Michel Foucault's Madness and Civilization contains a bold and influential account, over several historical epochs, of the relations between madness and society's institutions of care and control. Foucault's various theses are reviewed in the light of more empirical historical studies and are, on the whole, found wanting.

The effect of Vitamin C in manic-depressive psychosis was assessed by a double-blind, placebo controlled, crossover trial. Both manic and depressed patients were significantly better following a single 3 g dose of Vitamin C than following a placebo.

Preliminary results of a double-blind, crossover comparison of normal vanadium intake with reduced intake in manic and depressed subjects are reported. Both manic and depressed patients were significantly better on reduced intake.

These results are in keeping with the suggestion that vanadium may be an aetiological factor in manic depressive illness.

The ability of lymphocytes from manic-depressive and normal subjects to produce new pump sites in response to increased cell sodium was compared in a series of experiments. Ethacrynate or different potassium concentrations were used to increase cell sodium concentration. The lymphocytes of manic depressives had a significantly reduced ability to produce new pump sites. It is suggested that this may be the genetic defect underlying manic depressive psychosis.

The term ‘pseudo-hallucination’ has received two incompatible definitions. It can refer either to self-recognized hallucinations (exterocepted or interocepted) or to introspected images of great vividness and spontaneity. It is argued that the phenomena to which the two definitions refer might best be distinguished as perceived and imaged pseudo-hallucinations.

A phenomenological construct of ego-consciousness, subdivided into 5 aspects (vitality, activity, consistency, demarcation, identity) may help for systematic overview of the schizophrenic syndrome. Its construction and empirical evaluation, and the data of 260 schizophrenic probands are presented. The therapeutic implications of the model are elaborated in body-oriented treatment, especially of acute and severely ill cases.

Schizophrenia and affective disorders selected according to the Feighner criteria can be differentiated on the basis of 40-year outcome. Within schizophrenia the presence of disorganized thoughts at the index admission was associated with poor outcome, whereas better outcome was associated with the presence of delusions or hallucinations. Within the affective disorders, bipolar patients with grandiose delusions or ideas showed a poor outcome; a better outcome was found in unipolar patients with complaints of fatiguability or tiredness at the time of the index admission.

Various studies have shown: (i) increased rates of psychoses in immigrants to Britain, and a particularly high rate of schizophrenia in the West Indian- and West African-born; and (ii) a greater proportion of atypical psychoses in immigrants. A retrospective study of psychotic inpatients from a London psychiatric unit demonstrated increased rates of schizophrenia in patients from the Caribbean and West Africa. These patients included a high proportion of those with paranoid and religious phenomenology, those with frequent changes of diagnosis, formal admissions, and married women. The West Indian-born had been in Britain for nearly 10 years before first seeing a psychiatrist and, if they had an illness with religious symptomatology, were likely to have been in hospital for only 3 weeks. Rates of schizophrenia without paranoid phenomenology were similar in each ethnic group. It is suggested that the increase in the diagnosis of schizophrenia in the West Indian- born, and possibly in the West African-born, may be due in part to the occurrence of acute psychotic reactions which are diagnosed as schizophrenia.

A prospective study of patients with religious delusions identified 24 West Indian and West African patients. Those who had none of Schneider's first-rank symptoms of schizophrenia (principally West Indians) differed from those who did by virtue of early religious commitment, life-long religious experiences, an acute admission precipitated by social events, a greater chance of having their diagnosis changed, less than 10 different PSE syndromes, the absence of ‘twentieth-century’ delusions, and the presentation of malevolent witchcraft as the sole explanation of the episode. It is suggested that this group can usefully be considered as demonstrating an acute psychotic reaction of the type previously described in Africa and the Caribbean.

A national community survey of psychological symptom levels among samples of Indian immigrants and natives is reported. Using a quasi-random sampling procedure, a sample of 200 Indian-born residents of large towns in England was selected to match the age and sex structure of the total Indian immigrant population. An indigenous population, selected in the same way, was matched with the immigrants for comparison purposes. Psychological disturbance was measured with the Langner 22-Item Scale which has previously been specifically validated for use in this context. Other indices were constructed to test specific hypotheses.

The pattern revealed by mental hospital admission statistics was strongly supported by survey. Indian immigrants as a group experience far less psychological disorder than natives, despite the experiences of migration and of being an immigrant. On other measures Indians also manifested an adjustment superior to that of natives.

Among the Indian sample stable psychological adjustment was related to being young at migration, being acculturated to life in England and being socially integrated. A subgroup of higher social status, Indian females who had been upwardly socially mobile, emerged as the only group with a higher than average symptom level. However, even this group was at least as well adjusted as its English counterpart.

The strategies used by 40 chronic schizophrenic out-patients with persistent auditory hallucinations to cope with the intrusive phenomena were explored. Frequent coping mechanisms included changes in activity, interpersonal contact, manipulations of physiological arousal, and attentional control. A high risk of suicide was noted.

Coping behaviour appeared somewhat independent of clinical and sociodemographic variables. Successful coping appeared to result from systematic application of widely used coping strategies. The implications for the clinical management of patients with persistent auditory hallucinations are discussed.

Computer linkage of obstetric and psychiatric record systems made it possible to identify all women resident in the city of Edinburgh who had given birth to live or stillborn children in 1971–7 and to study (a) the distribution of psychiatric admissions relative to the time of childbirth and (b) the correlates of psychiatric admission in the first 90 days after childbirth. Having a first baby, being unmarried and undergoing Caesarian section were all associated with an increased risk of admission; twin births, perinatal death and maternal age were not. It is difficult to account for these and other established relationships purely in psychological or purely in somatic terms, suggesting that influences of both kinds are probably involved in the genesis of puerperal disorders.

There have been recent attempts to re-define those offenders who are sufficiently dangerous to justify a longer sentence for their current offence than is normally provided in law, but there is little information about the frequency with which serious sexual offenders are reconvicted. Follow-up studies of the re-conviction in the subsequent 24 years and 15 years of those found guilty of rape, incest, and unlawful sexual intercourse with girls under 13 in 1951 and 1961 have therefore been made. The present paper deals with those prosecuted for unlawful sexual intercourse with girls under 13. The results suggest that there is a low but more persistent tendency to re-conviction than is found in property offenders.

The variations in suicide mortality in England and Wales over a 100-year period (1876–1975) are explained by the development of a descriptive model. The model used is a stepwise linear regression using 5 variables including toxic gas production. The variables give a good description of the observed changes in suicide mortality. The limitations of the method and the data are discussed. Despite the limitations of the method, it can be concluded that toxic gas production affected total suicide mortality.

Successively admitted neurotic and non-neurotic depressives were compared with respect to stressful life events experienced in the 6 months before the onset of the illness. Almost equal proportions of neurotics and non-neurotics had experienced a single stressful event. Significantly more neurotics than non-neurotics had suffered multiple stressful events. An analysis of the multiple events revealed that many were related and involved a single calamity. For multiple unrelated stressful events no significant difference was found between neurotic and non-neurotic depressions.

Assessment of the relationship of life events to minor and major affective illness is beset by several methodological problems. The reliability and validity of measures is not entirely satisfactory. When the stress concept used is that of ‘threat’ or ‘emotional distress’ it becomes of crucial importance to define clearly the criterion variable: in particular, it is necessary to distinguish normal distress responses from depressive illness. In those studies using general practice or hospital patients it is important to determine whether life events provoke depressive illness or some illness behaviour such as service utilization. Because of these problems it is still not certain that life events cause depressive illness.

The teaching of ‘clinical skills’ is generally held to be central to postgraduate training in psychiatry, but the term itself has so far escaped exact definition. In an effort to study some of the component clinical abilities, their inter-relationships, and the factors promoting their transmission, all junior psychiatrists at the Maudsley Hospital were surveyed for their views on the clinical training they had received. Three hundred and seventy three assessments on 43 units were made. Trainees perceived the academic instruction and advice on formulating cases which they had received as being quite unrelated to the quality of help with interview skills and instruction in practical management, but feedback from the consultant to the trainee on the latter's performance was necessary for a high standard of both academic and practical instruction. Encouragement to do research was transmitted independently of other clinical teaching. Over a 3-year period the standard of multidisciplinary teamwork appeared to improve, but there was a decline in the standard of academic instruction and in encouragement to do research. These overall differences were due to changes in the teaching staff, rather than alterations in teaching methods. Surveys such as this may help to define the goals of postgraduate clinical training, and also monitor the extent to which an institution is achieving these goals.

Inj. (Des-Tyr1)-γ-endorphin was used in a pilot study over a period of 12 days for the treatment of 11 schizophrenics and the assessments were carried out using standardized rating scales. Only 2 patients showed an improvement. Euphoria and excitement were observed in 3 patients. The findings are discussed in contrast to the earlier reports of a dramatic improvement with the compound.

Opiate-like neuropeptides, such as beta endorphin, have been implicated in the aetiology of schizophrenic symptoms; and the relief of some symptoms, particularly auditory hallucinations, has been reported after injection of naloxone. An opiate antagonist, naloxone 1·6 mg, and placebo were administered in a double-blind, crossover design to 13 constantly hallucinating schizophrenic patients. Naloxone was found to be no different from placebo in its effect.