Every medical out-patient clinic contains a percentage of patients who are examined, investigated and eventually discharged, no structural lesion having been found to account for their symptoms. The term “functional” is used in this paper to describe such patients; i.e. those who have a disorder of the function but not of the structure of an organ, whether or not the disorder is regarded as primarily psychogenic. The purpose of this investigation is to examine carefully these out-patients and try to identify them more clearly by comparison with those in whom structural disease can be detected, with particular reference to the mental state.

A recent survey (Coppen and Kessel, 1963) of a random sample of 500 women from the general population investigated the prevalence of common menstrual symptoms and their relationship to personality as assessed by the Maudsley Personality Inventory (M.P.I.). The results showed that certain of these common symptoms have a positive and significant correlation with the Neuroticism scale of the M.P.I.; this was particularly notable for the symptoms of the premenstrual syndrome, i.e. premenstrual depression, irritability, swelling, etc., as well as for menstrual irregularity. Dysmenorrhoea, to the contrary of previous reports, showed no such association with neuroticism in this general population sample. The age and parity of the subjects were also found to influence the prevalence of many of these symptoms.

In the British Journal of Psychiatry for July, 1963, Costello and Smith described an investigation based on the prediction that “… reactive depressions would sleep more at the end than at the beginning of a set period of sleep and that endogenous depressions would sleep more at the beginning than at the end of a set period for sleep …”. Hourly observation by nurses of the sleep of 18 patients with endogenous and 41 with reactive depression failed to confirm the prediction.

Accounts of the parallel psychiatric treatment of identical twins are relatively rare. This case is especially unusual in two respects, first in the uncommon nature of the particular problem which they presented as their major symptom (i.e. homosexual attraction to elderly men), and secondly because they were treated together as a family group.

The purpose of this investigation was to obtain data on the influence of the subject's conscious knowledge of the content of a posthypnotic suggestion on obedience to that suggestion. Little information is available on this problem, which is one having obvious bearing on hypnotherapy. So that results could throw some light on the hypothesis that hypnosis can be explained as role-playing (Sarbin, 1950), a role-playing control group was employed.

It has been accepted that the major factor in the aetiology of senile dementia is the organic brain disease which can be demonstrated histologically (Corsellis, 1962). The work of Rothschild (1936) suggested that psychological differences between individuals might be contributory, and Sands and Rothschild (1952) claimed evidence that senile psychotics have similar pre-morbid personality traits to those found in involutional melancholies and that hypochondriasis, dependency and rigidity were prominent features in both. A similar opinion is given by Noyes and Kolb (1958), who believe that, “the person who develops senile dementia has often been characterized by rigid and static habits”.

Oxypertine (also known as WIN 18,501–2) is a member of a new series of indolylalkylphenyl-piperazines synthesized by Archer et al (1). It resembles serotonin in respect of its indole nucleus, and the piperazine side-chain indicates a structural relationship with some of the major phenothiazines. Pharmacological studies by Wylie and Archer (17) showed oxypertine to have tranquillizing properties, and following preliminary human tolerance investigations (15) the psychotherapeutic nature of the agent was investigated by various workers in the United States and Europe.

Neuropsychiatric sequelae after cardiac arrest or anaesthesia are infrequently reported. A review of the literature is given by Blackwood et al. (1963). Fletcher (1945) described permanent but comparatively mild effects which were attributed to nitrous oxide rather than to circulatory disturbances. Bedford (1955) described 18 cases of extreme dementia following general anaesthesia in geriatric patients who were quite well mentally before their operations. He indicated the diagnostic pitfalls involved in attributing minor psychiatric disabilities to the anaesthetic. Neuburger (1954) described diffuse cerebral damage combined with Wernicke-like lesions in the mamillary bodies in 2 patients. Brierley (1961) described the pathological changes in the brain of a 2-year-old child, who died 1 month after a cardiac arrest of 10–15 minutes. There were lesions in the mamillary bodies and inferior colliculi resembling those seen in Wernicke's encephalopathy. However, Brierley and Cooper (1962) later described a 43-year-old woman, whose blood pressure fell to unrecordable levels for 3 minutes and who became severely demented, developed Parkinsonism and had a Korsakoff type learning defect. She survived for 23 months. The brain showed most damage in the occipital cortex and thalamus, and less in the midbrain. Unfortunately the mamillary bodies were not identifiable.

The health of the young unmarried primigravida has attracted enquiry from obstetricians, psychiatrists, psychologists and social workers. Generally, by virtue of their youth and tissue resilience these girls are at an excellent physiological age for the processes of pregnancy and labour. Stewart (1952) showed in a carefully documented survey of 3,019 primigravidae that anomalous marital status did not appear to influence the occurrence of difficult labour which in fact was found more frequently among those who had been married before conception than among either the “illegitimate” group or the pre-marital conception group. Young unmarried women, therefore, may well be physiologically fit for child-bearing, but they may be psychologically unprepared for it. Emotional reactions during pregnancy are common, especially among unmarried women. Yet in our clinical management of disturbed pregnant women who are not married we have been impressed by the frequency with which emotional ill health has antedated their pregnancies. In many cases we have been tempted to view the psychiatric concomitants of their pregnancies as part of a continuum of morbidity recognized long before. It has been shown by Eysenck (1961) from psychological testing that unmarried mothers tend to be more neurotic and more extraverted than the general population, and among women students who were pregnant while at university Finlay (1962) has reported significantly more instability than among other women student patients. Illegitimate pregnancy may be accepted as the norm among some subgroups, while viewed as a catastrophe among others. For the purposes of study, however, it is difficult to find a group of young women in whom pregnancy could be less welcome, less acceptable, less manipulative or more disastrous than among university students. The very low pregnancy rates among students in Britain suggest that this may be so (Brown, 1962), as does the high correlation between unplanned pregnancy and student wastage among university students (Brown, 1962; Kidd and Dinwoodie, 1964).

Psychiatrists who have written about the Australian Aborigines have been less concerned with the psychiatry of this people than with the significance of their practices and beliefs for psychological and psychoanalytic theory. (Freud, 1913; Roheim, 1945; Fry, 1953). This outlook is reflected in the subsidiary title of Freud's Totem and Taboo: “Resemblances Between the Psychic Lives of Savages and Neurotics”. It was hoped that the analogies between “primitive” practices such as sub-incision or totemism and the repressed complexes of modern civilized peoples might shed light into the recesses of the modern mind.

There seems to be a series of conceptual problems regarding depressive illness and its classification. First, there is the problem of whether these illnesses have some biological function, whether they represent attempts on the part of human organisms to deal with or escape from situations of stress, or whether they should be thought of simply as psychologically meaningless events. Eysenck (1960) and Wolpe (1958) make it clear that they regard neurotic symptoms as meaningless, maladaptive patterns which can and should be removed by suggestion, deconditioning and behaviour therapy. Similarly, Mayer-Gross, Slater and Roth (1955) reject the suggestion that depressive illness may have an adaptive function. By contrast, clinical medicine, though resting heavily on the mechanistic causality models of physics and chemistry, does give some implicit recognition of biological purpose in physical illness. Thus, pneumonia represents not only the phenomenon of invasion of pulmonary tissue by infective agents, but also the phenomenon of bodily defence against such invasion. When such defence does not exist, the patient seldom gets to the physician in time to be diagnosed. That depressive illness might have an analogous biological function was suggested by Freud (1917) and elaborated in impressive detail by Lewis (1934). The converse view that depressive illness represents a breakdown in adaptive function is based on the views of Kraepelin (1913) who attributed the dominant place in the depressive group of illnesses to manic-depressive psychosis with its known hereditary basis. That hereditary factors do operate in the manic-depressive group proper seems to have been demonstrated more than adequately by Slater (1938) and Kallmann (1950). The evidence regarding other depressive reactions, whether recurrent or involutional, seems far from impressive. Nevertheless, Mayer-Gross et al. take the view that affective illness is primarily a question of constitution, that the content of the depression may be understandable in terms of the patient's life situation, but that the causes of breakdown given by relatives of patients are really symptoms of the oncoming illness. Interestingly enough, Henderson and Gillespie (1956) classify affective illness into manic-depressive and involutional depression, and note the importance of social factors (p. 276).

The terms “macrocosm” and “microcosm” have been taken by Jung from the traditions of the alchemists and the philosophy of Leibnitz for expressing his theories, but they are not often used elsewhere in psychiatry or psychology so it may be as well to define them when introducing them here.

The syndrome of acute catatonic delirium associated with fever and usually with a fatal outcome was reported over hundred years ago. The first to describe it was Calmeil in 1832 (cit. after Aronson and Thompson, 1950). Kraepelin (1904) includes these states in the group of “akute Verwirrtheit”. Most authors emphasize the acuteness and high mortality of these states. Thus Claude and Cuel (1927), Guiraud and Saunet (1938), Golse and Morel (1953), call them “délire aigu”, de Simone (1962) “catatonie pernicieuse”, Stauder (1934) “tödliche Katatonie”, Huber (1954) “lebens-bedrohliche Katatone psychosen”, Knoll (1954) “perniziose Katatonien”. English writers call them “acute lethal catatonia” (Fisher and Greiner, 1960), Scandinavian “delirium acutum” (Lingjaerde, 1954). In Russian journals one finds them described as “delirium acutum” (Agieeva et al., 1955; Molokhov, 1962), “ostrij bried” (Rohlenko, 1961) or more recently “hypertoxic schizophrenia” (Romasienko, 1962).

The drug-taking behaviour of young people is causing great concern. The topic has been discussed for some years in the national newspapers and in the medical journals, and early last year the Government decided to take action.

The clinician is deeply concerned with the difficulties of selecting a treatment method that will accomplish the goals which he wishes to achieve for a particular patient with specific symptoms and characteristics in a particular treatment setting, knowing that it is unlikely that any one single treatment will be universally and equally effective in all situations. The research investigator should attempt to help him by furnishing objective evidence as to the specific efficacies and limitations of methods of treatment in common use under the conditions that prevail where large numbers of patients are treated—in public mental hospitals. Adequate comparative information obtained under controlled experimental conditions is essential not only to therapists but also to patients and their families and to those responsible for the support and administration of treatment centres.

The term post-hypnotic suggestion (P.H.S.) will be used in this paper as meaning the form of words which constitute the suggestion, while by the term post-hypnotic effect (P.H.E.), will be meant the behaviour of the subject consequent on the P.H.S. Quantitative studies of post-hypnotic behaviour using slowing of reaction time (RT) as the P.H.E. have already been described in relation to the duration of P.H.E. (Edwards, 1963), and the influence of amnesia on P.H.E. (Edwards, 1965). The aim of the present study was to investigate the influence on P.H.E. of giving a signal similar to but not identical with the signal defined in the P.H.S. as that which would evoke the P.H.E.

It has long been recognized as a shortcoming of much of the psychiatric literature that it is based on the study of highly selected case-material, drawn from hospital and private consultant practice. This criticism, which has important implications for the interpretation of hospital statistics (Cooper, 1965), may be of equal relevance in the field of clinical description. Studies undertaken in general practice (Shepherd et al., 1959; Ryle, 1959) point to the existence in the community of large numbers of cases of minor psychiatric disturbance of a kind which is clinically identifiable, but which for the most part does not come under the scrutiny of trained psychiatrists. Whether such cases conform to the standard text-book descriptions of psychiatric illness, or can be incorporated into the existing nosology, is very much open to question. There seems little doubt that clinical studies in general practice are of great potential value in the study of mental disorder, and in particular that they may help to throw new light on the natural history of this group of affections.

Amphetamine psychosis arising during the course of long-continued amphetamine addiction resembles paranoid schizophrenia (Connell, 1958). Gradually the euphoriant effects of the drug are modified by anxiety accompanying ideas of reference and paranoid delusions. Auditory and visual hallucinations occur in a setting of clear consciousness and correct orientation. Restlessness, agitation and excitement are common accompaniments. An identical end-result has been reported in those cases that resulted from a single large dose of amphetamine or ingestion of the drug over a short period only (Wallis, McHarg and Scott, 1949; Herman and Nagler, 1954; Carr, 1954; Greenwood and Peachey, 1957; Connell, 1958). Accidental poisoning with amphetamine in childhood has been reported by Shanson (1956) and Patuck (1956) to result in hallucinations, hyperactivity, and a state of excitement and terror.

All forms of Repertory Grid technique are derivatives of an original proposed by G. A. Kelly (1955) as an integral part of the development of Personal Construct Theory (summarized Bannister, 1962). In essence, repertory grids are forms of sorting test. They differ from conventional sorting tests in that there are no standard sorting materials or sorting categories nor is there any standard single form of administration or scoring procedure. Their unique characteristics are that:

It has been increasingly the practice in Scotland for Procurators-Fiscal to obtain psychiatric opinions on the mental state of all persons accused of murder. Between 1953 and 1964 I made 66 such examinations, mainly in the Glasgow area; because of other commitments none were carried out between July 1955 and March 1958. The official Criminal Statistics for England and Wales (1) show that during the eleven years from 1953 to 1963 the number of persons found guilty of murder was 395 and of manslaughter 969; comparable figures for Scotland (3) were 43 and 148.