Since the definition of subnormality in the Mental Health Act (1959) specifically adds to its other descriptive statements, “… including subnormality of intelligence,” as part of the criteria for delineating this type of patient, it is clearly of great importance to come to some decision about the exact meaning of this phrase. One can either insist on a purely intellectual interpretation where the major emphasis is placed on the individual's estimated problem-solving ability relative to the community at large (Castell and Mittler, 1965); or one can broaden the concept to include much more than sheer intellectual ability (Shapiro, 1965) and argue that it also involves a person's social behaviour and his empirically demonstrated failure to adapt to the social and economic environment. If the purely psychometric view is taken, then reliance is placed wholly upon the use of standardized tests which are capable of arranging the population in order of intelligence, and which supply statistically defined cut-off points, according to the percentage of the whole population likely to fall beneath such limits. Conversely, if the clinical viewpoint is adopted, then intelligence levels assume a relatively minor role, and more emphasis is placed on social maturity, and behavioural control. In the absence of properly standardized, and widely accepted maturity scales, the clinical diagnosis is based mainly on subjective impression, supported by case history factors, and the knowledgeable experience of the examining medical expert.

In recent years, the Maudsley Personality Inventory (M.P.I.) has been widely used in experimental, psychiatric, social and applied research (Eysenck, 1959a, 1959b). Its use in a university setting has been described by Furneaux (1962) and Lynn and Gordon (1961).

In recent years there have been an increasing number of attempts to survey the distribution of psychiatric morbidity, or to estimate the need for psychiatric treatment, in the general population. Various methods of defining or diagnosing psychiatric illnesses have been used (Blum, 3; Scott, 20). These methods include interviews by psychiatrists (Lin, 17; Essen-Müller, 13; Hagnell, 14); the judgment of family physicians (11; Kessel, 16; Shapiro and Fink, 21); the use of self-administered symptom check lists (White et al., 23); and structured interviews by non-psychiatrists relating to symptom occurrence, attitudes, personality scales, etc. This paper outlines an attempt to determine some of the relationships between the results of a symptom-questionnaire; the diagnoses recorded by physicians; and the physicians' request for psychiatric consultation.

Whenever one person seeks to influence the behaviour of another, the outcome may be affected by a multiplicity of factors. When the deliberate manipulation of one of these is followed by a given response, we regard the manoeuvre as specific and causal for that event. While this conclusion is acceptable logically, in practice it frequently proves to be misleading because certain implicit assumptions are overlooked.

The main aim of this investigation is to determine whether patients with psychiatric illness have more somatic illness than those who are psychiatrically well, and conversely, whether those who have more than an average amount of physical sickness also suffer from an excess of psychiatric disability. A subsidiary purpose is to determine how much “psychosomatic” illness occurs in association with physical and with mental illness.

Recently the 1959 Mental Health Act has been criticized because of an apparent increase of psychiatric referrals from courts and prisons, and it has been suggested that there has been an increase of social pathology since the passing of this Act (Rollin, 1963). A previous study (West, Bearcroft and Smith, 1960) showed that men were remanded in custody rather than on bail for psychiatric reports largely for social reasons, and in a more recent study (Bearcroft and Donovan, 1965) the incidence of criminal behaviour in the mentally ill seemed to depend, to some extent, upon social factors.

Recently Kay, Beamish and Roth (1964) have shown that there is only a small fraction of old people with psychiatric disorder being cared for either as hospital in-patients or as residents in Homes. Their investigation was carried out in Newcastle-on-Tyne. They pointed out that various other reports concur with the view that medical services at the present time deal only with the visible part of the “iceberg” of mental disorder and handicap.

Since the initial review of patients in Glenside Hospital (Cooper and Early, 1961), a number of surveys have been carried out—Gore and Jones (1961), Norton (1961), Hassall and Hellon (1964), and Hassall, Spencer and Cross (1965). These studies are not directly comparable and all contain elements of subjective assessment.

The relationship between child and adult psychiatric illness, though of fundamental importance, has received scant attention, perhaps because of the split which exists between the study and treatment of children and of adults.

Conventional Child Guidance treatment includes a diagnostic “work-up” of five to ten hours and then weekly psychotherapeutic and casework interviews for the child and mother which last for months or years and are very expensive of professional time. There have been few reports of evaluation of such treatment, though Levitt (1963) combined the results of a number of studies to include nearly 10,000 child patients. Of those who received treatment, between two-thirds and three-quarters were improved, but a similar improvement rate occurred in those who were not treated. Eisenberg and Gruenberg (1961) found short-term treatment as effective as intensive psychotherapy, and Phillips and Johnston (1954) and Phillips (1960) claimed better results with short than with conventional treatment. Among the few reports from Britain is that of Barbour and Beedell (1955). They found no difference in outcome between treated and untreated cases or between short and long methods of treatment.

The anticonvulsants now in general use have made epilepsy among the mentally subnormal no longer the problem it was. However, the treatment of long standing epilepsy associated with behaviour problems or personality disorders in the so-called temporal lobe syndrome still remains a challenge. Surgical intervention seldom has a place in cases with severe and diffuse brain damage complicated by subnormal intellectual functioning, frequent seizures and personality changes.

Amylobarbitone has been shown to be effective in the symptomatic treatment of neurotic anxiety in a number of controlled trials (Raymond et al, 1957; Scott, 1955; Robin, 1959), and can therefore be used as a standard of comparison in the treatment of anxiety states. It is here compared with diazepam (7-chloro-1,3-dihydro-1 -methyl-5-phenyl-2H-1,4-benzodiazepin-2-one).

In his survey of drug-induced extrapyramidal reactions, Ayd (1961) found that they occurred in 38·9 per cent, of 3,775 patients treated with phenothiazines. La Verne (1961) reported the occurrence of dyskinesia in 48 per cent. of 270 cases treated with haloperidol. It is therefore standard practice in many units to administer anti-Parkinson drugs concurrently with tranquillizers.