Previous studies on schizophrenia in twins have quite recently been reviewed in detail by Gottesman and Shields (1966a) and Shields (1968). The indications of concordance in different series are highly diverging, in monozygotic pairs ranging from near unity to zero. The high concordance rates found by Luxenburger (1928), Kallmann (1946) and Slater (1953) stress the importance of genetic factors in the aetiology of schizophrenia, whereas the low concordance rate in two recent Scandinavian twin series (Tienari, 1963; Kringlen, 1966) has given rise to the question whether special genetic or environmental factors prevail in some populations. It has, therefore, been found of interest to study schizophrenia in a Danish twin population.

This paper reports a case which is noteworthy for two unrelated reasons, one genetic and the other therapeutic. The genetic interest lies in the rare instance of an identical twin with obsessive compulsive neurosis whose twin brother had a similar illness. The therapeutic interest focuses on clinical changes which occurred during unsuccessful treatment by desensitization and by aversion relief. These changes aid our understanding of compulsive behaviour and the difficulties in its treatment. At one stage in treatment independence was noted between anxiety and compulsions which suggested that compulsive behaviour need not always be maintained by its anxiety-reducing properties. The case history will first be described and discussed from the genetic point of view. The second part of this paper will focus on the unrelated aspect of treatment.

Thought disorder has always been regarded as an important symptom of schizophrenia. Attempts have been made to measure it by means of psychological tests: patients who manifest thought disorder clinically have been found to perform idiosyncratically on tests of concept-formation (1). The purpose of the first part of this investigation was to confirm the already established finding that schizophrenics, as a whole, are more thought disordered than controls. Not only were patients tested, but also their first-degree relatives; this aspect of the investigation, however, will be dealt with in the second part of the paper.

In a recent review (Dewhurst, El Kabir, Harris and Mandelbrote, 1968) the evidence relating the effect of stress to thyroid function has been surveyed. In that account the comment was made that although it is impossible to assess or quantify the psychological trauma that any mentally ill patient is undergoing, it would seem reasonable to assume that if emotional stress is associated with abnormal thyroid activity, then a study of thyroid function in mentally ill patients would reveal such abnormal activity. In the present work a study has been made of the function of the pituitary–thyroid axis in control subjects and in patients suffering from schizophrenia and affective illnesses. Since there is strong evidence that emotional stress in many cases affects endocrine function through the mediation of the hypothalamus and anterior pituitary gland, measurement of the blood concentration of thyrotrophic hormone (T.S.H.) has been used in the present investigation. A further reason for assaying the blood concentration of T.S.H. is that measurement of many of the more direct parameters of thyroid function are subject to variables which are difficult to control. Studies of the blood level of T.S.H. in psychiatric patients have not, so far as we know, been carried out previously.

During the course of routine investigations it was noticed that an abnormal number of low serum cholesterol results were occurring in our laboratory, and that these results appeared to come from mentally retarded patients. An investigation was therefore carried out on over 1,400 patients in the Stoke Park Group of Hospitals. Whenever blood was taken for routine haematological examination a serum sample was also collected for cholesterol determination. A preliminary report of these findings was made (Eastham and Jancar, 1967).

Mayer-Gross, Slater and Roth (1963) distinguish two ‘affective conditions’: affective Constitution and affective Disorders. The former comprises three personality types: (a) the hypomanic or hyperthymic, (b) the depressive or dysthymic and (c) the cyclothymic; the latter embodies the manic-depressive disorder of Kraepelin.

The impression that alcoholism is common among the Irish is a very old one. It has been given some scientific basis by comparative studies of alcoholism in various ethnic groups in the United States. Thus, Hyde and Chisholm (1944) found that the rejection rate for enlistees in the United States army because of chronic alcoholism was higher in the Irish than in any other national group. Confirmatory evidence came from Malzberg (1940) in a study of first hospitalization rates for various diagnostic categories in New York State, and Roberts and Myers (1954) in a prevalence study in New Haven found that the Irish had a far higher proportion under treatment for alcoholism and drug addiction than other national groups.

In an earlier investigation, Hassall and Foulds (1968) demonstrated certain differences between a group of alcoholics of 30 years and under and a matched control group. Such a group is not, of course, representative even of those alcoholics who come to psychiatric treatment. The present investigation was concerned to assess a wider range of such alcoholics, and try to determine whether any differences which might be found within this group could be attributed to chronological age, to age of onset of excessive drinking, or to length of time during which excessive drinking had been taking place.

“Blackout”, a confusing term sometimes denoting amnesia and at other times unconsciousness, has come in the alcoholism literature to designate memory loss associated with drinking alcohol. That alcoholics frequently experience amnesic episodes has been recognized since Bonhoeffer's time, and more recently Jellinek (1952) and others have popularized the notion that blackouts are an important predictor of alcoholism, a conclusion based on questionnaire data indicating that blackouts occur early in the course of alcoholism, well before the appearance of other alcoholic symptoms. Jellinek also believed that alcoholics often had blackouts after ingestion of modest, subintoxicating amounts of alcohol.

This report is based on a study carried out at the Unit for the Treatment of Alcoholism, Royal Edinburgh Hospital. The unit and its orientation has been described elsewhere (Walton, Ritson and Kennedy, 1966; Ritson and Smith, 1967). It is usual for patients to stay in hospital for six weeks rather than the three to four weeks that was the practice earlier (Walton et al., 1966).

Industrial rehabilitation of mentally ill patients was pioneered by Early in his highly successful Industrial Therapy Organization at Bristol. In this organization patients are first industrially trained in the hospital and then progress to a training factory situated in the community.

One major characteristic of behaviour disorder is persistent hostility towards authority. Those offenders who appear repeatedly before the Courts and are eventually diagnosed as cases of behaviour disorder, almost uniformly exhibit histories of difficulties with authority (8). Indeed, when a study was made of 87 case-notes of patients in a hospital for the mentally subnormal who were admitted as suffering from behaviour disorder, in order to discover those features of their previous histories which were common to all, it was found that every one showed a persistently troublesome relationship with authority figures (9).

Bi-temporal electrical convulsive therapy has been used extensively in psychiatric practice since its introduction by Cerletti and Bini in 1938. There are undesirable side effects, principally memory disturbance and confusion. The organic changes in the brain following E.C.T. are not yet understood, although some E.E.G. work has been carried out on this aspect (Martin et al., 1965).

There is considerable disagreement in the literature and in clinical practice on the value of electro-convulsive therapy (E.C.T.) in hysteria. The case to be described adds support to those who believe that E.C.T. has a part to play in carefully selected cases of hysteria that have proven resistant to more orthodox lines of treatment.

In the biological and social sciences the research worker is frequently faced with a two-dimensional, entity by variable, matrix of numbers. The matrix may contain scores of persons on tests, judgments of persons or objects by persons, measurements of physical characteristics of insects, economic statistics of areas, party votes in electoral districts, demographic or epidemiological or ecological counts of areas, and so on.