Synopsis An outline is provided of Henrik Sjöbring's contributions to psychology and psychiatry. Emphasis is placed on the significance of his work on mental functioning, personality dimensions and lesional disorders.

We examined the hypothesis that changes in the suicide rate of England and Wales since 1900 are an artefact of changes in the process of classifying violent deaths. Four potential sources of artefact were considered: (1) the reliability of the procedure for investigating suspected suicides; (2) coding by the Office of Population Censuses and Surveys; (3) changes in the law; (4) High Court decisions on suicide. None of these can explain the large observed fluctuations in the suicide rate.

A brief account is given of the evolution of the concept of social psychiatry and its relationship to that of social medicine. The central role played in its scientific development by Sir Aubrey Lewis is traced in some detail.

How well do we really know Thomas More? Directed to one of the most familiar figures of the sixteenth century, the question must appear absurd. Even without the aid of stage and screen, surely everyone has a clear idea of England's leading humanist, great wit, friend of Erasmus and other Continental humanists, author of Utopia, family man, man of convictions, ultimately martyr. The familiar Holbein portrait seems to sum it all up, as does at greater length the much admired biography of R. W. Chambers. Chambers, in fact, completed the picture when, to his own satisfaction and that of others, he disposed of ‘inconsistencies’ discerned by earlier observers between the cheerful reformer and ‘liberal’ of 1516 on the one hand, and the fierce opponent of Lutheran reform and savage polemicist of 1528–33 on the other. No man's personality in that age, not even King Henry's, seems more fully explored and more generally agreed than More's.

Concepts of disease have often been influenced by mediaeval scholasticdoctrines. Today these are best replaced by the premises of modern class logic. One of the basic problems then concerns the universal class of patients. Its solution depends on the answer to the question: What are the distinguishing attributes of this class? Scadding stipulated that these attributes must differ from the norm of a species and be associated with biological disadvantage. This paper argues that these attributes must be abnormal by the standards of a population and/or the norms of an individual, and must be associated with at least one of three criteria: (a) therapeutic concern for himself experienced by a person, (b) such concern for him experienced by his social environment, and (c) medical concern for him. This solution, though based on subjective criteria, seems to tally with the actual practice in diagnosing disease.

The insanity defence is considered in terms of the operation of incommensurable scientific and legal discourses, a dualism which in turn is held to reflect individualist values. This analysis is used to explain both the recurring nature of medico-legal controversy and the historical results of the defence in Victorian England.

Social psychiatry, like social medicine of which it is a part, has two basic sciences – biology and sociology. People with psychiatric disorders suffer from acute breakdowns or chronic impairments which can be severely disabling in themselves, but these are often precipitated, amplified or maintained by social pressures and social disadvantages and by personal reactions, such as a loss of self-esteem and self-confidence. It is impossible, therefore, to draw a line between the medical and the social aspects of treatment, care and prevention.

The chief innovations during the past 40 years have been made in the context of a change-over from a system of care based on large institutions towards a more open but much looser and less-coordinated system of smaller units managed by staff from different professions who have developed their own, sometimes conflicting, views as to the best ways of helping the mentally disabled. Nevertheless, knowledge has accumulated which, if properly applied, could lead to a better quality of life for the ill and disabled and a decrease in the burden placed upon relatives. Further innovations are now required which will lead to the development of a responsible, comprehensive and integrated mental health service.

It is not yet known whether social measures taken to relieve or prevent lesser psychiatric disorders will lead to a decrease in the incidence or prevalence of more severe conditions and this question deserves further investigation. There is evidence, however, that relatively inexpensive help can be useful in the short term.

Progress will depend upon the accumulation of new knowledge. One of the most encouraging trends has been the improvement of evaluative designs and methods aimed at testing ideas for improving services, thus allowing planners to make better informed decisions.

The crucial importance of economic, social and political factors in the definition and incidence of crime is undeniable, as is the need for socio-political change, but the part played by individual characteristics in determining who becomes labelled a criminal should not be neglected. Clinical criminology studies offenders as individuals, examines their peculiarities and their social problems and seeks ways to help them to lead less troubled lives. A wide range of treatment interventions is required, the psychiatric approach is not always the most appropriate.

In view of the lack of success in reducing recidivism by means of treatment, penologists see little justification for continuing to try. More successes might be recognized if treatment schemes were applied with greater realism and discrimination, and if proper evaluations were made more often. In any event, some offenders need treatment regardless of the effect upon their offending behaviour.

The main unresolved issues with respect to the psychological sequelae of brain damage in childhood are noted, and the previous studies of children suffering head injury are critically reviewed. A new prospective study is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a post-traumatic amnesia exceeding 1 hour but less than 1 week. The children were studied as soon as possible after the accident and then again 4 months, 1 year, and 2¼ years after the injury. The parents were interviewed, using systematic and standardized interview techniques; both parents and teachers completed behavioural questionnaires; and the children were seen for individual psychological testing using the WISC, the Neale Analysis of Reading Ability and a battery of tests of more specific cognitive functions. At the final follow-up, the severe head injury group (but not the other 2 groups) received a systematic neurological examination and the school teacher who knew the child best was personally interviewed. The findings are given on physical handicap, neurological abnormality, school placement and psychiatric referrals. All types of disabilities were both more frequent and more persistent in the children with severe head injuries.

1624 patients who were attending primary health facilities in 4 developing countries were examined to determine how many were suffering from mental disorder. Using stringent criteria to establish the presence of psychiatric morbidity, 225 cases were found, indicating an overall frequency of 13·9 %. The great majority of cases were suffering from neurotic illnesses and for most the presenting complaint was of a physical symptom, such as headache, abdominal pain, cough or weakness. The health workers following their normal procedure correctly detected one third of the psychiatric cases.

Attempts to underpin the classification of psychiatric drugs in biological and clinical terms are discussed with reference to their value and limitations. The current need for a multiplative, heuristic taxonomy is suggested.

I am grateful for the opportunity to comment on Dr Kräupl Taylor's paper. I agree with much of what he says and think that he agrees with some of what I have said. We both disapprove of Platonic realism, for which the term ‘essentialism’ used by Popper (1945) seems to me preferable, since it avoids the danger of confusion with the very different meaning of ‘realism’ in the later idealism–realism opposition. But he has misunderstood my position in the nominalist-essentialist argument; and he seems to think that my statement about the meaning of the names of diseases in medical discourse and the application of ‘modern systems of class logic’ in medicine are in some way incompatible or discordant, whereas I think they are complementary to each other.