The word ‘yoga’ is very old and occurs in early Upanishads like the Katha and the Svetasvatara as well as in Mahabharata but it was Patañjali who attempted for the first time to offer a complete system in his Yoga-Sutra. Authorities differ as regards the exact time of the composition of the Yoga-Sutra. According to some it was written in the second century b.c., whereas others believe that it was composed as late as the fourth century a.d.

Patients are usually referred to outpatient departments by their family doctors, and it is generally assumed that after the initial assessment in the surgery they are directed to the appropriate clinic. However, it is clear that this does not always occur. In some cases there is difficulty in deciding to which clinic a patient may most profitably be sent, and this is especially so when a patient complains of both physical and psychiatric symptoms.

In 1964 Lippold and Redfearn described the mental changes induced by the passage of small positive and negative polarizing Currents through the human brain in volunteer patients. They further reported the clinical effects of polarizing the brain in 29 patients with long standing depression (Redfearn et al., 1964), and they also conducted a controlled trial of polarization in depressive illness (Costain et al., 1964). When the head was positive to the leg, an elevation of mood was said to follow, while the reverse was the case with a negative head electrode. In the uncontrolled trial of long standing depressives, 13 were said to show clinical improvement of the 24 who were considered to be adequately treated. In the controlled trial a significant therapeutic effect was rated by both doctors and nurses. Sheffield and Mowbray (1968), using normal human subjects, failed to validate the mood changes said to follow positive and negative polarization. Lifshitz and Harper (1968) found no appreciable effect of polarization in five chronic male schizophrenic patients studied over 14 weeks. The following study was designed to replicate the double blind trial on depressed patients.

Progress in the behavioural sciences is bedevilled by the difficulty in finding adequate controls. This is a report of a patient who in two important respects provided her own control.

Blood-borne infection is a common complication of the self-administration of drugs of dependence by the intravenous routes. British drug addicts are notorious for their disregard of even the most elementary hygienic precautions. They will use dirty needles and syringes, which are often being used by other addicts as well. They may use unboiled tap water or even lavatory pan water to dissolve the drug for self-injection. They may not clean the skin before injection and in desperate moments may inject themselves through a number of layers of clothing.

A number of studies have appeared (4, 5, 10, 11, 14, 15, 17, 18, 20, 28, 31, 32) providing evidence suggesting that unilateral ECT admin istered to the non-dominant hemisphere produces less memory impairment than bilateral ECT. It was also concluded in those studies investigating the problem (i.e. all except 10, 14 and 31) that these two methods of treatment do not differ significantly in their therapeutic effects. Some of the studies included a group of patients receiving unilateral ECT to the dominant hemisphere, but the main emphasis in all has concerned differences between unilateral non-dominant and bilateral ECT.

This paper aims at introducing a series of articles on basic psychoanalytic concepts. Many concepts which have developed within psychoanalysis have been extended for use within other frames of reference and in very different settings. If psychoanalytic concepts have validity such extension should be possible and useful, but it seems inevitable that in the process of extension changes in their meaning will occur, and it is one of the purposes of this series of papers to examine a number of concepts from this point of view. The philosophical implications of change of meaning when concepts are transferred from their original context has recently been discussed by a number of writers, e.g. Kaplan (1964) and Schon (1963). In this connection psychoanalytic theory presents special problems of its own. It is often regarded as being a completely integrated and consistent system of thought, but this is far from being the case. Psychoanalytic concepts are not all well defined, and changes in their meaning have occurred as psychoanalysis has developed and its theories have changed. We hope to show some of these changes in the papers which follow. Further, the same term has been used with different meanings even at the same point in the development of psychoanalysis. A prime example of this is the multiple meaning of the term ego (Hartmann, 1956), or of terms such as identification and introjection (Sandier, 1960). We find a situation existing within psychoanalysis at the present time in which the meaning of a concept is often only fully discernible from an examination of the context in which it is used. The situation is complicated still further by the fact that different schools of psychodynamic thought have inherited (and then modified for their own use) much of the same basic terminology.

In a previous paper (Pilowsky, Levine and Boulton, 1969) the classification of a group of 200 patients on the basis of their responses to a depression questionnaire and certain other attributes was described. The classification was carried out by using a form of numerical taxonomy based on information theory (Wallace and Boulton, 1968). By this technique the 200 patients were grouped into three classes, labelled A, B and C. Class A was regarded as a mixed group of ‘reactive’ depressions, Class B corresponded to ‘endogenous' depression and Class C comprised a non-depressive group.

The anaesthetic agent propanidid (Epontol) has been extensively reported on in recent journal literature in terms of its general anaesthetic use. Published studies have included accounts of its effect on ventilation (Harnik 1964; Clarke, Dundee and Daw 1964) and on somatic pain (Dundee and Clarke 1965). There has, however, been no reference to a systematic trial of the drug in conjunction with electroconvulsive treatment (ECT), notwithstanding that the manufacturers (Bayer, Handbook 1965) have claimed that it is suitable for such use.

In a previous publication (Brown and Birley, 1968) we have presented some findings which suggest that life changes and crises frequently precipitate the acute onset, relapse or exacerbation of schizophrenic states. To summarize : consecutively admitted patients diagnosed as suffering from schizophrenia were seen at mental hospitals serving a known catchment area. The first fifty whose onsets occurred within three months of admission and could be accurately dated within a week were included. Both the patient and at least one other informant were interviewed about the occurrence of certain previously defined and datable events occurring to the patient or to close relatives. These included such events as moving house, starting or leaving a job, admission to hospital, birth, marriage or death during the twelve weeks prior to onset. These were classified, according to their apparent independence of the patient's control, as ‘independent’ or ‘possibly independent’. The former were those which could be regarded as outside his control, e.g. discovering a burglary or hearing of a brother's serious illness. ‘Possibly independent’ events were those which were considered to have been within the patient's control but which had not been brought about by any unusual behaviour on the patient's part. They were chiefly changes of job, or of opposite sex friends. (Loss of job would, under certain circumstances, be rated as ‘independent’, e.g. when a whole firm closed down).

The reports on the emotional reactions and adjustment of patients to chronic haemodialysis are often contradictory; nevertheless, all agree that this treatment is stressful.

The catecholamine hypothesis of affective disorders proposes that 'some-if not all-depressions are associated with an absolute or relative decrease in catecholamines, particularly norepinephrine, available at central adrenergic receptor sites. Elation, conversely, may be associated with an excess of such amines' (Schildkraut, 1965).

Patients not uncommonly attend psychiatric clinics with the primary complaint of a cos metic defect in their appearance, e.g. that their nose is big or somehow conspicuous, or that their chin is protuberant or receding. Of the various features concerned, complaints about the nose are by far the most frequent. Such patients also consult plastic surgeons requesting the operation of cosmetic rhinoplasty and it is not unusual for the surgeon to seek a psychiatric opinion about some of the cases he sees, as it has been thought that the motivation of such requests is sometimes complex and the desire for operation may be indicative of psychological disturbance. The surgeons would appear to refer those cases where the defect is minimal or, of course, where severe psychological disturbance is obvious even quite superficially.

Previous studies from our laboratory (2) indicated that treatment of depressed patients with electric convulsive therapy (ECT) or imipramine was associated with significant decrease of urinary calcium excretion. The studies described in this report were undertaken to find out whether the decreased urinary calcium observed during ECT or treatment with irnipramine was accompanied by changes in the excretion of other urinary metabolites such as phosphate, magnesium, sodium and potassium.

A programme was undertaken to study the attitudes of visitors to mental hospitals. Initially a series of individual non-directive tape-recorded interviews were conducted on a small sample of visitors, who freely discussed various topics, including staff attitude, visiting problems and difficulties in having a mentally ill relative. A provisional questionnaire was constructed from the significant points of the recorded interviews and was used on another sample of visitors in a pilot study, on the basis of which a final ‘multiple choice’ questionnaire was designed incorporating 28 items. Copies of the final questionnaire were then distributed from the wards of two mental hospitals to consecutive visitors, with a stamped envelope addressed to Nottingham University, informing them that the study was in connection with an independent survey. The distribution continued until few new visitors attended. Of the two hospitals, the first, The Pastures (Hospital A), serves a wide county catchment area and has an ‘unrestricted visiting hours' policy; the second, Kingsway (Hospital B), on the other hand, has a ‘limited visiting hours' policy and serves a compact urban catchment area. Altogether 510 questionnaires (75 per cent) were returned completed, 306 (8o per cent) for Hospital A and 204 (70 per cent) for Hospital B at the end of the study. The rest of the paper is confined to the analysis of these 510 questionnaires in relation to the question on the effect of unrestricted visiting, which has already been studied by Barton et al., from the nurses' point of view. The particular question asked by us was, 'some hospitals allow visitors to visit at any convenient time. What effect do you think this would have on (1) the patients, (2) the visitors, (3) the nursing staff, (4) the doctors?’ The replies were to be given on a five point scale for each question. The scale was ‘Very good-Good-No effect-Poor-Very poor.’ the graded adjectives being determined from the earlier tape-recordings.

In a typical classification problem each subject in a sample of N subjects is allocated to one or other of k exhaustive and mutually exclusive categories. For example, a sample of families may be classified into social-class groupings in accordance with the Registrar General's classification based on the occupation of the father or father substitute. Or a sample of psychiatric patients may be classified into one or other of the diagnostic categories recommended by the W.H.O. Now it occasionally happens that the same sample of subjects is classified, for a given set of categories, independently by two different agents. For example in the Plowden Reports, Appendix 3 Table 29, a sample of children is classified into types of secondary school, Grammar, Comprehensive, Technical, etc., on the one hand according to the parent's ambition for their children and on the other hand according to the type of school in which the children were eventually placed. In situations such as the latter a k k classification table evolves in which, when the categories are arranged in the same order, the matches between the two separate classifications appear in the cells of the main diagonal of the table and the mismatches appear in the off-diagonal cells (see Table I below). The question then arises as to how to compare the two separate classifications and to measure in quantitative terms the degree of agreement between them.

Weckowicz (1960), using pictures of common objects with superimposed lines, found that schizophrenics were less able to see the hidden figures than normal subjects and other patients. Unfortimately the task turned out to be too easy; most of the normal subjects and more than a third of the acute schizophrenics obtained the maximum possible score. Such a distribution of scores makes it difficult to carry out further analysis of the results. The aim of the present study was, using a more difficult task to obtain a better distribution, to confirm the lowered capacity of schizophrenics and to relate it to other variables. The task used was the ‘Gottschaldt Figures Test’, published by the University of California Institute of Personality Assessment and Research. This consists of the identification of two simple geometrical figures embedded in complex designs. The score (maximum = 20) is the number of figures correctly identified on two sheets, 2 minutes being allowed for each sheet. To ascertain how this task is ‘normally’ related to certain major personality variables, a group of neurotic patients was used, since they would not be expected to have any special disability on a task of this type.

Psychiatry and other medical disciplines have been paying increasing attention in recent years to the relationship between patient and doctor, and psychoanalytic concepts have been applied in order to formulate various aspects of this relationship. One of those most commonly applied is that of transference, which is now often loosely used as a synonym for relationship in general. The concept of transference will be discussed in detail in a further paper in this series, but a distinction has always been made within clinical psychonanalysis between transference ‘proper’ and another aspect of the patient's relation to the doctor which has been referred to in recent years as the ‘therapeutic alliance’, ‘working alliance’ or ‘treatment alliance’ (Zetzel, 1956; Loewald, 1960; Stone, 1961, 1967; Gitelson, 1962; Tarachow, 1963; Greenson, 1965, 1967; Friedman, 1969). The concept has been used in connection with the psychoanalytic treatment situation to describe aspects of what is familiar to all as the ‘therapeutic contract’ between the patient and his doctor (Menninger, 1958), and has been defined as ‘the non-neurotic, rational, reasonable rapport which the patient has with his analyst and which enables him to work purposefully in the analytic situation …’ (Greenson and Wexler, 1969). As far as the psychoanalytic situation is concerned, it has been maintained that the recognition of the difference between treatment alliance and other aspects of the patient-analyst interaction (such as transference) leads to an increased understanding of the processes which occur in that situation and, in particular, of those which enter into therapeutic failure. It is the purpose of this paper to examine the treatment alliance concept as it has developed within psychoanalysis and to consider its applicability outside the psychoanalytic treatment situation (Sandier, Dare and Holder, 1970).

In a recent article (Hope, 1969a) the author has demonstrated the theoretical relations between what psychologists call the analysis of persons and the analysis of tests. The demonstration was illustrated by an analysis of a hypothetical matrix M whose rows were called entities and whose columns were called variables. It was shown that, by combining Slater's (1964) method of spherical co-ordinate mapping with a method of numerical taxonomy suggested by the author, it is possible to perform a comprehensive and self-consistent pair of analyses whose conclusions can be read off three diagrams: a map of variables, a dendrogram of entities, and a profile diagram of the multivariate means of groups of entities.

Recently much interest has been shown in the screening of populations for the presence of disease, either latent or overt (Wilson and Junger, 1968). In psychiatric practice the importance has been recorded of screening patients for the presence of avitaminosis B12 as a possible cause of psychiatric abnormality (Henderson et al 1966). Several methods of estimating serum vitamin-B12 levels have been evaluated, but the microbiological assay remains the most suitable method for use in a routine laboratory.