The notion of transcultural psychiatry is an attractive one. It creates visions of palm-lined beaches and tropical abundance in the midst of which energetic epidemiology leads to aetiological revelations. Nissl commented to his friend Kraepelin (1904), about to embark on his journey to Java, that his research was only a scientific cloak to hide his enthusiasm for travel—a jest that all subsequent transcultural workers have had to suffer. It is unfortunate that not only are the palms and beaches overrated but the differences in culture and morbidity found are often scarcely greater than those existing between sections of one's own society, where even communication may be as great a problem. Even if the contribution made to the understanding of our own illnesses is meagre, transcultural studies can still be justified because they allow us to evaluate the needs of the peoples studied and, we may hope, permit us to indicate how they may be helped. The view sometimes expressed, particularly by anthropologists, that one should endeavour to observe without changing is unacceptable to doctors. Help is indeed required—there are no noble savages nowadays.

This paper presents findings related to the measure of stress in 641 schizophrenics (125 acutes and 516 chronics) and 95 comparable normals. Stress was defined as an imbalance between environmental demands and the respondent's ability to meet that demand successfully, and was measured in terms of level of stress experienced in relation to specific problem situations. Twenty-one dimensions of stress were measured, subsumed under the following four general areas: social performance, family interaction, social interpersonal interaction, and social maladaptive activities.

Results indicated that, in general, normals experience significantly less stress in dealing with life events than do schizophrenics. Within the schizophrenic group, the pseudo ambulatory chronic patients evidenced more stress than did their acute counterparts, a finding not previously described in the literature.

Implications of these findings do not support the present community after-care concepts. Discharged chronic schizophrenics appear unable to remain in the community for any reasonable period of time because of the high level of stress under which they function.

In recent years there has been an increasing interest in the observation that rates of psychiatric disorder and of educational problems in children may vary considerably according to area and to types of living conditions. However, very little is known concerning the extent to which rates actually differ, and even less about how particular area characteristics co-vary with the rates of different types of child disorder. Gath et al. (1972) found that child psychiatric referral rates were higher in areas of low social status, but data were not available to determine whether the difference lay in the preyalence of disorder or in the likelihood of detection or referral. Reading backwardness has also been associated with low social class areas (Miller et al., 1957; Eisenberg, 1966). In addition, it has been found that reading standards are lower in England than in Scotland (Davie et al., 1972). None of the studies of reading have taken IQ, into account, and it is not known whether the correlates are mainly with IQ or with a specific disability in reading. The present investigation was designed to examine these issues by determining if there were differences in the rates of child psychiatric disorder and of specific reading retardation between an inner London borough and the Isle of Wight. If differences were found, it also sought to examine the reasons for them, in order to elucidate possible causal or precipitating factors.

Disorders of the skin, either congenital or acquired, associated with nervous disorders and disturbance of normal mental functioning arc numerous. The classification is very wide-ranging and includes: phakomatoses, hamartoses, adenomatoses and neurocutaneous syndromes. In 1972, Liebaldt and Leiber collected 40 titles of the syndromes, and since then many more reports of the new syndromes and their variants have appeared in the world literature.

In his monumental work on the history of dynamic psychiatry (1970), Henri Ellenberger has traced the origin of the modern depth psychologies back into the mists of time. Both ills of the body and ills of the mind were originally handled by the priest-physician of primitive societies along much the same lines. But there came a parting of the ways. Glimmerings of an empirical approach to the external world led to some degree of objectivity and to the primordial elements of science. Some physical illnesses could be traced to physical causes, and an understanding of causation led in course of time to rational therapy along physical lines. But mental illnesses remained refractory. It was only in a small area of their vast extent that their causes could be attributed to bodily conditions and thereby to physical causes. Over a great reach of time up to the present day, or at least till yesterday, it was generally believed that, as bodily illnesses had physical causes, the illnesses of the mind must have psychological causes. It proved beyond the powers of priests or physicians to identify them; and there was no way of accounting for the variable course, outcome and responsiveness to treatment of mental disorders.

This study of suicide in Dublin during 1964–1968 from coroners' records was undertaken to estimate the discrepancy between coroners' verdicts, the national suicide statistics compiled from them and the clinical assessment of probability of suicide by psychiatrists examining the same records. The large difference in numbers of suicides deriving from the two approaches has considerable implications for national suicide statistics, and these have been briefly considered. From the findings presented we believe that we are justified in concluding that: (a) there are real differences in national suicide rates, at least between Ireland, England and Wales, and Scotland, and (b) the Irish suicide rate is low, though not as low as official statistics suggest, and (c) the discrepancy between official and ‘true’ suicide rates in Ireland is greater than in England and Wales and in Scotland.

Much attention has been devoted to the classification of the behaviour disorders of childhood, and various authors have identified what they consider to be clinically homogeneous groups. The alternative to a clinical approach to classification is a multivariate approach in an attempt to identify more scientifically the main dimensions underlying the wide range of behaviour disorders that occur in children. A model for a multivariate classification was pioneered by Hewitt and Jenkins (1946), who delineated three behaviour syndromes:

1. (a) socialized delinquency;

2. (b) unsocialized aggressive behaviour;

3. (c) over-inhibited behaviour.

It is generally thought that there is considerable regional variation in rates of educational retardation. American studies have shown that reading difficulties are considerably more prevalent in areas of low social status (Miller et al., 1957; Eisenberg, 1966), and Eisenberg (1966) found that inner city children had the lowest reading attainments. The National Child Development study (Davie et al., 1972) showed that reading standards were higher in Scotland than in England, and the Inner London Education Authority (1970) has shown that London primary school children have an average reading level below national norms. In south-east England, Morris (1959 and 1966) showed that levels of reading skills varied according to the characteristics of the schools the children attended. In Japan, a survey using teacher judgements has suggested that the prevalence of reading disability is greatly below that in Western countries (Makita, 1968).

The original aim of the U.S./U.K. Diagnostic Project, founded in 1965, was to examine differences in the national statistics for the diagnostic frequencies among patients admitted to state mental hospitals in the United States of America and to area mental hospitals in England and Wales.

In recent years there has been a resurgence of interest in pornography, particularly in Great Britain and the U.S.A. There have been many more publications on the subject, as well as various surveys and enquiries; some of these have been officially sponsored. Well-publicized prosecutions have helped to keep the topic in the public eye, but at the same time have drawn attention to uncertainties and ambiguities in present-day legislation (Tribe, 1973). Underlying all this is a continuing concern about the possible harmful effects of pornography, its implications for mental health and the need for more research and informed psychological guidance.

25-year-old female patient with a psychotic illness lasting three months in which schizophrenia and depressive episodes occurred was studied by serial EEGs. These were coded, masked and rated in a set way without knowledge of the clinical state. It was found that the schizophrenic state was characterized by a decrease in the amount and poor organization of alpha activity, as well as the occurrence of paroxysmal phenomena in particular atypical spike and wave. In the depressive episode, alpha activity was prominent and only scanty paroxysmal features were seen. Using these criteria a series of EEGs from psychiatric patients were assessed ‘blind’ with a view to separating them into either a schizophrenic or a depressive category. This proved possible in 17 cases (9 depressive and 8 schizophrenic). In only two was the categorization completely misjudged. These results suggest that further detailed study of the EEG, possibly with computer analysis, combined with assessment of the behavioural state might not only yield useful diagnostic information but also lead to a better understanding of the underlying neurophysiological basis of certain mental disorders.

This paper presents an analysis of the factors which influence coroners in their decision to classify some deaths as suicides and others as accidental or ‘open‘. The most important influence on coroners' behaviour was seen to be the manner by which the person died. Those who died by cutting, hanging, drugs or gas were significantly more likely to receive a suicide verdict than those whose deaths were due to drowning, jumping, shooting or poisoning. If the deceased left any intimation of a suicidal intent, this increased the likelihood that a suicide verdict would be returned. Finally, persons aged under 40 were significantly more likely to be returned as suicides than older victims, especially those aged over 70. All of these results show that coroners operate by observing the law as it defines suicide, that is, by looking for evidence of intent of self-inflicted death. Our findings concerning the factors associated with the suicide verdict help to clarify the meaning of the official data on suicides in Ireland, and illuminate the reasons why, using clinical rather than legal criteria, a much higher rate is obtained.

The brain stems of 24 mental hospital patients and 10 control patients were examined. Ten mental hospital patients were either deluded or auditorily hallucinated in clear consciousness, and of this group 8 presented with a diagnosis of schizophrenic syndrome. The nature and significance of lesions found in the midline reticular nuclei and the trigeminal n. are discussed. The results, and the dearth of other published material on this subject, indicate the need for further work in this field.

Large differences have been found between the Isle of Wight (IOW) and a (former) inner London borough (ILB) with respect to the rates of emotional (neurotic) disorders, conduct disorders and specific reading retardation in ten-year-old boys and girls (Rutter et al., 1975; Berger et al., 1975). This paper presents preliminary considerations on possible reasons for these differences. Any explanation must account for the fact that the differences in the rates apply to three rather disparate disorders. The epidemiological characteristics and psychosocial correlates of emotional disorders in childhood differ quite markedly from those of conduct disorders, and it appears highly likely that the causes of the two disorders are different (Rutter, 1965, 1970a; Rutter, Tizard and Whitmore, 1970). Although specific reading retardation overlaps markedly with conduct disorders, to a considerable extent it seems to have a separate set of aetiological influences (Rutter and Yule, 1973). Furthermore, there is little association between specific reading retardation and emotional disorder in childhood. It is also notable that the higher rates of disorder in London compared with the Isle of Wight apply just as much to girls as to boys, in spite of the marked differences between the two sexes in the correlates of psychiatric disorder (Rutter, 1970b).

There is now extensive evidence that autistic children manifest a specific cognitive defect involving language impairment (Rutter, 1974). The presence of such a deficit is demonstrated by the pattern of clinical findings (Rutter, 1968; Rutter, Bartak and Newman, 1971), the long term course of the disorder (Rutter, 1970), and the results of systematic experimental studies (Hermelin and O'Connor, 1970). Nevertheless, basic questions remain concerning the meaning of this deficit for theories on the nature and causation of infantile autism. First, what are the boundaries of the cognitive deficit and in particular does it extend outside language? Second, does it constitute the primary handicap which gives rise to other symptoms? Thirdly, if it does, does the cognitive deficit lead directly to the behavioural syndrome or must there be an interaction with a particular set of environmental or other circumstances for the syndrome to develop?

For about fifteen years now a tradition has been evolving in the psychiatric literature towards a taxonomic separation of suicides and attempted suicides, on the assumption that they involve distinct psychogenic factors (Stengel and Cook, 1958; Farberow and Schneidman, 1961). However, even the originator of the distinction agreed that a better understanding of attempted suicide could be gained if it is regarded as conveying a degree of uncertainty that the attempt will succeed or fail (Stengel, 1958), and that the separation of ‘… suicide and attempted suicide … is artificial (as) … it is possible to view suicidal acts as a whole and irrespective of outcome’ (Stengel, 1969, p. 121). The latter view has been reflected in the recent introduction and usage of the term ‘suicidal behaviour’ which includes both suicides and attempted suicides (Hetzel, 1971).

This study examines a series of elderly admissions to a psychiatric hospital and a geriatric hospital serving the same catchment area in order to evaluate the success of the two hospital services in separating their patients into two groups, and to study the effect, if any, on the prognosis of those patients who were ‘incorrectly labelled’.

The increasing involvement of psychiatrists in the general hospital presents opportunities for teaching medical students about the psychological evaluation and management of patients. We have found it useful to introduce this topic during the first year, by collaborating with colleagues from medicine and surgery in an interdepartmental course on patient care.

1. The incidence of non-fatal deliberate self-harm throughout the City of Bristol during 1972 and 1973 was assessed by means of a survey of patients presenting to Accident and Emergency Departments of hospitals in the area. Fatal or repeated acts of self-harm were not included in the survey. 2. The rates for females exceeded those for males at all ages, with peak incidence of 645 per 100,000 females (age group 15–29 years) and 334 per 100,000 males (age group 25–29 years). Ninety-three per cent had taken a drug overdose of some kind. 3. The problem was found in all electoral wards of the city, though its distribution was markedly centripetal, with a central area having morbidity rates up to 2.8 times that for the city as a whole. 4. The socio-economic correlates of deliberate self-harm were examined by reference both to a series of 368 patients interviewed soon after the event and to the pattern of its distribution throughout the city. A significant positive association was found with areas of overcrowding, lack of exclusive domestic amenities and high proportion of foreign born residents, but there was no correlation with the proportion of persons living alone nor with the type of accommodation. 5. The central high rate area was found to be heterogeneous in socio-economic terms, ranging from a student and young professionals' bed-sitter area to one with a high proportion of unskilled manual labourers and New Commonwealth immigrants. 6. The aetiological implications of the ecological findings for deliberate self-harm throughout the city are discussed.

In his original description of children with early infantile autism, Kanner (1943) commented that the parents were usually highly intelligent and that many were rather obsessive individuals who lacked real warmth. Subsequently he elaborated on these parental features (Kanner, 1949), and together with Eisenberg went on to suggest that autism was the result of an interaction between an innate ‘organic’ defect and a particular family environment (Eisenberg and Kanner, 1956; Eisenberg, 1957).