Northamptonshire is a county in which details of pedigrees containing patients suffering from Huntington's Chorea have been kept for the past 14 years. In some families these details cover a span of eight generations. Pleydell (1954) found the prevalence of this illness to be five cases per 100,000 in 1954 (eight choreic families in the county), but in 1955 he found four new affected patients in one family, making 6-5 cases per 100,000 in nine choreic families for the county. Reid (i960) found two new subjects in the tenth choreic family of the county.

The complex interaction of genetic and environmental influences in Huntington's disease results in successive generations living in deteriorating social circumstances. As the disease is untreatable (other than by palliative measures), spouses and unaffected children also suffer indirectly from its socio-psychiatric consequences.

There have been relatively few studies of Huntington's Chorea in Britain. They include those of Curran (1930), Critchley (1934), Spillane and Phillips (1937), Minski and Gutt- mann (1938), Bickford and Ellison (1953), Pleydell (1954), Lyon (1962), Heathfield (1967), and Oliver (1970). Julia Bell's (1934) monograph was primarily a review of the literature, but included cases previously reported in this country and the results of her own observations.

In the last ten years there have been a number of studies reporting an association between certain persistent oral dyskinesias in elderly people (particularly women) and prolonged medication with phenothiazines. Many of the cases described in these studies also showed some evidence of brain damage and because of this it has often been suggested that brain damage is an important contributory cause of oral dyskinesia. Buccal factors such as the edentulous state have also been incriminated (Joyston-Bechal, 1965; Evans, 1965). However, very few controlled studies have been carried out. The literature on this subject has been well reviewed by Crane (1968) and Kline (1968).

Since the first description of persistent oral dyskinesia following phenothiazine treatment by Sigwald in 1956 a good deal of evidence has accumulated indicating the regular occurrence of this syndrome. However there is a disagreement over its incidence and the aetiological role played by phenothiazine drugs. Kline (1968) in a recent review found a total of 114 cases of ‘irreversible’ oral dyskinesia and concluded that the incidence had been misrepresented since less than two dozen of these recorded cases were previously non-brain damage.

Environmentalists have long attempted to demonstrate relationships between various deficiencies in upbringing and adult mental illness. Early parent death is one of the most obvious and one of the most easily measured of such deficiencies, and many investigators have been tempted to the deceptively simple task of comparing the incidence of early parent death in patients and the general population. That there is so little agreement in the findings of the now considerable number of studies is a reflection of the methodological pitfalls which exist.

Reaction to the death of a closely related person is characterized by a period of shocked disbelief, a period of acceptance and suffering, during which time the libidinal attachment to the internalized object is gradually withdrawn, and a prolonged period of readjustment. The first two phases usually last a number of months and correspond to the state of acute grief described by Lindemann (1944), Wretmark (1959) and Parkes (1965). The third phase involves the adjustment to a life without the lost person and in some individuals may persist for a number of years.

Freud's Mourning and Melancholia (1917) stimulated much psychoanalytic speculation regarding the relationship between loss of a loved object and subsequent depression. Abraham (1924) considered ‘a severe injury to infantile narcissism brought about by successive disappointments in love’ to be an important factor in melancholia, and used the term ‘primal parathymia’ to describe the disagreeable experiences of childhood which give rise to adult depression. Klein (1940) related all states of depression and mourning in adults to a reawakening of the infant's struggle to make reparation to the mother he fears he has destroyed. She believed that adults who are prone to depression have never successfully worked through this earlier ‘depressive position’. Bowlby (i960) has likened adult grief and mourning to the reaction of children to separation from their mothers. He proposed the view (1961) that children are less capable of coping with death of a parent than adults and adopt the defensive mechanism of ego-splitting by which part of the ego still considers the parent to be alive. This imperfect resolution of the loss situation leads to a fixation on the lost parent and a tendency to react badly to further separations. Brown (1961), extending this theory, maintained that rejections in adult life are likely to release the repressed urges to recover the lost object, and to precipitate a depressive illness.

The present study is one of a series of investigations concerned with the relationship between parent death and mental illness. In previous studies (Birtchnell 1970 a and b) it has been shown that significantly more psychiatric patients, compared with a general population control group, experienced parent death during the first five years of life and during a period of one to five years before admission to hospital. It was further shown (Birtchnell 1970c) that within the patient group, though the incidence of early and recent parent death was similar among depressed and non-depressed patients, the severely depressed compared with the moderately depressed patients experienced sig- nificandy more parental bereavements during the first twenty years of life and during a period of one to twenty years before admission. In a large sample of depressed in-patients, Hill (1969) demonstrated a significant excess of early parent deaths in those who attempted suicide, and he suggested that this might be secondary to the association between early parent death and severe depression.

Pollin et al. (12) found that in a series of 11 monozygotic twins (MZ) discordant for schizophrenia all of the index twins weighed less at birth, 8 of the index twins were second- born and 7 out of the 11 mothers had varying thyroid pathology ‘of clinical significance’. The following report is probably the first giving details of investigations into a pair of MZ twins who were given thyroid extract during the neonatal period because of failure to make normal progress.

Progress in the behavioural sciences is bedevilled by the difficulty in finding adequate controls. This is a report of a patient who in two important respects provided her own control.

In a previous publication (Brown and Birley, 1968) we have presented some findings which suggest that life changes and crises frequently precipitate the acute onset, relapse or exacerbation of schizophrenic states. To summarize : consecutively admitted patients diagnosed as suffering from schizophrenia were seen at mental hospitals serving a known catchment area. The first fifty whose onsets occurred within three months of admission and could be accurately dated within a week were included. Both the patient and at least one other informant were interviewed about the occurrence of certain previously defined and datable events occurring to the patient or to close relatives. These included such events as moving house, starting or leaving a job, admission to hospital, birth, marriage or death during the twelve weeks prior to onset. These were classified, according to their apparent independence of the patient's control, as ‘independent’ or ‘possibly independent’. The former were those which could be regarded as outside his control, e.g. discovering a burglary or hearing of a brother's serious illness. ‘Possibly independent’ events were those which were considered to have been within the patient's control but which had not been brought about by any unusual behaviour on the patient's part. They were chiefly changes of job, or of opposite sex friends. (Loss of job would, under certain circumstances, be rated as ‘independent’, e.g. when a whole firm closed down).

Weckowicz (1960), using pictures of common objects with superimposed lines, found that schizophrenics were less able to see the hidden figures than normal subjects and other patients. Unfortimately the task turned out to be too easy; most of the normal subjects and more than a third of the acute schizophrenics obtained the maximum possible score. Such a distribution of scores makes it difficult to carry out further analysis of the results. The aim of the present study was, using a more difficult task to obtain a better distribution, to confirm the lowered capacity of schizophrenics and to relate it to other variables. The task used was the ‘Gottschaldt Figures Test’, published by the University of California Institute of Personality Assessment and Research. This consists of the identification of two simple geometrical figures embedded in complex designs. The score (maximum = 20) is the number of figures correctly identified on two sheets, 2 minutes being allowed for each sheet. To ascertain how this task is ‘normally’ related to certain major personality variables, a group of neurotic patients was used, since they would not be expected to have any special disability on a task of this type.