Ancient and Renaissance physicians implicated the soul's imaginative faculty in the genesis and remission of disease. The theory stated that images of objects of desire or aversion aroused emotions, which in turn set up humoral imbalances, disturbing digestion and other vital functions, culminating in various forms of pathology. This concept explained the therapeutic efficacy of ‘placebos’ in forms such as spells, charms and talismans. The theory merits close attention by contemporary physicians and researchers.

The planning of health services consists of a process that generally involves the following steps: (a) situational analysis, or the description, definition and statement of the problem, its characteristics and dimensions in relation to population and time; (b) the formulation of alternative tactical approaches to the handling and solution of the problem; (c) decision analysis or the selection of a plan; (d) discussion and implementation of the plan selected; (e) evaluation of the results achieved in relation to the problem, situations or populations concerned. This paper discusses the content of a programme of mental health services research for collecting and analysing the information needed to apply these processes to the planning of mental health services, monitoring the manner in which the plan is being implemented, and assessing its effectiveness in achieving short-term and intermediate objectives and long-term goals.

Statistical and epidemiological information play an important role in these processes, particularly in the situational analysis and the evaluation processes. Illustrations have been provided of types of data that are produced in the national mental health statistics programme in the United States. Difficulties in using such data to answer questions concerning the needs for mental health services, and manpower requirements for delivering services to meet these needs are discussed. In many instances, currently available data are quite inadequate for answering key issues such as these, plus others related to living arrangements of the population, the effect of services on the persons who receive them, their families and the communities in which they live. Thus, much still remains to be done to develop systematic, comparative morbidity statistics on the incidence, duration and prevalence of mental disorders in the general population, on the needs for mental health services, and on the effectiveness of our efforts to prevent disorders that can be prevented, and to reduce the amount of disability and distress caused by those that cannot be prevented or terminated.

A series of problems have been identified, the solutions to which would assist materially in providing data that would narrow gaps between available knowledge and that which is needed. The importance of establishing well-staffed research units at the catchment area level with stable funding to accomplish this is underscored. It is a matter of the greatest urgency that adequate resources - financial, manpower, scientific and administrative - be made available to solve these problems. If this is not done, then efforts to document quantitatively the effectiveness of programmes to prevent and control mental disorders will continue to suffer from many of the same shortcomings that have impeded our past and continue to impede current efforts to accomplish this.

Statements about prevalence, of the type ‘x% of the general population are mentally ill’, imply a concept of prevalence that is difficult to define operationally. It requires the specification of a cut-off point, a level of severity from which the presence of an illness can be inferred, and this is largely arbitrary. A more generally useful type of statement compares the frequency distribution of severity for declared cases with that for the rest of the population. This avoids the need for a defined cut-off point. We are still left with the problem of defining a dimension of severity and a declared case, but these should follow easily from a clear statement of the purpose of any specific inquiry. The argument is illustrated from the results of a study of self-referrals to general practitioners.

The hypothesis has recently been advanced that increased activity of central dopaminergic mechanisms underlies the symptomatology of the schizophrenias. The evidence that dopaminergic transmission in the corpus striatum is impaired in Parkinson's disease suggests that observations on the relationship between Parkinson's disease and schizophrenia may illuminate the pathophysiology of the latter disease. Four cases are reported in which an illness with schizophrenic features developed in the setting of longstanding Parkinson's disease; attention is drawn to earlier reports of schizophrenic illnesses occurring as.postencephalitic sequelae in the presence of a parkinsonian syndrome. These observations appear to conflict with the view that increased dopamine release in the striatum is necessary for the expression of schizophrenic psychopathology, but do not exclude the possibility that increased transmission may occur at other dopaminergic sites in the brain, for example the nucleus accumbens, tuberculum olfactorium or cerebral cortex. Similarly the dopamine receptor blockade hypothesis of the therapeutic effects of neuroleptic drugs cannot be maintained with respect to an action in the striatum in view of the differences between the actions of thioridazine and chlorpromazine in this structure, but may be tenable for actions at extra-striatal sites.

Cerebrospinal fluid (CSF) cortisol levels were examined in a total group of 65 patients. Those who were not depressed (ND), and those suffering from depressive neuroses (DN) had marginally elevated values. Patients with unipolar depression (UD) and bipolar depression (BD) had levels twice as high as the ND and DN patients. Psychotic UD and BD patients had the highest values, three to four times as high as the ND and DN subjects. A significant reduction of CSF cortisol levels was observed following treatment and recovery. Manic patients had moderately elevated CSF cortisol values. The CSF results were in good agreement with plasma total cortisol levels and with urinary free cortisol excretion. Age and sex effects were not responsible for the observed differences; similar results were found in patient subgroups studied in Australia and in the United States. Preliminary equilibrium dialysis data are presented for plasma and CSF cortisol binding. CSF cortisol was 20% bound and 80% free. Plasma free cortisol levels were in good agreement with CSF free cortisol values. Depressed patients have increased tissue and central nervous system (CNS) exposure to free, physiologically active glucocorticoids. The appearance of severe depressive symptoms which manifest a diurnal rhythm may be determined in part by excessive CNS exposure to glucocorticoids.

Nurses rated schizophrenics, subclassified upon the basis of the presence or absence of electrodermal orienting responses, with Wittenborn scales. Amongst non-institutionalized patients responders, who are more highly aroused psychophysiologically than non-responders, were more manic, anxious, assaultive and attention-demanding. Amongst institutionalized patients skin conductance levels and spontaneous fluctuations were associated with behaviour of a schizophrenic character.

Increases in plasma noradrenaline were found in a group of 12 subjects smoking cigarettes. The associated rises in pulse rate, blood pressure and plasma free fatty acids could be prevented by β-blockade with oxprenolol. This inhibition of the peripheral effects of catecholamines did not affect subjective satisfaction, indicating that central effects or other rewards are more important reinforcers. It is suggested that noradrenaline release in the hypothalamus is the final common pathway to pleasure in many situations, including smoking.

Biochemical studies of manic-depressive psychosis usually correlate biochemical findings with current affective state and hence any significant findings could be secondary to mood change. The present study attempts to correlate measures of the erythrocyte membrane cation carrier with clinical events, remote in time from the biochemical assay.

Erythrocyte sodium concentration, ouabain-sensitive potassium influx and Na-K ATPase were estimated in 11 patients before and after the cross-over point in a 2-year double blind clinical trial of lithium. Patients with the lowest erythrocyte Na-K ATPase and the highest flux sodium ATPase ratio tended to suffer most episodes of affective illness in the 2 years. Patients who had a low initial Na-K ATPase or a high initial flux sodium ATPase ratio, or in whom this ratio fell most with lithium or whose Na-K ATPase rose most with lithium, clinically responded best to lithium.

N1-Methylnicotinamide urinary output is examined in 38 healthy volunteers, 52 patients with secondary affective disorders (SAD), 55 patients with primary affective disorders (PAD) and 46 healthy first-degree relatives of PAD patients. The results indicate (1) that in PAD patients and their first-degree relatives the frequency of low Nl-MN excretion was significantly higher (p < 0001) than in healthy controls and in patients with secondary affective disorders, and (2) that PAD patients have a consistently low N1-MN output, at all times constant and independent of the clinical phases of the disease. These findings provide evidence that the low N1-MN levels may represent an index of a biological background linked to a high morbidity risk for primary affective disorders. The theoretical implications deriving from these data are briefly discussed.

Several so-called ‘non-specific’ or ‘non-drug’ factors are known to interfere with the response to psychotropic drug administration. Animal emotionality has been reported to change the outcome of psychoactive drug administration, so that the response to a stimulant or depressant drug may considerably change according to the baseline state of activity of the central nervous system. Prolonged socio-environmental deprivation or isolation has been shown to produce in rats three different types of abnormal behaviour which have been tentatively defined as ‘friendly’, ‘indifferent’ and ‘muricide’. Such unusual changes in rat behaviour are assumed to reflect a series of different emotional changes. The present experiments show that psychoactive drugs can exert a different effect in relation to the different kinds of animal behaviour used in the experiments. The investigation of the properties of psychoactive compounds, as performed in experimental animals showing behavioural alterations, is then suggested as being more fruitful in providing much information closer to the clinical results than that achieved with the experiments performed in normal laboratory animals.

There is evidence that changes in the concentrations of the monoamine neurotransmitters within the brain are associated with changes in mental processes, with disorders of control of movement and with certain neuropsychiatric diseases. These neurotransmitters are synthesized in the brain from aromatic amino acid precursors that have to be obtained from the circulating blood. In this study some factors which alter the rates of entry of four amino acids (the important neurotransmitter precursors L-tyrosine and L-tryptophan, as well as L-phenylalanine and L-histidine) into the brain have been studied and the findings considered in relation to conditions in which the quantities of one or more of the monoamine neurotransmitters formed within the cerebral cells may be either too large or too small. Thus too little neurotransmitter will be formed if competition between amino acids for the carriers transporting them into the cerebral cells causes the exclusion of a large proportion of any of the aromatic amino acid precursors from the brain. For example, L-tryptophan is partially excluded from the brain if a raised level of any one of several other amino acids is maintained in the circulation. Of these, L-phenylalanine inhibits the transport of L-tryptophan into the brain most effectively, while aromatic amino acids in general exclude L-tryptophan more effectively than do other neutral amino acids.

Over-production of one or more of the monoamine neurotransmitters is likely to occur when there is too much of one of the aromatic amino acid precursors in the brain cells as a result of abnormally high uptake from the blood, or as a result of their release by an excessive breakdown of the protein within these cells. Underproduction of neurotransmitters may occur in certain disease states, such as some aminoacidurias or Parkinsonism. We have listed some conditions associated with altered mental states or motor disability in which over- or under-production of monoamine neurotransmitters may occur and have tried to relate the findings in human disease with our experimental results.

Eleven children with phenylketonuria (PKU) taken off diet after the age of six showed significant decreases in rate of mental development compared with 26 control children of comparable IQ and with 17 PKU children of comparable IQ who remained on the diet. Changes in rate of mental development were significantly and inversely correlated with plasma phenylalanine levels in treated PKU.

The Camberwell Psychiatric Register was searched for contacts by the 2257 women resident in the register catchment area who were known to have had a child in 1970. Of these, 99 women (and 39 of their husbands) were found to have had a ‘new episode’ of psychiatric illness in the two years before or the two years after the birth of their child. The distribution of these ‘new episodes’ relative to the time of childbirth was then studied. In the women, both functional psychoses and depressive illnesses showed a sharp rise in the new episode rate in the three months immediately after delivery. There was also a suggestion of a secondary rise, less dramatic but more sustained, from the 10th to the 24th month after delivery. There was no comparable rise in the husbands. Women whose children were illegitimate had high new episode rates throughout the four-year study period, but not particularly so in the puerperium itself.

An unsuccessful attempt to discover the variation in the time of day chosen for the suicide of 100 consecutive cases is described. The reasons for the failure are discussed.

Independent studies which showed a difference between the EEG frequency spectra of test and control groups have been compared. Some of the test groups included schizophrenic patients, others comprised groups with dyslexia, reading disability and left preference. The EEG differences between the test and control groups are shown to be similar across the studies. It is suggested that the common attribute of the test groups relates to the functional organisation of the brain and that investigation of EEG correlates of this phenomenon may be of value to research into the biological basis of psychiatric illness.

The Isle of Wight Studies began in 1964–65 with a series of epidemiological studies of educational, psychiatric and physical disorders in 9- to 11-year-old children. These early studies were financed by the Department of Education and Science and the Foundation for Child Development (then the Association for the Aid of Crippled Children). The findings were fully reported in two books (Rutter, Tizard & Whitmore, 1970; Rutter, Graham & Yule, 1970) and only brief details are included here.