Four circumstances—in addition to my own limitations as a historian—have determined my choice of subject for this evening. Last November this Institute celebrated its Jubilee—that is, the 50th anniversary of the recognition of the Maudsley Hospital as a School of the University of London. In the following month the one-time Medico-Psychological Association, which owed its very name to a suggestion by Henry Maudsley, and has now developed into the Royal College of Psychiatrists, moved into its new headquarters in Belgrave Square. Since then we have had to mourn the death of Sir Aubrey Lewis, one of whose outstanding contributions to the Association, and to psychiatric history, was his Maudsley Lecture of 1951, devoted to the work and influence of Henry Maudsley.† Moreover, the early ‘70s are the centenary years of Maudsley's period of office as the senior editor of the Journal of Mental Science, now the British Journal of Psychiatry, with which I myself have long been associated. So it seemed that it might be appropriate for me to tell you something about the history of the Association, about Maudsley's relations with it, and about the various ideas, proposals and actions which eventually led to the foundation of this Hospital and Institute. In doing this I hope to furnish a few footnotes, as it were, to Sir Aubrey's Maudsley and Mapother Lectures, and these will be my personal tribute to one whom so many of us have held in affectionate admiration.

When Sir Aubrey Lewis died, psychiatry lost a major figure. He will surely rank with the great men of the past whose work he knew so well and would have judged substantial and enduring. The present assessment, written a few months after his death, can only attempt a preliminary evaluation of the work of a man who for more than twenty years was the dominant figure in British psychiatry.

Binet created the psychology of mental deficiency and incidentally the concept of intelligence which for many years has been a central issue in both psychology and education. He was primarily concerned with learning difficulties in children and it is a wry paradox that his development of the notion of intelligence has proved such a barrier to the study of the learning process. Intelligence for Binet was a summary term which stood in place of all the component elements of learning weakness which he noticed and assessed. His successors such as Spearman (1923), Burt (1937), Vernon (1950) and Jensen (1975) tend to use the term in an explanatory fashion although it is doubtful whether ‘intelligence’ explains ‘mental age’ or ‘mental deficiency’ except as a descriptive cross-reference.

The 16 PF was administered to 30 female attempted suicides and their spouses, to 20 male attempted suicides and their spouses and to 50 control men and their spouses. Both the female and male attempted suicides show personality disturbance, but there are also sex differences. The female attempted suicides and their spouses appear to share similar personality characteristics, but the spouses of male attempted suicides appear quite dissimilar from their husbands. The effect of the personality of the spouses is briefly discussed in the context of marital relationships of attempted suicides.

The purpose of the study was to clarify the attitude of patients with schizophrenia and paranoid psychoses towards hospital personnel and treatment procedures during the two pre-suicidal months. The study was carried out on subjects from south Finland who had committed suicide during a three-year period and had been treated under these diagnoses. The controls included suicides who had received psychiatric treatment for other reasons. A questionnaire was issued to ascertain the opinions of the doctor last in charge of the patient and other personnel. Both groups answered independently, and the opinions given were almost the same. Both groups stated that during the last pre-suicidal months the patients with schizophrenia and paranoid psychoses had shown a more negative or indifferent attitude towards personnel than the controls, and their attitude towards medication had been clearly more negative. Among them there were considerably more patients who had ceased to request support or attention. Thus these patients had developed a degree of despair which manifested itself in a negative attitude towards personnel and treatment.

Frequent references have been made to the similarities between highly creative and psychotic thinking. This study attempts to test the hypothesis that one explanation for such a correspondence lies in the fact that individuals in both these populations habitually employ common attentional strategies which cause them to sample an unusually wide range of available environmental stimuli.

A group of highly creative adults and a group of equally intelligent but low creative adults were compared with a group of acute non-paranoid schizophrenic adults on three tests designed to assess attentional and other cognitive styles.

The results offer support to the view that both highly creative and schizophrenic individuals habitually sample a wider range of available environmental input than do less creative individuals. In the case of the schizophrenic this involuntary widening of attention tends to have a deleterious effect on performance, while, in contrast, the highly creative individual is more able to successfully process the greater input without this incurring a performance deficit.

Twenty-two female patients with anorexia nervosa were assessed by means of objective personality testing. The EPI, Leyton Obsessional Inventory, Cattell's 16 PF and Raven's Matrices were used for this purpose. The personality profile that emerged was of a highly neurotic and introverted person with moderately severe obsessional features and average intelligence.

Two cases are presented in which treatment with lithium was complicated by thyrotoxicosis. The underlying physiological mechanisms are discussed.

Lithium suppresses thyroid function, so the early stages of thyrotoxicosis may be clinically undetectable. The symptoms and signs of thyrotoxicosis may be confused with the side effects of lithium, and if lithium is withdrawn severe rebound thyrotoxicity may occur. Furthermore, some of the side effects of lithium may be aggravated by thyrotoxicity.

These cases provide further evidence of the importance of routine screening of thyroid function before starting treatment with lithium.

The study dealt with the level of and diurnal alterations in the concentration of tryptophan, free tryptophan and tyrosine in the blood plasma of 20 inhibited depression patients and 10 healthy controls.

The results suggested that there was no distinct relationship between either the total plasma tryptophan or plasma tyrosine level and depression. On the other hand, the free plasma tryptophan level was, at all the times of day at which measurements were made, either significantly or almost significantly higher in the patients than in the controls. It was further found that the results of measurement were related to the patients’ clinical improvement, as measured by the Hamilton test, in such a way that after four weeks of treatment the free plasma tryptophan level in ‘poorly improved’ patients continued to be significantly higher in comparison with the controls, whereas the values for the ‘well improved’ patient group did not differ greatly from the corresponding values for the control group any longer.

It may be hypothesized that the rise in the free plasma tryptophan in depressive patients might represent an effort made by the peripheral body to compensate for the slowed-up serotonin metabolism of the brain, whereby the tryptophan mobilized from the periphery would serve as a sort of ‘endogenous antidepressant’ provided by the organism itself.

A follow-up study is reported of a consecutive series of 360 women who underwent termination of first trimester pregnancies by vacuum aspiration. Each patient received brief counselling before termination. Follow-up examinations were carried out by means of detailed, structured interviews at three months and between 15 months and two years (mean: 18 months) after termination. Outcome was assessed in terms of psychiatric symptoms, guilt feelings, and adjustment in marital and other interpersonal relationships, sexual responsiveness and work record. Compared with ratings of psychosocial adjustment before termination, significant improvement had occurred at follow-up in respect of psychiatric symptoms, guilt feelings and interpersonal and sexual adjustment; there was no significant change in marital adjustment. Adverse psychiatric and social sequelae were rare.

A hundred-and-twenty-five school phobic youngsters had been treated in a psychiatric in-patient unit for young adolescents of secondary school age over a seven-year period; a hundred of them were reviewed on average three years after discharge. About a third of cases were found to have improved little; they had persistent severe symptoms of emotional disturbance and continuing social impairment. Another third had improved appreciably and were affected by neurotic symptoms rather than social impairment. The remaining third had improved substantially or completely. School attendance difficulties had remained in about half of all cases. Subsequent difficulties in going to work were less pronounced. The best predictor of outcome was clinical state on discharge. High intelligence also emerged as a significant predictor of poor outcome. Five girls and a boy had already developed severe and persistent agoraphobic difficulties when reviewed. It was found that severe school phobia in early adolescence resembled adult affective disorders in some clinical features and in outcome.

As part of a survey of agoraphobic women in the general population, it was found that school phobia occurred in their children to a greater extent than would be expected. The average incidence in children aged 11 to 15 was 14 per cent. The women with school phobic children had had school phobia themselves to an undue extent.