A quotation from Edward Mapother can serve admirably as text for this address: ‘In practically all properly investigated cases of insanity, it is found that it is the result of a summation of multiple causes, effective in combination, though inadequate singly. It is this that renders all controversy between extremists of the physiogenic and psychogenic schools so futile’ (Lewis, 1969, p 1359). In the same year, 1922, in his Salmon Lecture, Adolf Meyer said: ‘The overmechanization of psychiatry … (has) led to too much reliance on chemistry and physiology as curealls in mental ills, while psychoanalysis, by laying too much emphasis on the subconscious and sex, has lost sight of the … functions of the conscious mind and has … disregarded the fact that man is subject to physical … biological … and social laws' (Meyer, 1922).

Earlier this year I was invited by the American Psychiatric Association to deliver a public lecture on the contributions of Sir Aubrey Lewis to psychiatry, with particular reference to his work in its historical perspective (Shepherd, 1977). By a happy chance the lecture in question is linked with the name of Adolf Meyer, an eponymous association which facilitated the exposition of the principal theme of my address. It was, I believe, Manfred Bleuler who first drew attention to the similarities between Adolf Meyer and Aubrey Lewis despite profound differences in their temperament and background (Bleuler, 1966). In retrospect it is now apparent that Lewis was Meyer's natural successor, both men standing out as the representative psychiatrist of his generation in the mainstream of psychiatry, each owing his pre-eminence as much to what he stood for as to what he achieved. This was the argument which I did my best to elaborate, drawing for the purpose on the sources and development of Sir Aubrey's ideas, on his manifold achievements and on the various legacies which he has bestowed to his own successors. And, since I was addressing a largely North American audience to whom he was a somewhat remote figure, I attempted to introduce my subject with a few words about the origins and character of the man himself.

It was only after much hesitation that I accepted your flattering invitation to contribute to this meeting in commemoration of Aubrey Lewis. On the one hand, I have the natural diffidence of a layman amongst experts. But as against this, although we were of the same generation, I cannot but be moved by a feeling akin to filial piety towards one whose work I so greatly admired, and to whom I am indebted for so many personal acts of kindness and generosity as I have been to Aubrey Lewis. I hope, therefore, that since the latter emotion has prevailed you will think it fitting that I should ask you to look back, from the standpoint of nearly a quarter of a century later, at the impressive paper on Health as a Social Concept which Aubrey Lewis read to the British Sociological Association in 1953.

A Special Committee of the College was appointed in May 1976 after the President had received a request from Dr Porter, the Regional Medical Officer of the SE Thames Regional Health Authority, for the College's advice on the problems of administration of ECT, especially when consent is withheld or given reluctantly. Although the Regional Authority had been concerned earlier with the problem, the situation which prompted further action was the publication in March of the Report of the Inquiry on St Augustine's Hospital, pages 63–71 of which dealt with the administration of ECT and recommended that the College ‘should give urgent consideration to these problems and issue clear guidance’.

During a study of drug incidents dealt with in one month by 62 casualty departments in Greater London, 395 drug-dependent individuals were identified. The great majority of these patients were seen in hospital following an overdose, and barbiturates were the drugs used most frequently. A high incidence of multi-drug use was noted, and many individuals had obtained their drugs from an illicit source. A history of repeated overdosing was common, and one fifth of the patients behaved aggressively while they were in casualty. The implications of these findings are discussed, with particular reference to the demands that are made on casualty departments by drug-dependent individuals.

Seven frequently-occurring, more or less stereotyped, adolescent presentations are described to illustrate the relevance of a specific clinical framework for adolescent disorder. This recognizes the maturational background in adolescence, the family involvement in this process and the various factors that can affect it. Disorder is viewed in terms of inappropriate identity choice at this time, a state of maturational deadlock, and can be categorized according to the types and severity of the maladaptive responses. Treatment, capitalizing on the adolescent's state of change and flux, concentrates on more adaptive future identity formation, and can be most rewarding. Orthodox assessment procedures, as used with adult patients, stand the risk of reinforcing a dependent ‘psychiatric patient’ identity.

Thirty-three married women, all agoraphobic but most with additional phobias, were exposed to a standard four-day intensive behavioural treatment programme as out-patients. The effects of this on the patients and their spouses throughout a one-year follow-up are reported and discussed.

A treatment for male genital exposure (exhibitionism) has been given successfully to 15 persons who have previously been resistant to change. The procedure involves the subject undressing before a mixed sex audience, followed by video-taping and subsequent replay to the patient. During the period of nakedness the subject describes in detail the events, his expectations and attitudes, and those attributed to his victim during exposure.

The success of the treatment appears to depend on the profound anxiety induced. During the phase of greatly increased anxiety, cognitive changes previously resisted seem to be made possible.

The excess incidence of schizophrenia reported from Ireland may partly be due to the unusual distribution of the Irish population by maternal age at birth.

This paper develops a structural equation model to assess the effects of mental state on EPI scores. This model is applied to results obtained from a clinical population. The findings show that: (a) the E scale is not influenced by mental state as measured by the Hamilton Anxiety Scale (HAS); (b) the N scale is influenced by HAS. An attempt to revise the N scale to produce an un-contaminated score is discussed.

In a double blind chlorpromazine-controlled trial, high dosage haloperidol (100 mg daily) given for three months, appreciably improved the mental state of male chronic ‘drug resistant’ schizophrenic in-patients in the rehabilitation/long-stay unit of one psychiatric hospital. The results of a three-month follow-up suggested that the improvement could be maintained in some patients on lower doses of the drug.

Serious extrapyramidal side effects were not seen at high doses. However, the majority of patients on haloperidol showed a deterioration in ward behaviour, possibly related to drowsiness, and developed raised serum alkaline phosphatase levels. These side effects disappeared in the follow-up period when either the drug was discontinued or the dose of haloperidol reduced.