Vanderveldt, 1965). Society, too, exacts much the same price from the minister of religion as it does from the doctor; it gives them both privileged positions, but demands from them exemplary behaviour and often superhuman qualities.

The diagnosis of anorexia nervosa is not always straightforward. Bliss and Branch (1960) regard all non-organic conditions causing anorexia as anorexia nervosa. However, more recent authors like Dally and Sargant (1960), King (1963), Crisp (1965b) and Bruch (1965) limit the use of the diagnostic label anorexia nervosa to a highly specific entity. Many patients who present with loss of weight and/or loss of appetite fit easily into this classical anorexia nervosa category, whilst many others are equally easily excluded.

This report is based on a study carried out at the Unit for the Treatment of Alcoholism, Royal Edinburgh Hospital. The unit and its orientation has been described elsewhere (Walton, Ritson and Kennedy, 1966; Ritson and Smith, 1967). It is usual for patients to stay in hospital for six weeks rather than the three to four weeks that was the practice earlier (Walton et al., 1966).

It is well known that an individual with a family history of schizophrenia carries an increased risk of manifesting the disorder in comparison with members of the population at large. Also, within the population of schizophrenic patients, individuals may or may not have other members of the family affected. Obviously also, schizophrenic patients may be distinguished by gradations of severity of the illness. Whether familial incidence of schizophrenia and severity co-vary, however, remains an open question.

Although the literature relating to the prognosis of male potency disorders and the factors that influence this is vast, there is a dearth of factual data on the subject. Most of the opinions expressed, without supporting figures, are clinical impressions, and the majority indicate that the outcome of therapy in these disorders is generally favourable (Ellis, 1948; Jones, 1919; Rees 1935; Allen, 1962; Stafford-Clark, 1954; Gutheil, 1959). However, Johnson's (1965b) recent important contribution has challenged this consensus; he suggests that; with or without treatment, the prognosis in disordered potency is much worse than has hitherto been believed.

The personality of people who develop a depressive illness has been the subject of much controversy. Most of what has been written is based on clinical observations made during the illness and on inferences drawn from symptoms and there are few investigations based on studies of patients when they were not ill. The present investigation was carried out on women after they had recovered from a depressive illness.

This paper examines the degree of electroencephalogram abnormality among the three phases of manic-depressive disease and the changes brought about by lithium carbonate. The earlier investigators (Berger, 1931; Lemere, 1936) reported no abnormalities in the EEGs of manic-depressive patients. Later workers (Davis, 1941; Hurst et al., 1954; Hes, 1960) found prominent changes between the two phases. However, Harding et al. (1966) noted no common pattern in their three cases when analysed for mean abundance, harmonic mean and variability of alpha rhythm.

Propranolol is a β-adrenergic blocking drug and so relieves symptoms due to excessive adrenaline release, and in particular slows the pulse rate, even in normal subjects (Bollinger et al., 1965). Because of this, Granville-Grossman and Turner (1966) undertook a double-blind trial of propranolol against placebo, showing that it was effective in anxiety. The General Practitioner Research Group has used chlordiazepoxide in comparative trials to new drugs in the treatment of anxiety (G.P. Clinical Trials 1968), under grants from the National Institute of Mental Health, U.S. Public Health Service (MY–4135 (CI), MH 0413–05 and PH 43–65–626). It was therefore decided to compare propranolol in like manner to chlordiazepoxide, in cases of anxiety neurosis seen in general practice.

Bright young schizophrenics, like bright young people generally, are interested in reading about their condition. From the vast and varied selection of literature available to them, they appear to show a marked preference for R. D. Laing's The Politics of Experience (1967). The present authors, like other members of the 'square’ older generation, are of the opinion that they know what is best, and that this book is not good for these patients. It is an appealing book, and emotionally there is not a false note in it. This alone makes it important. But it contains treacherous confusions, and while we do not presume to make choices for our young friends we do feel that it is our duty to clarify the alternatives as presented in this book.

Psychotropic agents are widely prescribed. The effects of a drug represent a complex interaction between the chemical agent, the individual patient and the environment in which the administration of the drug takes place. Many patients use alcohol (a C.N.S. depressant) and control complex machinery. It is necessary to know how a drug interacts with alcohol and especially how it affects driving skills. Murray (1960), in a 90 day study of 68 drivers on chlordiazepoxide, found that traffic accidents were ten times more frequent than the predicted control rate. Zirkle et al. (1959) established that chlorpromazine had “a supplementary and possible potentiating effect” on the impairment of co-ordination and judgement produced by alcohol in 24 human subjects.