Is leucotomy “one of the best treatments we have” or is it “sheer unadulterated barbarism”? These are two of the many points of view expressed to me whilst I was collecting material for this paper.

This is an attempt to describe a clinical syndrome which has hitherto received very little attention. It is widespread in Africa and has important medicolegal implications.

This paper, by a general practitioner and a psychiatric social worker, is based upon an investigation, at present in progress, into the influence of the family upon children's achievement and emotional adjustment, which is supported by the Mental Health Research Fund and supervised by Dr. D. A. Pond. In the present paper we are reporting on some of the data collected from part of the population being investigated. The main survey will include all families registered with the general practitioner (A.R.) where the head of the household is in Social Class III, IV or V, in which there are children born between 1949 and 1954, and from which at least one parent is also registered. From the first 70 families visited in this survey 50 couples, including those who cohabit but are not legally married, have been selected for the present study. The 20 excluded families consist of five where only one parent is registered with the G.P., four where the mother is separated or divorced, three unmarried mothers, and two families where one parent has died. Failure to co-operate fully, which seems more common in families known by the G.P. to be disturbed, led to the exclusion of six further families.

The Underwood Report (12) drew attention to the need for some system of classification in child psychiatry. This paper presents the results of a statistical study which was undertaken as relevant to that general enquiry.

The purpose of this paper is to describe the manner in which psycho-analytical concepts and theory may contribute to the difficult problem of diagnosis in schizophrenic reactions. At the present time there is an increasing realization that the criteria which are used in the diagnosis of these conditions are unsatisfactory, not only because they have a low prognostic significance but also because they fail to provide the research worker with discrete clinical concepts which he can use in physiological or psychological investigations. As Stengel (1960) has pointed out, the criteria employed in the diagnosis can vary extensively within the same hospital quite apart from the inevitable differences which exist within the one country and from country to country. It is the wide variation in what is called schizophrenia which has vitiated so much important and worthwhile research in clinical psychiatry.

A comparative study of the work performance of normal and schizophrenic workers was undertaken in the Rehabilitation Unit of Cheadle Royal Hospital. (Wadsworth, Scott and Wells, 1961). A group of 12 long-stay schizophrenics with a mean duration of hospitalization of 17 years, ±12·3 were matched with 12 normal subjects recruited to perform a normal industrial task. The task studied was the assembly, by gluing, of crepe to board; one of the initial stages in the manufacture of a carnival hat. The purpose of the study was to obtain comparative data that would help one to produce indices of employability, rather than to make evaluative statements which would relate only to mental hospital standards.

To make a comparative study of the fatiguability of chronic schizophrenics and non-psychotic depressives and to test Kraepelin's hypothesis that schizophrenia is typified by rapid and acute fall-off in work performance (Kraepelin, 1910). Kraepelin's explanation of the cause of this fall-off was in terms of constriction of volition. However, on the basis of operational definitions, there appears to be little justification for regarding the phenomenon as other than a special case of fatiguability.

This study is intended to yield information about the type of task that a chronic schizophrenic might be expected to succeed at and, conversely, the conditions under which their disabilities are magnified. The primary purpose is to obtain data to act as a guide in the design of work for such patients, and secondly to produce more general information about the differences between the normal person and the chronic schizophrenic on sequential operations. The task studied involved primarily both long and short-term memory functions, together with the associated processes of attention.

Over the past few years, workers in many diverse fields have become interested in the framework of the psychiatrist-patient relationship as a matter for study in its own right. Yet the pattern of professional opinions, conveniently subsumed under the term “orientation”, which the psychiatrist brings with him to the clinical situation, has received very little attention. In this paper an attempt will be described to measure certain aspects of psychiatric orientation, and to explore how these may be correlated with other variables.

The common ground between neurology and psychiatry is regrettably slight, but in either field there have been men who sought to bring about a rapprochement between them by evolving broad conceptions of the structure of mind. For example, Hughlings Jackson's concept of “levels” and Freud's description of the mind in terms of Ego, Super-Ego and Id are both essentially attempts to define and classify the intellectual and behavioural functions of the brain, so as to form a coherent basis for the study of the interactions and disorders of these functions.

This paper represents an attempt to measure the reliability of the clinical assessment of the reaction to pain and further to estimate the significance of this reaction in a group of chronic schizophrenic patients.

While anomalies of sensory and perceptual responses characterize many mental disorders it is only recently that any serious attempt has been made to investigate them experimentally.

Overinclusive thinking has been regarded by some authorities as an important aspect of the thought disorder found in schizophrenic patients (8). Norman Cameron (2, 3, 4, 5), who performed the pioneer studies in this field, defined overinclusive thinking as the inability to preserve conceptual boundaries, as a result of which distantly associated and even irrelevant ideas come to be regarded as essential parts of a concept. This abnormality necessarily makes thought more abstract and less precise. Furthermore, it can lead to overlapping concepts which share elements in common, when, normally, they should be mutually exclusive, a situation which allows the thought-disordered person to entertain two mutually incompatible ideas at the same time without recognizing the contradiction.

One of the obvious requirements of a clinical test which purports to assess any aspect of the impairment of behaviour is that of cross-validation; it should be able to discriminate between different groups of patients similar to those on which it was first standardized. This paper reports such cross-validation of a paired-associate learning test which Inglis (1959) has shown to discriminate between groups of elderly psychiatric patients with and without memory disorder.

Former attempts to restore weight loss in psychiatric patients have included hyperalimentation (Weir Mitchell, 8) and sub-coma insulin therapy (Debenham et al., 2; Sargant and Craske, 5; Sullivan, 7). The aim of the present trial was to compare weight gains in a group of patients given repeated small doses of insulin with two other groups to whom oral hypoglycaemic agents were administered, and with a control group. The drugs used were tolbutamide and chlorpropamide, both of which are sulphonylureas used in the management of diabetes mellitus, and known to induce hypoglycaemia in non-diabetic subjects (Hoenig and Gittleson, 4; Cardonnet et al., 1; Garcia Reyes et al., 3). Pharmacologically there are no qualitative differences in their mode of action. Stowers et al., (6) found the half-life of tolbutamide to be 3·5 hours and that of chlorpropamide 34·5 hours. The prolonged action of chlorpropamide permits once daily dosage, but tolbutamide, being a shorter acting drug, was given in divided doses to maintain depression of blood sugar over the 24 hours.

In view of the reports of Mendigutia et al. (6), Delay et al. (3), Kamphausen (5), Harenko et al. (4), Alleva (1), that haloperidol was very effective in controlling manic states, it was decided to treat a number of cases with this diagnosis using this new preparation.