Hypnotic drugs are most commonly used with patients at home, yet with few exceptions (Ghernish, Gruber and Kohlstaedt, 1956) most trials of hypnotic drugs are carried out in hospitals. Studies on such patients by general practitioners are valuable, but they often rely on retrospective or other forms of delayed reporting and their validity is thereby somewhat limited. This preliminary study therefore compared four widely used hypnotics with a placebo when normal subjects were sleeping at home. Their impressions of the quality of their sleep and other information, including their dreams, were collected by telephone the morning after the drug had been administered. All subjects were healthy and did not complain of sleep disorders; neither before nor at the time of the trial were they taking either hypnotics or other medication.

A fundamental anxiety, if not the fundamental anxiety, in males, according to classical Freudian psychoanalysis, is the fear of castration. According to Freud (1953, pp. 120–121; 1933a, p. 267) this is the fear of being castrated by the father as a reprisal for incestuous desires toward the mother. Nonetheless, the concept of the castrating mother also plays a prominent role in psychoanalytic literature, e.g. De Monchy (1952), Blos (1950), Fairbairn (1952), Klein (1948), and Bergler (1949).

Taste sensitivity may be a valid quantitative predictor of other kinds of reaction to the same drug by a given organism (Fischer and Griffin, 1963). Such a relationship in healthy subjects has been directly demonstrated for hyoscine butyl bromide (Joyce, Pan and Varonos, 1968), but the implications for the prediction of clinical response have apparently not yet been explored in a direct fashion. For example, in one group of female schizophrenics with a low taste threshold for quinine, a significantly lower dose of trifluoperazine elicited toxic effects than was the case in a group with a high taste threshold (Knopp, Fischer, Beck and Teitelbaum, 1966). But this study made, without testing, two important assumptions: first, that the dose necessary to produce toxic effects is positively correlated with the therapeutic dose; second, that the relationship between taste threshold and response to the drug is non-specific, so that the bitter substance quinine may serve as an indicator of response to any bitter-tasting centrally-active drug, or perhaps to any drug at all. The first of these propositions, though once fashionable, is certainly open to discussion; to accept the second would eliminate the interesting possibility of using differences in taste thresholds for a range of drugs to predict the drug to which the individual patient might best react.

A proportion of individuals suffering from schizophrenia show either physical or psychological signs of gonadal underfunction or incomplete sexual maturation (Hoskins, 1943; Hoskins and Pincus, 1949; Bleuler, 1954; Sands, 1957; Reiss, 1958; cf. Shader and Grinspoon, 1967). Rey and Coppen (1959) reported significantly lower, that is more feminine, androgyny scores (Tanner, 1962) in schizophrenic patients, although reduced scores were also found to a lesser extent in depressive and neurotic patients. Sex chromosome anomalies were not found in those patients with abnormally low androgyny scores (Cowie, Coppen and Norman, 1960), and it is possible that the abnormal physique is caused by some hormonal malfunction during development which also may be associated with a predisposition to psychiatric illness.

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.

Already an extensive literature exists on affective disorders, particularly depressive illness, in various developing countries of the world (Carothers, 1947; Tooth, 1950; Lambo, 1956 and 1960; Asuni, 1962; Pfeiffer, 1962 and 1963; Yap, 1965). Different authors have commented on different aspects of these disorders, and variations in their incidence, symptomatology and course have aroused widespread speculation regarding possible cultural influences on aetiology and clinical picture.

In recent years there has been a reawakening of interest in the practical application of hypnosis in the different medical fields. In the realm of psychotherapy, the evidence for such interest can be found in the many specialized works on the subject, as well as in such texts as the American Handbook of Psychiatry (1), and the Comprehensive Textbook of psychiatry (2).

The presence of a birth order factor in the aetiology of schizophrenia is indicated by evidence of two kinds. The evidence, however, is apparently conflicting.

A number of patients referred for psychiatric consultation were found to show an insurmountable reluctance to return to work. This problem is of wide importance, medically and socially. The author's total failure, despite all efforts, to achieve rehabilitation in terms of a return to work prompted a detailed family study.

Oral intake of amphetamine may cause the development of a schizophrenia-like paranoid psychosis (Monroe and Drell 1947, Connell 1958, Kiloh and Brandon 1962). Intravenous abuse of the drug causes more intense psychotic manifestations dominated by vivid visual and auditory hallucinations (Connell 1958, Kramer et al. 1967, Rylander 1967, Cohen 1968). In the present investigation a rating scale, was designed for the study of amphetamine psychosis in 15 intravenous abusers. A preliminary report of this work has been given earlier (Jönsson and Gunne 1969).

Pollin, Cardon and Kety (18) investigated the effects of large doses of various amino acids in combination with a monoamine oxidase (MAO) inhibitor on the behaviour of schizophrenics. They found that methionine in the presence of such an inhibitor was capable of producing behavioural changes which may ‘represent a biochemically induced acute flare-up of a chronic schizophrenic process on the one hand, or a toxic delirium superimposed upon chronic schizophrenia on the other’. Brune and Himwich (8) confirmed the clinical results of Pollin et al. On the basis of their previous work indicating that tryptamine appeared in increased concentrations in the urine before and during the activation of psychotic symptoms, they suggested that under loading conditions the formation of various N,N-dimethylated indoleamines might be facilitated in the body. The tertiary indoleamines so formed might mediate the psychotic effect of methionine with a MAO inhibitor on schizophrenic patients.

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).

In previous papers in this series we have discussed two concepts which have been used in connection with aspects of the relationship between the patient and his doctor. These were the treatment alliance (Sandler, Holder and Dare, 1970) and transference (Sandler, Dare and Holder, 1970). Although these two clinical concepts originated within the psychoanalytic treatment situation they are capable of extension outside it. Both relate to and emphasize processes occurring within the patient and tend to stress one side of the relationship only. Even the concept of treatment alliance, although nominally appearing to include the roles of both patient and doctor, has tended to be regarded from the point of view of processes and attitudes in the patient; the aspect of the therapist's attitudes, feelings and professional stance have to a large extent been omitted. However, in recent years more attention has been paid in psychoanalytic and other writings to the relation of the doctor towards his patient. Just as the term ‘transference’ is often used loosely as a synonym for the totality of the patient's relation to his therapist, so is the term ‘counter-transference’ often used in a general sense (both within psychoanalysis and outside it) to describe the whole of the therapist's feelings and attitudes towards his patient, and even to describe facets of normal, non-therapeutic relationships (Kemper, 1966). Such a usage is very different from what was originally intended, and as a consequence confusion has arisen about the precise meaning of the term. It is the purpose of this paper to examine the concept in the light of its origins and development within psychoanalysis and to comment briefly on some possibilities of its extension outside the psychoanalytic treatment setting.

Though there have been many investigations concerned with sibling order and mental illness there have been relatively few concerned with sibship size. The abundance of sibling order studies is probably due to the widely accepted belief that in such studies comparison with general population data is not necessary. Expected numbers within each birth rank are estimated by the Greenwood-Yule method, proposed in 1914, by which it is assumed that for any given size of sibship siblings should be evenly distributed among birth ranks. In the present population, in which family size has in recent years been decreasing, this assumption is clearly invalid, for the younger members of the larger families of earlier years are more likely to be included in a contemporary sample, the older members by now having died. Other factors influencing sibling position have been more fully discussed by Price and Hare (1969). Thus comparison with general population figures is necessary in sibling order studies, and a report on such a comparison will be published separately by the author.

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.

The clinical concept of the negative therapeutic reaction has been included in this series for a number of reasons. It is a concept of particular importance in the history of psychoanalysis, for it represents the clinical phenomenon chosen by Freud (1923) to illustrate the workings of an ‘unconscious sense of guilt’ and to indicate the existence of what he conceived of as a special mental agency—the superego. Moreover, it is a concept widely used in clinical psychoanalysis, although little has been written on the subject since Freud's original formulation of it. Unlike such concepts as transference (Sandler, Dare and Holder, 1970) and acting out (Sandler, Holder and Dare, 1970a) it has not been extensively applied outside clinical psychoanalysis. This may be regarded as surprising in view of the fact that it would seem to be readily capable of application without alteration to a wide variety of clinical situations.

The application of modern technology to medical treatment offers new avenues of approach, including the use of closed-circuit television (Trethowan, 1968; Moore et al., 1965). This paper describes the successful treatment of a patient in which video-tape recording was used.

In the published results of controlled trials of systematic desensitization with phobic patients there has been a consistent trend apparently overlooked by the authors. If this trend is valid, it means the results of such therapy with agoraphobic patients have been better, and those with patients with specific phobias worse than the authors have concluded. Understandably, the authors' interpretation of their results have been accepted and in fact used to discredit the value of behaviour therapy (Mayer, 1969). If an interpretation of results of trials which indicates that treatment is of considerable value is overlooked, and one which indicates that it is of little value stressed, the reason for this should be examined. Psychiatry is not so rich in demonstrably useful therapies that it can afford to allow one to be discredited before it is adequately evaluated. Yet this attitude is not limited to the above trials but is also commonly found in the reports of drug trials (McConaghy, 1966).

The excellent immediate response of many depressive states to ECT is well established, but unfortunately relapse is common. Pare (1968) noted that it was becoming increasingly common for anti-depressant drugs to be given concomitantly with and after ECT in order to prevent relapse, but there appear to be only two reports bearing on the value of this procedure. Seager and Bird (1962), in a blind trial, followed up 28 ECT treated depressives and found that the six month relapse rate was markedly lower in those who received imipramine after discharge (17 per cent) compared with those on placebo (69 per cent). Imlah et al. (1965), in a study of 124 patients, found that a relapse rate of about 50 per cent within six months of ECT when used alone was reduced by over one half when ECT was combined with and followed by either imipramine or phenelzine, but their trial was not conducted blind. The after-care of depressed patients is so important, particularly in view of the risk of suicide, that further evidence seemed desirable.

A repertory grid is obtained when a person compares and rates a set of ‘elements' in terms of an appropriate set of ‘constructs', using a consistent procedure throughout (Slater, 1964). The elements may be the names of real or imaginary people, qualities, or activities, in fact any group of items to all of which each construct is logically applicable.