If, at this distance in time, neither Mapother's nominalism nor Golla's vitalism-holism are at all satisfying, this is because so much has happened to the philosophy of science in the interval. The writings of Sir Karl Popper have had a revolutionary influence; and the important work he has done over thirty years or so is readily available in The Logic of Scientific Discovery (LSD, 1968) and Conjectures and Refutations (CR, 1969). Popper starts from the position that no logical basis for the accumulation of knowledge can be laid on inductive processes (and he also maintains that this is not the way the mind of the scientist works). From observing crows, and seeing that one after another they are all black, one cannot conclude that all crows are black. In general terms, it is not possible to proceed logically from single existential (‘there are …’) statements to universal statements; and an epistemological process that based itself on induction would be rocky at its very foundations. How is it then that science progresses, making mistakes from time to time, but recovering from them, providing for itself a firmer foundation for further work, anchoring it more deeply and extending it more widely? This could only be if the basic logical processes were not, in fact, inductive, as the nineteenth century scientist supposed. The search for an acceptable basic principle came down to finding a criterion of demarcation which would distinguish the empirical sciences from other branches of learning. Popper found it in the principle of refutability.

In 1965, when this study began, there were no clear guidelines about the optimum duration of in-patient treatment for alcoholics. Davies et al. (1956) had reported that at the Maudsley Hospital the aim was for a ‘short stay’ of between two and three months—but some individuals stayed for up to ten months. The policy at Warlingham Park Hospital as described by Glatt (1955) was for an in-patient stay of at least two months, though ‘on the whole about three months is the optimum period’.

For the study reported in the accompanying paper (Willems et al., 1973), a number of variables, thought to be of prognostic relevance in alcoholism, were selected and categorized in a rank order. These can be regarded as ordinal scales, since in every case (a) each category differs from the others, and (b) each is related to the others. In each case there can be said to be an underlying continuum and in all cases a higher number indicates, in our opinion, a less ‘desirable’ state.

Gilles de la Tourette's disease is a relatively rare condition characterized by multiple motor tics and an irresistible compulsion to swear. It was first described by Itard in 1825. Many years later, at the Salpêtrière under the tutelage of Charcot and Brissaud, Georges Gilles de la Tourette made a study of nine cases, including Itard's original one, and published his account of the disorder in 1885. He defined it as a nervous affliction characterized by motor incoordination accompanied by echolalia and coprolalia. He distinguished it from the large number of conditions which previously had been grouped under the heading of chorea. He pointed out similarities between this syndrome and the ‘jumping Frenchmen of Maine’ described by Beard in 1880 and the ‘myriachit’ of Siberia described by Hammond in 1884. Other authors however, question whether these conditions are really part of the same disorder.

Gilles de la Tourette's syndrome had been considered an organic, often hereditary illness for many years after it was first described in 1885 (1, 2), but when medicine became psychologically oriented, the syndrome was more frequently classified as a psychological illness (3), and patients have been said to be schizophrenic, psychotic, obsessive-compulsive, hysteric, to have inhibited aggression, and eventually to deteriorate intellectually and psychologically. However, no support for common psychopathological and dynamic factors was found in our previous study of 34 patients or in a review of the literature (4). Recently, as medicine has shifted back from a psychological orientation, and as case histories have accumulated, an organic aetiology has been more frequently postulated.

The Gilles de la Tourette syndrome is a puzzling disorder, usually beginning in childhood. It is characterized by (1) facial and bodily tics progressive in involvement and frequency, (2) grunting and barking noises and, (3) coprolalia (i.e. compulsive obscenities). Although this pattern of behaviour has been described with striking uniformity over the past century (Gilles de la Tourette, 1885; Fernando, 1967; Kelman, 1965; Lucas, 1967; Prabhakaran, 1970), no specific neurological or psychological aetiology has been found.

The literature of familial pre-senile dementia is adequately reviewed by McMenemey (1963) and Pratt (1967) and that on familial forms of Alzheimer's disease by Tandy and Bain (1970). In non-familial cases of Alzheimer's disease it has been possible to correlate the clinical features with the histological diagnosis obtained from cerebral biopsy (Sim and Sussman, 1962; Sim et al., 1966), and the present paper is an attempt to see whether, by using similar diagnostic criteria as listed in Table I, including cerebral biopsy, a similar consistency could be demonstrated in the affected members of each family.

Twin studies and investigations into the relationship between schizophrenia-like psychosis and cerebral dysfunction are of considerable interest. Refinement in twin studies has led to less emphasis being placed upon the genetic factor, but the pitfalls surrounding twin techniques, especially with regard to monozygous pairs and the similarity of their environment, have led Penrose (1971) to the opinion that twin study ‘is especially useful, not for genetical researches but in assessing the effects of environmental influences which lead to discordance in identical twin pairs'.

Over the years investigators have described psychiatrically abnormal individuals in the families of schizophrenics. These unusual persons have been given a variety of names: schizoids, schizoid psychopaths, and the condition called schizoidia or schizophrenia-spectrum illness (Kahn, 1923; Planansky, 1966). With recent developments in family and adoptive studies of schizophrenia which have indicated a genetic factor playing a causative role, the schizoid state has assumed more importance, especially in estimating the type of inheritance (Heston, 1970). Furthermore, the schizoid state is of considerable interest from a clinical standpoint since it may represent a ‘forme fruste’ of schizophrenia, and as such a study of schizoids from the point of view of the factors which may have prevented a full-blown schizophrenic process would be of great interest.

Boulton (1971), in an authoritative review, has pointed out that biochemical research into schizophrenia has depended upon the assumption that hallucinogens, such as mescaline and LSD produce a state similar to schizophrenia, and that such research has therefore principally been concerned with attempts to find hallucinogens, or substances closely related to them, in the bodily fluids of schizophrenics. Since this model has been criticized on phenomenological grounds, we decided to make a comparison between states of visual hallucinosis and of schizophrenia with thought disorder, using a measure which tests a common hypothesis concerning the origin of schizophrenic symptoms. This hypothesis suggests that the symptoms of schizophrenia are manifestations of failure of a hypothetical sensory ‘filter’ (Broadbent, 1958). This mechanism determines the individual's ‘selective inattention’ to the irrelevancies of his environment. Its function can be assessed by a study of habituation, which is the process whereby a randomly repeated stimulus fails in time to elicit an orienting response.

In recent years workers in the area have reached and secured several points of critical importance in the aetiology of schizophrenia. Studies carried out on children bora to schizophrenic mothers but separated from them at birth or in early infancy have established that genetic factors play a major role in the disease (Heston, 1966; Karlsson, 1966; Rosenthal et al., 1968). The index children in these studies become schizophrenic at roughly the same rates (10–15 per cent) as children reared by their schizophrenic mothers and much more commonly than control children separated from non-schizophrenic mothers early in life and placed through the same agencies to comparable foster or adoptive homes.

Sociopathy, alcoholism, and drug dependence have been shown to be the only psychiatric disorders more frequent among convicted male felons than in the general population (4, 5). In these studies, sociopathy, regardless of other disorders, was found in nearly 80 per cent. An increased prevalence of sociopathy, alcoholism, drug dependence, and hysteria, or Briquet's Syndrome (3), was found among the first-degree relatives of these felons; hysteria (Briquet's Syndrome) among the female relatives and the other disorders predominantly among the male relatives. Overall, 44 per cent of the male felons' first-degree relatives received a psychiatric diagnosis (6).

In 1954 a large survey showed that exhibitionists accounted for about a third of recidivist sexual offenders in England and Wales (Radzinowicz, 1957). As less than 2 per cent of convicted sex offenders fall into the recidivist category, the numbers concerned are small: a matter of a few hundred only. However, their frequent reappearances in the Courts and psychiatric clinics result in their constituting a problem out of all proportion to their numbers.

Complementarity of roles is chiefly responsible for the degree of harmony and stability obtaining in interpersonal relationships (Spiegel, 1957). Collins et al. (1971) compared decision-making in the marriages of a group of male neurotics and in a control group. They found that patient marriages were more often categorized as ‘segregated’ (where distinct areas of responsibility were demarcated for each spouse) or ‘husband-dominated’ (where most of the decisions were made by the husband). Conflict over decision-making was also commoner in the patient marriages. By contrast, the control marriages were more often co-operative (both partners collaborated equally in a co-operative manner). The authors suggested that the severity of the husband's neurosis led to the adoption of certain patterns of decision-making which in turn led to conflict. They proposed that these patterns of behaviour might partly explain the development of psychiatric symptoms in the patient's spouse. In a series of normal families in Australia, Herbst (1954) noted that as the percentage of separate decisions increased tension rose. The ‘syncratic’ family structure (comparable to the co-operative pattern) was below average in tension, while the ‘autocratic’ (comparable to the segregated pattern) carried the highest tension.

In an open clinical trial of clomipramine (chlorimipramine, Anafranil, Geigy), the phenomenological aspects and the response to treatment of twenty-five patients suffering from obsessional disorders were studied. The criterion for admission was the presence of distressing obsessional symptoms. Thirteen of the patients were diagnosed as suffering from a true obsessional state, six from depression, four from schizophrenia; one was an epileptic, and one was of uncertain classification. The drug technique has been described (Capstick, 1971a).

The absence of a motor-perceptual learning measure which has a control or partialled out effect for age and general intellectual level has become obvious and the need for such a measure has been seen to be urgent in relation to the assessment of cognitive functioning in the elderly. Work by Savage and his colleagues (1971) has highlighted the fact that the measurement of intellectual levels and intellectual learning ability for both verbal and performance or motor-perceptual aspects of cognitive functioning is essential if the normal and abnormal structure and changes in cognitive functioning at any age is to be more fully understood. This paper reports on the development of the Block Design subtest of the WAIS as such a performance learning test. To our knowledge, there has so far been no measure of motor-perceptual or performance learning which has built into it an acceptable level or process of automatic control for general or performance intelligence and for age.

In 1968 a new regional child psychiatry unit was opened in Birmingham, followed in 1969 by a regional adolescent unit. These events coincided with a general recognition of the need to train more child psychiatrists. It thus became possible to plan a new training scheme, using the new units, without the constraints which might have resulted from the existence of an established pattern of postgraduate training.

Deep muscular relaxation is an active component of systematic desensitization therapy. Most behaviour therapists induce relaxation in their patients by an abbreviated version of a technique originally described by Jacobson (4) called progressive relaxation. This report concerns a new way to facilitate deep muscular relaxation which is efficient, reliable and convenient.