Some authorities view the history of science as a sort of saltatory process in which periods of modest gain and of plodding ‘normal science’ are interrupted by dramatic leaps forward and episodes of ‘revolution’ (Kuhn, 1962). If this is so then genetics has, for the past several years, been in a phase of remarkably sustained and continuous revolution. The advent of the ‘new genetics' of recombinant DNA has resulted in new discoveries occurring at a breath-taking pace, many of which have important clinical implications. Recent findings of psychiatric relevance have included the localisation of the gene for Huntington's chorea on the short arm of chromosome 4 (Gusella et al, 1983) and the use of DNA probes in predictive testing (Harper, 1986). Advances have been achieved in the understanding of the molecular biology of Alzheimer's disease, and at least some of the familial forms of the condition appear to be linked to a gene on chromosome 21 (St George-Hyslop et al, 1987). However, perhaps the most exciting development for most psychiatrists has been the report (Egeland et al, 1987) of a major gene for manic-depressive illness linked to a marker on the short arm of chromosome 11. Could this signal the leap of biological psychiatry into a revolutionary phase? It is perhaps appropriate before attempting to answer this that we give some consideration to the recent historical background.

In commemorating the 25th anniversary of the British Journal of Psychiatry it is fitting to trace its history to its beginnings, The Asylum Journal, which made its bow on 15 November 1853. The publication of the Journal was a landmark, the prime importance of which can only be appreciated in the context of the history of the Royal College of Psychiatrists. The College itself is descended in direct line from The Association of Medical Officers of Asylums and Hospitals for the Insane, which under different titles has a continuous existence for more than 140 years, and can legitimately claim to be the oldest medical society in its field in the world.

“One spring, towards the end of March, I happened to be in Rome, and, hearing that the migration of the quails had begun, I went down to Palo on the sea coast in order to ascertain whether these birds, after their journey from Africa, showed any of the phenomena of fatigue.”

Defining chronic depression as persistent symptoms for 2 or more years, a prevalence of chronic depression of 12–15% is found in the literature. A four-part classification of chronic depression is proposed: Chronic Primary Major Depression; Chronic Secondary Major Depression; Characterological or Chronic Minor Depression (Dysthymic Disorder); and ‘Double Depression’. The literature indicates several factors predicting chronicity in primary major depression: more at risk are female patients, particularly those with premorbid neurotic personality traits, individuals with unipolar disorders, and those with higher familial loading for such disorders. Other factors are the adequacy and appropriateness of the treatment given, and the length of illness episode prior to treatment being received. Larger studies with well-matched controls are needed.

The nature and extent of psychological and social disability following head injury remain issues of considerable practical and theoretical interest. Practical because of the size of the problem and the resulting burden of care; theoretical because head injury should provide a powerful model for an improved understanding of the relationships between cerebral disorder and psychological impairment. (Lishman, 1973)

Maternal age is a neglected variable, with obvious implications for aetiology, in psychiatric research. In samples of schizophrenic patients, the distributions by month of birth and maternal age at birth show remarkable anomalies. These phenomena may be connected, because the seasonal distribution of births varies with maternal age, probably as a result of the age-dependent changes of fertility. Preliminary attempts to describe the seasonal effect in schizophrenia as a function of the shift in mean maternal age are not wholly successful at the quantitative level. Southern-hemisphere findings do not seem to fit the predicted pattern. Examples from other areas of research are discussed (sudden unexpected death in infants, congenital dislocation of the hip, and handedness) in which the seasonal distributions of births, and the findings on maternal age, conform to different varieties of the expected relationship.

Depression is unfortunately a very common illness; it is extremely unpleasant for sufferers and for their relatives and friends, and is associated with a substantial morbidity and mortality. The lifetime risk of developing depression was estimated by Boyd & Weissman (1981) as between 8% and 12% for men and between 20% and 26% for women. Estimates of point-prevalence vary, but a review of published studies suggests a level of 8.4% for men and 14.8% for women. A difference in prevalence of depression between men and women, with a twofold increase in women, appears to be well established. Recent evidence suggests, however, that the incidence of depression in men is rather more common than was previously thought: some apparent sex differences in frequency may be accounted for by a difference in coping with, and expression of, depressive symptoms (Angst & Dobler-Mikola, 1984). What is clear from the epidemiological studies in ‘normal’ populations is that much depressive illness remains untreated.

All existing treatments for depression, in particular the tricyclic antidepressants (TCAs), have drawbacks. Since the TCAs, for example, are associated with rather unpleasant and sometimes dangerous side-effects, which reduce compliance and compromise treatment, the search for new antidepressants with less unwanted effects and if possible greater efficacy remains an important goal. A recent trend in antidepressant research has been to develop compounds with specific pharmacological actions, which are selective for one of the amine systems. Currently, a number of specific 5-HT reuptake inhibitors are being developed, and some of these are now in clinical use.

The meaning of ‘melancholia’ in classical antiquity is opaque and has little in common with 20th-century psychiatric usage (Drabkin, 1955; Heiberg, 1927). At that time, melancholia and mania were not polar opposites (i.e. one was not defined as having opposite features to the other). Melancholia was defined in terms of overt behavioural features such as decreased motility, and morosity (Roccatagliata, 1973; Simon, 1978). Hence, in medical usage, ‘melancholia’ referred to a subtype of mania and named, in general, states of reduced behavioural output. These included disorders that might “exhibit depressed, agitated, hallucinatory, paranoid and even demented states … the ancient diagnosis of melancholy has no correct analogue in modern psychiatric practice …” (Siegel, 1973, p. 274).

Recently, there has been a dramatic rise in the number of case reports of multiple personality disorder (MPD). The phenomenology of the disorder is described and theories on aetiology are discussed. A review of the recent literature reveals a poverty of information on reliability of diagnosis, prevalence, or the role of selection bias. It is argued that iatrogenic factors may contribute to the development of the syndrome. There is little evidence from genetic or physiological studies to suggest that MPD represents a distinct psychiatric disorder. It is assumed that MPD is an hysterical symptom, and an attempt is made to catalogue the predisposing factors and influences that may lead to the clinical presentation.

The history of a concept of a body schema is linked with the fact that the discovery that there is such a thing as a permanent, albeit vague perception that one has of one's own body, has been mainly in observations of its pathological manifestation in the clinic.

Recent research on the factors that mediate the emotional wellbeing of the caregivers of dementia sufferers is reviewed. The roles of such factors as the caregiver's attributional style and coping strategies, the caregiver's relationship with the dementia sufferer, and levels of formal and informal support are discussed with reference to identifying those caregivers who are particularly vulnerable to emotional disorder or strain.

The literature relating to the acquisition, maintenance, and clinical significance of self-esteem reveals theoretical differences between earlier investigators. The nature of self-esteem remains controversial, and attention is drawn to some of the problems of construct validation and measurement. Despite the difficulties, self-esteem is a concept worthy of further pursuit. This will require a measuring instrument that captures the concept more effectively than those currently available.

The year 1963 was a time of innovation and excitement in British psychiatry, thanks largely to the National Health Service (NHS), which in 1948 had taken the mental hospitals from the control of the local authorities and made them part of a national service, which meant more money and far more medical staff. Rehabilitation of chronically ill patients resulted in a proliferation of out-patient clinics, home assessments, day hospitals, and even halfway houses; doors were unlocked, and informality became the order of the day. Hospitals with enough nurses demonstrated that the whole adult psychiatric service of an area could be successfully provided without a single locked door and almost without a compulsory order in a year. Medical superintendents disappeared and therapeutic communities developed. Suicide ceased to be a crime and became a new subject of research. And, of course, it was the era of successful chemotherapy, chlorpromazine in 1954 and imipramine in 1957 being the first of many drugs used.

A study of women in Islington confirms earlier findings of a high rate of reported marital violence (25% experiencing it at some time in their lives). Women who had experienced marital violence tended not to repeat the same pattern in subsequent relationships. Violence was associated with childhood neglect, but not early violence. Premarital pregnancy and teenage marriage were links between early neglect and marital violence, and were also important correlates of later marital violence, irrespective of such earlier lack of care. These early-adult experiences were also related to spending longer in a violent relationship. Women experiencing marital violence were more likely to have been depressed, and to have had low self-esteem, in the 3-year study period.

Suicide is a rare phenomenon – in most countries, it explains between 0.5 and 1% of all deaths – no more than 15 per 100 000 population. Although rates increase with age, its impact on the total mortality of the young is greater than its impact on the elderly. Despite its rarity, the subject has attracted, and continues to attract, wide interest among academics and popular writers.

The publication by the American Psychiatric Association in 1980 of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) - a text whose influence has been felt throughout the entire world and whose system of classification, particularly within the context of depressive disorders, has now been adopted by the majority of research work, no matter in what country it is implemented or published - has given the impression that an ‘American perspective’ has been substituted for the ‘European perspective’ that was predominant up to that point. However, this is a simplistic view of a complex history. Certainly, the basic methods of DSM-III originated from within those traditions which are particularly rooted in the USA, such as the quantitative approach to diagnostic criteria; these derive in the final analysis from the ‘statistical psychology’ devised by James McKeen Cattell at the University of Pennsylvania in 1887, and subsequently taught by him at Columbia University. But even among those factors which appear to be characteristically American, European origins can be detected: when he was in London, Cattell was the pupil of Galton, the founder of biometry. Furthermore, there has never existed in Europe any unanimity of opinion with regard to the problems of nosology: concepts supported in the German-speaking countries, in France, in the UK, or in the Scandinavian countries have only been partially adopted elsewhere and occasionally have remained specific to their national tradition. This paper will examine two of the fundamental points in the classification of depression which are linked to European perspectives - the notion of affective disorder and the endogenous/non-endogenous dichotomy - and will discuss the present situation created by the discordance which exists between the European and American approaches.