According to Wolpe (1964b) “conditioning therapists as a rule undertake treatment of all cases of neurosis“. However, some limitations in the application of conditioning therapies must be recognized, and the nature of their difference from psychotherapy requires definition. Considering the problem of unconditioned anxiety, which Wolpe (1964a) defines as occurring with an ongoing conflict situation when there are simultaneous impulses to opposing actions, we observe that Wolpe does not claim that conditioning therapies are applicable here. But behaviour therapists do not believe that anxiety generated by conflict plays a part in the causation of neurosis, and wholly discount the significance of repression. In general, mature personalities tend to resolve their conflicts, motivated by the driving force of anxiety, but in neurotically ill individuals, often unable to face problems arising out of personal shortcomings, these conflicts are not always in full awareness, though they may not be very deeply “repressed”. Quite rightly, behaviour therapists point out that in their case material, where conditioned neurotic reactions constitute the main symptoms, the patient may recover, though the forgotten incidents remain forgotten, as for instance in functional amnesia. Accordingly they conclude that resolution of repression is not a prerequisite for recovery. But, as even many psychoanalysts concede, the detail of the forgotten memory, the repressed incident, is of less importance than are the associated affects and attitudes, and it is these which often cannot be squarely faced by the neurotic patient. Unconditioned anxiety aroused by conflict comes indeed within the orbit of psychoneurosis. Wolpe (1964b) alludes to this as follows: “You may find a person who is in a chronic conflict situation … which arouses emotional tension, perhaps all the time; … treatment of neurotic anxiety reactions may be much impeded by emotional disturbance due to the life circumstances. But the behaviour therapist can often instigate action leading to the resolution of difficult situations.” How Wolpe (1964a) accomplishes this is described when he deals by behaviouristic analysis with reactions in which “crucial stimulus antecedents are obscure”. Claiming that it is possible to establish the stimulus antecedents of reactions in every variety of neurosis, he states that the patient may simply be unaware of certain of his reactions, because of “conditioned inhibition of awareness of particular responses”. He quotes a case of unacknowledged rebellion of a patient against domination by her husband, in whom the complete exposure of this set of attitudes within her led to the possibility of their expression and to therapeutic change. Although Wolpe (1958) denies that this type of phenomenon constitutes repression, he appears to imply a very similar event when he discusses “conditioned inhibition of awareness”. It seems pedantic to insist that these are conceptually quite different and to claim that behaviour therapists are unique and original in trying to uncover underlying attitudes and affects.

Hoffer and Mahon (2), using an extraction method of their own, have shown that certain compounds, separated on paper chromatograms, give a mauve colour. This colour comes on slowly over 30 minutes as a pink area which slowly turns mauve and then within a half to 1 hour has a typical mauve appearance. It then begins to fade and usually, within several hours, has gone. The presence of this mauve colour is taken as a positive indication of the presence of these substances, and Hoffer and Mahon state that the majority of schizophrenics have these unknown substances in their urine.

Oxypertine is a new piperazine derivative, believed to have tranquillizing, antiadrenergic and hypotensive properties. Unpublished reports have suggested that it might be useful in chronic schizophrenia, although the recent study by Calwell et al. (1964) shows that its usefulness in this condition is limited. In view of its putative tranquillizing effect, the present clinical trial was undertaken to determine, under double-blind conditions, its efficacy as an adjunctive treatment for chronic anxiety neurosis. Ratings of anxiety symptoms were the major criteria for assessing the patients' progress, but the IPAT Anxiety Scale (Cattell and Scheier, 1957) was also included as a potentially useful measure of anxiety. An investigation of its validity was a subsidiary aim of the study.

Among the numerous reports on toxic side effects of antidepressant drugs, the monoamine oxidase inhibitors appear prominent in causing such a variety of serious complications (4) that many physicians prefer to avoid their use altogether, and prefer other drugs (such as the Iminodibenzyl group) that produce their euphoriant effects more slowly but also more safely.

To see a ghost is a most impressive experience, but if the apparition is the observer's double the event must have added impact. The dramatic appeal of such a situation has long been exploited by authors and it would seem that their preoccupation has in some cases been dictated by personal experience, for example Maupassant and Dostoevsky (Coleman, 1934).

This study reports certain test findings and generalizations on the performance of a small number of top ranking British Motor Racing drivers. The first section deals with the formal tests, the second is speculative about the motives involved in choosing motor racing as a career.

The number of alcoholics admitted to mental hospitals in the United Kingdom has recently shown a sharp rise. In Scotland the admissions have risen from 732 in 1956 to 1,347 in 1961 (General Board of Control for Scotland) and in England and Wales from 1,285 in 1956 to 2,479 in 1960 (Registrar General). Figures for admission to general hospital units are not as yet available but they may well show a similar rise. Admission rates for alcoholism to Scottish mental hospitals are about four times higher than in England and Wales, and one-third of first admissions of middle-aged men to Scottish mental hospitals are suffering from alcoholism or alcoholic psychosis (Morrison, 1964). The rise in admission rates cannot be taken as indicative of a rise in prevalence; it may be that they reflect other changes, such as the attitude of the patients towards the acceptance of treatment, the attitude of the family doctor towards referral, and the availability of hospital beds.

Altered serum proteins in mental illness have been reported by workers in various parts of the world, and a review of these studies has led to the consideration of an autoimmune mechanism in the pathogenesis of some functional psychoses (Fessel, 1962a). Several reports have appeared in recent years which suggest the presence of antibodies in the serum of certain psychiatric patients to central nervous system tissue. Many of these have been reviewed by Vartanyan (1963). Fessel (1962b, 1963) demonstrated agglutination of latex particles coated with monkey brain extract and agglutination of tanned sheep red blood cells coated with human brain extract, but no precipitins in double diffusion in agar of the sera against monkey brain extract. As an alternative to antibrain antibodies he suggested a less specific physicochemical abnormality of the serum which caused the agglutination. Yokoyama, Trams, and Brady (1962), using a sheep red blood cell haemagglutination technique, showed the presence of anti-asialoganglioside antibodies in the sera of 3 of 14 schizophrenic patients and anti-ganglioside antibody in the serum of another. Kuznetzova and Semenov (1961), by complement fixation, demonstrated antibodies in the sera of 22 of 84 schizophrenics, mainly to human brain and not to other organs. The antibodies appeared more frequently in the later stages of the illness (Semenov, Morozov, and Kuznetzova, 1961). Skalickova and Jezkova (1961), also with a complement fixation technique, demonstrated blood and cerebrospinal fluid antibodies to grey and white matter during the “infectious” onset of schizophrenia, but not in the chronic, demented phase.

Prior to 1952 a Registrar was available at The Maudsley Hospital from 9.30 a.m. to 5.30 p.m. to see out-patients of the hospital who wished to consult a doctor outside the times of their routine appointments. In 1952 the necessity for a more extended service was recognized by the appointment of a Registrar to work whole-time in the Emergency Clinic. A special room and telephone were provided and in effect a psychiatric casualty department was established. The Hospital also offers an Emergency Service between 5.30 p.m. and 9.30 a.m., but this is not considered in the present study. With the change of policy towards more rapid discharge of patients from psychiatric hospitals and the care of the chronic mentally ill in the community, it seemed very probable that a psychiatric emergency clinic would be increasingly used for referral by family doctors and by patients spontaneously seeking advice, and in fact there were 1,830 attendances at the Clinic in 1958, 2,274 in 1960, and 3,377 in 1962.

The inability in a woman to tolerate intercourse is a factor which causes tremendous strain in marriage and leads rapidly to dissension between husband and wife and often the eventual break-up of the union. It is therefore a condition which it is vital to treat quickly and successfully if the partnership is to be saved.

The development of Day Hospitals for geriatric patients in this country over the past 15 years has been one means of attempting to relieve the problems arising from an increasing senile population.

A number of drugs capable of mono-amine oxidase inhibition have been marketed with the claim that they alleviate depressive illness. One of these is tranylcypromine (‘Parnate’), which has won notoriety on account of the severe headache experienced by those receiving the drug when they also eat ripe cheese (Lancet, 1964). In chemical structure, it is related to amphetamine. Amphetamine is a drug of addiction, and addiction to tranylcypromine was therefore to be expected. A preliminay notice of the present patient has already been published (Le Gassicke, 1962).

The discovery that N-allylnormorphine was a specific antagonist to morphine gave hope that an anti-barbiturate agent might be discovered. Shaw et al. (11) noted that in dogs, BB-methyl-ethylglutarimide (bemegride) dispelled the EEG changes induced by barbituric acid, and suggested that it may act as a barbiturate antagonist. Subsequent studies by Louw and Sonne (5) and Pederson (9) did not lend support to this theory, and Peacock (8) could find no specific pattern of EEG changes which could be attributed to the administration of bemegride. Ackner and Pampiglione (1) concluded that the demonstration of persistence of barbiturate-fast activity in the EEG after arousal did not support the hypothesis of a direct pharmacological antagonism, and suggested that bemegride was not a direct stimulant but caused an increased responsiveness in the patient.

The avowed intention of a recent paper by Dann (1964) on psychological disturbance in students of psychology was to encourage others to collect and publish further data. It was suggested by that writer that “the general impression amongst doctors” was that students and ex-students of psychology suffer more from psychiatric disorders than do other members of the population. Taking a sample of students reading psychology at University College, Swansea and comparing it with students reading other subjects at the same College, Dann found a statistically significantly greater proportion of the former to exhibit psychiatric disorder, mostly of a neurotic or psychosomatic sort. The criterion of when a consultation became one for a psychiatric disorder was subjective and “was stretched fairly widely”, and there is no information about whether the consultant was or was not aware of what course the student was on before arriving at the diagnosis.

Cryptomnesia belongs to the category of psychiatric terms which acquired a bad reputation and nearly passed into obsolescence. Its disrepute has come from its popularity with people who are believers in psychic forces, spiritualism, vitalism and other supernatural agencies. Such people have used it to denote the apparent ability of some mediums to become aware, when they are in a trance, of “hidden” memories—hidden in the sense of being inaccessible to them in their normal consciousness.

The recent development of industrial therapy (Early 1960 and 1963; Wadsworth 1958, 1961, 1962 and Smith 1963) in British mental hospitals reflects our current therapeutic optimism and takes advantage of a period of full employment in industry. Industrial therapy has been found to be an important weapon in the prevention or cure of institutional neurosis (Barton 1959). It is, of course, well known that during the past two decades institutional neurosis has been markedly reduced by a more permissive and non-authoritarian approach to patients, including amongst other things greater freedom, more enlightened nursing and the use of group techniques and occupational therapy in various forms. However, if patients are to be rehabilitated and the best use made of their personality resources, their lives within the hospital should be as close as possible to normal life in the community, and it follows that like normal citizens they should be employed at productive, useful and satisfying work for which they should receive proper economic rewards. This work may be in a factory setting, but need not exclude in some circumstances work in certain hospital departments. However, in order to prevent confusion the term industrial therapy should only be used when “patients are employed in factory-type work under medical and nursing supervision which aims at their rehabilitation and/or resettlement, the nature of the work being related to the needs of the individual patient, giving him both psychological and economic satisfaction”. It appears that in the United States the traditional employment of patients in hospital departments without pay (except token payments in kind) is now being called industrial therapy; it is likely, however that American interest in the totally different British concept of industrial therapy will lead there to a change in approach. It should, therefore, be stressed that an integral part of industrial therapy is financial reward for work done according to ability, motivation and production. Thus “economic satisfaction” is an essential part of any definition.

There is a good deal of evidence that hereditary factors make some contribution to determining a predisposition to neurotic illness, and some of the relevant literature has recently been reviewed by one of us (Slater, 1964). Raised incidences of neurotic illnesses and neurotic traits of personality of a like kind have been found among the first-degree relatives of obsessional neurotics, anxiety neurotics and persons diagnosed as suffering from hysteria. The evidence is much stronger in the case of the first of these types of illness than in the last. Such observations do not absolutely require a genetical explanation. It is possible that the similarities shown by relatives are not caused by their blood relationship, but by similarities in such aspects of the environment as early upbringing, social milieu, family tradition, etc. However, these findings do suggest that, if there is a genetical contribution to the personality traits which are associated with neurotic illness, this will most likely be due to a number of genes, additive in their action. This again would lead one to expect to find continuous variation between individuals in the degree to which they show such personality traits, and in our view the available evidence supports a multidimensional mode of variation.