In three recent articles, Slater (1972, 1973, 1975) has made certain claims concerning the nature of science, especially as it applies to psychiatry. Most recently (Slater, 1975), he has applied his criteria for assessing science to psychoanalysis, and has found it seriously lacking. In this article Slater's criticisms of psychoanalysis are used as a foil to attack his criteria for science. It is argued that his methodological criteria are extremely conservative and would be likely to cause the demise of scientific activity if at all seriously applied. Further, it is argued that psychoanalysis is a science on any reasonable application of Slater's criteria.

This paper attempts to define the areas of applicability of behavioural and mentalistic explanations of neurotic behaviour. It is argued that intentional behaviour requires mental concepts for its explanation on the grounds that the statement of reasons which form the basis of intentions cannot be submitted to a stimulus-response analysis. This argument applies to situations in which the therapist uncovers the reasons for purposeful action of which the agent may initially be unaware. It is further argued that behaviour of this kind is rule-conforming and not law-abiding and therefore is not susceptible to explanations of the kind that are available in other areas of science. It is nevertheless argued that causal explanations can be given in terms of reasons for action.

The pattern of decline of a mental hospital population over fifteen years is described. Continuing problems are commented on, particularly the presence of ‘old’ long-stay patients and the accumulation of ‘new chronic patients'. The number of beds required for each of these categories is estimated.

The dissolution of the mental hospital service by degradation is deplored, and a suggestion is made that some of the good points of the old service might be salvaged before it is too late.

This paper describes a psychogeriatric service in Gloucestershire. Agreement on policies was reached with general practitioners, Social Services, other psychiatrists and hospital nursing staff. The day hospital is regarded as the preferred area of treatment for a wide variety of patients, including the severely demented. In this service less than five per cent of admissions appear to become long-stay. With emphasis on day hospital and community support the number of beds for this type of patient recommended by DHSS may be excessive.

The present policy of reducing the number of patients in hospitals for the mentally handicapped involves the discharge of many patients to residential care outside hospital. This paper considers 89 patients discharged from a hospital in the five years 1971–75. 64 (70%) went to facilities controlled by the Social Services Department, ten to other residential homes, eleven to lodgings and four to other institutions. Thirty five (40%) were subnormal (WAIS Full Scale IQ 55–69); the remainder, an unexpectedly high proportion, severely subnormal (WAIS Full Scale IQ, under 55). The majority of the patients discharged were the normal-looking mentally handicapped, few of whom had a specific cause for their condition. The suitability of patients for discharge in relation to the services available was more relevant than their ages or their years in hospital.

Fifty-two patients thought to be suffering from dementia when first seen as neurological out-patients were fully investigated.

Four of them were found to have tumours, whilst in five the dementia was due to a treatable cause.

Neither a long history nor an age above sixty-five precludes a dementia being due to a treatable cause.

A case of folie à quatre is described affecting a proband and his wife, sister and brother. The three family members retained their symptoms of paranoid schizophrenia. The wife was not mentally ill and her delusions disappeared in time (folie imposée). Coincidentally, there were several cases of Huntington's chorea amongst her relatives. Different categories of folie à deux are demonstrated in the various family members and relationships.

Correlations between the ratio of erythrocyte to plasma lithium (Le/Lp) and clinical status have been reported by some authors and disputed by others. Examination of the literature on Le/Lp and erythrocyte physiology suggests that Le/Lp is determined by peripheral pharmacokinetic parameters and has no direct relationship to central pathophysiology. Because of this, and because of inconsistencies between studies reporting correlations of the ratio with clinical status, such correlations probably cannot illuminate either the pathophysiology of affective illness or the mode of action of lithium.

Among 18 patients receiving prophylactic, long-term lithium treatment for manic-depressive psychosis, a high incidence of increased thirst and frequency of micturition (60–70 per cent) was noted on direct questioning. Symptoms arose at varying times after the start of lithium therapy; in no patient did symptoms antedate the use of the drug.

Plasma levels of antidiuretic hormone were found, on average, to be higher than in normal control subjects for a given level of plasma osmolality, although the scatter of results was wide. It is suggested that elevation of antidiuretic hormone occurs as a compensatory mechanism for the polyuria which is a common feature of long-term lithium treatment. The more florid form of nephrogenic diabetes insipidus occasionally seen in lithium takers seems likely to be due to a different mechanism from the more common mild polyuria.

Estimation of lithium in 24 samples of serum and saliva show that there is a very high correlation between the lithium levels in serum and saliva (r= +0·88). The ratio found in our patients is very similar to that reported from North America. Estimation of lithium in saliva at different periods of time show there is a good degree of stability for saliva lithium levels. Thus saliva can be used as a substitute for serum for lithium monitoring. The practical advantages of this are discussed.

Reported reductions in the activity of platelet monoamine oxidase (MAO) in chronic schizophrenic patients might be contributed to by alterations in hormones, platelet numbers or other non-specific factors thought to affect enzyme activity. In this study, MAO activity in 27 patients with chronic schizophrenia was measured, using benzylamine as the substrate in an assay based on platelet counts instead of platelet protein, and was found to be markedly lower than mean MAO activity in 375 normal controls. These results were similar to those previously reported with tryptamine as a substrate for the enzyme. Serum testosterone, triiodothyronine, iron and iron-binding capacity were within normal ranges in individuals with reduced MAO activity, and none of these measurements was significantly correlated with MAO activities. Platelet MAO activity remained stable over time in patients and controls.

Five suicides in one family, mainly by burning, are reported. The ritualistic manner, closeness of events in time and absence of serious exogenous factors suggest the term ‘family suicide’.

Mortality data are presented from a four-decade follow-up study of 200 schizophrenic, 100 manic, 225 depressive patients, and 160 surgical controls (80 appendicectomy; 80 herniorrhaphy). Data for this analysis were available on 648 (95 per cent) members of the study population. Using sex-age standardized mortality ratios (SMR), the mortality experience of the study population was compared with that of the state of Iowa, the geographical area served by the admitting medical facility for the study group. Results are presented for a four-decade period beginning 1935–44, and ending 1965–74. All three psychiatric groups had a significant increase in mortality risk. This was most pronounced in the first decade following admission, although schizophrenic patients, especially females, continued to show a significant excess of deaths throughout the entire four decades of the follow-up period. During no decade of the follow-up period did the mortality of the surgical controls differ significantly from that of the Iowa population.

This paper considers possible relationships between cognitive deficits and symptomatology in schizophrenia. It is argued that a combination of defective filtering and slowness in response selection results in a state of information overload in acute schizophrenia. The methods by which normal subjects adapt to experimenter-induced overload may therefore be relevant to aspects of schizophrenic behaviour. The considerable intra- and inter-subject variability in symptomatology of schizophrenic patients may represent differing adaptations to similar cognitive disturbance, such secondary abnormalities being prominent in chronic patients. Sections of the literature on acute-chronic differences are consistent with such a formulation, although one cannot infer intra-individual change from cross-sectional studies; there is a clear need for longitudinal investigations in this area. The preferred method of adaptation will be dependent on the severity of overload, the environment, and personality factors independent of the psychosis. The implications for the modification of schizophrenics' behavioural abnormalities by operant procedures are discussed.

Two groups, 10 subjects in each, one consisting of depressed patients and the others normal controls, ranked photographs of faces for two sets of six constructs. One set consisted of the critical constructs of the Bannister and Fransella grid test, while the other set of constructs were all related to affect. The depressed patients showed a higher intensity score for affective constructs than did the normal subjects. There was no difference for critical constructs. The affective intensity score decreased on two further retestings for the depressed group; for the normal group they remained reasonably constant. These results may shed light on the reorganization in construing aspects of affect which occurs with depression and its remission.

Patients suffering from obsessional personality disorder (anankasts) have been described as possessing ‘superior memories', because of the detailed precision of their accounts. At the same time, such classical phenomena as doubt, checking and rumination imply faulty recall. This paradox is discussed, and some predictions drawn from a hypothesis regarding the cognitive characteristics of obsessional disorder. Findings are presented which indicate that, by comparison with matched psychiatric controls, anankasts do not excel in the long-term recall of factual information or meaningful anecdotal material. But they show the following mnemonic features:

(a) Superiority of immediate memory span, reflecting high levels of attention.

(b) Superior recall of ambiguous anecdotal material, reflecting a tendency to the pointless ‘rehearsal’ of such material.

(c) Weak redintegration in personal reminiscence.

It is suggested that anankasts' doubts about their remembering refer not so much to the correctness of what is being recalled as to the quality of the recalling itself.

It is argued that obsessional indecision reflects a formal cognitive characteristic, and should therefore be detectable in slower performance of insignificant, neutral tasks. The obsessional will not be handicapped in structured tasks requiring concentration and a deductive approach, but he will be slower in less structured tasks requiring a predominantly inductive approach. Results from two neutral (numerical) tasks support the predictions.

A replication study was conducted of the treatment of agoraphobics by exposure in cohesive groups, as described by Hand, Lamontagne and Marks (1974). The continuing improvement during follow-up, with consequent large overall improvement, reported in the original study was not replicated. However, the present study confirmed the usefulness of this procedure as a highly cost-efficient treatment.

The assumed equivalence of the Gelder and Marks (1966) phobic rating scale and its modification by Watson and Marks (1971) was examined. Large discrepancies between the scales were obtained for initial assessments and change scores. It is suggested that there is a need for workers in this field to agree on methods of measurement.