Non-restraint in the mid nineteenth century was a watchword, a battle-cry, a symbol of that movement for the reform of the treatment of the insane which has been called ‘one of the finest flowers of Victorian philanthropy’. The need for such watchwords and symbols to dispel stagnation and stimulate progress has been well exemplified in our specialty in these times; and, strange as it seems to one of my generation, ‘mechanical restraint’ has even in the last few months again become a subject for discussion.

The ‘religiosity’ of the epileptic has been recognized since the time of Esquirol (1838) and Morel (1860). These, and later French workers (including Marchand and Ajuriaguerra, 1948), have sought to explain the epileptic's religiosity as being the result of his disability, social isolation and his enhanced need for the consolation of religion. A specific conversion experience after a fit was reported by Howden (1872–73). The patient believed that he was in Heaven. He would appear to have been depersonalized, as it took three days for his body to be reunited with his soul. ‘He maintained that God had sent it to him as a means of conversion, that he was now a new man, and had never before known what true peace was…. He assured me that he was a converted man and that he was convinced he would have no more fits.’ Howden also reported on John Engellerecht who, after many years of depression, attempted suicide and appeared to die. After visiting Hell and Heaven, he cast off his depression, and acquired a state of religious ecstasy accompanied by visual and auditory hallucinations. Boven (1919) mentions a 14-year-old boy who after a seizure ‘saw the good God and the angels, and heard a celestial fanfare of music’. He regards the religiosity of the epileptic character as being due to experiences acquired in the course of an epileptic aura and in the subsequent confusional state. Eventually the patient becomes preoccupied with a cure which he believes depends entirely on God, and this belief is the basis of his euphoria. Boven stresses the intensified piety of the epileptic after a severe seizure.

The complaints, ‘I am a stranger to myself; I am unreal’, are manifestations of depersonalization which have been noted frequently by clinicians. Depersonalization has been reported in epilepsy, after drug ingestion, encephalitis, hysteria, manic depression, and schizophrenia, as well as in various neurotic patients. It has also been noted in normals, but usually after emotional shock or physical exhaustion. Most recently, persistent feelings of depersonalization have been elevated to the status of a diagnostic entity in itself.

The Kleine-Levin Syndrome, first categorized by Critchley and Hoffman in 1942, consists of periodic hypersomnia and megaphagia associated with abnormal mental states. Though a case of hypersomnia with doubtful megaphagia was described by J. A. Antimoff as far back as 1898, the first two cases definitely belonging to the syndrome lie hidden in a group of five cases reported by Willi Kleine (1925), a psychiatrist of the Kleist Clinic, Frankfurt, under the title of ‘Periodische Schlafsucht’. The patients were adolescent males who showed periodic hypersomnia with eating of excessive food and an unusual mental state. Writing on narcolepsy, a New York psychiatrist, Max Levin (1929), described a boy who exhibited pathological hunger in association with episodes of sleep of unusual duration. ‘The patient would sleep for long periods at the beginning of each attack. His appetite was enormous. He ate large meals and much in between meals. Max Levin rewrote his original case in 1936, and for the first time made specific mention of a ‘syndrome of periodic somnolence and morbid hunger as a new entity in nosology’ and quoted seven cases as ‘good’ examples of the syndrome.

There have been few cases of this syndrome published since the original papers by Kleine in 1925 and Levin in 1929. Critchley (1962) described 26 cases in his paper, in which he reviewed the condition fully. Earles (1965) mentioned 44 cases in the literature: a female case was recently discussed by Duffy and Davison (1968). According to Critchley the characteristic symptoms of this syndrome are ‘recurring episodes of undue sleepiness lasting some days, associated with an inordinate intake of food and often with abnormal behaviour’. Invariably male adolescents are affected; they are normal in between attacks and the condition tends to disappear in later life.

In 1943 Kanner described a disease entity which he referred to as ‘Infantile Autism’. Creak and Ini (1960) found no evidence of psychogenic aetiology in a study of 200 parents of autistic children. Bender (1955) retrospectively studied children seen at Bellevue Hospital for behavioural or developmental disorders and who had been diagnosed as schizophrenic before seven years of age. No preponderance of the sophisticated, intelligent, well-to-do parents as described by Kanner was found; every racial and religious group was represented, Jews predominating slightly. A strong genetic predisposing factor was indicated—40 per cent of the parents were schizophrenic. Stroh (1962) insists that the child's condition cannot be attributed to maternal mishandling, and Wing (1966) has said ‘It is possible to interpret the data to support both environmental and biological theories of primary causation, but on the whole the former argument is very difficult to sustain.’

Most subnormal patients in hospitals are not there because they require active hospital treatment. Leck, Gordon and McKeown (1967), Pilkington (1966) and Tizard (1964) have suggested that respectively 0·4 per cent, 10 per cent and 12 per cent of the hospitalized patients they studied were admitted as the result of medical advice, or were in need of ‘detailed specialist day to day diagnosis, care and treatment’. This study is part of a computer evaluation of medical data concerning 285 severely retarded children, admitted to hospital for very varying periods during 1964–1966. Altogether 375 admissions took place but of these 86 were readmissions, so there were 289 ‘primary’ admissions, 4 of whom had no traceable documentation, thus 285 (76 per cent) of the 375 admissions were studied.

Problem The following is a report of the differential relationships observed between retrospective reports of eight childhood experiences and self-derogation (SD) scores for adult subjects in five age groupings. Variability in the relationships between particular experiences and SD among the different age-groupings was to be expected for any of several reasons: social role-related variability in the evaluative significance of particular attributes (Kaplan, 1970); generational differences in evaluative standards; variability in interaction effects between earlier experiences and later circumstances associated with particular ages; etc.

Introduction Since the 1914–1918 war, when high psychiatric casualty rates were recorded amongst military aircrews, a considerable amount of research has been focussed on the psychiatric problems associated with aviation. Reported symptoms have included morbid anxiety, lethargy; anorexia, weight loss; restlessness, tremors, palpitations; depression, insomnia, nightmares; personality changes, loss of flying skills and avoidance of risks. Diverse opinions have been expressed on the genesis and therapeutic management of the syndromes. Some authors have drawn attention to the so-called neurasthenic features and concluded that the symptoms were predominantly physiogenic, reflecting a state of exhaustion arising from neural, biochemical or other mechanisms (e.g. Ferry, 1919; Josué, 1919; Head, 1919; Flack, 1920; Porton, 1936; Miller, 1936; Lottig, 1937; Walshe, 1941; Cobb, 1942). Some have distinguished between ‘neurasthenic’ symptoms and overt anxiety, ascribing the former to physical exhaustion and the latter to neurotic disturbance in predisposed individuals (e.g. Gotch, 1919; Armstrong, 1936; Hastings et al. 1944; Murray, 1944).

Man has always been interested in predicting the outcome of various random events and at times has been prepared to risk his money, his wife and on occasions his life, on his ability to make the correct guess. There has been much speculation and concern about the effect of gambling on the national well-being, but there is little doubt that for the individual there is great satisfaction to be derived from making a correct prediction and winning something for nothing. Many charities and some governments benefit from this common desire.

Forty patients who requested treatment to reduce homosexual impulses were randomly allocated to receive apomorphine or aversion-relief therapy. Details have been published (McConaghy, 1969), concerning the subjects, the method of treatment and the changes observed two weeks after treatment in reported subjective feelings and in penile volume responses to pictures of nude males and females. A further analysis of the penile volume responses at this time has now been made, and the subjects have been followed up for at least a year.

The concept of transference, as developed by Freud, arose within the context of the psychoanalytic treatment of neurotic patients. The extension of the techniques of psychoanalysis to a wider range of patients, including psychotics, has led to the introduction of a number of terms to describe special and additional forms of transference. This paper is concerned with aspects of the relationship between patient and doctor which are discussed in the literature under such headings as erotic transference (Saul, 1962), erotized transference (E. Rappaport, 1956; Greenson, 1967), transference psychosis (Rosenfeld, 1952, 1954, 1969; Searles, 1961, 1963; Wallerstein, 1967) and delusional transference (Little, 1958, 1960, 1966; Hammett, 1961).

A recent note by Karon and VandenBos (1) on psychotherapy of schizophrenic patients claims to have demonstrated that additional psychotherapy produced significantly better results than the usual hospital treatment; and that outcome depended strikingly on an interaction between the use of drugs and the experience of the therapist. In presenting their findings as a challenge to a report by May and Tuma, they fail to point out that their results run contrary also to the general trend in other studies of psychotherapy and schizophrenia. These indicate that, even when given by experienced therapists, psychotherapy for hospitalized schizophrenic patients is, in general, relatively ineffective, while drug therapy enhances results regardless of the therapist's experience.

Riemer (1955) has argued that gaze is an ‘expression of affect’ between individuals. Kendon (1967) writes that the direction of gaze has a regulatory and expressive function, and ‘fluctuations in the amount of eye-contact during the course of one conversation showed that it was inversely related to the amount of emotionality displayed by the participants'. Also that it has a regulatory function which governs the pattern of social interaction. Argyle and Dean (1965) made similar observations in their concept of intimacy. They postulate that there is an Intimacy Equilibrium; Intimacy is a function of eye-contact, physical proximity, intimacy of topic, amount of smiling etc. They have shown that an alteration in one variable produces a change in the others until an equilibrium is reached. Exline et al. (1965, 1966, 1967) have described other aspects of eye-contact in relation to sex, dependency, social reinforcement, affiliative needs and affective relations. These findings support those of Kendon and Argyle.

The use of mono-amine oxidase inhibitors (MAOI) entails the risk of hypertensive crises with various foodstuffs and other drugs. On the other hand, the tricyclic antidepressants have a slow onset of action, and this may be a serious disadvantage in a condition like acute depression where there is always a danger of suicide. The use of an MAOI can therefore be justified if it is shown to be more effective than the tricyclic compounds.

As part of the study of alcoholism, we have investigated the possibility that early age of onset of alcoholism indicates a possible diagnosis of personality disorder while later age of onset does not.

The Green Paper was welcomed as an outline of the new proposed structure and as a considerable advance on the first Green Paper of 1968, discussed in the Association's Memorandum published in the British Journal of Psychiatry, 1969, 115, 601–3.

1. The Royal Medico-Psychological Association feel obliged to express concern at the Department of Health's apparent lack of consultation with practising clinicians in the mental subnormality field before formulating policy. The Association welcomes experimental schemes with regard to patient care, and considers that these schemes should be properly evaluated in various parts of the country before their acceptance or rejection as national policy.