Kanner's descriptions of the children showing the abnormal behaviour pattern he observed and named 'early infantile autism’ are summarized. E. A. and N. Tinbergens' ethological theory of the aetiology of this syndrome is outlined and criticized. The major problem in evaluating this theory, apart from the absence of any evidence in its favour, is the lack of precision with which the Tinbergens use the terms ‘autism’ and ‘Kanner's syndrome’.

The Editor has kindly offered us space for replying to the paper by Wing and Ricks, in which they reject, and advise their readers to discard, our views on early childhood autism. Rather than using this space for a ‘counter refutation’ we prefer to call attention in this journal to what, after careful study of Wing's and Ricks' criticism, we still consider a potentially fruitful approach to the problems posed by the autistic deviation. We take this course because we feel that our critics have missed the point of our publications. As we see it, the disagreement is not so much a matter of facts per se as one of how to look at the problems. The primary aim of what we have written (as was indicated, for instance, in the subtitle of our joint paper of 1972) has been to sketch a method of approach, to illustrate its potential, and to advocate the application of this approach in child psychiatry. The method has been developed in studies of animal behaviour, where it has led lo valuable insights. But we have not simply extrapolated the results of animal studies. We have looked at certain details in the behaviour of the children themselves. When we applied this ‘ethological’ approach to autistic behaviour, we arrived at certain, naturally tentative conclusions which seemed, and still seem to us, to have the merit of being plausible interpretations of quite a number of hitherto puzzling parts of the syndrome.

Histories of depression-related symptoms were obtained from 3845 randomly selected adult residents of Kansas City, Missouri, and Washington County, Maryland. Depressed persons were slightly more common in Kansas City than in Washington County but within the latter area no urban–rural differences were observed. More depressed persons were found among blacks than among whites. Slightly more white females than males were depressed; no significant differences were found between black females and males. After adjustment for the effects of other independent variables, the probability of having symptoms of depression was highest among persons who were young adults, unmarried, not employed outside the home, poorly paid, and not well educated.

The ‘General Health Questionnaire’ was used to assess the psychiatric morbidity among 365 consecutive attenders at a general practice and to compare this with a systematic random sample of 213 patients drawn from the lists of the same practice. Those attending a general practitioner are shown to be more psychiatrically disturbed than a random sample of the practice population, and this difference remains when those attending for psychological symptoms are discounted. Various social and demographic characteristics which distinguish between those who do and those who do not attend a doctor with a given set of psychological symptoms are described.

A sample of individuals who had carried out acts of self-poisoning or self-injury were interviewed and information was also obtained from their general practitioners. More of both the men and the women had visited their general practitioners in the year before the acts than would have been predicted from national statistics, although this was not found to the same extent for persons aged 16–24. Thirty-six per cent of the sample had contacted their general practitioners during the week before the act and over 60% in the month beforehand. Sixty-three per cent had visited them for a variety of psychiatric and social reasons during the preceding year and had nearly all been prescribed psychotropic drugs, usually tranquillizers or sedatives. These were commonly the drugs taken in acts of self-poisoning. Methods of prevention are discussed.

An interview assessment of marriage relationships is described. It is shown to have good inter-rater reliability, high consistency across the accounts of both marriage partners and to be resistant to methodologic bias. A four-year follow-up study demonstrated high predictive validity to later marriage breakdown. The marriage measure also showed a strong association with behavioural deviance in the children. The intercorrelations between individual measures of various aspects of the marriage and the summary measure are given. A shortened version of the interview is described and preliminary findings are given on its validity.

An investigation into observer variation and depressive phenomenology is described. A group of 6 clinicians independently completed a 43-item sheet for 20 depressed patients at the same clinical interview. The coefficient of agreements on the items are given. Patient variables and observer variables did not have any influence on the degree of agreement. There was also an agreement in the subtyping of depression.

This paper presents a Personal Questionnaire which is sufficiently simple for use in most clinical settings. Following a brief description of Personal Questionnaires, their origin and background are discussed and some subsequent developments delineated. The method involves the use of a general set of adjectives which can be used to qualify the symptoms experienced by any given patient. Successive measurements of the symptoms can be made so that changes in their subjective intensity can be monitored. The internal consistency of ratings of each symptom on each occasion is used as a measure of reliability. As with all previous Personal Questionnaires the symptoms which are measured are unique to the individual, but unlike other methods the format of this Questionnaire is predetermined, which ensures its simplicity and ease of use.

Eighty anxious and eighty depressed patients were assigned randomly to receiving one of three versions of an information leaflet about their medication, or to receiving no leaflet at all.

Mean medication errors were reduced from 15 to 4% by provision of suitably constructed leaflets.

The results show the practical importance of informing patients about their medication and of paying attention to the difficulty level of any leaflets issued.

Four hundred ‘new’ long-stay patients were studied and assessments of their needs for treatment and accommodation were made. About one third appeared to need further care in hospital. A further third could possibly be discharged if suitable accommodation in the community were available: most of this group were more handicapped than present residents in hostels. The remaining third had diverse needs; many were multiply handicapped – for example, by physical disability or mental retardation in addition to psychiatric disorder. At the moment the psychiatric hospital is virtually the only agency to accept the care of such people.

Thirty-one females with primary anorexia nervosa were studied by means of a retrospective analysis of hospital notes. The patients were divided into 2 groups. The first group consisted of subjects who had become emaciated solely because of dieting, food refusal and excessive exercising (‘dieters’); the second of those who had used additional means to bring about weight loss such, as habitual vomiting and the abuse of purgatives (‘vomiters and purgers’).

Most ‘dieters’ were intense, introverted, socially withdrawn individuals whose anorexic behaviour had started in response to psychological stress. They had become completely preoccupied with thoughts of food, eating and losing weight. Several did well in treatment, and recovered fully from their anorexic symptoms. ‘Vomiters and purgers’, on the other hand, were more outgoing in respect to personality. Most had previously been obese and, as they had been unable to keep themselves thin by simply abstaining from food, they had learnt to use other means to control their weight. These latter patients did less well in treatment. They continued to experience difficulty in controlling their weight, and the majority persisted with their abnormal behaviour.

Emotional symptomatology data on 78 obese females treated for 3 weeks with fenfluramine, dextroamphetamine, or placebo were evaluated. These obese females were shown to be considerably less emotionally disturbed than neurotic females, and similar in emotional symptomatology to other females seeing physicians for nonpsychiatric complaints. Even within these marginally symptomatic patients, fenfluramine and dextroamphetamine were significantly more effective than placebo in reducing anxious, depressive, and anxious-depressive symptomatology. Fenfluramine was particularly effective in alleviating anxiety in patients who were initially higher in anxiety. Most important, fenfluramine produced significantly greater weight loss than dextroamphetamine in patients with higher levels of anxiety and depression, while dextroamphetamine was an especially effective anorexic in low anxious patients. Differences in initial anxiety and depression, even within relatively normal patients, may well affect results obtained with fenfluramine and dextroamphetamine in the short-term treatment of obesity.

The concept of psychopathic personality is currently being called into question. Grendon prison has been established for the treatment of psychopaths. A recent study of Grendon prisoners enabled an examination of some characteristics commonly attributed to psychopaths to be carried out. It proved difficult to obtain good agreement in rating such phenomena as ‘conscientiousness’, ‘sexual deviation’, ‘impulsiveness’. Of ten reliable variables including ‘personal relationships’, ‘lying’, ‘alcohol problem’, only five bore a significant relationship one to another. It was concluded that whilst the term ‘psychopathic disorder’ may be appropriate for a small handful of individuals the term is probably now used too widely and too loosely.

The case-history of a woman with psychiatric symptoms since childhood is reported, the best label for which was that of ‘chronic mania’. Cerebellar atrophy was suspected on radiological grounds. The literature on chronic mania in childhood and on cerebellar damage and mental changes is reviewed and the view is put forward that cerebellar dysfunction may play a part in the production of some psychiatric symptoms.

From a factor analysis of data from a learning experiment evidence is presented which appears to support the Blomfield–Marr thesis that in the learning of motor actions the cerebellum operates by the turning off of incorrect movements rather than by the turning on of correct ones. The factor model employed is that due to Godfrey Thomson which gives a neurostatistical explanation of the origin of mental factors.

The excretion of dimethyltryptamine (DMT) was studied amongst 122 recently admitted psychiatric patients and 20 normal subjects. DMT was detected in the urine of 47% of those diagnosed by their psychiatrists as schizophrenic, 38% of those with other non-affective psychoses, 13% of those with affective psychoses, 19% of those with neurotic and personality disorders and 5% of normal subjects. Ninety-nine patients were interviewed in a semi-standardized fashion, and also categorized according to a variety of operational definitions of the psychoses. The operational definitions failed to reveal any group significantly more correlated with urinary DMT than a hospital diagnosis of schizophrenia, but a discriminant function analysis of symptomatology could be used to define a group of 21 patients of whom 15 (71%) excreted detectable DMT. There was a general relationship between psychotic symptoms and urinary DMT, but specifically schizophrenic symptoms did not appear to be major determinants of DMT excretion.

Erythrocyte sodium and potassium concentrations, erythrocyte membrane ATPase (Na–K specific and non-specific) and the rate of potassium influx into erythrocytes (ouabainsensitive and insensitive) were estimated in a group of female patients suffering from mania and repeated on about two thirds of them when they had recovered. With recovery there was a statistically significant increase in the erythrocyte ouabain-sensitive potassium influx. The other parameters showed no significant overall change with recovery but the initial severity correlated significantly and negatively with the change in erythrocyte Na–K ATPase with recovery. The changes that occurred in the erythrocyte sodium concentration and Na–K ATPase activity were not random since they correlated significantly with changes in the active potassium influx.

Many surveys of general populations have suggested a high untreated psychiatric morbidity, variously referred to as mental illness, pre-clinical neurosis, minor neurosis, untreated depression, etc.

An Index of Definition of psychiatric disorders is described which incorporates cut-off points on the basis of symptoms rated in the Present State Examination. Eight degrees of definition are specified. At the ‘borderline disorder’ level and above, disorders are sufficiently well defined to apply the CATEGO program of clinical classification. This procedure enables in-patients, out-patients and samples of the general population to be compared.

Data from surveys in south-east London are presented in order to illustrate the technique. The main conclusion at this stage is that it is possible to identify, by strictly defined and repeatable procedures, a substantial proportion of people in the general population who have ‘borderline disorders’ that can be tentatively classified in terms of the ICD. Whether it is clinically useful to do so requires further investigation.

It is also suggested that techniques of this kind can be scientifically useful in comparing the level of morbidity in various populations, both referred and non-referred, and in testing theories concerned with the causes and treatment of various types of psychiatric disorders.