In this paper, elaboration of a Realist answer to some of the classical questions of psychology and epistemology will be sought, starting from a knowledge of Soviet and Western findings in psychophysiology (particularly the work of Pavlov, 1932, and Hebb, 1949; see also the summary by Burt, 1968). The point of departure taken in the philosophical literature is the paper by Place (1969). This paper will adopt a reflexological model of brain function—with its implied view that memory is synaptically encoded. While this model has largely fallen into disfavour it is used here paradigmatically—to show that well-developed physiological models in general can provide a satisfactory account of ‘mental’ phenomena.

Most people feel that they understand the word ‘morale’, though few may have attempted to think precisely about it. Certainly all great leaders throughout time have understood it in varying degrees, often purely instinctively. ‘Morale is at bottom a state of will or purpose’ was the way Hocking (1918) wrote of it in his book Morale and its Enemies, and over two hundred years ago Marshal Saxe in the same vein remarked ‘The secret of victory lies in the heart of human beings'.

The traditional psychiatric belief that homosexual women are emotionally unstable (3, 10, 21) has been challenged by Armon (1), Freedman (11), and Hopkins (13). The contention that such women are neurotic has typically been voiced by clinicians reporting on their own therapy patients (3, 10, 19). One exception is the recent psychometric investigation by Kenyon (15) who studied a non-clinical group of English homosexual women, and concluded that they were higher in neuroticism than a comparison group of heterosexuals. In contrast to the ‘illness' notion of homosexuality, the authors of three psychometric studies (1, 11, 13) dealing with non-clinical homosexuals and heterosexuals reported that heterosexual women were not better adjusted than homosexuals. The paucity of research in this area is exemplified by the fact that a total of only four studies, noted above, have been found to date by this author. Even the clinical literature, which is replete with case studies and therapeutic discussions concerning male homosexuality, is strikingly sparse in the area of lesbianism (19). The present study was therefore conducted to add to the small body of data we now have on the adjustment of homosexual versus heterosexual women.

When I received the invitation to deliver this year's Maudsley Lecture, I felt that a great honour had been conferred upon me. The series of the Maudsley Lectures provide a succession of pictures and a measure of the level attained by psychiatry, not only in Great Britain but throughout the world in recent times. Maudsley himself was a great master in the realm of clinical psychiatry. In these days psychiatry is menaced by many diverse and varied interpretations that tend towards bringing about its disintegration. Reading Maudsley's Pathology of Mind, and reading these lectures that have been given under his name since their foundation, constitutes an invaluable lesson that enables present-day psychiatrists to understand what their real situation is, and what is the field of action that is open to them as scientists in contemporary society.

The present research represents an attempt to study the construct of ‘conscience’ in quantitative fashion and to investigate its relation to various types of psychiatric disorders. The psychoanalytic literature deals extensively with aspects of functioning or behaviour which are related to the inner rules which influence man's conduct. In his early writing, Freud described conscience as ‘one part of the ego’ which judged it critically (6), but by 1921 (5) he referred to this self-critical agency as the ego ideal. In 1923, Freud included in the new construct superego the functions of ego ideal as well as conscience (7). Current emphasis continues to be on the censuring aspects of superego (12, 15) and its similarity to conscience (11).

The literature on the role of the wife of the alcoholic in his illness and its management has been critically reviewed by Bailey (1961). She points out that research findings are contradictory and that a unitary view of the wife's role is unwarranted. Kogan and Jackson (1964) have demonstrated within-group differences among alcoholics' wives with regard to their perception of their husbands' illness, and have suggested that such differences may have important prognostic implications. Rae and Forbes (1966) have offered a psychometric dichotomy based on the M.M.P.I. which appeared to distinguish a group of wives whose attitudes to their husbands' illness were supportive and realistic, in contrast to a group whose attitudes appeared to be the reverse. These latter wives were characterized by the M.M.P.I. as having the Psychopathic Deviate scale as a prominent feature of their personality profile. There have been no follow-up studies to assess the influence of the wife on her husband's response to treatment, and the present research attempts to assess this and to relate clinical variables to the psychometric characteristics of the marital partners.

Psychopathologists have tended to regard the phenomena of schizophrenic language as reflections of a more basic disturbance of thought. Writings on these topics generally link them together (e.g., Kasanin's Language and Thought in Schizophrenia, 1944). Critchley (1964), from his survey of major aspects of psychotic speech, concluded that the ‘causation of schizophrenic speech affection lies in an underlying thought disorder, rather than in a linguistic inaccessibility’. Differences of opinion are evident as to what the nature of this thinking disorder might be. Regression (Gardner, 1931; Kasanin, 1944), excessive concreteness of thought (Goldstein, 1944; Milgram, 1959) and deficiency in logical deductive reasoning (Von Domarus, 1944) are some of the more prominent hypotheses to be found in the literature relating to this problem.

The subject completing a repertory grid test records a large number of comparative judgements about himself and people known to him (the elements), using descriptions (constructs) elicited from him. The analysis of this grid provides extensive numerical data requiring interpretation by the tester. In previous work we have reported the use of grids in the investigation of psychiatrically disturbed students (Ryle, 1967, 1969) and have used the grids to predict and assess the effects of psychotherapy (Ryle and Lunghi, 1969). These interpretations of grid data were initially largely subjective and were usually related to clinical formulations based upon a psycho-analytic model. With experience, the assumptions underlying the interpretation of grid data have become more explicit and the time is clearly ripe for these assumptions to be subjected to more rigorous testing.

I should like to express my appreciation and gratitude to the fellows and members of our new College for placing me in the position in which I now stand. The Presidency is the greatest honour our Royal College can confer and the first occupant of the office sets out lacking guidelines or landmarks, without precedents or hallowed practices to constrain or cushion him. He will be expected to lead a democratically elected body of men towards their chosen objectives without falling prey to the dizziness or sense of grandeur that are prone at a height to deceive the senses. I am deeply conscious of the privilege, responsibility and the opportunities for advancing the discipline to which we are dedicated that are afforded by the Presidential office. I can only say that they will always have the first claim on such energies and talents as I am able to command.

After more than thirty years the operation of leucotomy still remains a controversial treatment, and its value is questioned by many. This scepticism, and the advent of new surgical techniques, have emphasized the need for careful appraisal of the results of psychosurgery. In a previous prospective study 40 patients were assessed six weeks after modified leucotomy, and 75 per cent of these patients were found to be clinically improved (Kelly, Walter and Sargant, 1966). They were less neurotic on the M.P.I., had lower Taylor Manifest Anxiety scores and rated themselves as less anxious; a good clinical outcome was associated with diminution of physiological arousal as measured by forearm blood flow and heart rate. This group has now been followed-up and reassessed 18 months after operation, and a further group of 38 patients has been examined before, and again six weeks after, leucotomy. The data from the two groups have been combined to determine the immediate outcome for various diagnostic categories, and a multiple regression has been performed to elicit which of the pre-operative factors predict a favourable post-operative result.

Psychological factors have long been posited as having a role in determining a person's response to open-heart surgery. As early as 1956 Bolton and Bailey reported a high correlation between a history of psychiatric problems and psychiatric complications following cardiac surgery.

In a previous study (Drewery and Rae, 1969), using the Interpersonal Perception Technique (I.P.T.) (Drewery, 1969), it was found that while the husbands and wives of the non-patient marriages had a clear concept of masculinity which they shared, the partners in the alcoholic marriages lacked this consensus; they were confused about the male socio-sexual role, and this confusion expressed itself in a conflictful interplay of dependence and independence needs. The conclusions then reported were applied to alcoholic marriages as if they formed a homogeneous group. The present study was designed to test the hypothesis that when alcoholic marriages are dichotomized in terms of the wives' Pd characteristics, two qualitatively and quantitatively distinct marital patterns would be revealed.

In the current state of psychiatric knowledge, clinicians must synthesize their personal view of the nature and cause of schizophrenia from several competing, complementary, and sometimes contradictory perspectives. They are also faced with the necessity of making day-to-day decisions concerning the diagnosis and treatment of schizophrenic illness in their patients. The present study seeks to clarify the relationship between clinicians' opinions on the nature or cause of schizophrenia and the way they diagnose and treat this disorder, as reflected in their opinions on which are the most useful diagnostic signs and modes of treatment.

A major problem in the affective disorders is what constitutes an homogeneous illness. A recent study enabled us to separate depressive illnesses into two types (1). The first we have called ‘depression spectrum disease’; its prototype is a female with an onset of a depressive illness before the age of 40, in whose family more depression is seen in female relatives than in male relatives, the deficit in males being made up by alcoholism and sociopathy. The second illness we have called ‘pure depressive disease’, the prototype of which is a male whose depression starts after age 40 and in whom there are equal amounts of depression in both male and female relatives and no large amount of alcoholism or sociopathy in the males. First degree relatives of depression spectrum disease are more likely to be psychiatrically ill (depression, sociopathy or alcoholism) than first degree relatives of pure depressive disease probands. Data of Hopkinson and Ley support this concept in part (2); they found that early-onset affective probands (< 40) had higher morbid risks for affective illness in relatives than late-onset probands (onset after 40). Further confirmation comes from a study of 259 alcoholics and their first degree relatives (3). Most of the psychiatrically ill male relatives had alcoholism; most of the psychiatrically ill female relatives had depression. As of the present the differentiation of the two kinds of depressive illness is made on the basis of a specific familial predisposition. Major clinical differences in the two groups have eluded us.

In the last two years psychiatrists, amongst others, have become aware of the technique of cluster analysis, and having obviously decided that this technique may be useful have applied it to sets of data (e.g. Pilowsky et al., 1969; Paykel, 1970), and in some cases drawn conclusions about the results. This paper will attempt to point out some of the problems of this type of analysis, in the hope that in the future casual users of the technique may be more aware of its possible pitfalls.

Reviewers of the literature are unanimous that in schizophrenia the outcome is better in cases where there is a history of stress shortly before the onset of the illness. Zubin et al. (1961) found 89 papers ascribing a favourable prognostic influence to stress and none maintaining that it had a bad or immaterial effect.

A woman was admitted to a psychiatric hospital. Feeling increasingly depressed she had made a suicidal attempt. Besides somatic complaints, she related friction with her husband. The latter reported her as being inadequate at coping with their children, with general domestic chores or with entertaining his business friends. The woman's full scale I.Q. on the Wechsler Adult Intelligence Scale was found to be 73, in the borderline subnormal range.