Psychopathologists have tended to regard the phenomena of schizophrenic language as reflections of a more basic disturbance of thought. Writings on these topics generally link them together (e.g., Kasanin's Language and Thought in Schizophrenia, 1944). Critchley (1964), from his survey of major aspects of psychotic speech, concluded that the ‘causation of schizophrenic speech affection lies in an underlying thought disorder, rather than in a linguistic inaccessibility’. Differences of opinion are evident as to what the nature of this thinking disorder might be. Regression (Gardner, 1931; Kasanin, 1944), excessive concreteness of thought (Goldstein, 1944; Milgram, 1959) and deficiency in logical deductive reasoning (Von Domarus, 1944) are some of the more prominent hypotheses to be found in the literature relating to this problem.

After more than thirty years the operation of leucotomy still remains a controversial treatment, and its value is questioned by many. This scepticism, and the advent of new surgical techniques, have emphasized the need for careful appraisal of the results of psychosurgery. In a previous prospective study 40 patients were assessed six weeks after modified leucotomy, and 75 per cent of these patients were found to be clinically improved (Kelly, Walter and Sargant, 1966). They were less neurotic on the M.P.I., had lower Taylor Manifest Anxiety scores and rated themselves as less anxious; a good clinical outcome was associated with diminution of physiological arousal as measured by forearm blood flow and heart rate. This group has now been followed-up and reassessed 18 months after operation, and a further group of 38 patients has been examined before, and again six weeks after, leucotomy. The data from the two groups have been combined to determine the immediate outcome for various diagnostic categories, and a multiple regression has been performed to elicit which of the pre-operative factors predict a favourable post-operative result.

Psychiatry suffers from the use of terms widely employed, poorly defined and variously interpreted. Delusion is one such term, but has appropriately commanded a good deal of attention (Hüber, 1955, 1964). Confabulation is another, but has not enjoyed the same critical scrutiny.

It has been said that any drug which is active and produces an effect which is beneficial must also, under similar or different circumstances, have side-effects which are neither beneficial nor desired (Hamilton, 1965). It is the balance between desired and undesired actions which determines the usefulness of any drug. Such a balance varies according to the individual patient's needs. Thus a life-saving drug will be given even if it has serious side effects, while this would not be justifiable for a drug with only a marginally therapeutic effect. Scrutiny of past results may enable clinicians to make finer predictions as to which patient will benefit from a certain drug and which will suffer unacceptable side-effects. Phenothiazines are one group of drugs whose efficacies and dangers have been discussed in this way.

The term ‘therapeutic community’ has been increasingly employed in recent years. The W.H.O. Report (1953) used it to describe a general approach of Freedom, Activity and Responsibility—a humane, liberal approach marked by full occupation, open doors, active rehabilitation programmes and increased community involvement—repeating and developing many of the features of the ‘moral treatment’ of the early nineteenth-century (Rees, 1957). This has now been widely adopted in Britain, U.S.A. and in Western Europe.

The management of sexual delinquents, especially those with compulsive putting into action of aggressive sexual impulses, poses great problems for the medical profession from the therapeutic as well as the moral standpoint. In the past thirty years or so numerous different approaches have been tried with varying degrees of success. A much abridged list of more recent treatment procedures includes: surgical castration (Stürup, 1968), sedative and/or tranquillizer drugs (Litkey and Feniczy, 1967; Bartholomew, 1968), female sex hormones (Allen, 1970); psychological measures such as psychotherapy (Ellis, 1956; Mayerson and Lief, 1965; Allen, 1970) and/or behaviour (‘aversion’) therapy (MacCulloch and Feldman, 1967) and ‘right up-to-date’ hypothalamotomy (B.M. J., 1969). Unfortunately surgery, which is the most reliably effective of these treatments, may have unpleasant sequelae; its use, which (in Britain at least) is beset with ethical problems, is therefore justified in only the most recalcitrant and/or dangerous types of offender, and only then when other methods have failed.

Amitriptyline is a widely used antidepressant and its effectiveness has been shown, e.g. in comparison with imipramine in double blind trial (Burt et al., 1962; Hordern et al., 1963, 1964). A disadvantage of currently prescribed tricyclic antidepressants is the necessity for administering the drug three times a day. It has been shown that general medical and in particular psychiatric patients fail to take their medication either in the prescribed dose or at all (Benstead and Theobald, 1952; Haler, 1952; Park and Lipman, 1964; Parkes et al., 1962; Porter, 1969). This failure rate may be as high as 50 per cent (Dixon et al., 1957; Willcox et al., 1965). Even in psychiatric in-patient studies there was still a high failure rate in taking prescribed psychiatric drugs (Hare and Willcox, 1967). A regimen consisting of a single daily dose is more reliably taken than one consisting of thrice daily dosage (Coppen et al., 1969; General Practitioner Clinical Trial 1970).

The patient, C, was a 33-year-old woman who attended hospital complaining of depression, inability to sleep, and weakness of hands and legs. This had been going on for 4 to 5 weeks. She had been suffering from ‘writer's cramp’ five years previously but this had been satisfactorily treated with drugs.

‘The Samaritans' were founded in 1953 to help ‘the suicidal and despairing’. As with similar lay agencies abroad, their growth in the past ten years has been vigorous; they now have more than 120 branches in the United Kingdom and these branches attracted over 50,000 clients in 1969. The Samaritans' aims have been described in detail by Fox (1968), but their most important aim is still the prevention of suicide. Their success in attracting the suicidal and preventing their subsequent death must therefore be the criteria of their effectiveness.

As part of an investigation concerned with investment by both hospitals and local authorities in mental health a number of analyses were made of various published statistics relating to costs and other operating characteristics. In the particular case of spending in mental subnormality hospitals what emerges is a pattern of such surprising variability that it was felt worthwhile presenting the information. It would appear that this particular crude analysis has not been pursued previously despite the existence of the great mass of cost statistics collected, processed, published and circulated within the Health Service. As the Service spent £39·1m. on these hospitals during the fiscal year 1968–69 one might have expected this comparative cost information to have been used in any planning process, particularly when, as will be seen, the magnitude of the variability is so considerable.

In 1966 Slater proposed a computational model for distinguishing polygenic inheritance and the effects of a single dominant gene. For a single dominant gene with diminished penetrance, affected relatives should be found predominantly on either maternal or paternal sides. He further proposed that to support a dominant gene hypothesis the ratio of unilaterally ill pairs to bilaterally ill pairs of relatives should exceed 2:1. ‘Unilateral pairs' means that there have been two or more ill relatives on either paternal or maternal sides; ‘bilateral pairs' that there has been at least one ill relative on each side.