In spite of the new methods of treatment and care introduced during the past fifteen years, schizophrenic patients are still liable to relapse with a recurrence of florid symptoms such as delusions, hallucinations and disturbed behaviour, and great suffering can be caused to all concerned (Brown et al., 1966). It has been shown that the onset of florid symptoms is often preceded during the previous three weeks by a significant change in the patient's social environment (Brown and Birley, 1968; Birley and Brown, 1970). Other studies have focused on the influence of more persistent environmental factors, such as the emotion expressed towards the patients by relatives with whom they were living. In an exploratory survey of discharged long-stay men it was found that close emotional ties with parents or wives indicated a poor prognosis (Brown, Carstairs and Topping, 1958; Brown, 1959). In a further study, patients were seen in hospital just before discharge, and their relatives were interviewed at home at the same time, and both were seen together at a joint interview shortly after discharge. It was found that those patients who returned home to live with relatives who were highly emotionally involved with them (as judged by ratings of the relatives' behaviour) were more likely to suffer a relapse of florid symptoms, even when the severity of psychiatric disturbance at the time of discharge was taken into account (Brown et al., 1962). Ratings of the patient's own expressed emotion showed much less involvement, and were much less highly associated with subsequent relapse. There was also a suggestion that short-term and long-term influences might have a cumulative effect; for example, that a raised level of tension in the home made relapse more likely in the event of a critical change in the patient's social environment (Brown and Birley, 1968). These facts, together with the contrasting but just as handicapping reaction of schizophrenic patients to an under-stimulating social milieu, were brought together in a more general theory of environmental influences on the course of schizophrenia (Wing and Brown, 1970). This also took account of the high physiological arousal which had been found in the most withdrawn schizophrenic patients (Venables, 1968; Venables and Wing, 1962). It was argued that in a socially intrusive environment acting upon a patient whose thought disorder was in any case liable to become manifest whenever circumstances became too complicated, a patient would tend to attempt to protect himself by social withdrawal; but this process might easily go too far, both in hospital and outside it, leading to complete social isolation and inability to care for himself. The optimum social environment, for those who remained handicapped, was seen as a structured and neutrally stimulating one with little necessity for complex decision making.

Despite extensive gross and microscopic scrutiny, no consistent pathological findings have emerged from studies of autopsy material from schizophrenic patients. Dunlap (1924) carried out the first controlled study involving schizophrenic and control brains and concluded that ‘there was not even a suspicion of consistent organic brain disease as a basis for the psychosis of schizophrenia’. More recently both Wolf and Cowen (1952), and Weinstein (1954), reviewed the neuropathological literature and concluded that there were no consistent findings at autopsy that could be construed as characteristic of schizophrenia. These authors felt that earlier claims were based on failure to appreciate the range of normal variation in the brain as well as a failure to include an adequate control population in the study.

Earlier work from this laboratory showed that rheomelanins (blood soluble melanins) form in normal and schizophrenic blood incubated with the catecholamines, with l-dopa, with adrenochrome and with adrenolutin-monohydrate (Hegedus and Altschule (1–4)). This work also showed that the erythrocytes of many patients with a diagnosis of chronic schizophrenia are abnormally susceptible to the haemolytic effects of the rheomelanins or their precursors, formed in their bloods during incubation with most of these chemicals (Hegedus and Altschule (2, 4)). Erythrocytes of the chronic patients showed especially marked haemolysis during incubation of their oxalated blood with adrenochrome, with adrenolutin-monohydrate and with dopamine. A test for routine use was developed on the basis of this phenomenon, and is reported in this paper. The conditions of this routine test were determined as regards quantity of chemicals, time and temperature of incubation, and rate of shaking during incubation so as to give maximum differences between normal and schizophrenic bloods.

In a series of previous papers fairly detailed studies of an individual patient with a precisely timed forty-eight hour periodic psychosis have been presented. Jenner (1963), and Jenner, Gjessing, Cox, Davis-Jones, Hullin and Hanna (1967) have presented the clinical findings. Essentially, for thirteen years the patient regularly suffered from one day of depression alternating with one day of hypomania. The change of state occurred during sleep, usually between 02.00 and 03.00 hours. There were only eight major defects of the cycle in ten years. The timing of the cycle was however influenced by the environment; this was confirmed when the patient lived in an artificial environment in which a day and night totalled twenty-two hours instead of twenty-four. The psychotic cycle then became one of forty-four hours rather than forty-eight (Jenner, Goodwin, Sheridan, Tauber and Lobban (1968)).

The treatment of neurotic emotional responses and behaviour patterns has probably generated more controversies and fewer verifiable observations than any other aspect of psychiatric practice. Tentative hypotheses have been all too quick to take root, expanding into comprehensive theoretical systems, and often obscuring the growth of objective information. Lately, however, a more cautious and empirical attitude appears to be gaining ground. For example, Marks (1971) has pointed out that workers in this field increasingly recognize the presence of factors influencing outcome which are not explained or even contradicted by those concepts and strategies which underlie the techniques employed. Psychotherapists of both behaviourist and psychodynamic persuasions are beginning to express an awareness of the limitations and dangers of a too rigid theoretical approach. Such a movement towards uncommitted empiricism seems a healthy trend. This may be furthered by the more careful examination of specific treatment regimes applied to a variety of diagnostically homogeneous groups of patients, an approach which is clearly preferable to sterile arguments about their relative overall effectiveness in the usual heterogeneous collections of neurotic patients with which the literature abounds. In the recently published Handbook of Psychotherapy and Behavior Change (1971), the editors comment on the frequency with which their contributors criticize the lack of replicated studies and the common failure to describe in adequate detail the specific features of patient, method and therapist. From whatever aspect it is viewed, psychotherapy emerges as a complex personal interaction containing many components, all difficult to quantify and unlikely to combine their effects in an easily predictable way.

Seizures induced by movement were first described by Gowers (1901), who considered them a variant of epilepsy. Several reports have appeared since then of attacks of choreo-athetoid movements precipitated by sudden movement (Lishman et al., 1962; Whitty et al., 1964; Stevens, 1966; Kertesz, 1967). The case described here is one of Lishman's et al's original group (Case No. 5); along with the movement-induced seizures he had developed over the years an increasing agoraphobia which had grossly restricted his activities. This paper reports on the successful treatment of this agoraphobia by ‘flooding’ and the associated amelioration of his movement-induced seizures.

Though divorce is frequent among psychiatric patients, its relative frequency among persons with various psychiatric disorders remains unclear. In addition, it is unclear to what extent family history variables, variables of the sexual history or marital history, or environmental deprivation are associated with divorce.

The hopes and fears of many different sections of the population were pinned on the legislation that took effect on 27 April 1968. To some it represented the admission of civil rights long denied, to others it seemed an uneasy compromise. The implications of the new Act have been reviewed by Hordern (1971), but there is still much confusion in the mind of the man in the street (and particularly the woman in the street) about what the legal position now is. Many laymen are under the impression that one can now obtain abortion on demand, but they must be balanced against those cynics who feel that the situation has not been changed in effect from what obtained in earlier years. There is certainly a lot of misunderstanding about what may be regarded as 'social’ reasons for termination of pregnancy, and this extends to a common belief that the majority of terminations are carried out under this category.

The aim of this study was to determine the relationship between loose or ‘allusive’ thinking and conditioning performance. The theoretical proposition examined was that looseness of thinking is associated with weak internal inhibition of autonomic responses in classical conditioning.

In a study by Hinchcliffe, Lancashire and Roberts (1971), results of verbal behaviour analysis are described which purport to show objective, quantified evidence of ‘psychological defence mechanisms' in the speech of depressed patients. The method employed was based on earlier work by Weintraub and Aronson (1962, 1964), involving the tape-recording of speech during interviews of both patients and controls. Analysis is made of both temporo-physical events (e.g. speech rate; pausing) and lexical and semantic content. Regarding the latter, particular emphasis was placed on frequency of ‘negators', defined as ‘not, never, nor, nothing’ (Hinchcliffe et al., 1971) and ‘All negatives, e.g. “not“, “no”, “nothing“, “never”.’ (Weintraub and Aronson, 1964). Such ‘negators' are taken to indicate ‘denial’ in the psycho-analytic sense. Hinchcliffe et al. used a group of ten depressed in-patients and a control group of ten surgical in-patients ‘matched for age, sex and socio-economic position’, but sharply demarcated in terms of their scores on the Zung Self-Rating Scale for depression (Zung, 1965). They found a preponderance of ‘negators' in the speech of the depressed group which was statistically highly significant (P < 0·005), comparing well with the findings of Weintraub and Aronson (P < 0 · 01). In a subsequent communication (Silverman, 1971), the present author expressed doubt as to the validity of the inference that ‘negators' do indicate ‘denial’ in depressed patients, and suggested an alternative experiment of which this is a report.

Studies on the relationship between physical constitution, personality and mental illness have been mostly confined to the Caucasian race. There has been no investigation, to our knowledge, of Oriental subjects, though a number of investigations of body type, composition and physiological functions without relation to mental aspects have been carried out on them. It is clearly important that work in this field should be extended to include subjects of different racial composition and socio-cultural background. The intercorrelations found between physical and mental characteristics in Caucasians may not apply to others.

The present study describes certain characteristics of an in-patient population of newly-admitted patients at the only psychiatric hospital (approximately 3,000 beds) serving the two million inhabitants of Jamaica.

The history of in-patient units for the psychiatric treatment of children in the United Kingdom is largely confined to recent years. Their number is now slowly expanding, and there are approximately 60 in-patient psychiatric units for children and adolescents (R.M.P.A. 1970; Department of Health and Social Security, 1970).

The growing adoption (1) of unilateral non-dominant ECT in place of the classical bilateral technique requires the accurate identification of the dominant hemisphere; the following simple method appears to be an improvement on those previously described (2) (3).