Modern hypotheses as to the aetiology of schizophrenia are likely to be multifactorial and to include psychosocial factors. A typical aetiological hypothesis might propose that an “identity” crisis precipitated psychotic symptoms in an individual who was predisposed to schizophrenia; the predisposition could be due both to inherited biological factors and to abnormal personality traits caused by a faulty family environment or other social factors. Hypotheses such as these lead to the expectation that schizophrenia would be precipitated by psychological stress. However, statistical studies which have attempted to relate the onset of schizophrenia to psychological stress have not produced evidence consistent with such an expectation. For example, hospital admissions for psychosis were not increased in England during the blitz (10, 12, 13). Nor was a grossly increased rate of psychosis found in populations of concentration camp survivors (9, 16). Also, it has been claimed that the rate of psychosis was not increased by combat exposure among U.S. soldiers in World War II, whereas the rate of neurosis was clearly affected by combat exposure (6). Consistent with this last point it has been stated that the rate of hospitalization for psychosis in U.S. military personnel has remained relatively constant over the last 40 years apparently independent of war or peace (7, 1), whereas the rate of hospitalization for nonspsychotic disorders has fluctuated widely (7).

Rampton is a Special Hospital catering mainly for subnormal and psychopathic patients with histories of dangerous and violent behaviour. Earlier work (McKerracher, Street, Segal, 1966) had shown that female patients were significantly more prone than males to mutilate their own bodies and smash hospital property. Such acts are usually regarded in this hospital as hysterical outbursts in which there is often an insensitivity to pain. Gross lacerations are often inflicted without the patient appearing to experience any suffering. Some kind of hysterical anaesthesia may be involved. It is known that this kind of behaviour is found in long-term patients suffering from (a) schizophrenia and (b) severe character disorder (Offer and Barglow, 1960).

This study illustrates some of the constitutional and psychological complications of being a twin, some difficulties that may arise in formal diagnosis and the therapeutic importance of separation.

The clinical examination of nominal aphasia has hitherto involved relatively unstandardized procedures. Random objects are presented to patients and account taken of their success or failure in finding the correct name (Allison, 1962). Recent work by Newcombe, Oldfield and Wingfield (1965) and Rochford and Williams (1962–1965) has drawn attention to a number of important variables affecting the likelihood of a correct response occurring. Oldfield (1966) in particular has presented a model of the psychological processes involved in object naming which raises a number of important theoretical questions concerning the nature of the deficit in nominal aphasia.

The traditional concept of manic-depressive psychosis has been either a bi-polar or a circular one, used interchangeably. The psychoanalytic school has invoked the polarity of much of human behaviour as an appropriate analogy. For example “The tragedy is succeeded by the satyr play: after the serious worship of God comes the merry fair… On the same basis the same sequence is represented by the cycle of guilt feelings and unscrupulousness, later by the sequence of guilt feelings and forgiveness…. The manic-depressive cycle is a cycle between periods of increased and decreased guilt feelings: … this cycle, in the last analysis, goes back to the biological cycle of hunger and satiety in the infant” (Fenichel, 1946, p. 409).

This is the first report of a six month survey of treated psychiatric illness in Lebanon, carried out with the collaboration of all three psychiatric hospitals in the country and twenty of the twenty-one psychiatrists practising within and outside of these institutions.

Schizophrenia still offers the psychiatrist one of his greatest challenges, in spite of the volume of research that has been lavished on it, and the many important therapeutic improvements that have been achieved.

With your permission I should like to try to give this address the pattern of a clinical demonstration: analysing a given set of problems, “a case”, and reasoning from the particular towards the general, so that the case under consideration may open the way to wider understanding.

This paper has three separate yet interrelated aims. First, it sets out to describe a series of clinical phenomena and attempts to show that they arise from a common source. Secondly, the consideration of this data may possibly amplify statements which have been made in the past regarding the nature of mental activity. Thirdly, there seems reason to believe that some of the phenomena described may help to provide a more rigorous definition of the transference concept.

Calculations based on Bellak's (1958) review of research into schizophrenia suggest that at that time well over 5,000 papers had been published. An index count of Psychological Abstracts since 1960 indicates that papers on schizophrenia have been produced at the rate of about 300 per year with a growth rate of 10 per cent. per annum. Yet few, viewing the problem of schizophrenia in perspective, feel that any kind of break-through has been made, and many would agree that the field is grossly confused. It may well be that the traditional cry that “more research is needed” misses the point, and that much of the research which has been carried out is of relatively little value because of our failure to meet the logical requirements for effective research within the area.

Very few cases of thyrotoxic psychoses have been reported during the last twenty years. Recent authoritative reviews on the management of thyrotoxicosis and its complications (Ingbar, 1966; Trotter, 1967) scarcely mention psychotic reactions. It seems that such conditions have become increasingly rare since the advent of modern anti-thyroid treatment. The present report attempts to summarize what is known about these disorders, and describes the clinical features, treatment and subsequent course of a schizophrenia-like psychosis which developed during thyroid crisis.

This is an interim summary pending a full account of four years' work in the villages of nine representative tribes of Ghana.

Clopenthixol is a thiaxanthen derivative (Fig. 1). Its full name chemically is 2-chlor-9-[3-(N-B-hydroxyathylpiperazino)-propyliden]-thioxanthen. Numerous uncontrolled trials to date (2, 3, 4, 5, 6, 7) have reported success with this drug in the treatment of schizophrenia, mania and other psychotic disorders.

The County Borough of Southend-on-Sea is a seaside town with an estimated population of 166,390 in 1965, approximately 24 per cent. of whom were over the age of 60, as compared with 17.8 per cent. of the total population of England and Wales, and 17.7 per cent. of the population of urban areas, outside the conurbations, with populations of 100,000 and over. As in other seaside towns of a similar character, the suicide rate is high: 181 per million population in 1965, as compared with 108 per million in England and Wales, and 120 per million in urban areas outside the conurbations with populations of 100,000 and over (Registrar-General, 1967). Of 237 (46.4 per cent.) consecutive suicides in Southend 111 were over the age of 60 at the time of death.

Several recent investigations have focused on the relationship between parental ill health and childhood behaviour disorders.

The present work is a study of the distribution of chromosomes in female patients with senile dementia and in two control populations, one the same age group and one below the age of 40.

Research in stuttering can be divided into two broad categories. The focus of attention has either been on the way the stutterer speaks or on the sort of person he is. In the first case, investigators have sought to isolate those conditions under which the stutterer's blocks, repetitions, or prolongations can be modified. For instance, there are studies on the effects of varying the size of the audience (e.g. Siegel and Haugen, 1964; Shulman, 1955), of providing delayed auditory feedback (e.g. Lee, 1951; Neeley, 1961) or various levels of noise (e.g. Mariast and Hutton, 1957; Sutton and Chase, 1961), and on the relationship between number of stutters and rhythmic speech (e.g. Barber, 1940; Fransella and Beech, 1965).

In European and American psychiatry, catastrophes like divorce and death of parents occurring in childhood are considered to be important factors, contributing to the psychogenesis of emotional disturbances. However, while dealing with neurotic Ethiopian students, the authors were struck by the conflicting role played by the apparent instability of marriage in this country, the frequency of death of one or both parents and the early departure from home of a child to get proper education. On the one hand there were such observations as the obvious unhappiness about his past of a neurotic student, who was deserted by his mother and left in a hospital for more than a year when her husband abandoned her. Later his mother accepted him once more, and he was called “the one who died and came back to life”. His father even started to visit his first wife again, among other things to tell her that the children of his second wife were so much more clever. Are these experiences exceptional and significant, or is the next observation more representative? Two small children were examined during a home visit, and afterwards directed to return to their mother. Without the slightest doubt and with evident affection they chose their grandmother, while their own mother, a next-door neighbour since she had taken another husband, stood looking at the scene with nothing more than neighbourly interest. It is obvious that the significance of a broken home (by which is meant death of one or both parents and permanent separation) needs to be reconsidered under the circumstances prevailing in a country like Ethiopia. One way of approaching the problem could be provided by a child's behaviour at school as related to the occurrence of above-mentioned catastrophes. Sherwin and Schoelly (1965) name the school-community as one “reference group” providing standards of normal behaviour. Employing the native teachers as observers would include an additional advantage. We, as European observers, might run the risk of introducing cultural biases when we judge a child's behaviour ourselves.

Psychiatrists have frequently pointed out that in a high proportion of individuals who commit suicide it is apparent that there is pre-existing psychiatric illness. It has been further shown that many of these people have received medical care and have been attending their doctor within four weeks of their death (Motto and Greene, 1958; Seager and Flood, 1965). The implication of these findings is that doctors do not always recognize psychiatric illness in their patients and are certainly not attuned to the possibility of suicide, even when the patient frankly states that he finds life is not worth living and that he has considered ending his life. Such straightforward information is not accepted at its face value. The doctor may hold the mistaken view that people who talk about suicide do not in fact commit the act. This statement is manifestly incorrect. It has been shown (Robins et al., 1959) that 70 per cent. of suicides have declared their intention of committing the act days or weeks beforehand.

Although systematic desensitization has been used for a decade in the treatment of phobias, its mode of action is not yet fully understood. During treatment by desensitization patients are relaxed while they are asked to visualize situations which evoke progressively more fear. Desensitization is given in the context of routine psychiatric management, and it is obvious that many variables may contribute to the overall effect of treatment. Among those which it is important to examine are: exposure, i.e. visualization of the imagined phobic stimulus without relaxation; relaxation without presentation of phobic images; densensitization, i.e. the pairing of the graded imagined phobic stimuli with relaxation; repeated suggestion of improvement; the relationship to the therapist, and finally the many non-specific effects of routine hospital care.