‘Citizen, soldier and psychologist’ was the description of Sir John used by his obituarist. He was an eminent psychiatrist of his time, but why is he mentioned as a psychologist and what did he do for the Army to be rewarded with a knighthood? He established his career in rural Devon and at the age of 27 he became the first medical superintendent of the Devon County Lunatic Asylum, now the Exminster wing of Exe Vale Hospital. Here he remained for 18 years, but at the age of 45 on becoming Lord Chancellor's Visitor, he retired with a pension of £650, the fruits of leading a vigorous campaign on behalf of medical superintendents who were previously unsuperannuated.

For the past fifteen years we have been studying aspects of relationships between sleep, activity, nutrition and mood. This paper comprises a brief statement of some of this research and our views to date.

A monozygotic twin assaulted his wife and daughter, killing both in an extremely brutal manner. Three years previously he had been like his co-twin today: a dutiful husband and father, an extremely hard-working and successful farmer, and a devout Christian known throughout the district for his gentle and considerate manner. His life changed following two frightening accidents after which he developed severe anxiety symptoms necessitating in-patient psychiatric treatment. This highlights the importance of psychological effects from an accident in producing marked personality change.

We have gone far in getting to grips with the nature of the error underlying mental handicap in many conditions. In a number of these, this has given scope, for example, for treatment based on biochemical correction, and for valuable preventive measures. The cause of the condition of many mentally handicapped patients, however, remains mysterious when neither history-taking nor investigations have led to any clues.

One thousand five hundred and seventy eight first degree relatives of schizophrenics, manics, depressives and controls were personally interviewed using the Iowa Structured Psychiatric Interview Form without knowledge of the probands' diagnoses. Our data, based on blind diagnostic assessment of the relatives, support the distinction between schizophrenia and affective disorders, although the distinction between schizophrenia and mania was not clear-cut. Our data could not support familial subtyping of paranoid and non-paranoid schizophrenia, and unipolar and bipolar affective disorders. Future studies attempting to develop research criteria for subtyping schizophrenia and affective disorders should utilize not only clinical and familial data but also biological markers and other non-familial variables.

First admission rates have been determined for immigrants living in Manchester. They show that immigrants as a whole had about twice the rate of British-born subjects, but that various subgroups had rates still higher, including those aged 35–44 and Asian women. According to hospital diagnoses the psychiatric conditions responsible for these increased rates are schizophrenia (in all groups) and neuroses and personality disorders (in the Asians). A case note study of the psychopathology showed, however, that the most characteristic symptoms of schizophrenia were not more common in the immigrants. It is concluded that most of the immigrants are suffering from paranoid psychoses, not schizophrenia.

An epidemiological study of first admission to psychiatric hospitals in Bradford revealed that foreign-born people had substantially higher illness rates than native born. Comparing the major World War II refugee groups it was found that morbidity was higher among Poles than Ukrainians. It is suggested that the difference can be partly explained by the lower social cohesion of the former. The resulting marginal identity is insufficient protection against the normal crises and losses of later life.

One hundred and sixty-six patients who had ECT in either 1971 or 1976 were interviewed. The 1976 sample represented 89 per cent of those available for interview. Their experiences of ECT and their attitudes to it are described. They found ECT a helpful treatment and not particularly frightening, but side-effects, especially memory impairment, were frequent.

Slater's model of assessing distribution patterns of ancestral secondary cases in family trees was applied to pedigree data on schizophrenia. Eighteen schizophrenic probands with at least two ill second-degree relatives were available for study. The distribution of unilateral to bilateral pairs of affected relatives did not deviate significantly from that expected in polygenic inheritance. Contrasting pedigrees with family history of chronic schizophrenia with pedigrees loaded with ‘soft spectrum’ disorders, i.e., borderline schizophrenia, did not alter the consistency of the data with polygenic transmission.

The families of 25 probands with sleepwalking and 27 probands with night terrors were studied. Eighty per cent of the sleepwalking pedigrees and 96 per cent of the night terror pedigrees included one or more individuals, other than the proband, who were affected by sleepwalking, night terrors, or both. Our data appear to fit a ‘two threshold’ multifactorial mode of inheritance. This finding supports the hypothesis that sleepwalking and night terrors share a common genetic predisposition, with sleepwalking being a more prevalent and less severe manifestation of the same substrate that underlies night terrors. Heritable factors predispose an individual to develop sleepwalking and/or night terrors, but expression of the trait may be influenced by environmental factors.

Children with typical autism, other early childhood psychoses and severe mental retardation without autistic behaviour were identified in an epidemiological study in an area of South East London. The social class distribution of their fathers was examined and no significant differences were found between the groups, nor in a comparison with the general population of the area. Fathers of children with autism and related conditions referred to an out-patient clinic with a special interest in autism, mostly at their own request, and fathers joining the National Society for Autistic Children, were of higher social class than both the average for England and Wales and the fathers of the study children. Joining the NSAC during its early years, and keeping up membership were also linked with higher social class. The findings supported the view that reports of a social class bias in autism may be explained by factors affecting referral and diagnosis.

Various characteristics of residents of a large hospital for the mentally handicapped were investigated in order to find any associations between these characteristics and the frequency of visiting by parents. The findings suggest that early attachment of the parents to the subjects is of more importance for visiting than present skills and behaviour. The most frequently visited subjects were more likely to recognize people, have some speech and have had a normal appearance as a baby. The unvisited subjects were more likely to have been born with an abnormal appearance and into homes with pre-existing social and emotional problems.

Sixty-six agoraphobic patients were followed up five to nine years after their treatment in three clinical trials of behaviour therapy. The main outcome measures used in the original trials were repeated by an assessor who interviewed the patients. Ninety-five per cent of patients were interviewed and partial information was obtained on a further two patients. The measures taken at follow-up were compared with those obtained prior to treatment and six months after treatment ended. On most measures of agoraphobia the patients were much better at follow-up than they had been before treatment. The assessor's ratings suggested that there had been little change in the patients' agoraphobia since six months after treatment. Some of the patients' self-ratings showed evidence of a slight improvement over this period. No evidence of symptom substitution was found.

Twenty-six subjects who complained of permanent unwanted effects following ECT were compared with two groups of control subjects on a battery of 19 cognitive tests. Many statistically significant differences were found in cognitive functioning, mostly attributable to the level of depression or medication in the complainers. However, after analysis of variance/co-variance some differences still remained, indicating impaired cognitive functioning in the ECT complaining group.

In a double-blind trial, 34 male chronic schizophrenic day-patients or in-patients in a hostel ward continued on fluphenazine decanoate given mostly once fortnightly or were switched to pimozide, given on four days each week. Over nine months relapse rates were similar for both groups, and while fewer patients on pimozide were prescribed antiparkinsonian drugs one quarter developed buccolingual-masticatory dyskinesia. Plasma pimozide levels suggested satisfactory drug compliance. Average plasma prolactin levels were within the normal range for untreated men in one quarter of non-relapsing patients on pimozide and three quarters on fluphenazine.

Two studies are reported, citing the effects of unilateral versus bilateral electroconvulsive shock therapy on the performance of short cognitive tests. In Study 1, seven tests were administered before and after three treatment sessions The most interesting finding was that performance improved significantly on the Knox Cube Imitation test following right unilateral shock. Study 2 replicated this unexpected finding. These results were interpreted as demonstrating that the left cerebral hemisphere is specialized for the processing of sequential time-dependent information.

Of a sample of families containing abused and at risk children, in 29 per cent one or both parents had attempted suicide. The rate at which the suicide attempts were repeated within a year was higher than that expected for other attempters of the same age group. A previous history of psychiatric disturbance and marital breakdown was strongly associated with the combination of child abuse and suicidal behaviour. The relationship between child abuse and attempted suicide did not appear in most cases to have been a direct one; often both forms of behaviour seemed to reflect marital difficulties.

Clinical experience with women in strictly controlled socially inferior positions in Saudi Arabia illustrates how somatic complaints can express emotional problems which have no other outlets. The women are passive and for therapy to succeed an alliance with a male relative is necessary. Measures to combat passivity can be of great benefit.

To test the possibility that the antidepressant action of ECT is due to an enhanced responsiveness to the stimulation of monoamine receptors, we have measured pituitary hormone responses to test doses of clonidine and methylamphetamine in depressed patients before and after a course of ECT.

There was no enhancement of the growth hormone response to either drug following a course of ECT. Cortisol responses to methylamphetamine were enhanced, but probably this was secondary to the partial or complete recovery of the patients. Further neuroendocrine studies of the mechanism of action of ECT in man are needed.

The effect of propranolol at a dose level of 1,280–1,920 mg per day was studied with a double-blind crossover design in twelve chronic schizophrenics with persistent psychotic symptoms despite maintenance treatment with a depot neuroleptic. By use of a psychiatric rating scale (CPRS), an improvement was seen during the two week period of propranolol compared to placebo treatment in six patients, whereas three patients were unchanged and three deteriorated. The effect on total symptom scores for the whole group was significantly better after propranolol. The data indicate that propranolol in high doses has an antipsychotic effect in some schizophrenic patients when receiving neuroleptics.