Headache alone is estimated to be the chief and central complaint of eight million people (8). In one series of five hundred cases only ninety-six were found to have an organic basis (4).

Although there is general agreement that the neuroses constitute a major public health problem there is little reliable information about their distribution. The difficulty is largely one of definition. As most people experience emotional conflict of some sort, the concept of neurosis can be widened so readily as to rob it of much value for medical purposes. Epidemiological enquiries have been hampered by disagreement about the nature of neurosis and by the lack of screening techniques (Shepherd, 1960). In consequence formal morbidity surveys have proved difficult to conduct and their results still harder to interpret.

Towards the end of 1961, the authors undertook a survey of the state of development of Industrial Therapy in mental hospitals of England and Wales (1). The results showed that already, of the 181 hospitals taking part in the survey 47·5% currently have Industrial Units and a further 15% are proposing to open them in the near future. This paper is a statement of some of the advantages and difficulties in opening an Industrial Therapy Unit. In discussing these problems we have drawn upon the experience we have gained over the past 6 years, the first 2 years of which we carried out sub-contract work and the last 4 years in running a commercially self-contained manufacturing business. The type of workshop that we have in mind is one dealing with a wide range of mental disability. The aims of the Unit will therefore be directed on many levels: the two principal levels being (1) preparing some patients for resettlement and (2) the occupational rehabilitation of patients with poor clinical prognosis within the walls of the hospital.

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.”

The purpose of this paper is to describe the manner in which psycho-analytical concepts and theory may contribute to the difficult problem of diagnosis in schizophrenic reactions. At the present time there is an increasing realization that the criteria which are used in the diagnosis of these conditions are unsatisfactory, not only because they have a low prognostic significance but also because they fail to provide the research worker with discrete clinical concepts which he can use in physiological or psychological investigations. As Stengel (1960) has pointed out, the criteria employed in the diagnosis can vary extensively within the same hospital quite apart from the inevitable differences which exist within the one country and from country to country. It is the wide variation in what is called schizophrenia which has vitiated so much important and worthwhile research in clinical psychiatry.

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.

Owing to the use of other therapeutic measures in mental hospitals, interest in brain operations undertaken for the relief of psychotic symptoms has fallen to a minimum. Hence, opportunities for studying the mental effects of such cerebral lesions are now practically non-existent. The investigation by Aaron Smith (1960) of the residual deficits as shown by the Porteus Maze Test in cases who had suffered topectomies eight years previously, as reported in this Journal in July, 1960, may very well be the last word on the subject. The time seems opportune, therefore, to make a brief summary of the results of a test that is now considered to be the most sensitive to frontal brain damage.

Patients are occasionally encountered who spend much of their lives gaining admission to hospitals apparently suffering from acute surgical and medical conditions. They elaborate long and complicated histories which are full of falsifications, and may submit to operations which they do not require. Consequently an extensively scarred abdomen is characteristically seen in those who undergo repeated laparotomies, but seldom is anything found at operation to account for their symptoms, although adhesions from former operations are occasionally noticed. Usually they leave hospital against medical advice, or discharge themselves while investigations are still in progress or before their operation wounds have fully healed.

Parnell's method of physical anthropometry (Parnell, 1954), which has been derived from that of Sheldon (Sheldon, 1940), measures body build in three components. These three components of physique are designated (1) linearity, which is the ratio of height to weight; (2) muscularity, which is calculated from limb girth and bone measurements; and (3) fat, which is derived from skin fold measurements. The values obtained by actual measurement of a patient to elicit these components are plotted on a chart from which is obtained a first estimate of somatotype. This so called M4 Adult Deviation Chart has been devised so that a rating of 4 in muscularity will bear a constant proportional relationship to stature and is a means of converting the anthropomorphic data into an estimate of the three components of physique. The relative importance of these components is indicated by rating each on a 7 point scale. The first estimate of somatotype obtained in this way is then combined with a visual assessment of somatotype, which is made from a standard three-view photograph, to give the final estimate of somatotype, which must therefore be partially subjective. This final estimate of somatotype is then plotted on a somatochart.

Not uncommonly, schizophrenia seems to arise in close connection with the puberal years. This is sometimes attributed to psychological or physiological stresses at puberty, but there is no really adequate understanding of the phenomenon. One cannot predict at all dependably which personality characteristics or which stresses will result in a schizophrenic breakdown near puberty.

Through the interpretation of certain features of the schizophrenic process, psychoanalytic theory links homosexuality and paranoid schizophrenia. This theoretical link derives from a concept of the dynamic development of the individual constructed from observations about individual cases rather than from any knowledge of the frequency of the linkage in the population of schizophrenic patients.

In the last few years many studies have appeared relating directly or indirectly to the role of adjustment in the ageing process. What factors influence the adaptability of the elderly person to his or her own disability, isolation or approaching death? In general the studies done by sociologists stress the importance of the social situation in which these persons find themselves. P. Townsend's book “The Family Life of Old People” (1957), the articles of Havighurst (1958) and his group in Chicago, and of Post (1958) are examples of this view. In what may be regarded in some way as a reaction to this tendency, we have the theory of disengagement of Cumming et al. (1960), in which “ageing is seen as an inevitable mental withdrawal or disengagement resulting in decreased interaction between the ageing person and others in the social system to which they belong”. But it is Irving Rosow (1960) who emphasizes this point more clearly. After critically reviewing diverse approaches, he states (and I quote from different paragraphs throughout his paper), “The root of the problem lies in regarding adjustment as a state or a condition at a point in time”. “What gerontologists have called adjustment is actually the result of the product of the ageing process”. “Thus it follows that the only way to evaluate conditions in later life is to compare them with some earlier patterns”. From there on he presents his own sociological theory of adjustment. Strengthening this view still further, a psychologist, Robert Peck (1960), reporting on one phase of the “Kansas Study of Adult Life” by the University of Chicago Committee on Human Development writes, “Adjustment to middle age and old age, in so far as it has been measured in this research, seems largely determined by personality characteristics which have been laid down earlier in life”. It is psychiatrists, however, who have insisted on the importance of the previous personality in the problems related to ageing, as may be noted in the publications of Cameron (1956) and Roth (1959).

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 statistics on mental hospitals published by the Ministry of Health (1957) show that the average length of stay for admissions to mental hospitals decreased in the period 1952–1956. According to the Registrar-General's Mental Health Supplement (1961) there was an average saving, between 1951 and 1958, of sixteen days for men and thirteen days for women, among patients staying less than one year. But these figures for stay only relate to the patients discharged each year, irrespective of the year of their admission, and furthermore we do not know what happens to particular groups such, for example, as schizophrenics. Although remarkable changes are occurring at the present time, study of them is hampered by lack of appropriate and up-to-date information.

The practice of psychiatry in general hospitals is increasing and some of the problems it raises have been widely discussed. Many administrative questions have received close attention (Bennett et al., 1956; Smith, 1961) and the advantage to psychiatric patients of having readily available medical, surgical and laboratory facilities has been clearly seen (Gillies, 1959). It has been shown, too, that patients with mental illness can be admitted to beds in medical wards and be treated there successfully (Brook and Stafford-Clark, 1961). On the other hand, much less attention has been given to the psychiatric requirements of the general hospital itself, and there is very little information about the use that physicians, surgeons and specialists are likely to make of a psychiatric service for their own in-patients. Studies of psychiatric morbidity among general ward patients (Mittelmann et al., 1945; Zwerling et al., 1955) are of great interest, but they tend to shed an artificial light on the problems of practical needs and probable demands. Shepherd, Davies and Culpan (1960) have provided the most useful report so far, on the incidence of psychiatric referrals by physicians and surgeons and the clinical conditions encountered. This was the result of a one-year work-study specially set up for the purpose of investigating these questions at a general hospital in London. However, there appears to have been no account of findings based on the routine work of a hospital where a psychiatric unit has been well established.

A comparative study of the work performance of normal and schizophrenic workers was undertaken in the Rehabilitation Unit of Cheadle Royal Hospital. (Wadsworth, Scott and Wells, 1961). A group of 12 long-stay schizophrenics with a mean duration of hospitalization of 17 years, ±12·3 were matched with 12 normal subjects recruited to perform a normal industrial task. The task studied was the assembly, by gluing, of crepe to board; one of the initial stages in the manufacture of a carnival hat. The purpose of the study was to obtain comparative data that would help one to produce indices of employability, rather than to make evaluative statements which would relate only to mental hospital standards.

Advances in hospital care of the elderly have led to an urgent demand on these services, and Cosin (2) has pointed out that it has often been necessary to provide them before their most practical uses have been evaluated. As Townsend (11) observes, some beds are occupied by patients who should have been in a different hospital unit more fitting to their particular type of disability.

It is more than twenty years since Lang advanced the hypothesis that some male homosexuals are sex intergrades with male morphological sex characteristics but a female chromosomal pattern (Lang, 1940). Is there now sufficient evidence to prove or disprove the theory? The purpose of this paper is to review the evidence to date, and to present the results of an investigation of the somatic chromosomes in a small series of male homosexuals.

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.

Some of the earliest objective approaches to the removal of specific anxieties and fears in children were based on the fact that neurotic (learned, unadaptive) responses can be eliminated by the repeated and simultaneous evocation of stronger incompatible responses. An early and well-known example of this approach was the experiment of Jones (1) in which a child's fear of rabbits was gradually eliminated by introducing a “pleasant stimulus” i.e., food (thus evoking the anxiety-inhibiting response of eating) in the presence of the rabbit. The general method of “gradual habituation” was advocated by Jersild and Holmes (2) as being superior to all others in the elimination of children's fears. This rationale was crystallized in Wolpe's (3) formulation of the Reciprocal inhibition Principle, which deserves the closest possible study: