Introduction There have been many theories put forward to explain the not uncommon symptoms of depersonalization. They were aptly summarized by Ackner (1954) in the following way. There are theories which regard depersonalization as a symptom with an organic basis; there are theories which consider it a disturbance of a particular psychological function; there are analytic theories; and finally there is a theory which would suggest that depersonalization is a form of schizophrenia. This paper is concerned with a re-appraisal of all these theories in the light of recent and current research on the subject.

Kurt Schneider (1939) set a high value on certain symptoms in the diagnosis of schizophrenia. He named them ‘first rank symptoms'. This paper gives an account of these symptoms in schizophrenics, on admission to mental hospital; the assumption being that if they are the defining symptoms of the illness then they should be most prominent in the acute phase.

A phobia may be defined as a persistent and inappropriate fear of a specific object or situation; the majority of phobias do not come to the attention of the psychiatrist, as they are readily circumvented and hence do not interfere significantly with the individual's mode of life.

This paper is the first in a series reporting a study of the effects of neurosis on the patient's marriage and marital partner, in which we repeated and extended observations made in a previous inquiry (Kreitman, 1964) and tested certain hypotheses arising from these data.

This paper is concerned with certain aspects of the marital interaction of male neurotics and their wives: more specifically it was designed to test hypotheses advanced to explain the findings of an earlier study (Kreitman, 1964), partly confirmed in Part I of this inquiry. The findings in question were (i) that the patients' spouses had a higher level of morbidity than controls, a discrepancy which tended to increase with lengthening of the marriage, and (ii) that patients and their spouses had low or zero correlations on measures of personality and pathology in the early years of marriage, but with the passage of time the interspouse correlation increased, with the spouse coming increasingly to resemble the patient, especially with regard to symptoms: conversely, the control couples generally showed positive correlations early in marriage, but thereafter declined in their level of similarity.

A number of hypotheses have been put forward (Gregory, 1959; Penrose, 1944) to explain the generally found higher incidence of psychiatric disturbance in the spouse of patients with mental illness. The relevant literature has been reviewed by Nielsen (1964). More recently, interest has centred around two contrasting hypotheses which seem best able to explain the available evidence.

A fundamental anxiety, if not the fundamental anxiety, in males, according to classical Freudian psychoanalysis, is the fear of castration. According to Freud (1953, pp. 120–121; 1933a, p. 267) this is the fear of being castrated by the father as a reprisal for incestuous desires toward the mother. Nonetheless, the concept of the castrating mother also plays a prominent role in psychoanalytic literature, e.g. De Monchy (1952), Blos (1950), Fairbairn (1952), Klein (1948), and Bergler (1949).

In recent years there has been a reawakening of interest in the practical application of hypnosis in the different medical fields. In the realm of psychotherapy, the evidence for such interest can be found in the many specialized works on the subject, as well as in such texts as the American Handbook of Psychiatry (1), and the Comprehensive Textbook of psychiatry (2).

In previous papers in this series we have discussed two concepts which have been used in connection with aspects of the relationship between the patient and his doctor. These were the treatment alliance (Sandler, Holder and Dare, 1970) and transference (Sandler, Dare and Holder, 1970). Although these two clinical concepts originated within the psychoanalytic treatment situation they are capable of extension outside it. Both relate to and emphasize processes occurring within the patient and tend to stress one side of the relationship only. Even the concept of treatment alliance, although nominally appearing to include the roles of both patient and doctor, has tended to be regarded from the point of view of processes and attitudes in the patient; the aspect of the therapist's attitudes, feelings and professional stance have to a large extent been omitted. However, in recent years more attention has been paid in psychoanalytic and other writings to the relation of the doctor towards his patient. Just as the term ‘transference’ is often used loosely as a synonym for the totality of the patient's relation to his therapist, so is the term ‘counter-transference’ often used in a general sense (both within psychoanalysis and outside it) to describe the whole of the therapist's feelings and attitudes towards his patient, and even to describe facets of normal, non-therapeutic relationships (Kemper, 1966). Such a usage is very different from what was originally intended, and as a consequence confusion has arisen about the precise meaning of the term. It is the purpose of this paper to examine the concept in the light of its origins and development within psychoanalysis and to comment briefly on some possibilities of its extension outside the psychoanalytic treatment setting.

In the published results of controlled trials of systematic desensitization with phobic patients there has been a consistent trend apparently overlooked by the authors. If this trend is valid, it means the results of such therapy with agoraphobic patients have been better, and those with patients with specific phobias worse than the authors have concluded. Understandably, the authors' interpretation of their results have been accepted and in fact used to discredit the value of behaviour therapy (Mayer, 1969). If an interpretation of results of trials which indicates that treatment is of considerable value is overlooked, and one which indicates that it is of little value stressed, the reason for this should be examined. Psychiatry is not so rich in demonstrably useful therapies that it can afford to allow one to be discredited before it is adequately evaluated. Yet this attitude is not limited to the above trials but is also commonly found in the reports of drug trials (McConaghy, 1966).

The value of visiting by relatives and others to the well-being of elderly in-patients is widely recognized, but there appear to have been few attempts to collect systematic information about it from visitors. A preliminary study was therefore made of visiting in a psycho-geriatric admission ward.