In the development of psychiatry, the paths in our two countries, Great Britain and France, have often run parallel, have frequently come into contact, yet each has retained its individuality and with it a nuance of its own. Pinel, freeing the “aliénés” of Bicêtre from their chains, and William Tuke, establishing the York Retreat, were effecting at almost the same time the same revolution in the treatment of the mentally ill, but the philosophical backgrounds of their actions were different; and though the Royal Medico-Psychological Association and the Société Médico-psychologique are of about the same age, their journals reveal that the preoccupations of their members are not absolutely identical. Certainly the interpenetrations have been fruitful. In establishing in Edinburgh, in 1823, the first formal teaching of psychiatry in this country, Sir Alexander Morison had been influenced by the example of Esquirol, his old master; and Théodule Ribot, the founder of modern French psychopathology, had found his conceptual model and his inspiration in the works of English psychologists, to whom he eventually dedicated a volume which became a classic. But too often, in an age which prides itself on having elevated the study of communications to the rank of a science, the diffusion of information meets obstacles which are more than material or linguistic, and a true medical particularism comes into being. The cultivation of national scientific traditions is a sign of creative originality; but, just as the virtues of hybridization have been demonstrated by the geneticists, the advantages stemming from a knowledge of the efforts and the results of other schools are not negligible for psychiatrists. In this paper I am going to attempt to contribute to this mutual understanding by presenting the recent major trends of French psychiatry.

In 1897 Ganser delivered a paper entitled “Concerning an Unusual Hysterical Confusional State” in which he described three prisoners who developed transitory symptoms of mental illness. The main features were disturbances of consciousness with subsequent amnesia for the episode, prominent hallucinations, sensory changes of an hysterical kind and, on questioning, peculiar verbal responses which have come to be regarded as the hallmark of the Ganser state. The illness terminated abruptly with full restoration of normal mental function. Despite Ganser's designation of the condition as hysterical, controversy over its precise nosological status has persisted over the past sixty-odd years. Is it in fact a form of hysteria, or is it a psychotic illness of brief duration? Is the hysterical pseudo-dementia described by Wernicke (1906) identical with or distinct from the Ganser syndrome? What is the relationship, if any, of the symptomatology of the Ganser state—the often-described “vorbeireden” and “approximate answers”—to the disordered thought of the schizophrenic and the dysphasia of the patient suffering from organic brain disease? Is it a fact that the Ganser syndrome occurs most frequently in patients in military or civil prisons and is rare in the non-delinquent population? To these and other problems the standard textbooks of psychiatry return conflicting answers.

The Body Image is our concept of the shape, the size and the mass of our body and its parts. It allows us to evaluate the space which our body occupies, and thus enables us to move about freely in our environment.

This paper reports and discusses the occurrence of transvestism in three members of the same family, over two generations. No similar series of cases has been found in the literature. Lukianowicz, in his survey of the subject, mentions two cases in which there was a suspicion of transvestite tendencies in another member of the family. Taylor and McLachlan mention that two brothers of one transvestite in their series were said to have symptoms similar to those of the patient. They located one of the two, but decided not to include him in their series because “his cross-dressing was not without strong and persistent criminal motives. He posed as a prostitute and carried a weapon with him to assault his ‘customers' before robbing them.”

There is still much disagreement about the best way to treat patients with phobic states. Until recently, drugs and various forms of psychotherapy have mainly been used. Lately, behaviour therapy has also come into use, as graded retraining in practice (Meyer and Gelder, 1963), or as desensitization in imagination (Rachman, 1959; Wolpe, 1961). Since few investigations have included adequate control groups, results such as those of Wolpe (1961) cannot indicate whether behaviour therapy is an advance on existing forms of treatment.

It has recently been pointed out by several authors that the psychometric assessment of the elderly patient has largely been geared to, or preoccupied with, the solution of diagnostic problems, measuring deterioration or discovering early dementia (Post, 1966; Inglis, 1962). Therefore, it appears that little attention has been paid to the use of psychometric tests in the broad area of prognosis. Often the psychiatric diagnosis of an elderly patient is quite clear, and in these circumstances it would be valuable to be able to discern reliable and significant changes in the cognitive status of such patients. For example, it may well prove quite significant, prognostically, to measure the rate of change in cognition of an elderly person suffering from a progressive cerebral disease. The rate of decline could be a prognostic indicator for the future disposal of the patient or for impending death. A variety of studies have shown that scores on measures of physical and cognitive abilities can predict death or discharge from hospital (Cosin et al., 1957; Inglis, 1959; Kleemeier, 1961; Kral, 1963). In the case of patients suffering from depressive “pseudo-dementia” (Post, 1965) it will probably be valuable to know if their cognitive status reflects changes in their clinical status. But probably the most important aspect of the psychometric assessment of the geriatric patient will be found to lie in measuring changes in function which may be the sequelae of treatment affecting brain function in general, i.e. anti-depressant preparations and electroconvulsive therapy.

This report evaluates the use of the Hamilton Rating Scale for Depression (HRS) (5) in a general medical in-patient population; it is one part of a comprehensive study of depression in these patients (10, 11). The Hamilton Rating Scale was designed to measure the severity of depression in patients already diagnosed as having depressive illness. Hamilton (5) states, “the scale quantifies the results of an interview and is of practical value in assessing the results of treatment.” Recently, the HRS has been used for measuring psychiatric patients' responses to antidepressant medications (7, 9, 12), but there are no reports of its use with medical patients.

The confusion over the definition and nosological status of hypochondriasis has been stressed by many authors. Jelliffe (1931) refers to it as “a strange child in the psychopathological family”, and Macalpine (1953) uses the phrase “a stepchild in psychiatry proper”. It has been described in terms of the disturbed attitude to health and to doctors and also in terms of the symptoms presented. Factor analysis is a method well-suited to the examination of such a problem and has been used to investigate psychiatric syndromes in order to dissect out the symptom clusters which have been subsumed under a single blanket term. (Hamilton, 1960, Friedman, 1964; Overall, 1962).

Bene (1965) in a previous issue of this Journal, has summarized the main evidence for the view that homosexuality is a product of defective role training and is not a result of any direct genetic mechanism. It is becoming apparent that once a child has been pronounced as a boy or a girl it has to learn the forms of behaviour appropriate to its ascribed sex. The learning or conditioning mechanism by which the child learns to make its role performance congruent with its' ascribed sex is not understood. Comfort (1964) has suggested that sex-typing may be some form of imprinting. Hampson (1965) investigating several types of hermaphroditism has found evidence that if the gender role has to be changed after about the third year of life, increasing psychological difficulties are encountered. He also points out that the development of the gender role coincides with that of language.