Previous papers in this series have concentrated on concepts which relate to the communications brought by the patient and to the factors, in both patient and therapist, which either facilitate or hinder the free flow and understanding of these communications. However, in the discussion of working through (Sandler, Dare and Holder, 1970a) reference was made to those interventions of the analyst which aim at bringing about enduring changes in the patient, and to the need for continual elaboration and reinforcement of the analyst's interventions. Whilst the term ‘interpretation’ is often used in a general sense to refer to these interventions (at least, to the extent that they are verbal) it seems appropriate to examine the concept in some detail.

When the Plymouth Nuffield Clinic was planned it was decided to evaluate its functioning in respect of the adult psychiatric services in Plymouth. This paper reports the findings. The Nuffield Clinic project was a joint venture between the hospital service and the local authority, so that they might collaboratively discharge their respective tasks in both the spirit and the letter of the 1959 Mental Health Act. Pilkington (1966) has described the ideas and the stages leading to the creation of the clinic.

Under the heading ‘manic-depressive psychosis' it has been common practice to classify both patients who have suffered from manic and depressive episodes and those who have suffered only from recurrent depressive episodes without manic or hypomanic phases. In recent years, however, evidence has accumulated (Angst, 1966; Perris, 1966; Winokur and Clayton, 1967; Zerbin-Rüdin, 1968) supporting the hypothesis put forward by Leonhard (1957) that manic-depressive (bipolar) and recurrent depressive (unipolar) psychoses are to be regarded as two separate forms of illness, not only in their clinical aspects but also from the genetical point of view (see also Angst and Perris, 1968). If this were accepted, older theories about the genetic transmission of a global ‘manic-depressive’ psychosis would have to be revised.

Surveys of homeless men have emphasized a variety of correlations and causes. Criminality (Edwards et al., 1968; Sewell, 1969; Laidlaw, 1956; Commissioners of Police, 1859), alcoholism (Straus, 1946; Wattenburg et al., 1954; Bogue, 1963; Blumberg., et al., 1966) and poverty (Booth, 1890; National Assistance Board, 1966; London County Council, 1962; Shelter, 1969) are some to which attention has been drawn already (Lodge Patch, 1970). The relationship of these to a rootless way of life seems less impressive than psychiatric factors (Anderson, 1923; Whiteley, 1955; Laidlaw, 1956: Skinner, 1966–7). Edwards, for example, showed that 24 per cent of men in a reception centre had been in mental hospitals; 7 per cent having been discharged within six months of the Survey.

The patient in the case presented below lacerated his wrists under conditions which have been used experimentally (8) and observed in man (7, 9) to produce alcohol amnesia. His family history is typical of those seen frequently in suicidal attempts (2).

It is frequently the case in investigations in the behaviour sciences that a number of independent raters are asked to rate the same sample of subjects with regard to certain signs, symptoms or characteristics of these subjects, and the question of comparing the results given by the raters then arises.

Various abnormalities have been demonstrated in schizophrenic patients in response to injected insulin. Thomas et al. (22), Harris (8), Freeman et al. (7), Mayer-Gross (10), and Braceland et al. (4) have shown a delayed or decreased response of blood glucose to insulin in schizophrenic patients. Meduna and McCulloch (11) observed that those schizophrenic patients who suffered from confusion and clouding of the sensorium particularly displayed a delayed or decreased response to injected insulin as well as a urinary hyperglycaemic factor and decreased tolerance to oral and intravenous glucose. Subsequent studies by Mueller (12, 13) demonstrated a rise or lack of fall in the plasma free fatty acids (FFA) following the administration of insulin intramuscularly or intravenously in chronic schizophrenic patients. Van Sickle et al. (23) confirmed these findings of insulin resistance in chronic schizophrenia and noted that this low FFA response was neither related to an abnormal release of, nor response to, epinephrine.

Whatever will be the verdict of posterity on the scientific value of psychoanalysis, its place in the history of thought and of psychiatry is assured. A profuse psycho-analytic literature exists and many eulogies of Freud have been published, but there are few first hand accounts of what went on behind the scenes of the various psychoanalytic societies that train and give professional status to analysts.

Kasanin (10) seems to have been the first author to use the term 'schizo-affective psychosis'. He drew attention to Lange's observations of catatonic features in mania, and to Claude's concept of 'schizomanie’. The case records of his young and acutely ill patients make one wonder, however, whether Kasanin had been sufficiently ready to recognize mixed manic-depressive states. Arising from the study of more prolonged illnesses, the Kleist-Leonhard school attempted to construct a number of sub-categories of schizophrenia in order to accommodate ‘cycloid’ cases. In this country, the term 'schizo-affective’ is at the present time in bad odour. Aubrey Lewis (11), employing very searching criteria, discovered schizophrenic symptoms in 23 of his 61 patients with affective psychoses, but derived them from hereditary and personality factors. Both Batchelor (2) and Mayer-Gross, Slater, and Roth (13), while admitting the occasional co-existence of manic-depressive and schizophrenic psychoses largely ascribed to mixed inheritance, have indicated that the schizo-affective label could be avoided by a more rigorous diagnostic approach and follow-up. These were employed recently by Clayton et al. (6), and of 39 schizo-affective patients 33 were re-assessed after at least one year; only 13 were still ill; and although 5 of them continued to show some schizophrenic symptoms, the authors interpreted their findings to indicate that schizophrenic deterioration was not a usual result of schizo-affective illness. Moreover, the family histories suggested a very strong relationship with ordinary affective illnesses rather than with schizophrenia or schizo-affective psychoses. These workers did not, therefore, confirm the claims of others (e.g. those arising from Mitsuda's (14) twin studies) to the effect that atypical psychoses were in a genetically different category from schizophrenia and manic-depression. The concept of 'schizo-affective’ has been devastatingly criticized by Foulds and Caine (7) on logical grounds.

There have been many studies concerned with families of schizophrenics. Both environmental and genetic factors are claimed to be responsible in the development of this condition. Nowadays, there is no absolute hereditarian or environmentalist. A number of studies have shown that genetic factors are present in schizophrenia. The issue of whether this condition is caused by a single major gene with diminished penetrance or by polygenes has not yet been satisfactorily proven. Although this issue is difficult to resolve, it is important to distinguish between these two possibilities of genetic inheritance. In the case of single gene inheritance, biochemical investigation would be fruitful, but not in the case of polygenic inheritance manifesting clinical abnormalities once it exceeded a given margin of tolerance.

The purpose of this article is twofold. Firstly as a contribution to the literature of female delinquency, a subject that has attracted little contemporary attention, with one notable exception, the essentially psychiatric study of a year's intake into a classifying Approved School by Cowie, Cowie and Slater (1968). Secondly as an examination of the hypothesis that early adverse experiences are related to female delinquency in particular and to behaviour disturbance in general.

Payne and Hewlett (1960) found that the schizophrenics having the highest factor scores on their dimension of overinclusion were diagnosed paranoid schizophrenic. Payne (1966) has suggested that if overinclusive thinking is construed as an inability to disregard irrelevant stimulation it is conceivable that overinclusive thought-disordered schizophrenics will come to hold delusions of reference and persecution as a consequence of their giving these irrelevances personal significance. In this way the paranoid schizophrenic's thought disorder is seen as the basis of his delusional symptomatology. A number of studies have lent support to this contention (Payne, Caird and Laverty, 1964; Lloyd, 1967). On the other hand several studies have failed to find the predicted relationship between overinclusive test performance and delusional symptomatology (Hawks, 1964; Chapman and McGhie, 1962).

Psychotherapy is the art of relieving psychiatric problems by psychological means. Which problems are psychiatric and which means of treatment are psychological could be debated at length. The boundaries of psychotherapy impinge on many areas—faith-healing, religious counselling, the many caring professions, psycho-pharmacology and neurophysiology. Numerous ideas and methods are subsumed under the term psychotherapy. Some psychotherapists confine their view of psychotherapy to a limited theory and technique, while others are more comprehensive in their practice and encompass a variety of viewpoints. In the past many different schools of thought proliferated, each claiming the superiority of its own methods and its theory, while being neglectful of other techniques and ideas. New ideas would often be treated as heresy, while pragmatism would be regarded with suspicion.

Self-injury is a frequent occurrence in both mentally subnormal and mentally ill patients. The aim of this study was to determine its prevalence and nature in hospital populations of such individuals.

There have been numerous psychotherapeutic approaches (e.g., total push, community therapy, token economy, buddy system, etc.) advocated for hospitalized chronic schizophrenics. Although these programs have had relative success in producing improvement in at least some of these patients, it remains to be demonstrated whether this improvement is due to the specific nature of these programs or to certain non-specific factors, such as attention and/or structure, common to all psychotherapeutic interactions.

Half the prison admissions for England and Wales are of persons on drunkenness charges (BMJ 1968). Ratcliff (1966) records that there were, in one year, 1,180 occasions in Scotland when a man was actually imprisoned as a result of a drinking offence. He found that on average the offender had seven previous sentences for the same alcoholic offence. An important factor for prison alcoholics is the extent to which they resemble or differ from alcoholics who are receiving psychiatric treatment.

It can be difficult to make a confident diagnosis and one that will stand the test of time when a person without a family history or previous history of psychosis presents as psychotic with overactivity, pressure of talk, loose association of ideas and perhaps some paranoid ideation. He may be schizophrenic or manic. The nature of the disturbance of speech, and by inference thought, may assist in making the clinical diagnosis, but standard textbooks (Slater and Roth, 1969; Freedman and Kaplan, 1967) state that pressure of speech, flight of ideas, clang associations, distractibility and inability to adhere to a line of thought are common to both conditions.

The first descriptions of anorexia nervosa, categorized in various ways, date back to the sixteenth and seventeenth centuries (Rudolph, 1970; Schadewaldt, 1965; Thomä, 1961). It seems clear that the condition has become more frequent in recent years, even though we must allow for the fact that such patients were formerly seldom seen by the psychiatrist, but were treated in general or paediatric hospitals as subjects of an endocrine disorder. It has been suggested that the recent increase in the incidence is related to the emancipation of women (von Baeyer, 1965), and to the increasing number of professional women who are mothers.

Perris (1966) has produced evidence that affective disorders which manifest both manic and depressive phases are genetically distinct from recurrent affective illnesses characterized by a series of depressive phases only. One of the most challenging aspects of this most interesting work by Penis is the suggestion that these bipolar illnesses might be transmitted in at least a fair proportion of cases by major genes at one or more loci. According to the calculations of Edwards (1960) the expectation of disease in the first degree relatives of probands with a polygenically determined disorder is approximately the square root of the expectation in the general population. In Perris's material the expectation in the first degree relatives of the 138 bipolar probands was 0·098 (9·8 per cent) for bipolar psychosis, and 0·185 (18·5 per cent) with the inclusion of other affective disorders which might be considered to be incomplete forms of bipolar psychosis. Although in population studies the cases of bipolar psychosis have been included with unipolar psychosis, and therefore the expectation of bipolar psychosis is not known, it is very unlikely to be as high as 0·03 (3·4 per cent) which is the square of 0·185.

Numerous studies have related psychiatric disturbance to season of birth. Barry and Barry (1961) cited nine independent studies which concluded that mentally ill persons, especially schizophrenics, tend to have been born during the first four months of the calendar year. Hare and Price (1969) reported more recent evidence of similar seasonal birth trends for large groups of hospitalized British schizophrenics and manic-depressives, as compared with neurotics. Barry and Barry (1964) later suggested that the seasonal birth pattern may be more relevant to middle and lower class schizophrenics than to upper class schizophrenics from private mental hospitals. Orme (1963) upheld this seasonality of birth pattern among less intelligent but not among more intelligent psychotics. Norris and Chowning (1962), who confirmed the seasonal birth pattern among Canadian schizophrenics from both public and private hospitals, observed that the significance of seasonal differences between schizophrenics and normal populations depends upon which population birth years are selected for comparison. Norris and Chowning therefore suggest that the seasonal birth trend among schizophrenics may be the result of random variations in birth rate together with post-hoc grouping of the particular years for comparison. While this interpretation and criticism is tenable for a given study, it has become less tenable as evidence converges from the many independent studies.