Considerable claims have been made for behaviour therapy, but the evidence for its effectiveness is still conflicting. There are several reasons for this. First, although behaviour therapy is a convenient term to describe treatments which reputedly share a common derivation from learning theory, it describes techniques which differ widely from one another in practice, and which at the same time have features in common with other forms of psychotherapy. Secondly, behaviour therapy has been applied to a variety of neurotic disorders, ranging from writer's cramp to phobias, and these syndromes often have distinct natural histories. Any general statement about the value of behaviour therapy in a mixed group of neuroses is therefore of limited value. Thirdly, the well-known tendency of neurotic disorders to respond to energetic and enthusiastic treatment with non-specific methods makes it difficult to assess the results of treatment unless a matched control group is included in the investigation, or, in the absence of a control group, an exceptionally high rate of recovery is obtained.

The establishment of a classification of affective disorders commanding wide agreement among clinical practitioners and investigators is one of the most pressing needs of contemporary psychiatry. This group of conditions has, in recent decades, displaced schizophrenia from the centre of the clinical stage. However, despite its prominence and importance in clinical practice, the territory remains inadequately charted. There is evidence to indicate that the uncertainty about the most clear and convenient lines of demarcation within this clinical territory makes a large contribution to the unreliability of psychiatric diagnosis. Thus, in a recent enquiry (Sandifer, Pettus and Quade, 1965) into the reliability of diagnoses made in 91 first admissions to a mental hospital by ten experienced psychiatrists, it was shown that the resolution of disagreement in the areas of “psychoneurosis—affective disorder” and “psychoneurosis—personality disorder” would have raised the overall reliability of diagnosis in this enquiry from 57 per cent. to 83 per cent.

The aim of this study was to evaluate changes in selected personality variables following a form of leucotomy described as orbital undercutting (Knight, 1959) and to relate these findings to clinical observations.

Jealousy is a complex emotion which most people have experienced at some time in life, at least during adolescence, and yet it is hard to describe precisely. Freud (13) said it is compounded of grief over the loss of a loved object, pain due to the narcissistic wound, feelings of enmity against the successful rival, and of a greater or lesser amount of self-criticism in holding oneself accountable for the loss. Even normal jealousy, Freud said, is by no means rational and is neither under conscious control nor necessarily proportionate to the external situation out of which it seems to arise.

It has been shown that in depressive states (Sedman and Reed, 1963) and in schizophrenia (Sedman and Kenna, 1963) there is an association between the occurrence of depersonalization, a premorbid insecure personality and depression of mood.

The study to be reported was carried out within the framework of Personal Construct theory as proposed by Kelly (1955) and summarized in Bannister (1962).

Physiological research has shown the fundamental importance of electrolytes in the functioning of the cell. According to the ionic theory, the resting and action potentials of nerve and muscle cells depend on potassium, sodium, chloride and other ions having a different concentration inside the cell to the concentration they have in the extracellular fluid. The cell membrane is freely permeable to potassium and chloride, but is much less permeable to sodium, and there is active transport of sodium which keeps the sodium concentration within the cell at about 1/10 of the concentration of sodium in the extracellular space. Because of this uneven distribution of sodium and the presence within the cell of impermeable anions (such as glutamic acid), potassium and chlorine are also unevenly divided between the cell and the extracellular fluid; potassium has a very high intracellular concentration and chlorine a low intracellular concentration compared to their concentration in the extracellular space.

The present study formed part of a larger one designed to compare the mental health of people living on a new housing estate in Croydon with that of people living in an older district of the town (Hare and Shaw, 1965). In the course of the study, information was obtained by interviewers and from general practitioner records on the health of nearly 500 families in which there was at least one parent living with one or more children (under 16 years). We were able to examine the health of the parents and their children in relation to various family factors, and it is the aim of the present paper to examine the association between health and family size.

“That the deceased took his life while the balance of his mind was temporarily disturbed” has been the Coroner's traditional verdict in cases of suicide; a verdict adopted to circumvent retribution by society and particularly to allow of burial in consecrated ground and avoid forfeiture of property to the Crown (Williams, 1958). There is a distinction between such a finding with its legal import and that of the psychiatric assessment, and this must necessarily affect psychiatric studies undertaken in the endeavour to understand the state of mind of the person who encompasses his own death, or to examine the wider implications of suicide in relation to the epidemiology of mental illness. Public opinion and cultural pressures have their effects on coroners' verdicts; and guilt or shame on the part of relatives or medical attendants may result in distortion or concealment of information.

I am sincerely grateful for the honour you have bestowed on me by the invitation to deliver this year's Maudsley Lecture. It means all the more to me as this Association made me feel at home almost from the day I came to this country more than twenty-six years ago.

Iohannes Cassianus, more commonly known as John Cassian, wrote his treatise De Institutis Coenobiorum et de Octo Principalium Vitiorum Remediis Libri XII around the beginning of the fifth century A.D. This work is important because it introduced certain Eastern ideas into Western thought. Some of these ideas are of considerable psychiatric interest.

Although the efficacy of chlorpromazine and other phenothiazine derivatives in the treatment of schizophrenic psychotic reactions has been established for almost a decade, there remain differences of opinion regarding which symptoms and behaviours are affected favourably by psychopharmacologic treatment. By and large, the phenothiazines have been characterized as “ataractics” or “tranquillizers”, the implication being that their predominant action is to calm excited patients by relieving the patient's anxiety or other forms of psychic distress. However, clinical experience increasingly asserts that the phenothiazines influence many manifestations of schizophrenic patients other than anxiety and excitement, including symptoms such as incoherent thought and apathy.

Before Freud, homosexuality was usually thought to have constitutional causes. Indeed, some recent studies have again proposed that genetic factors play an important role in its aetiology. Kallmann (1952), for instance, studying forty male homosexuals with identical twins, found that 39 of the twins were also homosexual. Slater (1962) suggests that homosexual patients tend to be the younger children in their families and to have elderly mothers, so that they might have been born with chromosomal abnormalities. There is, however, a growing tendency to assume that one of the causes of homosexuality is the lack of normal childhood relations with the parents. Fenichel (1946) suggests that homosexuals tend to be mother-fixated and to have identified with their mothers because, while their fathers were weak, their mothers were domineering, and psychoanalysts, in general, agree with his views. West (1959), who compared homosexual and heterosexual in-patients in a mental hospital, found that the combination of an over-intense relationship with the mother and an unsatisfactory relationship with the father is typical for the homosexual. Bieber et al. (1962) compared homosexual and non-homosexual patients in psychoanalysis. They claim that in the majority of cases the behaviour of the mothers of homosexuals toward their sons was seductive and over-indulgent, domineering and inhibiting, while the behaviour of their fathers was hostile, ambivalent or indifferent. O'Connor (1964) compared homosexual patients with heterosexual neurotic ones, all of whom were serving in the Air Force. He found that a high proportion of the homosexuals had, in their childhood, poor relations with their fathers and had been more attached to their mothers, though some had not got on well with their mothers either. He also reports that a number of the homosexual patients were raised in foster-homes, while none of the heterosexual ones were. The main difference between his two groups was that a much greater proportion of the homosexuals did not have normal relationships in their childhood with their fathers. West (1959) quotes Liddicoat (1956), whose subjects were non-patients and who found that unsatisfactory relations with the father were more common in her sample than undue attachments to the mother. So did Westwood (1960), whose subjects were also recruited from among non-patients, and who states that many homosexuals from his sample had over-possessive or over-protective mothers, but even more had inadequate or absent fathers.

A study was made of 57 suicides committed by mental hospital patients in Helsinki in the period 1952 to 1963 (Achté, Stenback and Teräväinen, 1965). This report is concerned with the frequency of physical disease, hypochondria, and alcoholism in these 57 suicides.

Since its introduction by Cerletti and Bini in 1938 electroconvulsive therapy has become a major bulwark of therapy in psychiatric practice. Until a few years ago, before the introduction of the psychotropic drugs, it was the commonest method of physical treatment employed in psychiatry.

This paper deals with information obtained from nearly five hundred families in which at least one parent was living with one or more children aged 15 or under. It examines the association between the health of fathers and mothers, and also between that of parents and children. Elsewhere (Hare and Shaw, 1965a) we showed that, in the sample population from which these families came, there was a strong tendency for persons with poor mental health to have poor physical health as well.∗ We took this to support the view that in any population there tends to be a group of persons, comprising some 10 to 15 per cent, of the whole, who are particularly prone to ill-health of all kinds and who make a correspondingly high call on the facilities of the health service. One of the objects of the present study was to try and determine if there were families, as well as persons, prone to ill-health—in other words, whether a high rate of ill-health in (say) fathers was associated with high rates in other members of the family.

Seventy-six male patients referred to the Maudsley Hospital with a primary complaint of impaired sexual potency were studied in order to define the natural history of these conditions (to be reported). Two of the patients who complained of impotence were found to have intracerebral tumours. In the first case the tumour was limited to the temporal lobe: in the second case it was situated in the posterior part of the frontal lobe.

Patients who do not comply with therapeutic procedures have been of longstanding concern to the clinician and have presented knotty methodological problems to those involved in evaluating the effectiveness of different treatments and treatment modalities (1, 2, 4, 6, 10, 11, 12, 13).