Considerable claims have been made for behaviour therapy, but the evidence for its effectiveness is still conflicting. There are several reasons for this. First, although behaviour therapy is a convenient term to describe treatments which reputedly share a common derivation from learning theory, it describes techniques which differ widely from one another in practice, and which at the same time have features in common with other forms of psychotherapy. Secondly, behaviour therapy has been applied to a variety of neurotic disorders, ranging from writer's cramp to phobias, and these syndromes often have distinct natural histories. Any general statement about the value of behaviour therapy in a mixed group of neuroses is therefore of limited value. Thirdly, the well-known tendency of neurotic disorders to respond to energetic and enthusiastic treatment with non-specific methods makes it difficult to assess the results of treatment unless a matched control group is included in the investigation, or, in the absence of a control group, an exceptionally high rate of recovery is obtained.

Conditioning therapy has been widely applied in the treatment of certain kinds of neurotic illness.

This case is considered to merit a brief report, mainly for the following reasons which will be further considered in the Discussion: (1) the extent of the sexual deviation and its true nature were not immediately apparent; (2) there has recently been a suggestion that the success of aversion therapy in similar cases may have been in a large measure dependent on a “transference situation”. We think that this case may contribute some evidence to the contrary.

Ever since the clinical entity of “Folie à Deux” was first introduced (Lasègue and Falret, 1877), a great number of clinical and theoretical studies have appeared in the literature dealing with this relatively rare and interesting mental syndrome. In the English medical literature, up to date, 93 cases of “Folie à Deux” have been reported (Gralnick, 1942), a further 17 cases of “Folie à Trois” (Wolff, 1957; Dewhurst and Eilenberg, 1961), one case of “Folie Imposée à Quatre” (Ropschitz, 1957), one case of “Psychosis of Association” involving a mother and three sons (Page, 1942) and one case of “Folie à Quatre” involving four members of a family (Gralnick, 1943), have also been reported. I personally recorded one example of “Folie à Trois” at the Lebanon Hospital for Mental Diseases in 1947, involving a mother and her two daughters, and another interesting case of “Folie à Deux” in Baghdad (1961) involving a young boy who broke down under the influence of his spiritualist cousin. During the course of the boy's illness the cousin broke down herself into an acute delusional state. Both patients eventually recovered completely.

Some years ago, we reported a study of the illness experience of children according to the presence or absence of a psychoneurotic condition in each of their parents (Buck and Laughton, 1959). It was stated to be part of a larger study of family patterns of illness, including that of possible similarities in the psychiatric histories of husbands and wives. Although the latter was investigated with rather interesting results the work was not published upon completion because we hoped to add to the data. In the last few years, interest in this subject has been revived, particularly by the work of Pond et al. (1963) and Kreitman (1964). It now seems desirable that our results should be published because of their interesting relationship to those of the more recent investigations.

The health of the young unmarried primigravida has attracted enquiry from obstetricians, psychiatrists, psychologists and social workers. Generally, by virtue of their youth and tissue resilience these girls are at an excellent physiological age for the processes of pregnancy and labour. Stewart (1952) showed in a carefully documented survey of 3,019 primigravidae that anomalous marital status did not appear to influence the occurrence of difficult labour which in fact was found more frequently among those who had been married before conception than among either the “illegitimate” group or the pre-marital conception group. Young unmarried women, therefore, may well be physiologically fit for child-bearing, but they may be psychologically unprepared for it. Emotional reactions during pregnancy are common, especially among unmarried women. Yet in our clinical management of disturbed pregnant women who are not married we have been impressed by the frequency with which emotional ill health has antedated their pregnancies. In many cases we have been tempted to view the psychiatric concomitants of their pregnancies as part of a continuum of morbidity recognized long before. It has been shown by Eysenck (1961) from psychological testing that unmarried mothers tend to be more neurotic and more extraverted than the general population, and among women students who were pregnant while at university Finlay (1962) has reported significantly more instability than among other women student patients. Illegitimate pregnancy may be accepted as the norm among some subgroups, while viewed as a catastrophe among others. For the purposes of study, however, it is difficult to find a group of young women in whom pregnancy could be less welcome, less acceptable, less manipulative or more disastrous than among university students. The very low pregnancy rates among students in Britain suggest that this may be so (Brown, 1962), as does the high correlation between unplanned pregnancy and student wastage among university students (Brown, 1962; Kidd and Dinwoodie, 1964).

It has long been recognized as a shortcoming of much of the psychiatric literature that it is based on the study of highly selected case-material, drawn from hospital and private consultant practice. This criticism, which has important implications for the interpretation of hospital statistics (Cooper, 1965), may be of equal relevance in the field of clinical description. Studies undertaken in general practice (Shepherd et al., 1959; Ryle, 1959) point to the existence in the community of large numbers of cases of minor psychiatric disturbance of a kind which is clinically identifiable, but which for the most part does not come under the scrutiny of trained psychiatrists. Whether such cases conform to the standard text-book descriptions of psychiatric illness, or can be incorporated into the existing nosology, is very much open to question. There seems little doubt that clinical studies in general practice are of great potential value in the study of mental disorder, and in particular that they may help to throw new light on the natural history of this group of affections.

The aims of this paper are first, to describe some clinical features of patients eventually diagnosed as having a depressive illness who were referred to a general hospital clinic set up to study hypochondriasis, and secondly, to investigate why some patients with depressive disorders develop somatic symptoms while others do not.

What happens to schizophrenics after their discharge to the community has been a subject of several recent studies. Most of this work is from the Social Psychiatry Research Unit at the Maudsley Hospital and deals with prospects of rehabilitation and resettlement, morbidity in the community, and the impact which these patients have on their families. Earlier follow-up studies of chronic patients who left certain London hospitals between 1949 and 1956 point to a satisfactory resettlement in two-thirds of cases (Brown et al., 1958). In more recent papers rather cautious conclusions were drawn, especially where morbidity in the community and not just lengths of hospital stay and re-admission rates were ascertained (Wing, 1963; Wing et al., 1964). Whilst the time spent in hospital by schizophrenics is now much shorter, re-admission rates continue to rise, and according to Wing “… in the absence of effective community services the policy of early discharges is based to a large degree on the willingness of relatives to attempt the role of nurse and put up with considerable discomfort and distress”. Furthermore, with existing services so different in various parts of the country, no reliable data exist which would indicate to what extent a fully developed community service could prevent morbidity of discharged schizophrenics. What is needed, according to Wing, would be a combination of the Nottingham community services, the Worthing day-centre and industrial workshops on the Bristol pattern.

Suicide is obviously in part a medical problem and various writers have suggested that action on the part of doctors might reduce its incidence. In particular, attention has been directed towards recognizing and promptly treating depressive illness and in the management of such illness suicide is regarded as a significant risk.

Prior to 1952 a Registrar was available at The Maudsley Hospital from 9.30 a.m. to 5.30 p.m. to see out-patients of the hospital who wished to consult a doctor outside the times of their routine appointments. In 1952 the necessity for a more extended service was recognized by the appointment of a Registrar to work whole-time in the Emergency Clinic. A special room and telephone were provided and in effect a psychiatric casualty department was established. The Hospital also offers an Emergency Service between 5.30 p.m. and 9.30 a.m., but this is not considered in the present study. With the change of policy towards more rapid discharge of patients from psychiatric hospitals and the care of the chronic mentally ill in the community, it seemed very probable that a psychiatric emergency clinic would be increasingly used for referral by family doctors and by patients spontaneously seeking advice, and in fact there were 1,830 attendances at the Clinic in 1958, 2,274 in 1960, and 3,377 in 1962.

The development of Day Hospitals for geriatric patients in this country over the past 15 years has been one means of attempting to relieve the problems arising from an increasing senile population.

The present study is part of a sex-chromatin survey in a mental hospital. It has been made as a preliminary step in finding the prevalence and incidence of sex-chromosome abnormalities among patients with mental illness; and it also has the purpose of studying the psychopathological and genetic aspects of sex-chromosome abnormalities. The study comprises all clinically hypogonadal patients referred by the psychiatrists at this hospital to the cytogenic laboratory during a period of approximately 1 month. In a survey of this kind we can expect to find patients with certain abnormalities of the sex chromosomes.