Five years ago, with the co-operation of the Jesmond Council of Churches, I opened a Clinic in Church premises in Newcastle upon Tyne. A rota of clergymen of all denominations volunteered to help at each session, which were held on a Monday afternoon and, later, also in the evening.

Longitudinal clinical studies have provided evidence for years to support the value of classifying psychiatrically ill patients according to well-described syndromes whenever possible. Using such classification as a base, knowledge has been accumulated concerning aetiology, prognosis, and treatment of such diverse disorders as general paresis, schizophrenia, manic-depressive illness, antisocial personality, and others. Our understanding of the essential nature, causes, and treatment of psychiatric disorders is far from complete, and what we do know has been learned more through systematic studies of syndromes than through analyses of intrapsychic and interpersonal processes, however important those may be. In order to treat a psychiatrically ill patient it is at least as important to understand the syndrome from which he suffers as to understand the nature of his personal problems. The physician can attend to the former without neglecting the latter.

A number of recent reports have drawn attention to the abnormal EEG findings obtained in subjects with Klinefelter's Syndrome (Dumermuth, 1961; Hambert and S: son Frey, 1964; Hambert, 1964; Nielsen, 1969; Nielsen and Pedersen, 1969; Pasqualini et al., 1957; Prader et al., 1958; Zuppinger et al., 1967). An increased prevalence of epilepsy within this group has also been noted (Hambert, 1964). Much less is known about the electroencephalogram in the XYY syndrome, the available data being limited to single case reports or reports involving only a few subjects (Borgaonkar et al., 1968; Bartlett et al., 1968; Court-Brown et al., 1968; Cowie and Khan, 1968; Forssman, 1967; Forssman and Hambert, 1966; Kessler and Moos, 1970; Leff and Scott, 1968; Mintzer et al., 1968; Nielsen and Pedersen, 1969; Nielsen and Tsuboi, 1969; Nielsen et al., 1966; Pergament et al., 1968; Persson, 1967; Weiner et al., 1968; Welch et al., 1967). This paper describes the initial findings of a comparative study of Special Hospital patients with sex chromosome abnormalities and a group of matched controls of normal chromosome complement from the same institution.

Systematic desensitization is unquestionably the most popular of the behaviour therapies. To circumvent several difficulties specific to this technique we devized a new treatment paradigm—the reciprocal inhibition of anxiety by aversion relief (Solyom and Miller, 1967), from which 31 of 40 phobic patients (80 per cent) benefited (Solyom, Kenny and Ledwidge, 1969). The present paper reports on a systematic comparison of the two treatment techniques in terms of: (1) the rate and degree of improvement; (2) the specificity versus the generality of improvement; (3) prognostic indicators favouring one treatment over the other.

The involvement of a number of psychiatric hospital staff members in group psychotherapy meetings constitutes multiple therapy. In such a situation one staff member is customarily assigned the role of ‘therapist’ and the rest are called ‘observers'. Observers are often passive, but they may participate in the group proceedings as co-therapists (MacLennan, 1965; Bloom and Dobie, 1969). Multiple therapy is said to enhance treatment (Mullan and Sanguiliano, 1960; Rubins, 1967), but this may be a rationalization to excuse its continued practice (MacLennan, 1965), particularly as it is so useful for training staff in group psychotherapy (Gans, 1962).

Doubt about one's sexual identity and ideas of changing sex have been shown to be typical of sufferers from schizophrenia (Gittleson and Levine, 1966; Gittleson and Dawson-Butterworth, 1967).

When a patient tells his therapist, directly or indirectly, that he is contemplating suicide, his communication is likely to evoke a strong reaction, although, like the patient's plea, it may, or may not be straightforward.

The purpose of the present paper is to draw attention to a remarkable similarity in the age-incidence curves of schizophrenia and neurosis when the sexes are combined. Hare and Price (1969), in a study on the season of birth of schizophrenic patients, found that the age-distribution of cases of schizophrenia (I.C.D. 7th Revision nos. 300, 303) seen for the first time at the Bethlem-Maudsley Hospital during the years 1951–1963 was very similar to that of the cases of neurosis (I.C.D. nos. 310–18) seen there during the same period. However, these cases included out-patients as well as in-patients, were not necessarily first-ever attendances at a psychiatric clinic, and, because they had been referred to a teaching hospital which did not serve a particular geographical area, may have been a somewhat unrepresentative series. For these reasons, their findings (illustrated in Fig. 1 of their paper) might have been no more than a coincidence.

Since Wolpe (1958) developed the idea of psychotherapy by reciprocal inhibition, systematic desensitization has emerged as an effective method of treatment in phobic states. There exists, however, a group of phobias which cannot be effectively treated with these techniques. These include fears of death, illness, harming other people, etc., and have been recognized by other authors as a separate group by themselves (Marks et al., 1969; Marks, 1969, 1970): phobias of internal stimuli. The search for a suitable method to treat these cases led us to use the thought stopping procedures described by Wolpe and Lazarus (1966, p. 132). There has been a notable lack of literature concerning this method, although Wolpe refers to J. A. Bain who used this technique in 1928.

The paranoid—non-paranoid distinction among schizophrenics may be useful and meaningful (14): certain psychological and physiological responses have been shown to distinguish patients of these subgroups (5, 12, 16) and biochemical (2, 5) and morphological (7, 9, 17) differences have also been demonstrated.

In this study memory changes during and after electroconvulsive therapy were investigated by means of three different tests. The investigation was double-blind and the subjects were 96 patients hospitalized with depressive illness. Amounts of post-ECT amnesia were evaluated in relation to number of treatments for symptom remission and stability of the therapeutic result over the period of one year.

Recently, Mitchell (1969) treated 16 migraine subjects using a combination of three specific behaviour therapy techniques namely, applied relaxation training, desensitization and assertive therapy. Migraine episodes for the treatment subjects decreased by an average of 89.5 per cent when compared with their pre-treatment base rate; no change was reported by six control subjects. The present investigation reports the comparative effectiveness of the three behaviour therapy techniques used previously. The specific therapeutic effectiveness of applied relaxation training was compared with that of combined desensitization (relaxation application, desensitization and assertive therapy). This comparison follows the conclusion by Cautela (1969), ‘… that relaxation can be considered a self-control technique in its own right: first, when it is used to reduce the overall anxiety level, and second, as a means of decreasing anxiety or tension whenever the patient is either involved in a readily identifiable anxiety-provoking situation, or is experiencing anxiety without being able to discern the antecedent conditions (p. 328.)’ It was predicted that combined desensitization would be more effective than the single-model procedure of applied relaxation training.

There is little definite information about the psychological correlates of the XYY chromosome anomaly. Hope et al. (1967) made observations on 7 subjects relevant to Reactive-Narcissism (Ss scores lower), Dependence (higher), Over-activity (lower), HOQ (More obsessional). Other studies with inconclusive results have been made by Little (1968), Nielsen and Tsuboi (1969) 9SS, Street and Watson (1969) 22SS, and Forssman (1970) 11Ss.

Memory deficit persists as the principal undesirable side effect of convulsive therapy. In an attempt to minimize this deficit Lancaster, Steinert and Frost (1958) introduced unilateral electrode placement to the non-dominant hemisphere as an alternative to the standard bilateral placement of electrodes. They suggested that clinical improvement with unilateral placement was the same as for bilateral ECT, but that memory impairment was less severe.

The treatment of phobic states by desensitization is tedious and not always completely successful (Marks, 1969). Recently newer methods claiming improvement in speed and efficacy have been introduced, such as flooding or implosion (for example, Boulougouris et al., 1971) and prolonged exposure (Watson et al., 1971). An approach based on respiratory control which seems to be as effective as other methods and even more rapid in action is described in this short paper.

This is a case in which it seems reasonable to assume that a patient developed a maladaptive conditioned response, which was symbolic of an underlying conflict. She was treated successfully by a single session of behaviour therapy. Not only did the symptom disappear, but there seems to be an improvement in the underlying unconscious conflict.

The clinical research reported here has two thrusts or purposes: one theoretical and one practical. The theoretical question can be stated: Is psychotherapy in general, and group psychotherapy in particular, a lawful, directive, and predictable process that can be understood from a behavioural or learning point of view? The second question and the more practical and down-to-earth one, is whether analyzing group therapy from a learning point of view can suggest and direct our attention to practical improvements in the technical work that we carry out as group therapists, whatever our theoretical persuasions.

The difficulty in calculating the incidence and prevalence of transsexualism is obvious. Those figures which can be arrived at are always minimal values, and a group of persons with transsexual symptomatology, which are most difficult to assess, will always elude the calculations.

Most psychiatrists who have made a study of abnormal psychosexual development accept Money's postulate as to the manner in which heredity and education determine sexual development. This assumes that genetical and hormonal factors influence psychosexual development only through bodily shape, while sexual behaviour is learned like the native language. Nevertheless, Money himself raises the question as to whether patterns of sexual play, activity and distractibility in the two sexes are not elements of a strong genetical determinism.