The purpose of this paper is to report on therapeutic measures which have been used on my Unit at the Maudsley Hospital for several years and have been gradually elaborated with the help of registrars who have learned to apply them under my general supervision. The measures are derived from the therapeutic technique Freud recommended. In 1913, when he reviewed the development of his technique, he said: “In the earliest days of analytic technique we took an intellectualist view of the situation. We set a high value on the patient's knowledge of what he had forgotten, and in this we made hardly any distinction between our knowledge of it and his…. We hastened to convey [it] to the patient in the certain expectation of thus bringing the neurosis and the treatment to a rapid end.

Interesting accounts of injuries resulting from self-applied constricting bands have been given by Thurston (1963, 1967), Little (1965), Cutler (1967), Turney (1967) and Glew (1967). Callum (1967), Noott (1967) and Webb (1968) have reported injuries in babies where the band was presumably not self-applied. Cohen (1967) noted lesions in mental defectives produced by self-applied elastic bands round the teeth.

Do psychiatrically disturbed teenagers tend to be physically immature? This paper describes an investigation designed to answer this question by formal methods and to test beliefs based on imperfect evidence. Through the development by Tanner, Whitehouse and Healy (1962) of a refined technique for the estimation of physiological maturity by measurement of skeletal age, it has been possible for an investigation to be carried out in this area with considerable confidence in the instrumentation. For the author, interest in physiological maturity was prompted by both clinical impressions and experimental findings, both of suspect validity, yet each pointing to the possibility that physiological maturation might be significantly different in normal and in disturbed adolescents.

In 1952 Osmond and Smythies, with Harley-Mason, suggested that schizophrenia might be due to an abnormality in the metabolism of epinephrine, by which a mescaline-like substance such as dimethoxyphenylethylamine (DMPE) might be produced by O-methylation at the third and fourth positions. It was felt then that DMPE might have “psychotomimetic properties” similar to mescaline.

As Mr. Justice Marshall said recently when making the appropriate hospital order: “The interests of the public are best served by curing the patient”, but with psychopathic disorder some still believe cure to be virtually impossible (Cleckley, 1953; Gould, 1959) and others doubt whether the condition can be treated at all. Genetic endowment (Heaton-Ward, 1963), damage to the developing foetus (Stott, 1962) and early adverse childhood experiences (Scott, 1963) have been thought to militate against later treatment success. Unfortunately all writers in this field are handicapped by the lack of long-term follow-up studies on the natural history of the condition.

Although there is a voluminous psychiatric literature concerned with obsessional personality disorder, there are very few psychological studies of the condition. In particular, whilst the thinking of anankasts has been classically and perceptively described by many psychiatric authorities, only a handful of psychological experiments exclusively concerned with anankastic cognition have been reported (cf. Skoog, 1964). It is suggested that this is largely because interest has centred on the content of obsessional behaviour at the expense of its form. The present study is a brief report of one among several investigations suggested by consideration of the formal qualities of obsessional thought as opposed to its “dynamic” or symbolic features. The hypothesis (Reed, 1968) is that the formal characteristics of anankastic cognition are directly related to functional impairment in the spontaneous organization and integration of experience. It is postulated that this failure is expressed in the over-structuring of input and in the maladaptive over-defining of categories and boundaries. From this may be derived the prediction that, given a classificatory or conceptual task, the anankast will be over-specific in his interpretation of the given class and therefore too strict in his acceptance of appropriate class members and attributes.

In studies which attempt to assess the efficacy of some new treatment it is customary to make a formal assessment of the relevant behaviour or symptomatology using standardized inventories, checklists, symptom rating scales or ad hoc ratings of variables considered to be important by the clinician-researcher. Ratings made at the beginning and end of treatment are compared for groups of patients using improvement scores, arbitrary cut-off points and other devices aimed at circumventing the statistical problems arising from the non-normal distributions of most rating scales. Present practice favours the use of some nonparametric statistic in these comparisons. The aim of this paper is to present a method which facilitates the analysis of ratings made on more than two occasions, allowing a trend analysis to be carried out without making assumptions about the distribution of scores. The method also allows the clinician-researcher to make a statistically-based decision regarding the efficacy of the treatment in question for individual patients.

In a recent review (Dewhurst, El Kabir, Harris and Mandelbrote, 1968) the evidence relating the effect of stress to thyroid function has been surveyed. In that account the comment was made that although it is impossible to assess or quantify the psychological trauma that any mentally ill patient is undergoing, it would seem reasonable to assume that if emotional stress is associated with abnormal thyroid activity, then a study of thyroid function in mentally ill patients would reveal such abnormal activity. In the present work a study has been made of the function of the pituitary–thyroid axis in control subjects and in patients suffering from schizophrenia and affective illnesses. Since there is strong evidence that emotional stress in many cases affects endocrine function through the mediation of the hypothalamus and anterior pituitary gland, measurement of the blood concentration of thyrotrophic hormone (T.S.H.) has been used in the present investigation. A further reason for assaying the blood concentration of T.S.H. is that measurement of many of the more direct parameters of thyroid function are subject to variables which are difficult to control. Studies of the blood level of T.S.H. in psychiatric patients have not, so far as we know, been carried out previously.

“But surely, in the third act when the father sends the son from his home, your intent is to probe the unresolved oedipal strivings of both men?” The man from the Sunday Review of the Creative Arts looked up from his note-pad, a faint air of well-bred surprise on his manicured face.

It has been suggested by Philip (1969) that more information could be gleaned from conventional drug trials if it were possible to assess the efficacy of treatment for each patient in the trial. A method for the statistical analysis of individual response to treatment has been put forward by Philip using a modification of Ferguson's nonparametric trend analysis of correlated observations (Ferguson, 1965). Sutherland, Sutherland and Philip (1967) have described the details of a double-blind drug trial in which the efficacy of Prondol, an imipramine derivative, was compared with a standard imipramine preparation. The patients in their trial were rated on the Hamilton scale for depression (Hamilton, 1960) on admission, after two weeks' treatment and after four weeks' treatment. Since the data were not amenable to analysis by parametic methods, Mann-Whitney U tests (Siegel, 1956) were calculated to ascertain whether the change scores between rating occasions were different for the two groups of patients. This cumbersome procedure showed that there was no difference in change scores between the trial drug group and their controls for the 0–2 week and 0–4 week comparisons; there was, however, a significant tendency for the control drug group to show significantly greater change between the two week and four week assessments.

The relationship between a patient's illness and psychiatric disturbance in the spouse is a matter of importance and increasing interest (Penrose, 1944; Slater and Woodside, 1951; Gregory, 1959; Ryle and Hamilton, 1962). Explanations based on environmental conditions (Pond, Ryle and Hamilton, 1963), genetic factors (Coppen, Cowie and Slater, 1965) and assortative mating mechanisms (Kreitman, 1962; Nielsen, 1964) have been found to be inadequate and research has come to focus on the nature of the marital interaction itself (Kreitman, 1964).

Oculo-cutaneous pigmentation has often been reported (Brit med. J., 1967) in patients receiving heavy doses of phenothiazines. This paper sets out to investigate, (a) the incidence of ocular pigmentation in such patients; (b) whether the measures suggested by Valentine and Jardine (1966) for minimizing this complication are effective; (c) the relationship of ocular pigmentation to extrapyramidal symptoms (and hence whether the pigmentation can be regarded as a sign of brain damage).

During the course of routine investigations it was noticed that an abnormal number of low serum cholesterol results were occurring in our laboratory, and that these results appeared to come from mentally retarded patients. An investigation was therefore carried out on over 1,400 patients in the Stoke Park Group of Hospitals. Whenever blood was taken for routine haematological examination a serum sample was also collected for cholesterol determination. A preliminary report of these findings was made (Eastham and Jancar, 1967).

The ordinary process of specialist examination of individuals on remand involves among other things the making of judgments of several kinds. Among these judgments are those as to normality, subnormality, abnormality, and types of abnormality. For some, such as the establishment of subnormality, there are technical aids, e.g. standard tests of IQ. For others, available aids are often inadequately standardized, inordinately time-consuming, or subject to other critical objections, e.g. as to their appropriateness. This may leave the specialist clinical observer dependent solely on his clinical acumen over a considerable area. This may not matter as regards the outcome in final judgments made, but may make the process unduly burdensome and lengthy.

A number of studies have suggested that psychiatric syndromes differ in the socio-cultural factors with which they are associated, such as age, race, social class and religion, as well as in the patients' family and personal backgrounds.

The aim of the present study was to examine more closely than has previously been done some widely accepted generalizations about the ritualistic behaviour of patients suffering from obsessional neurosis. Observation of such patients had suggested that their behaviour is less consistent and is governed by a much greater complexity of factors than is normally assumed. In addition it seemed that such over-simplification has led to the construction of inadequate theoretical models to explain ritualistic behaviour. Moreover it appeared that this over-simplification was linked to the fact that there have been very few systematic studies of the obsessional ritual itself: most descriptions of obsessionals' behaviour seem to be based on the retrospective and rather general accounts, given by the patients themselves in the relative calm and detachment of the consulting-room situation. Observation of patients actually performing rituals suggested that such accounts might well be misleading. Therefore, it seemed likely that it would be profitable to study the rituals of individual obsessional patients systematically and in some detail. In the investigation reported here, three such studies were carried out. The first two, which are reported briefly, were relatively uncontrolled and had as their aim the derivation of more specific hypotheses to be tested in a later investigation. The third study, which is reported more fully, was concerned with testing out these hypotheses by the more rigorous investigation and manipulation of the rituals of a further obsessional patient.

Pericyazine (“Neulactil”), introduced in 1961, is a phenothiazine with tranquillizing and stimulating properties.

The hypothesis has been proposed (Reed, 1968) that the formal characteristics of anankastic cognition are directly related to functional impairment in the spontaneous organization and integration of experience. It is postulated that this impairment is expressed in the over-structuring of input and in the maladaptive over-defining of categories and boundaries. In a previous communication, Reed (1969) has reported results from a verbal conceptual test which support one prediction derived from the hypothesis—namely, that given a classificatory or conceptual task the anankast will be over-specific in his interpretation of the given class and therefore too strict in his acceptance of appropriate class members.

The “punch-drunk” syndrome of boxers was recognized by lay people many years before it received attention from the medical profession. The syndrome included slurred speech, ataxic gait and impaired mental function and so simulated alcoholic intoxication. Martland (1928) gave the first clinical description of its neurological and psychiatric features. These consisted of cerebellar, striatal and pyramidal signs in varying combination together with dementia and sometimes episodic psychotic behaviour. Martland stressed the psychiatric features of the syndrome, and noted that of 23 punch drunk boxers known to him, four were permanently in mental hospitals.

Parkinsonism is generally considered to be essentially a disturbance of motor function, yet it is frequently accompanied, according to some writers (Hughes, 1961; Macdonald Critchley, 1955; Niehbuhr, 1961), by some degree of intellectual deterioration, especially in the later stages of the illness.