To psychiatrists who entered clinical practice in the decade 1955–65, ‘behaviour therapy’ probably conjures up the names of Eysenck, Lazarus and Wolpe; the invocation of learned maladaptive anxiety as the basis of most neurotic illness; desensitization by graduated exposure in imagination and real life to anxiety evoking situations. Neurotic ‘symptoms' were maladaptive habits and the ‘symptoms' were the disease, not merely outward manifestations of underlying disorder. Eysenck (1959) described behaviour therapy as all methods of treatment which were based on ‘modern learning theory‘. The ‘bell and pad’ treatment for enuresis and aversion therapy for alcoholism were appropriated and refined. Operant conditioning crossed the Atlantic and the application of Skinnerian principles was illustrated by Krasner and Ullman (1965). In the early sixties, at the very least behaviour therapy offered a possible treatment for a small proportion of psychiatric patients, for example those with phobias, tics or alcoholism, a group for whom other treatments were of little value.

Let us try to project ourselves back into the places and minds of physicians and psychiatrists in, say, 1900. When they spoke of disease, what did they mean? They meant, typically, something like syphilis. ‘Know syphilis in all its manifestations and relations,’ declared Sir William Osler (1849–1919), ‘and all things clinical will be added unto you.’ (1). Obviously, this is no longer true. Indeed, how many cases of syphilis do modern medical students see between the time they enroll in school and the time they graduate? In the United States, Osier's maxim has been replaced by another which asserts that ‘mental illness is our number one health problem‘. This would make schizophrenia—the most common and most disabling of the so-called mental diseases—the successor of Osier's syphilis, showing us immediately what a gulf separates us from him. For, clearly, a physician may know all there is to know about schizophrenia, and yet be totally ignorant of medicine.

Anyone acquainted with Dr Thomas Szasz's previous writings about mental disorder, the nature of its relationship to the Law and to the problems of drug dependance (Szasz, 1961, 1963, 1970, 1972, 1975) has learned to look in the first instance for the dualism, the poles of which are to be demonstrated as irreconcilable. For, as Glazer (1965) has pointed out, one of Dr Szasz's main conceptual devices is ‘the dichotomy game‘. A phenomenon may belong to category (x) or another category (y) but not to both. As a first step it is as well to examine the definitions of the categories in question. They are liable to prove inconsistent or idiosyncratic or just to be omitted. In other cases, as Professor Stone (1973) has shown in his detailed and telling dissection of the tortuous and confused logic pursued by Dr Szasz in The Myth of Mental Illness, the definitions are incomplete or erroneous and the implied anti-thesis dubious or false. Beginning with the equation that a lie is to a mistake as malingering is to hysteria, Szasz manages, following a maze of tortuous and self-contradictory arguments, to emerge at the conclusion that it would be ‘… more accurate to regard hysteria as a lie than as a mistake‘.

This paper reports relationships between symptoms and premorbid personality in a varied sample of depressed patients. Symptoms were rated by a psychiatrist at clinical interview; personality was rated by patients on self-report after clinical improvement, using the Maudsley Personality Inventory and an inventory of obsessive, hysterical and oral personality. Additional ratings on the latter were obtained at interview with a relative. The most prominent finding was that patients with premorbid neuroticism also showed a neurotic rather than an endogenous symptom pattern. Additional relationships were relatively weak but consistent with previous studies. Depressives with neurotic rather than endogenous symptom pattern showed more evidence of oral dependent personality and less obsessionality. Patients with hysterical personalities tended to be less severely ill and to show a pattern characterized by mixed depression and hostility with less evidence of anxiety.

The effects of tricyclic antidepressants on the heart are reviewed. Statistically significant increases in heart rate and in atrioventricular conduction times were found following the administration of tricyclic drugs to 32 depressed patients. The method of His bundle electrocardiography was used to study atrioventricular conduction in ambulant patients and in patients admitted after an overdose of tricyclic antidepressant drugs. Distal conduction defects were frequently found in patients following tricyclic overdosage, but these were not seen with doxepin overdosage. Impaired distal conduction was also found in occasional patients on therapeutic doses of tricyclic drugs. Some animal experiments giving similar results to the above clinical findings are also described. The clinical implications of these findings are discussed.

The antidepressant activities of mianserin hydrochloride were investigated and compared with those of amitriptyline. The therapeutic efficacy of the two drugs appeared similar, but the incidence of side-effects was significantly higher with amitriptyline. Plasma levels of mianserin were determined during the trial and were not related to the therapeutic activity of the drug.

The possibility that schizophrenia and creativity are two aspects of the same process is discussed, and parallels between different types of schizophrenia and different factors of creativity are sought. The discussion begins at a theoretical level, but its main thrust is an analysis of the research literature at an empirical level. Similarities are pointed out between tasks used for the purpose of operationally defining the schizophrenic ‘deficit’ and tasks used to define creativity. Some evidence is found for different subtypes of schizophrenics exhibiting different factors or types of creativity.

The 24-hour oral temperatures of 51 chronic schizophrenic patients, 19 non-schizophrenic chronic psychiatric patients and 14 non-patients have been measured and compared. The chronic schizophrenics have an earlier peak temperature and differ significantly from the other groups. Compared with the non-schizophrenic patients their hourly mean temperatures reach significantly higher levels in the morning. Compared with the non-patients their mean temperatures fall to significantly lower levels in the evening after 5.00 pm.

Studies on the relationship between season of birth and mental disorder have been substantially confined to northern hemisphere regions. Such studies have generally found an excess of winter births of schizophrenics, and variably an excess of winter births of manic-depressive and mentally retarded patients. In the present study information on sex, diagnosis and date of birth was obtained on all 20,358 patients first admitted to psychiatric facilities in New South Wales between July 1970 and June 1974 and born in New South Wales. The collective 1962–71 monthly live-births for New South Wales were used as a control. A significant winter excess was found for the female schizophrenic group, while a significant spring excess was found for neurotic patients, most marked in those with anxiety neurosis. It is hypothesized that the relationship between schizophrenia and winter birth is consequent upon a greater sensitivity of schizophrenics to those physiological factors which determine conception in the general population.

Each of thirty-six female agoraphobic out-patients were treated by one of three methods: 8 sessions of imaginal flooding followed by 8 sessions of practice in the real situation; 16 sessions of combined flooding and practice; or 16 sessions of practice alone. Three therapists treated equal numbers of patients in each group, and there was some evidence that patients' response varied according to the therapist seen, irrespective of treatment group. There were no significant differences between treatment groups after 8 sessions, 16 sessions or on six-month follow-up. It is concluded that there are no long-term differences between the effects of treatments involving exposure to either imaginai or real phobic situations or to a combination of both, provided that patients are encouraged to practise between sessions.

This paper reports the results of measures taken during treatment in the study of imaginai flooding and exposure to real phobic situations previously described by Mathews, Johnston, Lancashire, Munby, Shaw and Gelder (1976). On weekly measures of change a similar reduction in phobic behaviour in all treatments was found, confirming the previous findings. Differences in therapist effectiveness were also confirmed. On measures of the immediate effects of treatment, exposure to the phobic situation had consistent positive effects, imaginai flooding had little or no detectable effect. It is proposed that the treatments studied differ in their immediate effects on phobic behaviour but also have the common effect of facilitating counterphobic behaviour outside the treatment situation, and that this is the main agent of therapeutic change.

The outcome of a standard four-day intensive symptomatic treatment programme with 39 agoraphobics is examined in relation to the incidence of fresh symptom emergence. Twenty-six patients suffered fresh symptom emergence during follow-up, and there was a significant association of fresh symptom emergence with poorer outcome at one-year follow-up. About 18 per cent of patients were adversely affected by the treatment programme, as judged on a wide range of symptoms and measures of inter- and intra-personal adjustment. Sixteen individually treated patients are then compared with the 39 group-treated patients and differences in drop-out rate are discussed.

The paper reports an extension of work into the relevance of personality and pre-treatment expectancies for allocation and response of patients to group psychotherapy. The results show that subjects who are internally directed in interest and who have a liberal attitude to a variety of social issues and a ‘psychological’ set to treatment are more responsive to group psychotherapy as seen by their therapists as well as by themselves. Those who are externally directed in interest and who have a conservative attitude to life and a more ‘medical-physical’ set to treatment are more likely to be referred for behaviour therapy; if referred for group psychotherapy they are likely either to drop out or to show very limited response to treatment.

Factors from the social history of male psychopaths were examined in relation to their success or failure as measured by re-convictions or psychiatric hospital re-admissions 2–3 years after treatment at Henderson Hospital. From these data a weighted prediction formula was calculated and was tested out on a further cohort of patients. As a prediction instrument it was found to be reliable to a degree of significance just above the 1 per cent level. Other aspects of the subsequent career of treated patients are noted, in particular a tendency to early but often short-lived relapse and then longer standing success.