For the purposes of this paper the South-East Asia region has been taken to include India, Ceylon, Burma, Thailand, Indonesia and the Philippines. The region thus demarcated is not merely an area of geographic contiguity but also comprised almost entirely of developing countries involved in a process of social change as a result, principally, of exposure to the West. The traditional economy of agricultural self-sufficiency in all these countries is coming to be replaced increasingly by an industrial economy which is essentially tied up with world trade. Most of the countries in the region have emerged from a colonial status into independent states with a renascent and sensitized nationalism. There is in these countries abundant enthusiasm for new goals set up after achieving independence; but this is dampened with a sense of self-doubt that prevails as much amidst the leaders as amidst the led. Thus in this region a generation of people appears to be trying to outlive its history and live on hopes for a new future.

When a Western-trained doctor first encounters the practice of medicine in the Third World, he cannot fail to be impressed by the apparently limitless sea of morbidity—infection, faulty sanitation, malnutrition, congenital and acquired malformations—with which a very small number of trained personnel have to cope, as best they can. In public health planning of these countries priority has to be given to arresting the killing diseases, such as malaria, tuberculosis and other deadly infections, and to the provision of basic hygiene, of pure water, and of adequate nutrition. The next priority goes to deploying preventive measures against debilitating disease, wherever such measures are known, and their application has been shown to be feasible; and finally when the expectation of life has been satisfactorily increased, attention is given to interventions which improve the quality of life.

Longitudinal studies of psychiatric disturbance in communities are important in order to determine the natural history of mental disorders. Most studies have focused on the prevalence of known psychiatric disorders and response to treatment, but only a few on the follow up of a population not previously recognized as psychiatrically ill (Beiser (1), Hagnell (5), Helgason (6), Myers and Bean (10)). The present study is an attempt to do this, and also to follow up untreated disorder within a community.

One of the better known facts about suicide rates is their remarkable stability in terms of the sex of the victim, the methods used and the age-specific rates in different societies over considerable periods of time. Suicide studies suggest that the frequency and methods of suicide are determined largely by the culture, social mores and a number of other factors— possibly demographic—which remain relatively stable over fairly long periods (Whitlock, 1971). Methods of suicide can vary from country to country (Dublin, 1963; Stengel, 1964). In Australia, there has been a remarkable consistency in the major methods of suicide throughout this century (Saint, 1965), although Hetzel (1971) has pointed out the marked rise in rates from self-poisoning in the last twenty years. Burvill (1970) has contrasted the methods of suicide in Western Australia with those reported in America and Britain, as has Whitlock (1971) among the various immigrant groups in Australia, although he warned that his results were based on comparatively small numbers of suicides in minority population groups. Overall age-standardized suicide rates among immigrants to Australia are substantially higher than those prevailing in their country of origin and among the Australian-born population (Whitlock, 1971; Burvill et al., 1972).

The different classifications of homicide used make comparative studies difficult. For our purposes we will sub-divide homicide as follows: (i) ‘Abnormal homicide’, comprising (a) ‘murder-suicide’ in which the murder suspect commits suicide, and (b) ‘abnormal murder’, comprising cases where (i) the murder suspect is mentally ill, or (ii) the court returns a verdict of manslaughter by reason of diminished responsibility. (2) ‘Normal homicide’, a term we will use synonymously with ‘normal murder’, i.e. murder committed by the mentally normal.

The experience of another person is never directly available to us, just as our own experiences cannot be directly experienced by other people. ‘We're all of us sentenced to solitary confinement inside our own skins' (Tennessee Williams). We can use empathy to get closer to another person's experience; in other words we imagine ourselves in the same situation as he is in and credit him with the feelings we would then experience. However, it is invariably our own experience that we use as the yardstick. We judge another person's experience from his behaviour, of which speech is one of the most informative parts. If another person says, ‘I see a man’, and there is indeed a man in our shared visual field, then both of us assume we are sharing a common perceptual experience. When there is no external referent, as in the statement ‘I feel sad’, the assumption of a common experience rests on more tenuous grounds. We can sometimes look to an external situation, like the loss of a close relative, to confirm that we understand the statement in the same way. But on many occasions there is no readily understandable link between a person's mood and the situation in which he finds himself. In judging a person's mood we also depend a great deal on non-verbal accompaniments of emotional states, but these are known to vary from culture to culture and from individual to individual. The movements used to express emotion, particularly those of the face, are so complex that very few attempts have been made to describe and categorize them accurately. There is a paucity of studies of this kind between Charles Darwin's pioneering work of 1872, which attempted to show the similarity of emotional expression throughout the races of mankind, and the recent work of Ekman and Friesen (1968) and Grant (1970). The few systematic studies in the intervening century do not support an invariable pattern of expression accompanying specific emotions. However, Ekman et al. (1969) found that subjects from literate cultures accurately identified emotions from photographs of the face, although subjects from pre-literate cultures showed much less agreement.

There is a wide variety of training programmes in psychiatry in the United States. There are such programmes at most well-known Medical Schools and Universities; at various clinics, some of international reputation; at the psychiatry departments of many large city hospitals, and at many of the state hospitals.

Diurnal variations in symptom intensity have long been recognized as a characteristic feature of depression, and have always had a prominent place in clinical descriptions of the illness. A worsening of depression in the morning has classically been associated with endogenous depression, while a worsening in the evening has been described as characteristic of reactive or neurotic depression (Kiloh and Garside, 1963; Winokur, Clayton and Reich, 1969). Yet, in spite of the widely held belief of the diagnostic relevance of diurnal patterns, little systematic research on these patterns has been reported.

In a previous paper (Tresise and Stenhouse, 1968a), the authors quantitated the normal time response patterns in the phases of electroplexy, where the four anaesthetics, methohexitone sodium, thiopentone, amylobarbitone sodium and diazepam were used in sub-anaesthetic doses. Patients treated without anaesthesia were included in the study. The dependence of the times of subsequent events on the time of clonus onset in the orbicularis oculi muscles were also established. The statistical technique employed in that study was simple linear regression. The interrelationships between the various factors indicated the desirability of extending the study by the use of multiple regression techniques. This paper presents the results of the extended study.

In an earlier study this research group reported iprindole, a relatively new tricyclic derivative, to be an effective drug for use in depressed neurotic out-patients (ii). We found it to produce significantly greater improvement than placebo on a variety of outcome measures. Good response to iprindole as compared to placebo has also been reported by Hicks (5) and Daneman (3). Sterlin et al., comparing iprindole with amitriptyline in a relatively small patient sample, reported that iprindole, while faster acting, produced less overall improvement (15); differences in improvement did not, however, reach statistical significance.

The question whether schizophrenic mothers have increased risk for obstetric complications (OCs) has practical relevance to fertility recommendations and obstetric surveillance for such women. From a theoretical viewpoint the study of OCs in schizophrenic women concerns the possible relationship between tension-anxiety and OCs, and, additionally, whether the offspring have an increased risk for disturbance based at least partially upon an increased incidence of OCs. Recent evidence suggests a relationship or interaction between genetic factors contributed through family lineage and OCs attending the gestation of genetically-high-risk offspring. Increased OC rates have been found to be differentially characteristic of the pre-schizophrenics or the pre-disturbed persons within discordant monozygotic twin pairs (27), discordant regular sibling pairs (23), and offspring of schizophrenic mothers (18). Mednick (15, p. 56) has suggested that the OCs ‘trigger some characteristic which may be genetically predisposed’.

The problem of the long-stay patient in the Mental Hospital has been discussed for a long time. The prediction that there would be a steady decline in the number of these patients made by Tooth and Brooke (1951) has not been borne out by the evidence of Baldwin and Hall (1967), and more recently by Hailey (1971). They have shown that although there has been a fall in numbers the rate has been far from steady.

A family doctor's wife, aged 42, S.R.N., J.P., social worker and citizen of excellent character, drove her car through a nearby town at about 10.30 p.m. on an autumn night. Later a cyclist was found dead in the road along which she had just passed, parts of her car were found at the scene of the accident, and subsequently damage to her car was found to correspond with the damage to be expected had it been involved in this accident.