The reprinting by the Institute of Psychiatry, on its fiftieth anniversary, of Dr. Peter Scott's paper (1) describing Maudsley's work as a pioneer in criminology reminds us of the prominent part Maudsley played in the debate between psychiatrists and lawyers which has been in progress for nearly a century and a half, with, for much of that time, little satisfaction for either side. It is a classic example of the difficulties of inter-disciplinary communication. My only qualification to be the Maudsley Lecturer is that I happen to be doubly qualified in law and medicine, and, as Chairman of the Institute, a good deal closer to psychiatry than most lawyers. My qualities as an interpreter must therefore make good the intellectual deficiencies of which a glance at the list of my forty-seven distinguished predecessors makes me acutely conscious.

In 21 widows and 46 amputees a psychological reaction to loss designated as ‘grief’ was commonly reported. This included an initial period of numbness, soon followed by restless pining with preoccupation with thoughts of the loss, a clear visual memory of the lost object and a sense of its presence. Defensive processes, reflected in difficulty in believing in the loss and avoidance of reminders, were also evident.

Widows differed from amputees in showing more evidence of overt distress in the early post-loss phase, but whereas these features diminished in prevalence in the course of the next year the equivalent features reported by the amputee group remained virtually unchanged.

The Maudsley Personality Inventory and the Beck Depression Inventory, with additional items to assess depressive functional shift features and outlook on life values, were administered to 100 patients diagnosed as suffering from depressive illness. Patients’ scores for questions eliciting information about symptoms assumed to be dependent on personality correlated at substantial and significant levels with N scale scores of the Maudsley Personality Inventory. Similar levels of correlation were found for the added items for assessing life values. Items believed to assess changes in functions independent of personality, such as the features of the Depressive Functional Shift, showed no correlation with either N or E scales of the Maudsley Personality Inventory, while demonstrating a substantial level of correlation with the depression scale. It is concluded that whereas changes in innate biological functions independent of environment are direct indications of the depressive illness process, psychological symptoms of the illness may reflect changes in personality dependent on upbringing, education and cultural background, thereby producing greater variation in this group of psychological symptoms.

Sixty-four per cent of 874 freshmen and sophomore women sent questionnaires about premenstrual and menstrual symptoms returned them. They differed from those not returning the questionnaires only in year of school. As predicted, women reporting premenstrual affective symptoms were more likely than those who did not report them to seek psychiatric care at the Student Health Service and to be diagnosed as affective disorder at the service.

A replication study of the effects of single-night sleep deprivation therapy was carried out as a preliminary to a controlled comparison with orthodox antidepressant measures. The results show that sleep deprivation therapy was acceptable to a majority of the patients studied, and was followed by an improvement in over half those who completed treatment. Adverse effects were minimal. The authors feel that further clinical and physiological study is warranted.

In a double-blind trial 600 μg. of thyrotrophin-releasing hormone (TRH) was compared with placebo given daily for four days to two groups of ten patients. There was no significant difference between the antidepressant effects of TRH and placebo.

Eugen Bleuler has had a major influence on American psychiatry. His theory of schizophrenia, linking descriptive psychiatry to Freud's psychoanalytic concepts, has had an important influence on diagnosis and treatment, especially in America. This paper will summarize first some textbook descriptions of Bleuler's contribution and then some major issues which Bleuler discusses in his book Dementia Praecox, or the Group of Schizophrenias. I hope to demonstrate that the textbook accounts do not adequately describe the complexity and ambiguity of Bleuler's approach.

This investigation has provided evidence against the hypothesis that heterozygous carriers of a schizophrenic gene have a reproductive advantage through enhanced fertility. An advantage arising from lower mortality between birth and the end of the reproductive period was not investigated, but should be examined before we search for other explanations of the apparently stable polymorphism of schizophrenia.

To study looseness of associations and other theoretically relevant variables of speech pathology, 51 acute psychiatric patients, including 26 schizophrenics, were studied at the acute phase of their disorder by means of a free verbalization interview. The results on these 51 patients during the acute period were.

1. 1. There were clear differences between the schizophrenic patient group and the control patient group, the overall index of deviant verbalizations being significant at the .001 el.

2. 2. Many types of looseness were found in non-schizophrenic patients as well as in schizophrenics. Except at the very mildest levels, however, the variants of overt looseness were strikingly more frequent in occurrence and severe in degree in the schizophrenic group (p < .01).

3. 3. Gaps in communication, vagueness of ideas and blocking, though present to some degree in our control group, were much more common in the schizophrenic sample (p < .001).

4. 4. In the control group of patients, private meanings (including neologisms), repetition and perseveration were extremely rare, and current delusional thinking virtually non-existent. Private meanings and current delusional thinking were conspicuously present in the schizophrenic sample; repetition and perseveration were present to a mild degree in this acute schizophrenic sample.

5. 5. Schizophrenic patients tend to show more looseness of associations when faced with a request to talk about topics not related to their illness.

Programmes of suicide prevention require for their planning accurate epidemiological surveys.

Doubt has been cast on the accuracy of many existing surveys because of the realization that suicide is under-reported and because of the lack of consistency in the procedure for suicide ascertainment.

Two studies are described in this paper which attempt to examine the problem.

The first is part of an international study supported by the World Health Organization. In it, Denmark and England are compared, and it is shown that there are striking differences in suicide ascertainment procedure between the two countries. Next, on a blind basis, coroners and their opposite numbers in Denmark examine a sample of each other's case records. It is found that the Danes consistently report more suicides than do the English coroners on the same case material; thus considerable doubt is cast on the supposed difference in suicide rates between the two countries.

In the second study, deaths by poisoning are examined for certain coroners' districts in England and Wales. It is shown that there is considerable variation from one district to another in the relative proportions of these deaths which achieve an accident, an open or a suicide verdict. This suggests that in England and Wales coroners may not be consistent in their suicide ascertainment criteria.

Hypotheses attempting to account for differences in suicide rate based on such epidemiological surveys should be viewed with great caution.

Twenty-five doctors and 50 nurses working in the medical wards of a general hospital were interviewed. They were asked to indicate typical motives for self-poisoning and were then shown brief accounts of four typical case histories. They were asked to choose from a list of motives those they considered applied to each case. They then rated each motive for acceptability and understandability, and each case for sympathy and readiness to help.

Motives were of two principal types—‘manipulative’ (i.e. aimed at eliciting a response from others) and ‘depressive’ (i.e. communicating despair and aimed at withdrawal, escape or death). ‘Depressive’ motives were more acceptable and evoked more sympathy or readiness to help in both doctors and nurses than ‘manipulative’ motives.

Doctors and nurses differed in various ways. Nurses were generally more accepting, more sympathetic and more likely to seek professional help as an alternative way of coping. Doctors distinguished more clearly between ‘suicidal’ motives, of which they were relatively accepting, and ‘manipulative’ motives, which they accepted less. Attitudes to the four cases differed, primarily in the motives attributed. Those differences may also reflect differing severity of problems, personal responsibility for problems, social class, sex or age.

The implementation of a policy of ‘community care’ is seen to involve a number of assumptions, some of which are rarely examined. These can be roughly categorized as involving the nature of mental illness, the nature of community, the course and treatment of mental illness, the proper scope of psychiatry, the burden on the community and the efficacy of social work. Data bearing on these assumptions are reviewed, and the conclusion is offered that they are far from being uncontentious.

It is suggested that the movement toward community care has many of the attributes of a moral enterprise which, unless substantiated by benefits to the patient or his family, may be the latest diversion of the psychiatric conscience from the care and treatment of the chronic mentally ill.

Three separate studies were carried out to examine the patterns of mental health care in an Indian village. The first examined the conceptual frameworks of the various traditional and modern healers. The second was an attitude study inquiring about the type of healer favoured for psychiatric consultation. The third was a population survey in which every person with one or more symptoms was asked if he or she had consulted anyone for relief of distress.

Besides the modern doctors there were three types of traditional healers: Vaids, practising an empirical system of indigenous medicine; Mantarwadis, curing through astrology and charms; and Patris, who acted as mediums for spirits and demons.

It was found that a large majority (59 per cent) of those with symptoms had consulted someone. The consultation was determined more by the severity of illness than by socio-demographic factors. Modern doctors were more popular, but most people consulted both traditional and modern healers without regards to the latter's contradictory conceptual framework. Literacy and other sociodemographic factors had no influence on the type of consultation.

A conclusion was reached that any scheme for introducing modern psychiatry into rural areas should make use of the locally popular healers, both traditional or modern.