When I received the invitation to deliver this year's Maudsley Lecture, I felt that a great honour had been conferred upon me. The series of the Maudsley Lectures provide a succession of pictures and a measure of the level attained by psychiatry, not only in Great Britain but throughout the world in recent times. Maudsley himself was a great master in the realm of clinical psychiatry. In these days psychiatry is menaced by many diverse and varied interpretations that tend towards bringing about its disintegration. Reading Maudsley's Pathology of Mind, and reading these lectures that have been given under his name since their foundation, constitutes an invaluable lesson that enables present-day psychiatrists to understand what their real situation is, and what is the field of action that is open to them as scientists in contemporary society.

The present research represents an attempt to study the construct of ‘conscience’ in quantitative fashion and to investigate its relation to various types of psychiatric disorders. The psychoanalytic literature deals extensively with aspects of functioning or behaviour which are related to the inner rules which influence man's conduct. In his early writing, Freud described conscience as ‘one part of the ego’ which judged it critically (6), but by 1921 (5) he referred to this self-critical agency as the ego ideal. In 1923, Freud included in the new construct superego the functions of ego ideal as well as conscience (7). Current emphasis continues to be on the censuring aspects of superego (12, 15) and its similarity to conscience (11).

A major problem in the affective disorders is what constitutes an homogeneous illness. A recent study enabled us to separate depressive illnesses into two types (1). The first we have called ‘depression spectrum disease’; its prototype is a female with an onset of a depressive illness before the age of 40, in whose family more depression is seen in female relatives than in male relatives, the deficit in males being made up by alcoholism and sociopathy. The second illness we have called ‘pure depressive disease’, the prototype of which is a male whose depression starts after age 40 and in whom there are equal amounts of depression in both male and female relatives and no large amount of alcoholism or sociopathy in the males. First degree relatives of depression spectrum disease are more likely to be psychiatrically ill (depression, sociopathy or alcoholism) than first degree relatives of pure depressive disease probands. Data of Hopkinson and Ley support this concept in part (2); they found that early-onset affective probands (< 40) had higher morbid risks for affective illness in relatives than late-onset probands (onset after 40). Further confirmation comes from a study of 259 alcoholics and their first degree relatives (3). Most of the psychiatrically ill male relatives had alcoholism; most of the psychiatrically ill female relatives had depression. As of the present the differentiation of the two kinds of depressive illness is made on the basis of a specific familial predisposition. Major clinical differences in the two groups have eluded us.

The official suicide rate for England and Wales has been higher than Scotland's (1) for at least 70 years. Since national differences in official suicide rates are quite frequently cited as an index of differences in social well-being, it is of some importance to know whether these differences are valid or whether they are merely artefacts caused by varying criteria for deciding what evidence is necessary to write 'suicide’ upon the death certificate.

Most people suffer from so-called ‘nervous symptoms' sometime during life, and their activity is influenced in varying degrees by these symptoms. There are a number of works reporting high prevalence of so-called neurotic symptoms: Rennie and his collaborators studied a sample of the population in the age range 20–59 of the central residential area of New York City and found that 75 per cent manifested significant symptoms of anxiety and that only 11 per cent of the lower class and 29 per cent of the upper class were psychiatrically symptom-free respondents (Rennie, Srole, Opler and Langner, 1957). Leighton found the life-time prevalence (after the age of 18) of psychoneurotic symptoms in a small town (population about 3,000) to be 67 per cent (Leighton, 1956). Winter interviewed 200 apparently healthy workers (mean age 36·6 years, 141 males and 59 females) of various social strata of Berlin, and found only 18 per cent free from so-called neurotic symptoms, i.e. anxiety, phobia, insomnia, headache and other psychosomatic symptoms (Winter, 1959). Agras, Sylvester and Oliveau found the prevalence of fear of storms, enclosures and journeying alone in females of Burlington to be 31 per cent, 14 per cent and 10 per cent respectively, and noted that psychiatrists saw only a small percentage of the phobic population (Agras, Sylvester and Oliveau, 1969). In all of these surveys, the authors noted that the majority of those with symptoms appeared to function well in the society. In Japan, a comparable survey is lacking, but Kasahara and Sakamoto investigated by questionnaire 2,481 students who entered Kyoto University in 1967 and found 24·1 per cent suffering from headache and 18 · 5 per cent from difficulty in falling asleep (Kasahara and Sakamoto, 1970). On 30 August 1970, N.H.K. (Japanese Broadcasting Corporation) invited to the studio 100 males who had graduated in 1945 from a single metropolitan all-male middle school for a programme entided ‘Age Forty’, in which health, economical and social status of this age group was enquired into. Among these, 26 ‘often suffered from palpitation and shortness of breath without significant exertion’, and 34 often awoke in the middle of the night or too early in the morning and could not get back to sleep again.

In peripheral hospitals and their crowded outpatient clinics many neurotics are treated, sometimes for a number of years, with sedatives or tranquillizers, a few words of sympathy and encouragement and, often electroplexy. The reasons often given for failure to offer psychotherapy are that it is of doubtful benefit or that it is too time-consuming.

The following report is about the procedure which was developed to involve school young people with mental hospital personnel, and the transactions between people in multiple organizations involved with this are described. Youth volunteers working in a mental hospital were making some sort of impact which seemed worth looking at in more detail with the various people involved to seek meaning in a phenomenon. The working relationship of a hospital-based Voluntary Services Organizer (J.L.) and a Consultant Psychiatrist (T.L.) is portrayed.

Paternal incest has been known and recorded in all periods of history and in all types of civilization. It seems to be a universal phenomenon which does not recognize any historical, geographical, racial or social boundaries: it was practised by royal families in classical Egypt, Greece, Peru and Japan; it occurred among some ruling families in mediaeval Europe; nowadays it has been reported in most industrial countries of Europe and America, as well as in the remote islands of Polynesia. Incest seems to exist everywhere, in spite of the fact that it is regarded as taboo in many primitive societies (Cooper, 1932; Freud, 1919; Walker, 1940), and is condemned in all Western societies, both by the Church, which regards it as a serious 'sin’ and by the Law, which makes it an indictable offence.

Among patients admitted to psychiatric hospitals are some who are discharged undiagnosed. It can be expected that psychiatric patients, as patients in other medical specialties, who do not meet the criteria for any of the established diagnostic groups, will be considered as undiagnosed until the course of their illness and clinical picture makes the diagnosis evident. The undiagnosed patients are a diagnostic and therapeutic challenge. Because in a space of five years, 256 patients left undiagnosed, it was felt that this group merited investigation.

This study compares the mental symptoms of two groups of aged mental hospital patients. One group had senile brain disease but no brain infarcts. The other group had brain infarcts but no positive evidence of senile brain disease.

Hormone treatment for impotence and impotentia ejaculandi (delayed or absent ejaculation in the presence of normal erections and desire) (Johnson, 1965) is based on two assumptions: namely—that (1) potency in the male is androgen dependent and (2) impotency is due to relative androgen deficiency (Miller, 1968; Margolis et al., 1967; Sobotka, 1969). The synthetic preparations most frequently used are methyl testosterone, various esters, including the propionate, deconate, enanthate, etc. (Tuthill, 1955; Kupperman, 1967) and more recently a number of testosterone- ‘aphrodisiac’ combinations (Margolis et al., 1967; Cooper et al., 1971, etc.). Despite some claims of therapeutic success for the various regimes, the administration of exogenous hormones has several pharmacologic disadvantages. For instance methyl testosterone, which has to be taken sublingually or bucally, may be associated with severe toxic effects such as cholestatic jaundice, etc. (Goodman and Gilman, 1965). Parenterally administered testosterone esters, although less toxic and more certainly absorbed than methyl testosterone, have all the drawbacks of the intramuscular route; also their rate(s) of tissue release may not be optimal for metabolism. Additionally, all these synthetic compounds may inhibit endogenous testosterone formation and spermatogenesis by suppressing pituitary gonadotrophins. Long term administration may result in Leydig cell inactivity and even disuse atrophy. Recently Harkness et al. (1964, 1968) have observed that clomiphene (Fig. 1), a non-steroid triethylene derivative which in females stimulates the anovulatory ovary to secrete oestrogens (Bishop, 1970), significantly raised the levels of urinary steroid metabolites, including testosterone, in a proportion of ‘normal’ and corticosteroid deficient males. This unexpected testosterone elevating effect suggested its possible ‘experimental’ use as an alternative drug treatment in impotence. Accordingly a limited pilot study on five ‘primary’ (non-organic) impotent males was conducted: its main aims were (a) to assess the potential clinical utility of the drug and (b) to study its effects on the ‘pituitary-testes-axis' as reflected by plasma testosterone levels.

Venables (1969) has suggested that a disturbance of lateral balance might be found in schizophrenia. Since this balance may be reflected in the hand dominance shown by the individual an investigation into the handedness of schizophrenics was carried out.

The Recruitment of Psychiatrists Every teacher of psychiatry bears a dual responsibility. Not only must he inculcate the essential principles of his subject into medical students, irrespective of their eventual choice of career within medicine, but he must also help recruit into psychiatry a sufficient number of doctors to develop the psychiatric services of tomorrow. Moreover, the quality and personal attributes of these recruits must be such as to do credit to the profession.

Until relatively recently, senile dementia has been a much ignored problem in psychiatry, but largely due to considerable social, medical and demographic influences much needed interest and energy have been injected into geriatric psychiatry. Although the historical development of this diagnostic concept has been shrouded by the use of ambiguous and often emotive language, certain major threads in its history can be teased out.