One of the aims of child psychiatry is to support and supplement parents who are having difficulty in their task of socializing their child. At least as important an aim is to keep within bounds the cost of socialization. This cost is certainly excessive when social demands on the parents stifle natural, biologically determined, attitudes to the extent that they provide a noxious rather than a facilitating environment for their child.

The psychoses of infancy have long been a matter for controversy. The nature of the disorders, their aetiology, relationship to adult forms of psychosis, long-term outcome and response to treatment are still areas of disagreement among clinicians. Follow-up studies should provide information relevant to some of these problems. Unfortunately, the findings of published investigations have been contradictory. To a large extent contradictions appear to be related to differences in diagnostic criteria, but the failure of many writers to describe their cases adequately has made it difficult to assess the significance of possible differences.

The two major follow-up studies of children suffering from infantile psychosis, that of Kanner's cases (Kanner, 1943 and 1949; Kanner and Eisenberg, 1955; Eisenberg and Kanner, 1956; Eisenberg, 1956; Kanner and Lesser, 1958) and that of psychotic children seen by Creak (1962, 1963a and b) have shown the generally poor prognosis for these children. In both studies about half the children were in full-time residential care (usually mental sub-normality hospitals) at follow-up, and only 5 per cent. to 17 per cent. could be said to be well adjusted. Similar findings have been reported in the other published studies (reviewed in Rutter, 1966a). Kanner and Eisenberg have described the course of the characteristics of aloneness or autism shown by all or nearly all children with infantile psychosis (Kanner, 1943; Kanner and Eisenberg, 1955; Eisenberg and Kanner, 1956). Although some psychotic children emerge from their solitude to a greater or lesser extent, a lack of social perceptiveness usually remains even in adolescence or early adult life.

The Renal Unit of the Queen Elizabeth Hospital, Adelaide, South Australia, provides the only specialized renal service for the State's population of one million. Established two years ago, it has developed a programme of recurrent haemodialysis and has used recurrent peritoneal dialysis for a period. It is associated with a renal homotransplantation programme. The Unit staff consists of a full time Director, one Senior Medical Registrar, a Senior House Physician, nurses and technicians. There is a close liaison with the University of Adelaide Department of Surgery which has been responsible for establishing and running the homotransplantation programme with a staff of a Senior Lecturer and the assistance of two Honorary Assistant Surgeons. The psychiatrist works closely with the group and interviews all patients entering the programme. His role has been that of an observer and adviser on the management of patients in chronic renal failure, and in the psychological screening of potential kidney donors.

The first human renal homotransplantation was performed in 1936. Recently, with the introduction of improved immuno-suppressive techniques, this operation has been carried out on an increasing number of occasions. The first renal homotransplantation in South Australia was performed in February, 1965. The donor was related by marriage to the patient and was not consanguineous. The patient is still alive and at work sixteen months later (June, 1966).

The reports of the Registry of Human Kidney Transplantation show that the operation is being carried out with increasing frequency. Its medical, surgical and immunological problems are well documented, but attention needs also to be paid to the psychological difficulties of patients in chronic renal failure for whom this operation is recommended. Thus, Kemph (1966), in a study of seven cases has drawn attention to the unconscious hostility shown by some donors to recipients. The present paper is one of a series (Cramond, Court et al., 1967; Cramond, Knight et al., 1967; MacNamara, 1967) in which the psychiatric contribution to a renal unit and the criteria used in donor-selection have been discussed, as well as some of the psycho-social problems arising in connection with the work of the unit. It is now proposed to deal with some psychological, social and economic problems which recipients meet during rehabilitation, and the ambivalent dependency that may develop between recipient and donor. Although only a short series of cases has been studied so far, an awareness of this interaction will help to establish better criteria for future donor selection.

This paper attempts to show something of the interaction between social factors and the response to treatment in patients with chronic renal failure who embark on a programme of recurrent dialysis. The social work involved was carried out on the series of patients reported by Professor Cramond and his colleagues in the three articles preceding this one.

The title of this review would be regarded by some psychiatrists as provocative; they would relegate the biochemical concomitants of depression and mania to a secondary position and deny that biochemical changes have any place in the aetiology of these conditions. However, in my view, the weight of evidence, although it is by no means conclusive, suggests that biochemical changes are most important in the aetiology of affective disorders. A biochemical aetiology implies that there are certain biochemical changes in the brain which need to be restored to normal before the patient's clinical condition will improve. This does not deny that psychological and environmental events may precipitate and maintain the biochemical events which in turn lead to the affective disorder. The study of these biochemical events is clearly at too early a stage for speculations about the interrelationship between environmental and endogenous elements to be fruitful; this study must wait until the biochemical aetiology is clearer than at present.

In several previous studies it has been shown that the mean tremor amplitude displayed by morbidly anxious patients is greater than that of normal control subjects. The most detailed experiments were those carried out by Redfearn (1957). He compared the findings obtained in groups of male morbidly anxious patients and controls, and in addition to confirming the existence of a difference in tremor amplitude, he reported that the tremor of male anxious patients showed a greater degree of accentuation of the 8–10 c/sec. components than the tremor of a matched control group. Halliday and Redfearn (1956) compared the tremor spectra obtained from normal male and female subjects, and found that the curve for men was similar to that for women.

It has been found that a significant progressive reduction in the amplitude of physiological tremor in the 4–12 c/sec. range occurs when relatively unpractised subjects carry out a series of trials in a motor task involving a controlled muscle effort (Carrie, in press.

As a result of three decades of painstaking work, R. Gjessing (1932–1960) published ten classical Beiträge zur Somatologie der periodischen Katatonie. These studies are being continued by L. R. Gjessing (1956, 1958, 1964, 1965) on some of the original patients and on additional subjects.

Since human electroencephalography was first introduced by Berger in 1929, there have been many attempts to correlate the alpha rhythm with various aspects of personality. Lemere (1936) first reported a relationship between “good” and “poor” alpha rhythms and cyclothymic and schizoid personalities respectively. Gottlober (1938) found a correlation between a high alpha index (per cent. time alpha) and extraversion. However, Henry and Knott (1941) pointed out that the group studied by Gottlober was loaded both with high alpha indices and extraverts, and with additional data were unable to find a significant relationship between extraversion-introversion and alpha index.

In a leading article on mental symptoms in vitamin B12 deficiency (Lancet, 1965), it was pointed out that “though mental illness due to vitamin B12 deficiency is uncommon, it is readily treated, and, as in general paralysis of the insane, its protean manifestations and uncertain physical signs call for an easily applied screening test comparable to the Wassermann reaction”. In the correspondence which followed it was suggested that in psychiatric practice today mental symptoms were likely to be found more frequently in association with vitamin B12 deficiency than with a positive serological test for syphilis (owing in part to the increasing number of patients with deficiency syndromes following gastro-intestinal surgery); and that estimation of serum B12 concentration should be performed much more readily without waiting for clear-cut haematological evidence or neurological complications of megaloblastic anaemia (Hunter and Matthews, 1965). This was emphasized by the evidence of Strachan and Henderson (1965) who described three patients with psychiatric syndromes attributed to vitamin B12 deficiency in whom not only peripheral blood but also bone marrow was normal; and the report from a mental hospital in Norway by Edwin et al. (1965) that of 396 patients over the age of thirty years admitted over a twelve months period, 23 (5·8 per cent.) had serum B12 concentrations below the critical level of 100 μμg. per ml. as estimated by Euglena gracilis assay. This finding was challenged by Herbert et al. (1965), who suggested that drugs of the phenothiazine group administered to the patients might have suppressed the growth of the organism, but this was disputed by Edwin et al. (1966).

The search for objective indices in diagnosis and prognosis of patients suffering from mental illness remains a matter of great clinical interest. While advances in this field have been reported from time to time, no method has become unequivocally established, and in affective disorders much interest has focused on the possible link between mood and physiological change. Cannon's work on the “Bodily Changes in Pain, Hunger, Fear and Rage” (1920) indicated the breadth of this relationship and gave impetus to attempts at rating emotional responses by the severity of their accompanying autonomic changes. Papez (1937) also emphasized that “emotion is such an important function that its mechanism, whatever it be, should be placed on a structural basis”. While this is being sought currently in the limbic system, reticular formation and hypothalamus, the importance of the autonomic system as effector pathway of physiological responses accompanying emotional states has in no way diminished.

There is evidence that the susceptibility to certain diseases varies in people of different blood groups. Associations have been claimed to exist between the ABO blood groups and diseases such as duodenal ulcer, carcinoma of the stomach, pernicious anaemia, diabetes mellitus, and rheumatic fever. The most convincing evidence for an association between a blood group and a disease is that of the increased frequency of group O in patients with duodenal ulcer (Aird et al., 1954), and also an increased frequency of non-secretion in the same disorder (Clarke et al., 1956).