It has often been suggested in recent years that there is no such thing as mental illness; that the conditions psychiatrists spend their time trying to treat ought not, properly speaking, to be regarded as illness at all, or even to be the concern of physicians. Szasz is the best-known exponent of this viewpoint, and the core of his argument is essentially this: that as prolonged search has never demonstrated any consistent physical abnormality in those regarded as mentally ill, and as their ‘illness' consists simply in behaving in ways that alarm or affront other people, or in believing things which other people do not believe, there is no justification for labelling them as ill, and to do so is to use the word illness in a purely metaphorical sense (Szasz, 1960). Schneider had previously been led by the same reasoning to the conclusion that neurotic illness and personality disorders were ‘abnormal varieties of sane mental life’ rather than disease, but he took care to exempt schizophrenia and cyclothymia by assuming that both would in time prove to possess an organic basis (Schneider, 1950). The argument Eysenck puts forward in the first edition of his textbook, though written from the quite different standpoint of academic psychology, is a similar one. After observing that ‘the term psychiatry does not denote any meaningful grouping of problems or subjects of study’ he went on to suggest that the traditional subject-matter of psychiatry should be divided into a small medical part ‘dealing with the effects of tumours, lesions, infections and other physical conditions' and a much larger behavioural part ‘dealing with disorders of behaviour acquired through the ordinary processes of learning’, thereby implying that most of what doctors regarded as mental illness was really learnt behaviour rather than disease, and therefore much better understood, and dealt with, by psychologists than by physicians (Eysenck, 1960). A third line of attack is provided by R. D. Laing, and a fourth is exemplified by the sociologist Scheff. Laing argues that schizophrenia, far from being a disease or a form of insanity, is really the only sane or rational way adolescents have of coping with the intolerable emotional pressures placed on them by society and their families (Laing, 1967). Scheff has developed the somewhat similar argument that what psychiatrists call mental illness is largely a response to the shock of being labelled and treated as insane and the expectations this produces; in other words that schizophrenia is created by the people and institutions that purport to treat it (Scheff, 1963).

Sixty-eight psychiatric in-patients who had completed the Delusions-Symptoms-States Inventory (D.S.S.I.) on admission were retested after one month. On first testing 92.6 per cent conformed to the hierarchy of classes of personal illness model, and on the second occasion 91.2 per cent. Of those who could improve, 72 per cent did so, most commonly by moving down one hierarchy class, e.g. from the Neurotic Symptoms class to the Dysthymic States class. (On the other hand only 30 per cent of the 61 patients who originally reported symptoms did not do so after one month.) Thus although it is clear that the patients as a group changed markedly, they have not departed from the hierarchy. These results indicate that either the symptoms further up the hierarchy remit before those lower in the hierarchy or they remit together. Certainly those lower in the hierarchy do not go first. It is suggested that the results would be difficult to accommodate within strict disease-entity models, and that they have different implications for both treatment and the assessment of change in current state.

Only Scandinavian investigators have reported on demographic aspects of reactive psychoses. Data from the National Health Service, Denmark, for age at first admission, sex, and length of stay in hospital in reactive, manic-depressive and schizophrenic psychoses are analysed. Differences in sex incidence ratios, age at first admission and length of stay are evident between the three psychoses. The differences noted are considered to provide indirect evidence supporting the separate diagnostic categories.

Two cases of Gilles de la Tourette's syndrome occurring in Sri Lanka are reported. Both patients had the characteristics of the syndrome as described by Fernando (1967): (1) Childhood onset (below 16 years of age); (2) Multiple motor tics; (3) Unprovoked vocal utterances which may progress to coprolalia. Both responded to haloperidol, withdrawal of medication being followed by relapse, and reintroduction by remission.

The literature on the aetiology of the condition has been reviewed. The weight of evidence favours an organic cause, although psychological precipitation cannot be ruled out.

The physiological response to stress falls mainly on the cardiovascular system, adrenergic stimulation resulting in peripheral vasoconstriction and an increase in systemic blood pressure. The analogous effects that occur in anxiety-provoking situations immediately suggest an association, whether causal or effectual, between raised blood pressure and anxiety. It has also been suggested that hypertensive individuals exhibit more aggressive traits than others and that these may be hidden or suppressed, becoming manifest by abnormal elevation of the blood pressure (Smirk, 1957).

Sixty-five patients primarily referred for erectile impotence were investigated. Information was obtained from patients and their partners. The demographic data are compared with those from a non-impotent psychiatric out-patient group, matched for age. Results indicate that impotent cases do not form a homogeneous population and can be classified into three fairly distinct groups. These groups differ in age, marital status, sex drive, pre-marital and post-marital relationships, duration of illness, etc. Group 1 develop impotence because of anxiety in sexual situations, Group 2 react to the sexual response and personality of their partners, while Group 3 decline, perhaps from inherent constitutional causes. Factors such as religious restrictions, sexual taboos, alcoholism and homosexuality do not appear to be of any aetiological importance.

Eighty-two obsessional neurotics were studied from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions. An attempt was made to ascertain the frequency with which the different forms and content occur and their effect on the final outcome of the disorder. Five types of obsessions were identified: doubts, obsessive thinking, fears, impulses, and images, in order of frequency of their occurrence. Compulsive acts could be classified in two types, depending on whether they yielded to or diverted the underlying obsession. One-fourth of the patients displayed no compulsions. The content of obsession could be classified in five broad categories as relating to: dirt and contamination, aggression, inanimate-impersonal themes, religion, and sexual matters, in order of the frequency of their occurrence. The paper, while offering an interpretation of these findings, emphasizes the part played by socio-cultural factors in the character of an obsession's thought content.

The absence of compulsions was found to be associated with good prognosis. A downward gradient was noted in the final outcome of patients without compulsions, those with controlling compulsions alone, those with both varieties of compulsions, and those displaying yielding compulsions alone, in that order. Based on this observation the paper suggests a prognosis-related hierarchical continuum of the severity of obsessional disorder.

Twenty patients with chronic obsessive-compulsive rituals were treated in a partially controlled design by in-vivo (real life) exposure with self-imposed response prevention. Treatment included 4–12 weeks as in-patients, and lasted a mean of 23 sessions. All patients were followed-up for at least two years. No patients dropped out during the trial, though one refused domiciliary treatment after discharge. Significant improvement in compulsions was found after three weeks of real-life exposure, and continued during follow-up. At two years follow-up 14 patients were much improved, one improved and 5 unchanged; in a third year of follow-up the improved patient became symptom-free after further exposure treatment. Improvement after three weeks exposure predicted good outcome at 6 and 12 months follow-up.

Muscular relaxation treatment had no significant effect on rituals. Modelling of exposure conferred no advantage over exposure alone for the group as a whole, though it may help selected patients. The role of response prevention is unknown. Patients' commitment to treatment facilitates exposure. Domiciliary treatment with involvement of family members in therapy seems crucial in some cases. Pilot group treatment of patients and families together suggests that this may be a useful adjuvant to individual treatment by increasing motivation and aiding follow-up.

Compulsive slowness presents special treatment problems but can be improved by a prompting and pacing approach.

The course of rituals was often independent of that of agoraphobia, marital problems and depression where these had initially coexisted with rituals. Depressive episodes were common before, during and after treatment, and required tricyclic medication.

The trial sample was predominantly female but was otherwise typical of patients with compulsive rituals. Of the 125 obsessive-compulsives seen in the first author's unit over four years 96 per cent were offered behavioural or antidepressant treatment. One quarter refused behavioural treatment after it was offered.

Real-life exposure with self-imposed response prevention is usually an effective procedure for lasting reduction of chronic compulsive rituals in well motivated patients.

Ninety-three chronic neurotic patients whose previous psychiatric treatments had proved unsuccessful were included in this study, and selected patients, relatives and G.P.s were briefed to expect stress during therapy.

Assessment made by therapist and patients before and after therapy was made on the basis of the acceptability of eight aspects of their life. Follow-up lasted 2 ½ years.

Of the 93 patients, 87 per cent showed positive change, a small number showed temporary negative change and one patient became psychotic but later recovered.

The ‘contamination’ of results due to therapist involvement in assessment is offset against corroborative evidence of change, in that 96 per cent of patients became independent of the psychiatric and social services after years of dependency in many cases. There were also marked changes in life situations and relationships.

A need for increased facilities for basic and in-service training of group therapists is indicated.

Many severely subnormal patients talk little to each other. In this experiment, three pairs of subjects were reinforced for talking to each other, and learned to do so quite quickly. Whether social speech would continue to occur without the benefit of external reinforcement was examined by observing the subjects through a one-way mirror in a bare interview room adjacent to the teaching room immediately after each training session. On some occasions untrained subjects were observed in the bare room with the trained subjects.

The reinforcement of social speech was demonstrated to be effective by the use of a reversal design (baseline, reinforcement, no reinforcement, reinforcement), where the rate of speech increased considerably when reinforcement was available but decreased when it was discontinued. Generalization of the increased social speech, however, was very poor and only significantly above baseline levels with the pair who seemed responsive to social as well as material reinforcement. The implications of this for training programmes are discussed.

Although the semantic differential has been quite widely used with mental defectives, its usefulness (in its traditional form) with such a population has not been conclusively demonstrated.

The semantic differential was developed and shown to be valid as an index of representational mediation processes. However, there is also evidence of a mediational deficiency among retardates which, therefore, ought to be reflected in retardates' responses to the semantic differential. Thus, the present study was designed to test two hypotheses: (a) that mild grade retardates, in comparison with subjects of average intelligence, would show less discrimination in the use of the semantic differential, and (b) that such discriminative deficiencies would in turn predispose toward a polarized response bias among the retarded.

The results, which supported both hypotheses, are discussed in terms of their implications for the usefulness of an unmodified semantic differential with the mentally subnormal.

T. S. Eliot, standing on his doorstep, with his Boston Evening Transcript in his hand, ‘turned wearily as he would turn to nod goodbye to Rochefoucauld if the street were time and he at the end of the street’. The same weary gaze characterizes the attitude of most psychiatrists towards important figures in the past history of their subject. A crude indication of this state of affairs is the total absence of any historical questions in most psychiatric examinations. For its jobbing practitioners, psychiatry might as well exist in a historical vacuum. And why not? History has its own snares and delusions. Henry Ford called it ‘bunk’. Alfred North Whitehead remarked that ‘a science which hesitates to forget its founders is lost’. And Karl Popper, who has done a thorough demolition job on the concept of ‘historicism’, has warned us that ‘if our civilization is to survive, we must break with the habit of deference to great men’. In contrast to psychiatrists, students of art study its history for at least a year. If we regarded psychiatry as an art, how does our history look then?

A case of schizophrenia in a 47,XYY male diagnosed according to strict phenomenologicai criteria is presented. The authors suggest that the 47,XYY chromosome anomaly should be added to the list of possible causes of symptomatic schizophrenia, and express the hope that future investigations of the effects of an extra Y chromosome on brain function will yield clues as to the aetiology of idiopathic schizophrenia.

The present study has been made with the purpose of studying the frequency of chromosome aberrations in a male psychiatric hospital population, especially in order to look for possible associations between minor chromosome aberrations such as variations in short arms or satellites in D or G chromosomes as well as in Y length on the one hand and mental illness and criminality on the other.