The more recent and better designed studies of the reliability of psychiatric diagnosis (Schmidt and Fonda, 1956; Norris, 1959; Kreitman, 1961; Kreitman et al. 1961) suggest that the earlier pessimism may not be entirely justified. At the present time it seems safest to conclude that there are some states that some psychiatrists can diagnose reasonably reliably under some conditions. Nevertheless, even if psychiatrists could be shown to be highly reliable under optimal conditions, their diagnoses could only serve as the criterion by which to develop some more objective, public and quantitative means of classification, since the optimal conditions cannot readily be met in routine practice. It is desirable that any such quantitative scale should be reasonably compatible with existing psychiatric classification. As Eysenck (1960) has argued, “the degree of correspondence observed is of some interest in making possible the translation of experimental findings from one field to the other…. Even if there were no correspondence at all with psychiatric diagnostic classifications, this would not in any way invalidate the empirical findings”.

In the clinical evaluation of new drugs, many investigators employ a simple crossover design, where half of the patients first receive the active drug for a given period of time, followed by a switch to an inert placebo for a similar period of time; the other half of the patients begin the trial on placebo, and are subsequently switched to the active drug. When the criterion measure consists of an over-all rating of, say, “Improved” or “Non-Improved”, the data lend themselves to a chi-square analysis. It is clear, however, that in many clinical circles, this analytic technique is being consistently misused, despite the fact that the various pitfalls and underlying assumptions have been widely emphasized (Lewis and Burke, 3). The purpose of this brief note is to demonstrate the proper use of chi-square, and also to show that, when incorrectly used, the clinical research investigator may increase the probability of prematurely discarding an effective drug.

The problem of drug addiction is numerically a relatively minor one in this country at the present time, although the effects on the patients concerned, particularly as a considerable proportion belong to the medical and allied professions, are profound. The Interdepartmental Committee on Drug Addiction in its Report (1961) attributed our relative freedom from the problem largely to the present attitude of the public towards drugs and to the systematic enforcement of the current Dangerous Drugs legislation. In the U.S.A., on the other hand, drug addiction is a matter of national concern and there the hand of the physician treating drug addiction is controlled by Federal legislation. Tremendous efforts have been made, with only a limited degree of success, to diminish its incidence particularly during the past twenty years. Legislative measures, notably the Harrison Act of 1914, have been introduced; national committees have been set up to discuss the problem; and two hospitals (Lexington, in Kentucky, and Fort Worth) both entirely devoted to the treatment of drug addiction, have been established. As a direct result of these efforts a considerable amount of valuable information concerning drug addiction has become available, particularly as a result of the work of Isbell and his colleagues at Lexington Hospital. The addictive properties of new preparations have been assessed; the metabolic, pharmacological and biochemical aspects of drug addiction have been investigated, and research into the psychological mechanisms underlying drug addiction has been carried out.

In a recent report (Reidy, 1960) of experiences in running a newly opened Centre for disturbed pre-adolescents, it was found that the majority of cases had presented as emergencies. The author goes on to state that “To my knowledge there has been little written on what constitutes a psychiatric emergency in pre-adolescent children. The dangers of suicide and homicide, the main reason for emergency hospitalization of adults, are, according to the literature, rarely present in pre-adolescents.”

In the course of urine-testing with Phenistix in a survey∗ of the inmates of remand homes, classifying schools and approved schools, only one positive result has been obtained from 2,300 boys and 541 girls tested so far in the London area. This was obtained with the urine of a boy who proved not to be Phenylketonuric, and further investigations were carried out in his case and with members of his family.

It is now accepted that the underlying cause of mongolism is a trisomy of the 21st chromosome (Denver classification). This finding has given a new impetus to research into this condition. It is hoped by investigating these people to be able to find out what genetic information is carried on this extra chromosome, this would be of great interest to all students of human biology, as well as being of use in the more general field of human medicine. It is very unlikely that the extra chromosome in every case will carry the same genetic information, and this would account for the within species differences in the syndrome of mongolism.

The primary aim of family psychiatry is to demonstrate how the mental health of family members is interrelated. It is a study in which aspirations have outstripped techniques, possibly because research workers have attempted to apply the subtlety of clinical insights to details of family dynamics. Yet only confusion can follow such attempts while basic general data are still lacking; and as Post's (1962) survey illustrates so clearly, our present certain knowledge, despite great and continuing labour, remains exiguous.

In Great Britain systematic population studies of treated mental illness have received little attention. In exception Carstairs and Brown (5) have carried out a retrospective psychiatric census of two small communities in South Wales, to include admissions to mental hospitals, attendances at out-patient clinics and all cases of suicide and attempted suicide over a five and a half year period. Martin et al. (18) have explored the incidence of neurosis on a new housing estate. More extensive programmes have been undertaken in the U.S.A., particularly that of Hollingshead and Redlich (15) in their detailed study of New Haven, Connecticut, and in Scandinavia as exemplified by Larsson and Sjögren's (16) study of a rural population in Sweden.

In the course of the past few years, a series of related studies (Aserinsky and Kleitman, 1955; Goodenough et al., 1959; Wolpert and Trosman, 1958) has demonstrated beyond doubt the association of normal dreaming with the appearance of rapid, binocularly synchronous eye-movements. It has also been claimed that the rapid eye-movements (REMs) represent scanning movements made by the dreamer as he “watches” the visual events of the dream (Dement and Kleitman, 1957a; Dement and Wolpert, 1958). The REMs are absent during dreaming among those with life-long blindness, but are retained for some years by those whose blindness arises later than childhood (Berger et al., 1962a). In a study of undisturbed nocturnal sleep by Dement and Kleitman (1957b) periods of eye-movements were observed to occur fairly regularly at about 90-minute intervals throughout the night in association with the lightest phases of cyclic variation in depth of sleep, as indicated by the electroencephalogram (EEG). These REM periods had a mean duration of about 20 minutes, and 4–6 occurred per night.

There are conflicting psychiatric opinions about the value of separating depressive illnesses into several syndromes on clinical grounds, and so far experimental attempts to reach a classification of depression by distinguishing physiological or biochemical features which characterize one group rather than another have had only limited success. One interesting series of experiments in this area has been that of Shagass and his colleagues on the sedation threshold (Shagass et al., 1956, Shagass and Naiman, 1956, Shagass, 1954); they report that neurotic and psychotic depressions can be differentiated by means of EEG and other reactions to sodium amytal (amylobarbitone sodium) neurotics requiring greater amounts of the drug to reach the sedation threshold.

It has been suggested (Foulds, 1961b) that a double classificatory scheme, which takes account of both the more unstable symptom variables and the rather more enduring and stable personality variables, should increase the reliability of the psychiatric diagnosis.

In recent years there has been increasing experimental evidence that specific disturbances of perception occur in schizophrenia. Reduced size constancy in schizophrenic patients has been reported in studies by Raush (13), Crookes (6), and Weckowicz (16). Further investigations by Weckowicz and his colleagues (17), have also demonstrated reduced distance constancy in schizophrenia. (The retinal image of an object alters proportionately with the distance at which it is perceived. Size and distance constancy refer to our normal ability to compensate for changes in the stimulus and thereby to retain a stable perception of the object.) Brengelmann (3) and Angyal (1) have shown that schizophrenic patients have difficulty in reproducing briefly exposed visual stimuli. Penrose (12) has shown that schizophrenics perform poorly in a variety of tests involving visual discrimination.

There are reasons for supposing that both neurotic and normal individuals are likely to react differently to questions about nervous and about physical symptoms, and that those who are readier to respond to physical than mental questions might be those who adopted a particular attitude or mental set which we shall call “defensive”.

Recent interest in the problems of long-stay mental hospital populations has led to a number of studies which have been concerned with rehabilitation and particularly the re-activation of chronic, deteriorated patients by deliberate and systematic modification of their environment. In some of these studies, attention has been focused on the hospital ward itself, both as the background against which personal and social deterioration may be assessed, and as the means of re-building desirable patterns of behaviour (Cameron, Laing and McGhie, 1955; May, 1956). Another group of rehabilitation studies has been concerned with the value of specific work programmes. Industrial-type workshops in Dutch mental hospitals have been discussed by Carstairs et al. (1955), and the value of industrial and productive work in hospitals in this country, as well as some of its therapeutic effects, have been described in other publications (Baker, 1956; Stern, 1959; Collins, Fynn, Manners and Morgan, 1959). Considerable developments in the rationale and organization of sheltered as well as financially viable industrial workshops or factories for chronic mental patients have been made more recently (Wadsworth, Scott and Tonge, 1958; Early, 1960; Cooper and Early, 1961; Wadsworth et al., 1961).

SKF 7261 is a low dosage phenothiazine derivative belonging to the piperazine group, other members of which include trifluoperazine (“Stelazine”), prochlorperazine (“Stemetil”) and perphenazine (“Fentazin”, “Trilafon”).

Frank Fish's paper, published in The Journal of Mental Science in September 1961, pp. 978–985, deals with issues which are fundamental for psychiatry. He examines the different approaches used in existential psychology and especially the philosophical basis of existential psychiatry. In his conclusion, he denies its value. His paper demands a reply, since it contains misrepresentations.