Considerable inconsistency exists in the literature concerning the clinical features of depression associated with a good response to anti-depressant medication. Abraham et al. (1963) summarized the literature to that date; the general consensus of opinion was that imipramine had its best effect in depressions of the endogenous rather than those of the neurotic type, but their study on depressed out-patients did not support this conclusion. Browne et al. (1963), working with in-patients, reported that reactive depressives showed a better response to amitriptyline than did endogenous depressives. Burt et al. (1962), in their report of the response of 73 depressed female in-patients treated with imipramine or amitriptyline, demonstrated a much better response to both drugs by reactive as compared with endogenous depressives. Spear et al. (1964) found no significant difference in respect to “endogenicity”, in the response of depressed in- and out-patients to tranylcypromine and imipramine. Richmond and Roberts (1964) reported that out-patients suffering from endogenous depression responded much better to a variety of anti-depressant drugs than did those suffering from reactive depression.

In recent years British psychiatric training has received interested scrutiny from the other side of the Atlantic, and there has been appreciation of the broad based approach in dealing with the larger community of psychiatric patients, which as Keir (1964) has pointed out is beginning to occupy the attention of our American colleagues. It has been noted by Cameron (1965), Lesse (1966) and others that there are disadvantages in the predominant approach in American training—which focuses on dynamics, inference and formulation—in that this has produced a neglect of clinical observation and accurate description, giving little knowledge of syndromes or the natural history of psychiatric conditions.

The term “psychoanalysis” has a triple usage. First, it describes a connected body of observations about unconscious mental processes, systematically classified and more or less colligated and brought under general laws. This first meaning places psychoanalysis among the sciences, but a difficulty at once arises; for the phenomena with which psychoanalysis is concerned, and the methods used to study them, are so different from those upon which our tradition of science was first based that the question arises whether it is science at all.

Since its inception in 1961 the policy of the psychogeriatric unit at Severalls has been to maintain elderly patients in their own homes for as long as possible. There are a number of reasons for this attitude. Many old people are afraid of hospitals. Some with memory defects not significant in the home become confused and distressed in unfamiliar surroundings. Admission to hospital may permanently dislocate the habits of a lifetime and break the delicate threads of informal support by neighbours, friends and others who call regularly. Once admitted, re-establishment in the community may be difficult or impossible.