The diagram, which has no relation to brain structure, represents the way in which, in terms of function, mood is regulated by a mechanism which is disordered in cases of pathological elation and depression. It illustrates the points in the regulation mechanism at which physical treatment with different agents can be applied. This theoretical model reconciles the following observations:

The following are summaries of work carried out at Powick Hospital, Worcester, as a project approved by the Medical Research Committee of the Birmingham Regional Hospital Board, which also gave financial assistance.

The efficacy of anti-depressant drugs, including imipramine and the so-called monoaminase inhibitors, and their potential as a replacement for E.C.T. remain undefined. Imipramine, which has been most extensively studied, has been shown to produce an initially lower improvement rate than E.C.T. in depressives, though after six months the results are little different (Kiloh and Ball, 1961). Dewhurst and Pare (1961) have reported that the quality of improvement in the cases who improved with nialamide in their partially blind trial was comparable to that seen with electroplexy. There is still a lack of controlled trials on the monoaminase inhibitors, particularly as regards patients sufficiently disturbed to warrant hospitalization. Harris and Robin (1960) found no evidence that phenelzine influenced recovery in these patients.

The following study was designed to compare the effectiveness of imipramine (Tofranil) and pheniprazine (Cavodil) in the treatment of endogenous depression. Controlled trials have shown the value of imipramine (Holdway, 1960) and therefore no placebo group was included. The theoretical advantages of a cross-over technique were considered to be outweighed by such disadvantages as the tendency for the effects of the first therapeutic agent to continue into the second phase of the experiment; and the tendency for rapid remissions to occur with anti-depressive drugs and to persist for a period despite withdrawal. Thus two similar groups of patients, each treated with full dosage of their respective drugs, were compared. The selection of patients was randomized, and the trial was blind throughout.

It may be recalled that the Recommendations adopted by the General Medical Council in 1957 refrained from specifying the period of time to be allotted to particular subjects, or the sequence in which they should be taught. They considered the primary task to be that of finding means to reduce the congestion in the curriculum: to instruct less and to educate more: and they trusted that the licensing bodies and schools would not feel limited in their right, even their duty, to experiment with different courses and various methods of teaching.

Differences between the suicide rates in various parts of the same country or in different parts of an urban area have frequently been investigated. Correlations between the incidence of suicides in different districts of large cities and their socio-economic characteristics have been established (Cavan, 1928; Sainsbury, 1955). Suicide rates of contrasting communities, urban and rural, have been compared (Carstairs and Brown, 1958).

Two main difficulties are met with in epidemiological studies of mental disorders. Firstly, the problem of finding all the cases occurring in a population, or a representative sample of them; and secondly, the problem of classification.

In St. Crispin Hospital, Northampton, there are male identical twins (J.L. and P.L.) who for nearly a quarter of a century have suffered from an atypical psychosis. They were previously studied by Palmer (3). Their sister (B.L.) had a similar mental illness but she obtained relief from a leucotomy operation at an early stage. The mother was also affected, but the onset of illness in her case was later in life. There are two unaffected siblings.

The term “stressor agent” was first introduced to medicine by Selye (1950). Stressors really referred to patho-physiological phenomena associated with shock-like mechanisms, but psychiatrists have made use of the concept and to them stress implies mental conflict, anxiety-tension and defensive re-organization in relation to unpleasant psychic events. This re-organization might be maladaptive and lead to neurotic or deviant behaviour. It is always difficult to isolate a distressing event and attach prime importance to it in the aetiology of psychiatric disorders. What is minor discomfort for one, calling for minor adjustment, may represent severe pain for another by touching on some specially sensitive aspect of the personality, causing drastic emotional and behavioural changes. With these reservations in mind it is possible to extend the psychological concept of stressors to include the field of juvenile delinquency.

Popular psychiatric terms are often used uncritically and it is salutary to examine our usage from time to time. “Obsessional” is such a word; it may describe a symptom or a type of personality, with immediate possibilities of misunderstanding. Here it is used to describe a type of personality, as in the phrase “obsessional personality”. The current usage of this phrase will be examined and it will be compared with the usage of the “anal-erotic character” of psychoanalysis. The two terms differ: the obsessional personality is purely descriptive while the anal-erotic character is based on a theory of personality development; yet they are often used synonymously. Do they differ in descriptive detail? If so, how and why? An attempt will be made to answer these questions by an analysis of descriptions of the terms.

“O the mind, mind has mountains; cliffs of fall, Frightful, sheer, no-man-fathomed.”

The importance of the anatomical basis of the simpler motor and sensory functions of the central nervous system, and their disorders, has been recognized for over a century (Brown-Séquard, 1855). But that more complex intellectual functions and their disorders should also have a relevant anatomical substrate is only slowly coming into recognition. Indeed, a still-fashionable theory of mental function, originating in Vienna towards the end of the last century, regards the study of brain structure as unnecessary and beneath contempt—for all that its founder began as a neuro-anatomist.

Exploratory experimental work into the effects of sensory deprivation on human subjects has developed rapidly during the past decade and many reports have been published. It would appear to be necessary, however, to pause for a moment and to review the work which has so far been executed with a view to facilitating the systematic investigation of this phenomenon.

Recent research has suggested that the social desirability factor may be considered both as a response set, which exerts a contaminating influence on personality tests (Edwards, 1957), and as a measure of pathology. With respect to the latter, Tolor and Boitano (1960) found that increased severity of psycho-pathology tends to be associated with a decreased ability to make socially acceptable choices on a check list consisting of an equal number of socially approved and socially disapproved items. Moreover, Fordyce (1956) pointed out that the “psychotic factor” resembles a definition of social undesirability. The present study represented an attempt to focus attention on the possible meaning of differences in social desirability in terms of differences in degree of ego-strengths of subjects. The purpose, therefore, was to determine the relationship between one aspect of ego strength, namely, the body image as reflected in the figure drawings, and the social desirability variable, as measured by a check list.

The investigation to be reported in this paper was conducted with two principal aims in view. Firstly, it was desired to confirm evidence that memory disorder in elderly psychiatric patients may be due to a breakdown of processes underlying short-term retention (Inglis, 1960; Inglis and Sanderson, 1961). Such previous evidence supported the notion that memory disorder may in fact result from a disturbance of one of the mechanisms adduced by Broadbent (1957) to account for the ability of young normal adults to respond sequentially to information simultaneously presented through different sensory channels (e.g. both ears at once). Secondly, it was desired to extend the study of these retention processes in such patients to the case in which the channels for the simultaneous presentation of digits comprise two different sensory modalities (i.e. eye and ear together).

In discussing current trends in mental hospital statistics, it is convenient to make a distinction between patients who have been resident for more than two years (the longstay group) and short or medium stay patients. The chances of discharge, once an individual has been resident for two years, are low and become progressively lower the longer he stays. In mental hospitals in England and Wales from 70 to 80 per cent. of patients are longstay; and the majority of these are diagnosed as schizophrenic (75 per cent. in 1954), although no more than one-third of newly admitted patients are given this diagnosis. There has been a consistent tendency over the past 30 years for a decreasing proportion of schizophrenic patients to be retained continuously for two years after admission—for example, about 60 per cent. of schizophrenics admitted in 1930 were retained in this way, compared with 30 per cent. in 1950 (Brown, 1960). Since then there have been important changes in social treatments and administrative policies, and the major tranquillizers have been introduced. The proportion of schizophrenics retained for two years or more has now approached 10 per cent. at many hospitals (Brown, 1959; Wing et al., 1959). However, very little is known in numerical terms about the extent to which the patients have to be readmitted to hospital once they have been discharged. The only satisfactory studies of the readmission of schizophrenic patients were made before the introduction of the recent changes in discharge policy, and dealt with admission cohorts in which the proportion retained for two years ranged from 60 to 30 per cent. (e.g. Freyhan, 1958; Shepherd, 1957). Reduction within this range did not appear to lead to an increased risk of readmission. However, the possibility cannot be dismissed that a further reduction would lead to the discharge of patients with a special liability to relapse and readmission.

There are few incidents more calculated to disturb the well-ordered routine of a surgical unit than when a patient develops a severe psychiatric disorder in the post-operative period. Such episodes may occur suddenly after an interval of seemingly uneventful recovery and in some instances may be of such severity as to result in an appreciable and even dangerous deterioration in the patient's physical state. The impact on relatives must also be considered, for it is easy to understand the dismay which they must experience on observing the patient pass from a state of apparent composure into one of hyperkinetic excitement, panic, or confusion.

In view of the recent revival of interest in deconditioning, the treatment of a series of 35 cases of anxiety by this method may be of interest. This series has not been recorded previously although the treatment was carried out 20 years ago.