Many studies show that incidence and prevalence rates of schizophrenia are related to the social characteristics of the patient's environment; hypotheses—such as that of social isolation—have been invoked to account for the association, but for the most part remain unconfirmed. That the symptoms of schizophrenia or that the clinical form of the illness may also be affected by environmental factors is less clearly established. Nevertheless, some interesting observations have been made, by Benedict and Jacks (1954) and by Yap (1951) for example. Sherman and Sherman's (1934) study of delusions in a mixed American population is probably the most detailed investigation of this kind. They found that American men formulated their grandiose delusions in terms of wealth; foreign-born males did so more often in terms of literary or artistic abilities; and in negroes a religious component tended to predominate. White women were less grandiose and more paranoid than men; but in negro women the reverse was found. Hallucinations were more common in women than in men, and far more common among negroes than whites. Somatic delusions were found more frequently in white than in negro families.

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.

The invitation to give a commemorative lecture of such importance evokes feelings of gratitude and pleasure that a body as distinguished as your own should show interest in the work of one's collaborators. This is especially so for us because the field in which we work might seem, to superficial observation, to be remote from practical interests. It has long been our hope that by study of a relatively simple animal we might be able to discover some of the fundamental features of living memory systems, which have not yielded to investigation in mammals or man. Your interest encourages us to think that we may be on the right lines and I hope that in return it may be possible to tell you at least something of the principles that underlie the coding and storing of information in the nervous system. But the brain is a very complicated instrument and the problem is far from solution. The account that I shall give will be grossly over-simplified and will probably seem to present an absurdly static picture of what we all know to be a continually active and dynamic system.

The more recent and better designed studies of the reliability of psychiatric diagnosis (Schmidt and Fonda, 1956; Norris, 1959; Kreitman, 1961; Kreitman et al. 1961) suggest that the earlier pessimism may not be entirely justified. At the present time it seems safest to conclude that there are some states that some psychiatrists can diagnose reasonably reliably under some conditions. Nevertheless, even if psychiatrists could be shown to be highly reliable under optimal conditions, their diagnoses could only serve as the criterion by which to develop some more objective, public and quantitative means of classification, since the optimal conditions cannot readily be met in routine practice. It is desirable that any such quantitative scale should be reasonably compatible with existing psychiatric classification. As Eysenck (1960) has argued, “the degree of correspondence observed is of some interest in making possible the translation of experimental findings from one field to the other…. Even if there were no correspondence at all with psychiatric diagnostic classifications, this would not in any way invalidate the empirical findings”.

A hundred years ago it was generally believed by the medical profession, and particularly by alienists, that masturbation was an important and frequent cause of mental disorder. Today no one believes this; and the masturbatory hypothesis (as we may call it) has in all probability been finally abandoned. If we enquire into the history of this change we find, somewhat surprisingly, that medical references to the harmfulness of masturbation are vanishingly rare before the 18th century. For practical purposes, the whole history of the masturbatory hypothesis is contained within the last 250 years. This history is not one in which the present-day psychiatrist is apt to feel much pride. Yet it is worth studying, not only for its own sake (and the history of psychiatric ideas is a much neglected subject), but also for the light it throws on the peculiar difficulty of refuting causal hypotheses in psychiatry. The aim of the present essay is, first, to give a short history of the idea that masturbation is an important cause of mental disorder and, second, to examine some of the reasons for the rise and fall of this idea and why it persisted for so long (1).

The “mnestic syndromes” proper belong to the class of “organic syndromes” of which they are a more or less ill defined sub-group. Though memory disturbances do occur in psychogenic disorders, the mnestic syndrome has in relation to these only a differential diagnostic significance. Disturbances of memory may, of course, appear in other organic syndromes, but only when memory defects are the dominant clinical feature or the sole defect (probably quite rare) should one speak of the “mnestic syndrome”. A number of sub-types or syndromes, e.g. the so-called Korsakov syndrome, are contained in the mnestic syndrome. As the syndrome may show various types of amnesia, dysmnesia or hypermnesia, the term “mnestic syndrome” was suggested rather than “amnestic syndrome” (Conrad, 1953).

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.

The trainee psychiatrist usually looks upon patients' relatives as a nuisance. Later, he realizes that an essential part of psychiatric treatment is to mitigate the effects of the patient's illness on his family, and to protect him from injudicious interventions on the part of his friends. Finally, it may occur to him that the patient's illness might be causally linked with recent or past psychological disturbances of close associates. A review of recent researches into the relationship between illnesses of individual patients and psychological disturbances in the people around them (Post and Wardle, 7) revealed that much of the work was inconclusive, largely because the investigators had been prematurely preoccupied with some theoretical issues of interpersonal psychiatry. It was, therefore, decided to approach the subject from a practical, clinical angle.

In the clinical evaluation of new drugs, many investigators employ a simple crossover design, where half of the patients first receive the active drug for a given period of time, followed by a switch to an inert placebo for a similar period of time; the other half of the patients begin the trial on placebo, and are subsequently switched to the active drug. When the criterion measure consists of an over-all rating of, say, “Improved” or “Non-Improved”, the data lend themselves to a chi-square analysis. It is clear, however, that in many clinical circles, this analytic technique is being consistently misused, despite the fact that the various pitfalls and underlying assumptions have been widely emphasized (Lewis and Burke, 3). The purpose of this brief note is to demonstrate the proper use of chi-square, and also to show that, when incorrectly used, the clinical research investigator may increase the probability of prematurely discarding an effective drug.

There have been abundant studies of dreams from the point of view of their content, but few have examined the mode of dreams irrespective of content. For analysing and interpreting the content of dreams first-hand accounts have been used, but these verbalizations—owing to communication limitations alone—are far from identical with the dream experience. These verbalizations necessarily lump together the elements of the experience in order to provide a coherent description.

Dementia, of several types, has long been known as one of the possible fates of the alcoholic. Since Gigon and Odermatt (1925) and Shattuck (1928) called attention to the likeness between alcoholic polyneuritis and that found in beriberi evidence has accumulated of the part played by lack of B vitamins. It is now accepted that Wernicke's encephalopathy is identical with cerebral beriberi (de Wardener and Lennox, 1947) and results primarily from a deficiency of thiamine. The same brain lesions are found in Wernicke's encephalopathy and Korsakov's psychosis, allowing for the length of the illness (e.g., Victor et al., 1952; Malamud and Skillicorn, 1956) and Victor and Adams (1961) consider that Korsakov's psychosis in alcoholics is the psychic manifestation of Wernicke's encephalopathy.

Following the socio-psychiatric surveys on the Chinese population in three communities from 1946 to 1948 (Lin, 1953), similar studies were carried out in Taiwan (Formosa) from 1949 to 1953 on four aboriginal tribes. The purpose of these studies was to investigate the characteristic features of mental disorders among the aborigines and the relationship of the occurrence of mental illness to their differential levels of social development. The present paper reports the main results of the comparative psychiatric surveys on 11,442 aborigines distributed among tribal groups of different levels of acculturation.

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.

Many investigators have pointed out the social and psychological meanings of broken homes and their effects on individuals' behaviour. Goldfarb (3) stressed the importance of normal parental relationships both in ego formation and in the transfer of ego functions from parent to child. Thompson (16) maintains that the loss of a familiar perceptual framework may be as equally important as the loss of a love-object. Bowlby (2) points out that love deprivation and superficial relationships frequently lead to maladjustment and delinquency. Kardiner (4) emphasizes the importance of the social and cultural values of tender emotion as the basis of social cohesion and culture. Several research workers have found high incidences of broken homes among schizophrenics (Pollack et al., 10; Lidz, 5; Oltman et al., 8) and among neurotics (Madow and Hardy, 6; McGregor, 7). Other research workers have been concerned with the incidence of broken homes among individuals who attempt suicide (Palmer, 9; Reitman, 11; Sainsbury, 12; Batchelor and Napier, 1; Stengel and Cook, 14; Walton, 18; Teichner, 15; Toolan, 17; Simon, 13). However, the majority of the latter group of studies have lacked comparative control groups. The present study investigates several factors of social disorganization which distinguish a group of attempted suicides with a history of broken homes from a group of psychiatric out-patients who have not attempted suicide but have a history of broken homes. All comparisons will be between attempted suicides and psychiatric out-patients from broken homes.

Recent improvements in the treatment of psychotic patients (Ministry of Health, 1960; Registrar General 1957 and 1958) have, by contrast, drawn attention to the non-psychotic population of mental hospitals. This paper deals with this latter group. Their self-referent attitudes have been chosen for study as there is a persistent tradition in psychology which asserts their importance. This can be traced through McDougall (1923), the writings of Jung on Individuation (1939), Hilgard (1954), Sherif and Cantril (1947), Symonds (1951) and Carl Rogers (1951). Associated with this tradition is the concept that an important change in the attitude of a person to himself may lead to important changes in behaviour. This, if true, holds out hopes of therapeutic advance. This paper therefore studies the self-referent attitudes found in a characteristic sample population of non-psychotic patients in mental hospitals.

This paper reports the work of a clinical team on 100 consecutive first admissions to a unit constructed for the treatment of psychopaths at Balderton Hospital, Newark, Notts, and opened 1958–61. To prevent bias all male admission with behaviour disorder admitted between 1958–60 are here reported except: five admitted for observation of less than a week, twenty-two admitted only for remand, and those with a Wechsler or Stanford Binet I.Q. less than 56. The unit specialized in delinquents with mental disorder, and received admissions from all over Britain.

The problem of drug addiction is numerically a relatively minor one in this country at the present time, although the effects on the patients concerned, particularly as a considerable proportion belong to the medical and allied professions, are profound. The Interdepartmental Committee on Drug Addiction in its Report (1961) attributed our relative freedom from the problem largely to the present attitude of the public towards drugs and to the systematic enforcement of the current Dangerous Drugs legislation. In the U.S.A., on the other hand, drug addiction is a matter of national concern and there the hand of the physician treating drug addiction is controlled by Federal legislation. Tremendous efforts have been made, with only a limited degree of success, to diminish its incidence particularly during the past twenty years. Legislative measures, notably the Harrison Act of 1914, have been introduced; national committees have been set up to discuss the problem; and two hospitals (Lexington, in Kentucky, and Fort Worth) both entirely devoted to the treatment of drug addiction, have been established. As a direct result of these efforts a considerable amount of valuable information concerning drug addiction has become available, particularly as a result of the work of Isbell and his colleagues at Lexington Hospital. The addictive properties of new preparations have been assessed; the metabolic, pharmacological and biochemical aspects of drug addiction have been investigated, and research into the psychological mechanisms underlying drug addiction has been carried out.

Social medicine seeks to discover and tries to remedy pathogenic influences arising from poor housing, poverty, and occupational hazards. Similarly, social psychiatry has shown much concern with the prevalence and incidence of mental disorders in different socio-economic classes, in urban as against rural surroundings, and especially in conditions of relative social isolation or integration, which have often been found to be linked with certain areas of towns and cities. The limitations of this ecological approach have been summarized by Clausen and Kohn (1954). They were highly critical of many of the assumptions made by ecological workers, and they felt that their approach was too coarsegrained. The units studied were too big, and they suggested that a study of family relations and of more intimate interpersonal interactions would be more rewarding and more likely to shed some light on the social aspects of mental ill-health. They might have added that it would also be much more difficult.

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 relationship in the same patient of epilepsy and psychosis is little understood. Although patients with temporal lobe epilepsy especially tend to show more psychiatric disturbances than do other epileptics, it is still not agreed whether an “epileptic psychosis” exists in its own right, any more than whether there is such an entity as the “epileptic personality”. The literature is full of contradictory statements and hypotheses. This is inevitable considering that epilepsy is a symptom-complex of diverse aetiology. However, within the total population of epileptics, it is possible to define groups with one or more common characteristics, e.g., similar pathology, localization, symptomatology, or inheritance. In studying the psychiatric manifestations it is probably better to try to relate them to such sub-groupings than to epileptics as a whole. The problem is of practical concern, for the incidence of epilepsy is between 0·4 and 0·5 per cent. of the general population (College of General Practitioners, 1960), while Pond and Bidwell (1959) in their survey of the practices of 14 family doctors pointed out that about a third of the epileptic patients had psychological difficulties.