An investigation was undertaken into the first admissions to (for the years 1963, 1965, 1968, 1972) and the total discharges from (for the years 1963–72) Scottish mental hospitals and psychiatric units of male doctors and other social class I males. The overall rates for both first admission and for all discharges were more than twice as high among male doctors as among other social class I males. First admission and total discharge rates for drug dependence, alcoholism, neurotic and ‘functional’ depression and for affective psychosis were all significantly higher among doctors than non-doctors. Doctors were more likely than non-doctors to have been referred by themselves or by medical sources other than general practitioners, and were as willing as non-doctors to enter hospital voluntarily. Greater access to psychiatrists may have contributed to their higher rates of in-patient care, but it is improbable that such factors accounted for all of the excess in rates of drug dependence, alcoholism and depression.

A quotation from Edward Mapother can serve admirably as text for this address: ‘In practically all properly investigated cases of insanity, it is found that it is the result of a summation of multiple causes, effective in combination, though inadequate singly. It is this that renders all controversy between extremists of the physiogenic and psychogenic schools so futile’ (Lewis, 1969, p 1359). In the same year, 1922, in his Salmon Lecture, Adolf Meyer said: ‘The overmechanization of psychiatry … (has) led to too much reliance on chemistry and physiology as curealls in mental ills, while psychoanalysis, by laying too much emphasis on the subconscious and sex, has lost sight of the … functions of the conscious mind and has … disregarded the fact that man is subject to physical … biological … and social laws' (Meyer, 1922).

Mental retardation may be associated with a number of environmental factors such as undernutrition, lead poisoning or exposure to neuroactive drugs during a critical period of brain development. Possible biochemical mechanisms operating in these various conditions and in animal models are reviewed in relation to the vulnerable period hypothesis. Small brains are common in the mentally retarded, and this may be related to a developmental abnormality particularly at the level of the synapse.

The monthly number of births in Norway fluctuates between a maximum in January–May and a minimum in October–December. This cyclic seasonality is assumed to be of biological origin, but indirectly it is influenced by social factors and consequently tends to vary a great deal. There is a secondary birth maximum in September, corresponding to a peak of conceptions during the traditional festivities around Christmas and New Year. It is shown that this maximum is much less variable within the country studied, though it probably varies from one country to another in relation to the impact of the mid-winter traditions.

The January–May birth maximum is known to be higher in schizophrenia than in the general population, while no such difference is observed in Norway for the September birth peak. It is felt that there is a fundamental difference between the two birth maxima and a corresponding difference between schizophrenic patients and the general population. Minimal paranatal brain damage of seasonal origin is suggested as an explanation.

A study of the cases of 100 doctors admitted to The Retreat, York, confirmed the findings of a'Brook et al (1967) in all important respects, addiction being the outstanding feature of the series.

Earlier this year I was invited by the American Psychiatric Association to deliver a public lecture on the contributions of Sir Aubrey Lewis to psychiatry, with particular reference to his work in its historical perspective (Shepherd, 1977). By a happy chance the lecture in question is linked with the name of Adolf Meyer, an eponymous association which facilitated the exposition of the principal theme of my address. It was, I believe, Manfred Bleuler who first drew attention to the similarities between Adolf Meyer and Aubrey Lewis despite profound differences in their temperament and background (Bleuler, 1966). In retrospect it is now apparent that Lewis was Meyer's natural successor, both men standing out as the representative psychiatrist of his generation in the mainstream of psychiatry, each owing his pre-eminence as much to what he stood for as to what he achieved. This was the argument which I did my best to elaborate, drawing for the purpose on the sources and development of Sir Aubrey's ideas, on his manifold achievements and on the various legacies which he has bestowed to his own successors. And, since I was addressing a largely North American audience to whom he was a somewhat remote figure, I attempted to introduce my subject with a few words about the origins and character of the man himself.

Eight hundred psychiatric patients and eight hundred controls completed a handedness preference questionnaire. There was no significant difference in handedness between the two samples, but, contrary to some previous reports, excess of sinistrality was not associated with male sex. The distribution of handedness was similar in neurotics and controls, but among psychotics in general there was a higher proportion of fully right-handed subjects. Among schizophrenics there was a significantly higher proportion of left-handed writers among males than females. There were relatively few left-handed writers of either sex among patients with affective psychosis. Female patients with personality disorders had a significantly higher proportion of mixed handedness than controls. The findings are considered in relation to suggestions that functional psychoses may be associated with asymmetrical cerebral dysfunction, and that poorly lateralized function may be related to anomalous psychological development.

This article formulates a definition of the term dangerousness, indicates why the commission of dangerous offences cannot be reliably predicted, and then reviews the several factors which have been or might be used by those who have to make decisions about dangerousness in criminals. It suggests that these factors are useful insofar as they help to illuminate the individual's capacity to feel sympathy and to learn by experience. Since the accuracy of prediction varies inversely with time, the maintenance of personal relationships and good communication seems the inescapable requirement in the management of potentially dangerous criminals.

The history of writer's cramp is reviewed, and the study of ten cases described. Nine of the patients were male with obsessional personalities, and involved in a conflict with some bearing on the act of writing. Treatment by psychotherapy and re-education produced either temporary or little improvement; biofeedback, used in six cases, produced some benefit in four, of which only one relapsed. Although no statistical weight can be attached to the results of so short a series, biofeedback appears to offer a promise of response which merits further investigation. The use of the electromyograph is discussed also as a means of discriminating between tension and tremor in such cases, with particular reference to their psychosomatic meaning.

It was only after much hesitation that I accepted your flattering invitation to contribute to this meeting in commemoration of Aubrey Lewis. On the one hand, I have the natural diffidence of a layman amongst experts. But as against this, although we were of the same generation, I cannot but be moved by a feeling akin to filial piety towards one whose work I so greatly admired, and to whom I am indebted for so many personal acts of kindness and generosity as I have been to Aubrey Lewis. I hope, therefore, that since the latter emotion has prevailed you will think it fitting that I should ask you to look back, from the standpoint of nearly a quarter of a century later, at the impressive paper on Health as a Social Concept which Aubrey Lewis read to the British Sociological Association in 1953.

Some recently published data on the seasonal incidence of mania are re-examined. The reanalysis confirms a strong seasonal trend in females, but also demonstrates a similar trend in males; the latter result is at variance with an earlier finding which showed no seasonal pattern in males. A simple harmonic curve would describe the data extremely well in both sexes, and the parameters of these curves (the amplitude of variation and the time of maximum incidence) are very close for males and females.

A description is given of the coping behaviour of seven men who survived a shipwreck and were not rescued until 13 days later. The principal behaviours shown by the men were attachment ideation, drive to survive, modelling, prayer and hope. Particular attention is paid to the first of these, and consideration given to its likely origins in behavioural evolution. It is proposed as a hitherto inadequately recognized coping behaviour. A follow-up examination 12 to 24 months later showed that five of the seven men available had developed substantial psychiatric disorder, while by contrast one was not only well but claimed to have been enriched by the experience. Exposure to extreme adversity or disaster may have long-term effects on mental health. Further longitudinal studies of disaster victims are necessary for the design of informed after-care.

SUMMARY The paper describes a two-month period of study in four bipolar manic-depressive patients in a metabolic ward. Plasma renin activity, packed cell volume, plasma sodium and potassium were determined at intervals. Twenty-four-hour urinary sodium, potassium and creatinine were also estimated daily. Aldosterone production rate was measured on two occasions for each patient. Three of the patients showed at least one episode each of mania and depression during the study, while the fourth patient, who was receiving prophylactic lithium throughout, had one ten-day depressive episode but was otherwise normal.

No obvious relationship between mood and plasma renin activity was observed, but the group showed a high resting renin activity, a blunted renin response to posture, and inappropriate aldosterone production rates for the renin activity found.

It is postulated that a primary defect in the aldosterone-renin system may be present in bipolar manic-depressive psychosis.

Thirteen patients diagnosed as having affective disorders, and who were taking lithium, were compared with drug-free controls on short-term and long-term memory tasks. There was some indication that patients on lithium may show an impairment of short-term memory at fifteen-second delay intervals, and possibly enhanced long-term recall of difficult material. Further comparison with results obtained from six patients on tricyclic antidepressants seemed to reduce the possibility that the lithium group's scores were a function of their psychiatric status.

As the group sizes were small, all the findings need to be replicated.

Pathological bereavement reactions following the death of a close relative or friend have been well documented in the literature. Similar grief reactions have been described following other personal losses, such as the loss of a limb or the loss of one's home.

The cases of three women are described in whom pathological grief followed another category of loss, that represented by the death of a much loved domestic pet. The patients suffered disabling psychiatric symptoms following the death of their pet dogs. The dogs were all of the toy dog variety and had been at least 13 years of age at the time of their death. Institution of psychiatric treatment resulted in rapid recovery and at follow-up after a year there had been no recurrence of symptoms.

A review of the abundant literature concerning the distinction between delusional and non-delusional depressions, especially of the work of Aubrey Lewis, reveals that before the introduction of specific therapies most in-patients with major depressive illness eventually recovered; the small percentage who did not almost all came from the delusional group. The dichotomy lost its clinical significance after the introduction of ECT, as both groups were equally responsive. However, accumulating evidence indicates that unipolar delusional depressives are significantly less responsive to tricyclic anti-depressant therapy than non-delusional depressives. The presence or absence of delusional thinking should be considered as a significant criterion in the classification of depressive disorders, and the presence or absence of delusional thinking should influence the choice of treatment for severely depressed patients.