I am sincerely grateful for the honour you have bestowed on me by the invitation to deliver this year's Maudsley Lecture. It means all the more to me as this Association made me feel at home almost from the day I came to this country more than twenty-six years ago.

Before Freud, homosexuality was usually thought to have constitutional causes. Indeed, some recent studies have again proposed that genetic factors play an important role in its aetiology. Kallmann (1952), for instance, studying forty male homosexuals with identical twins, found that 39 of the twins were also homosexual. Slater (1962) suggests that homosexual patients tend to be the younger children in their families and to have elderly mothers, so that they might have been born with chromosomal abnormalities. There is, however, a growing tendency to assume that one of the causes of homosexuality is the lack of normal childhood relations with the parents. Fenichel (1946) suggests that homosexuals tend to be mother-fixated and to have identified with their mothers because, while their fathers were weak, their mothers were domineering, and psychoanalysts, in general, agree with his views. West (1959), who compared homosexual and heterosexual in-patients in a mental hospital, found that the combination of an over-intense relationship with the mother and an unsatisfactory relationship with the father is typical for the homosexual. Bieber et al. (1962) compared homosexual and non-homosexual patients in psychoanalysis. They claim that in the majority of cases the behaviour of the mothers of homosexuals toward their sons was seductive and over-indulgent, domineering and inhibiting, while the behaviour of their fathers was hostile, ambivalent or indifferent. O'Connor (1964) compared homosexual patients with heterosexual neurotic ones, all of whom were serving in the Air Force. He found that a high proportion of the homosexuals had, in their childhood, poor relations with their fathers and had been more attached to their mothers, though some had not got on well with their mothers either. He also reports that a number of the homosexual patients were raised in foster-homes, while none of the heterosexual ones were. The main difference between his two groups was that a much greater proportion of the homosexuals did not have normal relationships in their childhood with their fathers. West (1959) quotes Liddicoat (1956), whose subjects were non-patients and who found that unsatisfactory relations with the father were more common in her sample than undue attachments to the mother. So did Westwood (1960), whose subjects were also recruited from among non-patients, and who states that many homosexuals from his sample had over-possessive or over-protective mothers, but even more had inadequate or absent fathers.

The present study is a sequel to the investigation concerned with the genesis of male homosexuality (1965). In both investigations the same methods were used and their description can be found in the previous study.

It probably goes without dispute at the present time that the precise content of a schizophrenic's thought, like that of anyone else, is derived from experience. Even the remarkable mélange of Schreber's memoirs could in large part be traced to his childhood experiences (Niederland, 1959). There is generally little doubt that the exact form and the course may be determined by age and experience; the effects of genetically determined intellectual endowment are uncertain (Elsässer, 1952; Rosenthal, 1963). The very occurrence of schizophrenia as a clinical phenomenon challenges the investigator, and there are many who question whether experience alone could result in schizophrenia in any and all human beings. They ask rather to what extent and by what mechanisms is the occurrence of schizophrenia determined by genetic factors.

Writer's cramp (scrivener's palsy, mogigraphie, graphospasms, cheirospasmus, crampe des écrivains, dyskinésie des écrivains, graphic dyskinesia, Fingerkrampf, Schreibkrampf, etc.) is one of a large group of functional motor disorders, known as “occupational neuroses and cramps, craft neuroses, professional neuroses, crampes fonctionelles et professionelles, spasmes professionelles, impotences professionelles, Beschäftigungsneurosen, Beschäftigungskrämpfe”, wherein there is a specific impairment of a learned motor skill. Generally, writer's cramp is characterized by muscular spasm, inco-cordination, and discomfort, variously described as fatigue, weakness, stiffness, or pain when attempting to write. Occasionally, there is an accompanying tremor or jerking of the involved upper limb. There is said to be great variability in the detailed clinical picture. Writing may be difficult or impossible, but outside the act of writing the symptoms generally disappear. Often there are fluctuations within a chronically progressive course but the condition may arrest at any stage of its development.

Accounts of the parallel psychiatric treatment of identical twins are relatively rare. This case is especially unusual in two respects, first in the uncommon nature of the particular problem which they presented as their major symptom (i.e. homosexual attraction to elderly men), and secondly because they were treated together as a family group.

The drug-taking behaviour of young people is causing great concern. The topic has been discussed for some years in the national newspapers and in the medical journals, and early last year the Government decided to take action.

At present there exist in the literature numerous references to mental illness in different cultures; these vary from consideration of disorders peculiar to certain cultures, e.g. Koro, Latah, Amok, Wihtigo, etc., well reviewed by Yap (Yap, 51) to the problems of acculturation and mental illness. Examples of the latter include the studies of Tooth and Carothers, the latter suggesting that Westernization and detribalization increased the incidence of psychosis in Africans (Carothers, 2; Tooth, 45). Slotkin (42) pointed to the paranoid schizophrenia phenomena among acculturated Menomini. Hallowell (14, 15) found significant Rorschach differences between acculturated and unacculturated Salteaux.

The possibility that desipramine might prove to be a rapidly acting antidepressant was first raised by laboratory studies. In 1959 desipramine was isolated as a metabolite of imipramine (Hermann et al., 1959; Hermann and Pulver, 1960), and a series of papers then followed (Brodie et al., 1961; Gillette et al., 1961; Sulser et al., 1962) in which it was shown that reserpine-induced inactivity in the rat can be more rapidly reversed by desipramine than by imipramine. This was referred to (Gillette et al., 1961) as an experimental demonstration of the relative rapidity of the “antidepressant” action of the two drugs. Other experimental reports should however warn against incautious interpretation of laboratory findings. Garattini et al. (1962) showed that desipramine is not responsible for all the actions of imipramine: in mice, leptazol convulsions are inhibited by the latter but not by the former drug. Dingell et al. (1964) were able to show considerable species differences in the rate at which imipramine is converted to desipramine and in the rate at which desipramine is then destroyed. Their paper also emphasizes the paucity of information on the metabolism of imipramine in human subjects.

At the time when this investigation was being considered (June, 1961) the efficacy of the monoamine oxidase inhibitors in the treatment of depressive illnesses was already well recognized. It was also evident from a study of the published papers on this group of drugs that their use was accompanied by a number of side-effects which often raised problems in treatment. The clinical trial of a new drug of this class which, from the pre-clinical toxicity studies in animals, held promise of being less toxic than M.A.O. inhibitors already in clinical use was therefore considered worth while. Such a trial also seemed a useful opportunity to follow up previous observations with phenelzine (Gilmour, 1960) and the suggestion of Sargant (1961) that, given concurrently, M.A.O. inhibitors may potentiate the effect of E.C.T. and reduce the number of exposures necessary, and that their continuance after a course of E.C.T. has been completed may reduce the relapse rate.