Jealousy is a complex emotion which most people have experienced at some time in life, at least during adolescence, and yet it is hard to describe precisely. Freud (13) said it is compounded of grief over the loss of a loved object, pain due to the narcissistic wound, feelings of enmity against the successful rival, and of a greater or lesser amount of self-criticism in holding oneself accountable for the loss. Even normal jealousy, Freud said, is by no means rational and is neither under conscious control nor necessarily proportionate to the external situation out of which it seems to arise.

Patients who do not comply with therapeutic procedures have been of longstanding concern to the clinician and have presented knotty methodological problems to those involved in evaluating the effectiveness of different treatments and treatment modalities (1, 2, 4, 6, 10, 11, 12, 13).

Obsessions are abnormal mental compulsions. They are experiences with a compelling quality which persistently intrude into consciousness. Though recognized by the patient as an irrational product of his own mind and resisted by him, they are incapable of being expelled. They may be thoughts, images, fears, urges, or acts. An obsessional disorder is one where such symptoms dominate the clinical picture and are not associated with any underlying psychosis.

This investigation arose from the clinical observation that there are certain people who are psychiatrically very ill yet live at home or in the community, whilst others no less disturbed are referred to mental hospitals and kept there for varying periods. Although several excellent studies have been done on chronic schizophrenics and other serious mental illnesses after discharge from hospital, no study has been found in the literature concerning chronic cases who have never been hospitalized, and it was hoped that a careful investigation of such patients and their circumstances, i.e. social and economic conditions, the organization and attitudes of the family, the psychiatric condition of the patients, etc., would lead to a better knowledge of community care.

Reports coming from Central Australia draw attention to mental instability in the Aborigines who live between Hart Range and Lake Nash near the Queensland border (Fig. 1). Well-informed persons—welfare officers, nursing sisters, an aerial medical officer (“flying doctor”) and cattle station managers—are firmly of the opinion that these Aborigines show an undue amount of instability and frank mental illness. Furthermore, South Australian mental hospital records reveal that in recent years, many Aborigines of this region have been referred to Adelaide for treatment of unusual psychoses. Statistics of the sort available in more settled areas are lacking. There is no local psychiatric service to keep a register of disorders occurring in this population. But the local impression of mental instability is strong and the questions it raises are clearly important. Is there a localized instability in Central Australia ? If so, what is its distribution? What is its nature? Is its cause to be found in constitutional peculiarities of the people ? Or in environmental stresses that they are undergoing in their cultural transition ?

Psychiatrists who have written about the Australian Aborigines have been less concerned with the psychiatry of this people than with the significance of their practices and beliefs for psychological and psychoanalytic theory. (Freud, 1913; Roheim, 1945; Fry, 1953). This outlook is reflected in the subsidiary title of Freud's Totem and Taboo: “Resemblances Between the Psychic Lives of Savages and Neurotics”. It was hoped that the analogies between “primitive” practices such as sub-incision or totemism and the repressed complexes of modern civilized peoples might shed light into the recesses of the modern mind.

It has been increasingly the practice in Scotland for Procurators-Fiscal to obtain psychiatric opinions on the mental state of all persons accused of murder. Between 1953 and 1964 I made 66 such examinations, mainly in the Glasgow area; because of other commitments none were carried out between July 1955 and March 1958. The official Criminal Statistics for England and Wales (1) show that during the eleven years from 1953 to 1963 the number of persons found guilty of murder was 395 and of manslaughter 969; comparable figures for Scotland (3) were 43 and 148.

Mebanazine (‘Actomol’) introduced in 1960 for the treatment of depression is a monoamine-oxidase inhibitor hydrazine derivative having the following structural formula:

Nortriptyline (Allegron, Aventyl) is the demethylated metabolite of amitriptyline. Preliminary trials by Bennett (1962), Oltman et al. (1963) and Leahy et al. (1964) indicated that it might be an effective anti-depressant. Forrest et al. (1964) found that it compared favourably with amitriptyline, a widely used anti-depressant of established efficacy. This investigation also compares nortriptyline with amitriptyline.

This paper describes a double blind controlled trial of the compound trimipramine ('Surmontil’), which does not appear hitherto to have been reported upon by the English-speaking investigators, though there have been many clinical studies reported by French, and some by Italian authors.

Among the numerous reports on toxic side effects of antidepressant drugs, the monoamine oxidase inhibitors appear prominent in causing such a variety of serious complications (4) that many physicians prefer to avoid their use altogether, and prefer other drugs (such as the Iminodibenzyl group) that produce their euphoriant effects more slowly but also more safely.

Cryptomnesia belongs to the category of psychiatric terms which acquired a bad reputation and nearly passed into obsolescence. Its disrepute has come from its popularity with people who are believers in psychic forces, spiritualism, vitalism and other supernatural agencies. Such people have used it to denote the apparent ability of some mediums to become aware, when they are in a trance, of “hidden” memories—hidden in the sense of being inaccessible to them in their normal consciousness.