In commemorating the 25th anniversary of the British Journal of Psychiatry it is fitting to trace its history to its beginnings, The Asylum Journal, which made its bow on 15 November 1853. The publication of the Journal was a landmark, the prime importance of which can only be appreciated in the context of the history of the Royal College of Psychiatrists. The College itself is descended in direct line from The Association of Medical Officers of Asylums and Hospitals for the Insane, which under different titles has a continuous existence for more than 140 years, and can legitimately claim to be the oldest medical society in its field in the world.

The year 1963 was a time of innovation and excitement in British psychiatry, thanks largely to the National Health Service (NHS), which in 1948 had taken the mental hospitals from the control of the local authorities and made them part of a national service, which meant more money and far more medical staff. Rehabilitation of chronically ill patients resulted in a proliferation of out-patient clinics, home assessments, day hospitals, and even halfway houses; doors were unlocked, and informality became the order of the day. Hospitals with enough nurses demonstrated that the whole adult psychiatric service of an area could be successfully provided without a single locked door and almost without a compulsory order in a year. Medical superintendents disappeared and therapeutic communities developed. Suicide ceased to be a crime and became a new subject of research. And, of course, it was the era of successful chemotherapy, chlorpromazine in 1954 and imipramine in 1957 being the first of many drugs used.

A viable neuropsychology of schizophrenia requires, first, that signs and symptoms be understood in terms of underlying psychological processes and, second, that these underlying processes be related to brain systems. We propose that the negative signs of schizophrenia reflect a defect in the initiation of spontaneous action, while the positive symptoms reflect a defect in the internal monitoring of action. The spontaneous initiation of action depends upon brain systems linking the prefrontal cortex and the basal ganglia. Internal monitoring, carried out in the hippocampus, of spontaneous action, depends upon links between the prefrontal cortex and the hippocampus via the parahippocampal cortex and the cingulate cortex.

Interest in the long-neglected neuropathology of major affective disorders has recently been rekindled, partly because of the emergence of brain-imaging techniques. We review the literature suggesting that attention be given to the neuroanatomy and neuropathology of primary and secondary affective disorders. Computerised tomography studies show that patients with affective disorders tend to be similar to schizophrenic patients and significantly different from normal control subjects in ventricle:brain ratio, sulcal widening, and cerebellar vermian atrophy. As yet, there are few neuropathological investigations of the brains of patients with primary affective disorders. Suggestions for further research in the neuropathology of affective disorders are offered.

The aetiological factors relevant to the development of post-concussional symptoms are reviewed. From the numerous studies carried out to date, it would appear that both physiogenic and psychogenic influences are important in their genesis. However, where mild-to-moderate injuries are concerned, organic factors are chiefly relevant in the earlier stages, whereas long-continued symptoms are perpetuated by secondary neurotic developments, often of a complex nature.

For 18 years, Northern Ireland has suffered a changing pattern of civil disorder. Early years were marked by widespread sectarian rioting, shootings, and bombings, which heightened community tension and caused much social and commercial disruption. However, in recent years, terrorist organisations have been more selective in their acts of violence. There are methodological difficulties in assessing the psychological impact of civil disorder and terrorism. But, as well as can be judged from community surveys, hospital admissions and referral data, psychotropic drug usage, suicide and attempted suicide rates, and from assessment of the actual victims of violence, society has not ‘broken down’ nor has the impact been judged considerable. Possible explanations are discussed.

The tremendous increase in interest in childhood and adolescent depression that has occurred since the early 1970s has resulted in a large and contradictory literature. Development of the concept of childhood depression, and the many clinical studies of depression and its concomitants, both psychosocial and biological, are critically reviewed. A number of methodological and theoretical problems are discussed.

It is incumbent on anyone who is honoured by an invitation to deliver the Maudsley Lecture to familiarise himself with the preceding lectures of the series. For me, the task has been unexpectedly instructive. Since its inception in 1919, the list of lecturers is impressive by virtue of not only their eminence, but also the heterogeneity and range of their selected topics. Taken as a group, the lectures emerge as a line of beacons which illuminate the direction, if not always the advances, of psychological medicine over the past three generations.

Psychopathic personality has always been a contentious concept, but it continues to be used in clinical practice and research. It also has its contemporary synonyms in the categories of antisocial personality disorder in DSM–III (American Psychiatric Association, 1980) and “personality disorder with predominantly asocial or sociopathic manifestations” in ICD–9 (World Health Organization, 1978), and some overlap between these and the legal category of psychopathic disorder identified in the English Mental Health Act 1983 is commonly assumed. Although the literal meaning of ‘psychopathic’ is nothing more specific than psychologically damaged, the term has long since been transmogrified to mean socially damaging, and as currently used, it implies a specific category of people inherently committed to antisocial behaviour as a consequence of personal abnormalities or deficiencies.

Psychiatrists and general practitioners have found new ways of working together in the last ten years, but there have also been separate activities which could develop into rivalry. These opportunities and dangers are the central theme of this paper. Ways are considered in which the psychiatry of general practice differs from the experience of psychiatrists. Forms of help are suggested which general practitioners need from psychiatrists, whether in clinical practice or education.

The hypothesis that schizophrenia is a recent disease can explain why descriptions of schizophrenia-like disorders were rare before 1800, why the prevalence of insanity in the Western world increased during the 19th but remained low in the non-Western world until the 20th century, and why schizophrenia has become milder in the West during recent decades. It also explains why schizophrenia has ‘persisted’ in spite of its associated low fertility. The evidence for the hypothesis is somewhat frail, but perhaps not more so than that for alternative hypotheses.

Schizophrenic patients were recruited into a trial of a prophylactic behavioural intervention with families. Families with at least one high Expressed Emotion (EE) relative were randomly allocated to one of four intervention groups: Behavioural Intervention Enactive; Behavioural Intervention Symbolic; Education Only; Routine Treatment. Patients from low-EE families were randomly allocated to two groups: Education Only or Routine Treatment. Relapse rates over nine months after discharge were significantly lower for patients in the two Behavioural Intervention, compared with Education Only and Routine Treatment groups. There was little difference between the two low-EE groups. Patients returning to high-EE relatives showed significantly higher relapse rates than those returning to low-EE relatives, in groups not receiving active intervention. Changes from high to low EE occurred in the Behavioural Intervention groups, and similar although less extensive changes occurred in the Education Only and Routine Treatment groups. Changes in criticism and marked emotional over-involvement (EOI) occurred generally in high-EE groups but were larger in magnitude in the Enactive and Symbolic groups. Reduction of hostility only occurred in the Behavioural Intervention groups. These results give partial support for the causal role of EE in relapse. There were no significant differences between the groups with respect to contact with the psychiatric services or medication.

Families were identified, in north-east Wiltshire (UK), (population 200 000), in which there was a pattern of two or more generations of child maltreatment and where there were also two or more children maltreated in the current generation (born between 1960 and 1980). These children had high rates of mental handicap, backwardness, and antisocial behaviour, and there were also characteristic patterns of emotional disturbance. The post-neonatal death rate for the 294 index children was very high, but higher still for their brothers and sisters. Some of the deaths, and at least 11 cases of violence-induced mental handicap (VIMH), were caused by characteristic types of child abuse – particularly violent shaking and throwing of infants, and secret suffocatory practices. There were very strong indications that larger numbers of children than the 11 proven VIMH cases had also suffered blunting of the intellect, physical complications such as epilepsy, and educational problems, as well as emotional and social maladjustment as the consequence of ill-treatment and neglect. Within the families, for children remaining at home, forms of ill-treatment and poor quality care persisted and ultimately affected most, or all, of the children in each family unit. Many families were chaotic, and within each family unit there were children frequently in care who suffered multiple placements, and who needed sustained specialist support throughout their childhood, encompassing a huge range of professional and other social support services. Such detail was generally underplayed or not accessible, and its full significance for children in each family could only be assessed by combining direct personal clinical involvement with record linkage methods, depending in turn on good co-operation from all agencies concerned wholly or partly with child protection.

The case records of 499 victims of civil and terrorist violence were examined, and the presence or absence of post-traumatic stress disorder (PTSD) and associated features recorded. The results support the face, and predictive, validities of PTSD. ‘Acting as if the event were reoccurring’ and 'survivor guilt’ seemed not to be characteristic symptoms, and the homogeneity of the emotional state in PTSD was questionable. Only marital disharmony and suicidal behaviour were associated complications. PTSD seemed to be found in a wide range of stressors, but the danger in over-reliance on results from combat veterans is emphasised.

The enigmatic title is taken from my first professorial lecture given on 21 December 1980 at the Royal Manchester Children's Hospital. It linked psychiatry, mythology, and Christmas, bringing together three incredibles, in trying to bridge the credibility gap that makes paediatric/psychiatric liaison so tricky. The hospital psychiatrist is, like Tiresias in Sophocles' play, a bisexual (equally as available as repellent). Blinded when he once saw truth (mythically he peeped at Athena bathing), he was given the gift of prophecy by way of consolation. Tiresias, like the psychiatrist, although blind, knows all but, tiresomely, will not speak what he knows. “How does he know?” whisper the non-psychiatrists. “He is blind, he knows nothing”, they muse.