In 1926 Mapother stated that in manic depressive psychosis we are dealing with “a merely quantitative deviation” from the normal, morbid only in its undue prolongation or if disproportionate or disastrous in its degree. He included anxiety neuroses along with mania and all varieties of depression as members of the manic depressive group. Perhaps these beliefs reflected the inevitable pessimism of a period when therapy was largely expectant and custodial. Somewhat despondently Mapother goes on to say “sub-division serves little purpose unless the types discriminated are correlated with differences in the unknown—for example in causation, prognosis and treatment”.

This investigation is concerned with the prevalence of dysmenorrhoea and premenstrual symptoms in the general population and with their relationship to personality.

Many authors have expressed the opinion that such relationships exist, but we will confine our review here to those studies which have presented supporting data. Wittkower and Wilson (1940) studied 57 patients with primary dysmenorrhoea and found there was a history of childhood maladjustment four times as often in these patients as in a control group. They considered that patients with dysmenorrhoea could be classified into two main personality types: the first, “characterized by deep resentment of their feminine role”; the second, “obviously immature physically and either shy or shut-in or chronically anxious and complaintive”. Sainsbury (1960) observed a significantly raised neuroticism score on the Maudsley Personality Inventory for patients attending hospital for dysmenorrhoea. Such views as these are not universally held, and would certainly not be shared by many gynaecologists. Nor are they supported by the little evidence forthcoming from population studies.

I have been deeply moved by your invitation to deliver this year's Maudsley Lecture. Founded to commemorate so distinguished a man, it has become most properly one of the honours of psychiatry.

In the course of a study of families containing children of primary school age, we have collected detailed social and medical histories of the parents. In earlier papers (Ryle and Hamilton, 1962; Hamilton et al., 1962) based upon part of the population studied here, we have confirmed the reliability of the Cornell Medical Index (C.M.I.) as an indicator of neurosis. The aim of the present paper is to investigate whether social factors within a relatively homogeneous, largely working-class population, are related to neuroticism. While differences in the rate of neurosis between the social classes have often been described, interpretations of these differences are difficult because they may be due not only to variations in the rate of illness but also to differences in the mode of presentation, in symptomatology or in attitudes to medical treatment or to research enquiry. On the other hand, in studying a population such as ours, with small social class differences, the range of social factors available for measurement is reduced.

Doctors have climbed mountains with explorers and travelled the world with kings and statesmen; they have gone on humble journeys with sick folk, voyaged for money, fled from their enemies, sought new knowledge. We have travelled to learn about psychiatric opinion and practice abroad, and have greatly profited thereby.

Since its first formulation, the concept of manic-depressive illness has been subject to successive modification and, on the whole, to progressive enlargement. It was Kraepelin, following on the attempts of Baillarger, Falret and Magnan, who grouped together all the various nosographic forms distinguished by isolated depressive or manic crises, periodic or alternating (and even the form designated as involutional melancholia), including them all under the sole class name of manic-depressive psychosis. The morbid entity thus defined was regarded as distinguished by the periodicity of the crises, each with a tendency towards social remission. Aetiologically the causation was seen as preponderantly hereditary.

The last twenty years have seen great changes in British administrative psychiatry. Jones (1955, 1960) has described how the mentally ill began to be assembled into special institutions for their own good (and society's protection) some 150 years ago. The humanitarian revolution associated with the names of Pinel and Tuke and the philanthropic enthusiasm of Shaftesbury and the other early Commissioners in Lunacy led to the widespread building of asylums, especially after the Acts of 1845 and 1853. This was a period of great interest in administrative psychiatry, or asylum management, as the writings of Conolly (1847, 1856) and others show. During the latter half of the nineteenth century the enthusiasm was lost and the asylums became custodial. The consolidated Lunacy Acts of 1890 and 1891 fixed a pattern of humane custody scrutinized by Lunacy Commissioners which persisted little changed for 50 years. Custodial decline was also seen in the United States and some causes of it have been discussed by Bockoven (1956) and Ozarin (1954). In the last 20 years, however, and especially since the end of the 1939–45 War, there has been a marked change in the conditions of the mentally ill.

Numerous recent electroencephalographic studies have revealed the cyclical alternation of two distinct types of sleep (Dement and Kleitman, 1957a), which have been termed “fore-brain” and “hind-brain” sleep by Jouvet (1962). The former is accompanied by slow waves and spindles in the electroencephalogram (EEG) and the latter by a low-voltage, fairly fast EEG pattern; spasmodic, conjugate rapid eye movements (REMs); relaxation of neck and throat muscles in cat (Jouvet, 1962) and human (Berger, 1961); and recall of dreams following awakening (Dement and Kleitman, 1957b).

So little consideration is given in early medical writings to sexual disorders, that it seems that these were, for many centuries, hardly regarded as the concern of the physician. There are a few exceptions. For example: Hippocrates (Airs, Waters, Places XVII-XXII) discussed the part played by constitutional and environmental factors in the causation of impotence among the Scythians. Later, Caelius Aurelianus, according to Zilboorg (1941), while expressing disgust at the debauchery which characterized Imperial Rome, seems to have recognized that sexual perversions were illnesses which, at times, were epidemic in character. Subsequently, and in particular during medieval times, problems of this nature seem to have had a moral rather than a medical connotation. Indeed it was not until towards the close of the nineteenth century that any real insight into the medico-psychological nature of sexual difficulties and deviations became apparent. This new awareness reached its peak following the investigations of Havelock Ellis, Freud, Stekel and others, and the formulation of certain psychoanalytic hypotheses.

The present paper continues our study of the parents of children of primary school age, in a sample taken from one of the authors' N.H.S. list. The details of the selection of this population, the methods of data collection, and the absence of any relationship between various social factors and neuroticism, were described in a previous paper (Pond et al., 1963) and are not repeated here. In this paper we report upon the marital history and adjustment of the parents of these 100 families, and investigate the relationship between neuroticism and these factors.

The question of the specificity of anorexia nervosa is at present unsettled. Mayer-Gross et al. (8) describe it as a syndrome with its own particular psycho-physical characteristics, and others have drawn attention to consistencies in family history, personality and symptoms in series of cases (3, 10). But no statistically controlled study has confirmed its specificity, indeed the one such study of recent years, reported by Kay (6) and Kay and Leigh (7), concluded that there is no specific anorexia nervosa, that the label covers psychogenic anorexia occurring in a wide variety of psychiatric settings. This was a retrospective survey of a series of 37 patients diagnosed as suffering from anorexia nervosa in the past. It is possible that the lack of specificity might have been due to the imprecise definition implicit in such a sampling procedure. Although the study failed to demonstrate a specific anorexia nervosa, it did not finally refute the existence of such an entity.

The linguistic philosophers have tended to maintain that philosophy is reducible to the ways in which language is used. Without going all the way with them I believe that they have made a valuable contribution to thought, and that it is often illuminating to look at current problems in that way. In attempting to do this for psychiatry my object is to draw attention to the existence in psychiatric thought of what may be called a number of different languages, to consider briefly the rules which apply to each and those which govern the attempt to translate one language into another, and also to look at the relations between psychiatric languages and certain other types of language.

The wording of the Mental Health Act, 1959 makes it clear that an application under Section 29 replaces both the old Urgency Order and the D.A.O.'s three-day order as a means of compulsory admission to a mental hospital or the psychiatric ward of a general hospital. It was intended to be limited to cases where the patient's mind is so acutely deranged as to make him a grave and immediate danger to himself or others, so that the delay in obtaining a second medical recommendation required for admission under Section 25 might spell disaster.

Legal adoption has gained enormously in popularity over the last thirty-five years. Beginning in 1927 with under 3,000 cases, a peak was reached in the early post-war years with over 21,000 orders granted in 1946, while over the last decade this figure has stabilized at an annual average of 13,500. Something like a third of these adoption orders are for mothers wishing to confer legitimate status on their own children born before or out of wedlock, while in a small proportion of other cases children are adopted by relatives acting in loco parentis. We are left with a clear majority of cases (probably about 60 per cent.) in which the purpose of adoption is to create or complete a family where fertility is known or believed to be impaired. Only rarely will a couple adopt in preference to reproducing, although there are certain circumstances in which such a decision would be justified, for example where pregnancy carries serious risks for a woman healthy in all other respects or where there is a likelihood of inherited abnormality in her child.

Hughlings Jackson has exerted a considerable influence in psychiatry. This statement will surprise most psychiatrists because the work of “the father of British neurology” is not known to have made any direct impact on their specialty. It is true that striking similarities between Jackson's basic principles and those of so-called dynamic psychiatry have for some time been noted. But they have been regarded either as incidental or as indicative of the general influence of the theory of evolution.

Depressive illness is protean in its manifestations. The symptoms may be primarily psychological, such as misery, indecisiveness, irritability, inability to concentrate, or insomnia. They may be mainly physical, and the patient may present with one or more of a bewildering number of somatic complaints, often blaming those for his change in mood (Watts, 1957). Pain is a common and diagnostically puzzling presenting symptom of depression and other psychiatric disorders (Walters, 1961). It may take the form of generalized or poorly localized aches and pains, often associated with a feeling of tension, or it may be sharply delimited (Critchley, 1935). This form of localized pain may so dominate the symptomatology that the patient is referred by his general practitioner to a variety of specialists, who may perform a series of special investigations or even exploratory operations. Clearly, every effort must be made to exclude organic disease, even if positive signs of psychiatric illness are recognized, as an organic disease can obviously co-exist with a psychiatric one. In spite of thorough investigation, there will remain a proportion of patients in whom no lesion can be found to account for their symptoms.

The literature concerning this rare syndrome, alternatively known as maladie des tics, has been mainly descriptive since it was first mentioned by Itard (1825) and later by Gilles de la Tourette (1885 and 1899). Its nature remains in doubt, and until recently it has been believed to be a progressive condition inevitably ending in psychosis or pursuing a chronic course.

Urinary excretion of adrenal metabolites, especially neutral 17-ketosteroids, is often low in patients with anorexia nervosa (Escamilla, 1949; Bliss and Branch, 1960). This has been taken (Emanuel, 1956; Greenblatt et al., 1951) to provide evidence of adreno-cortical insufficiency secondary to defective pituitary function (Sheldon, 1939; Perloff et al., 1954). According to Perloff et al. (1954) “prolonged starvation may result in functional hypopituitarism, whose differentiation from the syndrome of hypopituitary cachexia due to structural impairment of the anterior pituitary gland is at times extremely difficult, even when the accepted tests for endocrine adequacy are performed”.