In the treatment of alcoholism our aim should be to adapt the treatment to the individual patient. It is recognized that alcohol addiction is a manifestation of a multitude of differing neurotic or personality disorders and that radical treatment must focus on the underlying disorder.

The belief that the phenomena of ‘crime’ and of ‘epilepsy’ are associated has a long history and probably was put in its most forceful form by Lombroso (1889; see Ferrero, 1911). Nobody now believes, as did Lombroso, that most criminals are epileptics, but the controversies surrounding the extent and form of any relationship have by no means yet been finally resolved.

According to a recent theory, schizophrenia is confined to people with a particular genetic predisposition and the disorder arises from a specific breakdown in the central part of the system that controls growth (Burch 1964, 1968). We call diseases of this general class autoaggressive. Their pathogenesis has two distinctive phases: initiation and development. Initiation, which is a purely random process, entails a form of spontaneous somatic gene mutation in growth-control stem cells.

The relative contribution of genetic and environmental factors to the development of homosexual behaviour is a controversial subject. The original suggestion that homosexuality is a purely inherited trait has been attributed to Krafft-Ebing (Kallmann, 1952). Perhaps the strongest support for this view was Kallmann's series of 40 male monozygotic twin pairs showing 100 per cent concordance for the overt practice and quantitative rating of homosexual behaviour (Kallmann, 1952). This report has been criticized, and Kallmann later conceded that the 100 per cent concordance was possibly a statistical artefact (Kallmann, 1960). Habel (1950), who obtained the index twins from a prison population, found concordant homosexuality in 3 out of 5 monozygotic pairs (60 per cent), but none of 5 dizygotic pairs. In a more recent study, Heston and Shields (1968) found concordant homosexuality in 2 out of 5 monozygotic pairs (40 per cent) and 1 out of 7 dizygotic pairs (14 per cent). Heston and Shields (1968) also report a family with a sibship of 14 which included 3 pairs of male monozygotic twins, in two of which both twins were homosexual and in the third both heterosexual; no environmental factors which differentiated the homosexual from the heterosexual sibs could be detected. These workers also refute the suggestion that the tendency for monozygotic twins to be more alike with regard to homosexuality than dizygotic twins is related not to genetic factors but to problems of sexual identification which predispose to homosexuality (Money, 1962) by pointing out that there is no evidence that monozygotic twins per se are especially prone to become homosexual.

Disturbances of electrolyte metabolism have frequently been reported in depressive illness. Whether these changes are aetiologically important or secondary to the illness is uncertain. However, the maintenance of sodium and potassium gradients across cell membranes is of vital physiological importance. The distribution of electrolytes across cell membranes is probably responsible for the generation and propagation of impulses in excitable tissue. There is evidence that electrolyte changes are closely associated with alteration in cerebral activity. Margerison et al. (7) reported a significant coefficient of concordance between mean daily urinary sodium potassium ratios, the electroencephalogram mean abundances (8–9 c.p.s.) and word output.

Hypnagogic hallucinations are well established in text books of psychiatry, as also are hypnopompic hallucinations. Hypnagogic hallucinations are those which occur as the subject falls asleep and prevent him falling into a sound sleep, whereas hypnopompic hallucinations occur when the subject is waking up. Since by definition hypnagogic hallucinations actually waken the subject, the distinction between these two types of mental phenomena may be artificial. Psychiatric texts vary in their assessment of the significance of these hallucinations, and, with some exceptions, they have generally been considered as ‘normal’ phenomena.

In recent years several workers have followed-up the status of patients with phobic disorders after treatment (Terhune, 1949; Friedman, 1950; Tucker, 1956; Roberts, 1964; Sim and Houghton, 1966; Marks and Gelder, 1965; Marks, Birley and Gelder, 1966). These studies were retrospective in that evaluation was largely based on past records, and systematic interviews did not provide the main source of data. Some patients were included with phobias of duration ranging from three days to 32 years, while follow-up results were usually reported at varying durations after treatment, so that it was not possible to evaluate serial change in a cohort.

Religions mysticism (hereinafter referred to as R.M.) is defined as (alleged) direct experience of ultimate reality seen as personal or hyper-personal. It may take any one of three forms: nature mysticism, theistic mysticism, and monist mysticism. In nature mysticism, the percipient feels the whole of Nature, including man, to be pervaded and directed by Mind (the capital letters are used deliberately). Wordsworth's Prelude and Tintern Abbey provide classical examples. In theistic mysticism, the percipient feels himself to be aware of the God of religion in a purely spiritual manner, which in respect of its immediacy is felt to be analogous to sensory perception. Thomas Aquinas, in fact, defines this kind of experience as ‘direct awareness of God, analogous to sensory perception.’ In monist mysticism, the percipient feels himself to be the One-and-Only Mind. The Yogi mystic, Swami Vivekananda, provides the classical example of this latter type of experience, proclaiming ‘I am the Blissful One’.

The use of drugs (as intoxicants) is universal; the hedonistic use of such drugs has led to their abuse, and has always been a social problem. Although the indulgence in some drugs is confined to certain cultures, others like alcohol have been commonly used all over the world. Alcohol, opium, hemp (cannabis and its several preparations) have been widely used for their exhilarating qualities.

Serum lithium estimation has recently assumed great importance in psychiatry. It can be successfully undertaken in any ordinary hospital laboratory equipped with a simple flame photometer such as the EEL (Evans Electroselenium Limited). It has been found that de-proteinization of serum is very satisfactorily achieved by addition of hydrochloric acid and subsequent heating. This avoids the retention of lithium in the precipitate which is associated with the use of trichloroacetic acid and of ethanol. The method is simple for the technician and very reliable and accurate.

In the past two decades revolutionary scientific advances and social developments have changed our attitude to the management of conditions associated with severe mental subnormality. Therapeutic achievement has admittedly been on a limited scale, and in terms of medical treatment in the conventional medical sense is likely to remain so. Very great hope lies, however, in the use of our newly-gained knowledge and expertise for prevention rather than cure.

There is good evidence that genetic factors are necessary, though by no means sufficient, for the development of schizophrenia. Several studies have compared the incidence of schizophrenia in identical and in fraternal twin pairs: these studies are discussed, for example, in the Medical Research Council Annual Report 1965–66 (pp. 54–61), where Essen-Möller's (1963) cumulative figures are quoted: Identical (MZ) pairs: 69 per cent concordant for schizophrenia (both schizophrenic) (194/280 pairs). Fraternal (DZ) pairs: 13 per cent concordant for schizophrenia (both schizophrenic) (59/448 pairs).

Evidence from a detailed investigation and review of the literature on monozygotic twins discordant for schizophrenia indicates that the schizophrenic index case was lighter in weight at birth than his co-twin (Stabenau and Pollin, 1967). Lane and Albee (1966) reported that schizophrenic singletons were significantly lighter in birth weight than their sibs.

Milner (1963), using urinary saturation tests to determine ascorbic acid levels in a group of male chronic schizophrenics, reported that far higher doses of ascorbic acid were required to achieve saturation in that group than in normal subjects. Briggs (1962) observed hypovitaminosis C in schizophrenics, and postulated a disturbance of ascorbic acid metabolism which could be relevant to the biochemical basis of schizophrenia.

A neurotic patient is like a traveller in unfamiliar country forced to rely upon a deficient or systematically falsified map. The joint explorations undertaken with the therapist can enable the patient to revise this map. One condition which must be met for this to occur is for the therapist to recognize clearly how the patient sees his relationships with others, including the therapist. The present paper reports a method of investigating how far this condition is met, using a dyad grid test completed by the patient and by the therapist.

A prospective study of mood changes through pregnancy and puerperium was undertaken by a research group centred on the North Middlesex Hospital, Edmonton, London. Data collected from 189 women revealed an evolution of mood changes in those who later developed puerperal depression, which was characterized by anxiety at the first ante-natal visit, elation during later pregnancy and depression in the puerperium. The findings were in agreement with other workers in this field. The arguments in favour of a hormonal aetiology of puerperal depression are presented.

Psychiatrists have been interested in the terminal stages of schizophrenia for many years. The attempt to distinguish different lines of evolution for this mysterious illness has unfortunately not been very successful. One can only agree with Henri Ey, who said, ‘… the final stages (of schizophrenia) are not the clinical expression of well-defined types, of real entities. They are organized forms in the schizophrenic catastrophe, forms of liquidation of the bankrupt psyche, which depend less on a specific process than on its psychodynamic vicissitudes.’

The technique of systematic desensitization employing methohexitone-induced relaxation was first described in 1966 (Friedman, 1966) and a review of results of treatment by this technique at six-month follow-up was encouraging since 15 of 18 patients continued to show marked improvement (Friedman and Silverstone, 1967). The present study reviews 124 patients treated by the same method.

Abnormalities of sex chromosomes are associated with various forms of neuropsychiatric disorder, and Polani (1969) has reviewed the literature. While there were numerous reports associating the XXY and XXX constitutions with psychiatric disorder, the position was somewhat different with regard to Turner's syndrome. The purpose of this paper is to describe a patient who was shown to have the clinical pattern of Turner's Syndrome and an XO/XX/XXX mosaic chromosome pattern, and who presented with a schizophrenic illness.

It is well recognized that LSD (lysergide) can give serious adverse reactions, including suicide and prolonged psychosis; Smart and Bateman (1967) have reviewed the subject thoroughly. However, examples reported refer largely to cases where the LSD was self-administered. Medical case reports usually cover small case numbers, and publication may be determined by high adverse reaction rates. There has been no methodical survey of the pooled experience of psychiatrists since Cohen's study in 1960. This reported 44 replies sent out to 62 American investigators who had published papers or whose work was known to the author. Replies covered 5,000 subjects with 25,000 LSD or mescaline sessions. In this series, there were only two suicides that Cohen regarded as directly related to the LSD, and there were psychotic reactions (lasting more than 48 hours) at a rate of 0·8 per 1,000 experimental subjects and 1·8 per 1000 patients. It is unfortunate that one-third of the investigators failed to reply to Cohen's questionnaire.