The ageing of many populations in recent years has directed increasing attention to the social, medical and biological problems of senescence. The psychological changes associated with ageing occupy a central position in inquiries in this field. The expectation of mental disorder shows a steep increase with advancing chronological age, and beyond 75 years a large part of this increase is accounted for by disorders associated with degenerative changes in the central nervous system for which we lack remedies at the present time. Larsson et al. (1963) have estimated that the aggregate morbidity risk for these disorders up to the age of 70 is 0·4 per cent., up to age 75, 1·2 per cent. and up to age 80, 5 per cent. For higher ages estimates were probably less reliable, but the calculated risk up to the age of 90 was 5·2 per cent. In a survey of a random sample of elderly people aged 65 and over in the general population, Kay et al. (1964), found a total of 4·2 per cent. of elderly subjects to be suffering from senile dementia, 2·9 per cent. being mild cases. The condition is generally recognized as being a major cause of serious infirmity among the elderly in psychiatric, geriatric, general medical and community practice alike.

The effects that mentally ill people have on their families have been more commented upon than studied. The currently favoured practice of community care has increased the need for a systematic attempt to evaluate the families' problems, and an opportunity to do this occurred when a community psychiatric service was introduced in Chichester in 1958, while the neighbouring Salisbury district continued with a conventional hospital-based service. The Medical Research Council's Clinical Psychiatry Research Unit has been evaluating the new service to find out how it affects referral and admission rates; how it influences social and clinical outcome, and the effect it has on the community itself. As the patient's family is the sector of the community most closely concerned in any extension of the extra-mural care of patients, we began by assessing the effects on them. The present paper therefore describes the assessments we made of the burden the patients' families carried in the Chichester Community Care Service and compares their burden with that experienced by families in Salisbury, where admission to hospital was more commonly practised. The comparison is made in terms of the relief that was afforded the two groups of families over a period of two years.

Research workers are commonly regarded as geese who occasionally lay golden eggs. The three main ways of encouraging them to do so reflect different views of the extent to which this odd process can be either stimulated or directed.

Information theory is sometimes presented as a new philosophy; here it will be presented as an essentially practical branch of science. Its essence occurs when an engineer says: “You can't get ten manoeuvres out of that satellite when you've only five signals.” He is thinking along the usual and well understood lines of cause and effect, but using a rather unusual approach: instead of trying to relate each cause to its particular effect (e.g. “what is the cause of tuberculosis?”), he is bringing a set of (five) causes into some relation with a set of (ten) effects. Throughout this article, information theory will be used in accordance with what I believe to be its true nature—that it is the body of knowledge developed to help when we have problems in which large numbers of causes are related in some way to large numbers of effects.

Last December I received one of the most surprising letters of my life—an invitation to give the next Maudsley Lecture before this Association. I am deeply grateful for this honour, all the more so since I stand in considerable debt to the hospital which Henry Maudsley founded and which bears his name, having spent two fruitful years there as a research student.

“What's the use of their having names” the Gnat said, “if they won't answer to them?” “No use to them“, said Alice, “but it's useful to the people that name them, I suppose. If not, why do things have names at all?”

In the examination of a psychiatric patient it is usual to distinguish between objective and subjective symptoms. Objective symptoms in clude all concrete events that can be perceived by the senses, e.g. reflexes, registrable move ments, an individual's physiognomy, his motor activity, verbal expression, written productions, actions and general conduct, etc.; all measur able performances, such as the patient's capacity to work, his ability to learn, the extent of his memory, and so forth, also belong here. It is also usual to include under objective symp toms such features as delusional ideas, falsifica tions of memory, etc., in other words the rational contents of what the patient tells us. These, it is true, are not perceived by the senses, but only understood; nevertheless, this “under standing“ is achieved through rational thought, without the help of any empathy into the patient's psyche.

The term “agoraphobia” was coined by Westphal, who in 1872 published a monograph Die Agoraphobie (12) in which three male patients were described with the following symptoms:

… impossibility of walking through certain streets or squares, or possibility of doing so only with resultant dread of anxiety … no loss of consciousness … vertigo was excluded by all patients … no hallucinations or delusions to cause this strange fear … agony was much increased at those hours when the particular streets dreaded were deserted and the shops closed. The patients experienced great comfort from the companionship of men or even an inanimate object, such as a vehicle or a cane. The use of beer or wine also allowed the patient to pass through the feared locality with comparative comfort. One man even sought, without immoral motives, the companionship of a prostitute as far as his own door … Some localities are more difficult of access than others; the patient walking far in order not to traverse them … Strange to say, in one instance, the open country was less feared than sparsely housed streets in town. Case 3 also had a dislike for crossing a certain bridge. He feared he would fall in the water. In this case there was also apprehension of impending insanity.

The extent to which psychiatric disability after head injury depends upon the brain damage which has occurred remains a problem of considerable practical and theoretical interest. In 1904 Adolf Meyer saw the need for caution in approaching this question since there was “no direct measure of the damage of a concussion”; similarly in 1945 Denny-Brown saw that the most serious obstacles to better understanding still lay in the difficulty of obtaining a reliable estimate of the severity of injury to the brain and in the impossibility of differentiating clinically between simple skull fracture, laceration or contusion of the brain.

There have been numerous reports on the survival rate after rupture of an intracranial aneurysm, but the actual quality of survival amongst those who recover has been little studied. In this paper the physical, emotional, and intellectual state of a group of 79 survivors from rupture of an anterior cerebral aneurysm is recorded.

“When man experiences that certain sequences of mental events lead to behavior which has, as a matter of fact, survival value, he calls such mental facts ‘right’. It would be better, however, if instead of this word some neutral symbol were being used for those particular events; because the word ‘right’ leads to the unfortunate notion that some combinations of mental facts are intrinsically better than others. …”

Antisocial psychopaths are a community problem, not only to themselves but to their family doctors, social workers, and others who become involved in their affairs and their treatment. This article compares two attempts to provide an area service for males with psychopathic traits, the first in England and the second in Wales.

The importance of diagnosis, both in rendering available the knowledge accumulated in the past and in providing a guide to future developments, has long been emphasized in British psychiatry. Thirteen years ago, Mayer Gross, Slater and Roth (5) observed in the first edition of their textbook that diagnosis “has never been only naming and labelling. Ideally it implies judgment of causation, and even if this is impossible for lack of knowledge it always includes a plan of action, i.e. of treatment. …” The authors contrasted this approach with a derogation of the value of diagnosis which they felt had become extant in certain schools of psychiatry, and they deplored this tendency, stating unequivocally “the contemptuous attitude to diagnosis which is so prominent a feature of many contemporary schools runs counter to the entire spirit of medicine”. The pendulum now appears to be swinging back and, whilst several centres have remained preoccupied with socio-cultural and psychodynamic approaches to psychiatric illness, interest in psychiatric diagnosis has redeveloped both in Great Britain and in the United States (Kreitman, 1961; Kreitman et al., 1961; Ward et al., 1962; Sandifer et al., 1964, 1966, 1968). The phenomenon is probably related to a current tendency to exchange ideas across the Atlantic, and to the need for a common diagnostic code emphasized by cross-national epidemiological data, mental hospital population movement statistics, and studies of the efficacy of treatment. Clearly adherence to universally accepted diagnostic criteria is mandatory if meaningful comparisons are to be drawn from these and other psychiatric statistics obtained from different national settings.

Rapaport (1945) was the first worker to advance evidence that at least two types of formal thought disorder contributed to the disturbance of thinking found in schizophrenia; and furthermore that neither of these types of thinking was specific to schizophrenia. Rapaport administered the Bolles Goldstein Object Sorting Test to 217 psychiatric patients and to a control group of 54 patrolmen. He found that schizophrenics showed a tendency to function more at a concrete level and less at an abstract conceptual level, as described first by Vigotsky (1934). This tendency was also shown by depressives and by persons who were not mentally ill but had a poor cultural background.

This paper reports the results of a psychiatric study of the families and husbands of patients with hysteria. In a series of previous publications designed to clarify the diagnosis of hysteria, it was shown that certain clinical criteria will define a group of patients with a highly uniform clinical course and prognosis (3, 4, 5, 9). It was also suggested that the same clinical picture is seen among first-degree female relatives more frequently than among the general female population, and that alcoholism and sociopathy are seen more frequently among first-degree male relatives than among the general male population (1). We decided to extend the investigation to more cases, and to study the husbands of the index cases as well.

In recent years, a number of surveys of attempted suicides have been reported (Middleton et al., 1961; Sclare and Hamilton, 1963; Parkin and Stengel, 1965; Whitlock and Schapira, 1967). Other studies (Kessel, 1965; Oswald, 1966) have shown that the number of cases of attempted suicide has greatly increased in the last decade. Apart from one survey from Tasmania (Gold, 1965), all these have come from large urban or industrial communities.

A number of studies have demonstrated that married pairs in which both partners have, or have had, a psychological illness are substantially commoner than would be expected by chance. These have been reviewed elsewhere (Kreitman, 1964; Nielsen, 1964). In most of these investigations the findings have been analysed in terms of “neuroticism” or of nonspecific “mental illness” without reference to diagnosis, and detailed attention has rarely been given to any other clinical features.

In December, 1965, a patient was admitted to the wards at Parkside Hospital, Macclesfield, with a Korsakoff syndrome which had appeared following a suicidal hanging attempt. Strangulation as a cause of the Korsakoff syndrome appears in all surveys of the numerous causes of the disorder, from Bonhoeffer (1904) to Lewis (1961), but only one case (Whiteley, 1958) has been described in the English literature and this only briefly. Indeed, the whole subject of the neuropsychiatric sequelae of attempted hanging has received scant attention in the English literature, yet according to statistics of the Registrar-General (Stengel, 1964), hanging is the second commonest method of suicide in males in this country. Moreover, Bokonjic (1963) has collected 19 cases admitted to hospitals in Aarhus and Copenhagen between 1948–1958 suffering from the anoxic effects of attempted hanging, whilst Berczeller and Nowotny (1935) claimed to have dealt with 100 hanging survivors in the Vienna University Clinic over a ten-year period. Possibly of greater importance in justifying a review of this subject is the fact that the neuropsychiatric sequelae of attempted hanging are really those of cerebral anoxia. In this age, when surgical techniques involving interruption of the cerebral circulation are growing more frequent and when methods of anaesthesia and particularly dental anaesthesia are evoking a good deal of attention and contention, it is important that the psychiatrist should have some acquaintance with the psychological and neurological symptoms and signs that are caused by cerebral anoxia.

There seems little doubt from available statistics that the Republic of Ireland has the highest rate of hospitalized psychiatric morbidity in the world. There are no complete international figures available for this statistic but the World Health Organization published for the first time in 1961 returns for numbers of patients treated in hospital in 119 different countries (W.H.O. 1961). In many cases the returns were incomplete or unsatisfactory in one or more particulars. The ideal was to establish for each country the total number of patients treated during each one of the five years 1955–1959. The number treated was defined as “the patients present at the beginning of the year in the various public and private institutions specializing in psychiatry and in other institutions (general hospitals, etc.) plus admissions and readmissions during the year”. Unfortunately this ideal was achieved for only a minority of the 119 countries. The difficulties encountered in compiling the figures are set out in the publication itself.