Nineteenth-century theories of human volition are discussed in relation to ideas on insanity and responsibility. Attention is drawn to the importance of accounts of volition for medical psychologists and to the implications of these accounts for medical and lay discussion of criminal responsibility.

The concept of mental illness is explored by noting its connections with other concepts, such as deviance, social maladjustment and morbidity. It is fitted to patients from some of the chief categories into which they are classified by psychiatrists. The objection that the concept is one of value is examined and deflated.

Food intake, appetite and a variety of feelings were measured pre- and post-operatively in obese patients undergoing jejuno—ileal bypass surgery. Decreased food intake correlated closely with the amount of weight loss at both 4 and 30 months after surgery. Malabsorption correlated with weight loss at 4 months but not 30 months post-operatively. The cause of the decreased food intake is unknown and cannot be completely explained by either depression, nausea, malabsorption, liver disease, an attempt to avert diarrhoea, or decreased appetite.

Twenty-one patients on The Royal Free Hospital dialysis programme and 21 control subjects were examined using the Semantic Differential. Results were analysed by the method of check-style analysis and by a comparison of concept profiles for the 2 groups using a multivariate analysis program.

A highly significant difference (p < 0·001) was found between the check-styles of dialysis and control groups. The implications of this finding are discussed.

Three concepts were selected for particular study: ‘my self’, ‘my ideal self’ and ‘people’. There were significant differences in profiles between the 2 groups on all 3 concepts.

Subgroup analysis showed further differences for sex, age and length of time on dialysis.

Eighty-three chronic obstructive bronchitic patients were psychologically assessed before being randomly allocated to 1 of 3 management regimes. The following measures were taken: psychiatric disturbance, personality, social-desirability response set, vocabulary, expectations about treatment, attitudes and beliefs about bronchitis, effect of patient's bronchitis on the family, work, self, physical exercise, smoking, and general health. Outcome was assessed after one month and again one year later, and the measures included physiological tests of lung functioning, an exercise tolerance test, reported symptoms, time off work, drop-out, and death.

Contrary to expectations, it was found that psychological variables had some prognostic significance for outcome assessed by medical measures of illness severity. More important was the finding that, in bronchitics under retiring age, weeks off work during the year of the study could be predicted by psychological variables but not by physiological measures of illness severity.

The concept of psychophysiologic disorders and the major theories invented to account for such disorders are critically reviewed. The Irritable Bowel Syndrome (IBS) serves to illustrate the application of each theory and provides a vehicle for their appraisal. The tendency to think of ‘physical’ and ‘psychological’ as separate entities rather than separate languages has led to attempts to make a categorical distinction between disorders caused by ‘psychological’ factors and those caused by ‘physical’ factors. Some of the theories developed to account for psychophysiologic disorders are unscientific and none can adequately account for all the features of IBS. It is concluded that the concept of psychophysiologic or psychosomatic disorder is outmoded.

A review of psychological contributions to cancer research is presented and a theoretical framework of heuristic value for such investigations is suggested. The author's study of women with breast cancer is described and methodological limitations are considered. There is evidence that psychological and psychobiological studies can make a useful contribution to cancer research, providing they are based on rigorous scientific methods.

Eight definitions of schizo-affective psychosis have been compared in a sample of psychotic first admissions. Their mutual concordance is very low (mean 0·19) showing that there is very poor agreement about the meaning of the term ‘schizo-affective’ at present. Ten patients (4·5 % of admissions and 8 % of psychotic admissions within the age group studied) satisfied 3 definitions, a figure which demonstrates the numerical importance of this group of unclassified mental disorders.

Skin conductance responses to a series of tones were measured in 41 patients during an acute episode of schizophrenia before they received treatment and after 4 weeks of treatment with either α-flupenthixol, β-fiupenthixol or placebo. Patients who did not habituate to the tones prior to treatment tended to show no symptomatic improvement during the course of treatment. Patients who habituated and also showed an acute onset of their current symptoms (‘Feighner negative’ patients) showed a marked improvement even without active medication. Skin conductance responsivity did not change with improvement in symptoms alone, but decreased in patients on active medication (α-flupenthixol).

Non-habituation of skin conductance and insidious onset (i.e. fulfilment of the Feighner criteria) were found to be independent predictors of poor outcome. Taken together, these criteria may define a group of patients with particularly poor prognosis.

It is suggested that, if depressed patients have deficient noradrenergic function at central α-adrenergic receptors, then they will also have impaired corticosteroid responses to methylamphetamine but unaltered growth hormone responses. This prediction has been confirmed when the responses of a group of patients with endogenous depression were compared with the responses of a group of patients with other functional psychoses, a group of patients with reactive depression, and a group of patients with other psychiatric diagnoses. These findings support the hypothesis that there is a functional deficiency of noradrenaline at some central α-adrenergic receptors.

Multicompartmental studies of tyrosine in patients suffering from affective disorders and controls gave estimates of 2 major pools of amino acid, together with the associated fractional clearance rates and fluxes. The 2 pools were considered provisionally to represent extracellular and intracellular tyrosine.

The multiaxial diagnostic model, consisting in the systematic formulation of a patient's condition according to separate clinical variables or aspects, is receiving increasing attention in several parts of the world. This innovative model promises to improve diagnostic reliability and validity and involves many methodological challenges. This paper reviews patterns and issues in the conceptualization of axial content, number and organization of axes, dimensional versus categorical scaling, and evaluation and further development of multiaxial systems.

This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.

The Leyton Obsessional Inventory gives both an indication of the range of obsessional symptoms present and the degree of resistance and interference associated with each symptom. A new method is described in which the covariation of resistance and interference is represented in the form of a matrix. The results, using this method, can give a unique picture of the quality of the patient's symptoms from the clinical standpoint and provide useful guidelines for treatment and follow up. Automatic data-processing is offered for the convenience of clinicians and researchers wishing to utilize the test in this form.

A consecutive series of 90 admissions of functional patients was examined with the Present State Examination (PSE). Based primarily on PSE findings together with previously published diagnostic criteria, we identified 11 clear or index cases of schizophrenia, 12 of affective psychoses, and 12 of neurotic/personality disorders. All patients were given daily 2 analogue scales, one measuring mood and the other alertness. Among the index cases, the depressives were distinguished by low scores on both scales and the manics by high scores. There was little overlap in the distribution of the scores among the diagnostic groups, suggesting that these scales might be effective psychological markers of clear affective versus clear non-affective functional disorders.

Among the undiagnosed cases, those with low or high scores on both scales resembled index affectives phenomenologically, clinically, and demographically. The scores of the ‘affective-like’ patients overlapped little with those of the ‘non-affective-like’ patients. The scales therefore might be practical diagnostic aids.

Seventy-nine junior psychiatrists at the Maudsley Hospital answered 16 biographical questions and a 68-item questionnaire measuring attitudes to the psychoanalytical, biological, social, behavioural, and anti-medical models of mental illness. The psychoanalytical model was the most clearly defined and its adherents the most dogmatic, while those supporting the social model were the most eclectic. Sex, social class, education and political sympathy proved a poor guide to the orientation of the respondent. Individuals who had decided on a career in psychiatry before entering medical school were the most critical of the biological model. Biologically minded psychiatrists were older and, in contrast to Kreitman's findings, there was a shift from a psychoanalytical to a biological preference with increasing psychiatric experience. The importance of scientific attitudes in psychiatry was endorsed by biologically and behaviourally inclined psychiatrists but denigrated by supporters of the analytical approach. Adherents of the psychoanalytical model had as many academic qualifications as the biologically inclined, but had fewer publications and were less active in research. It appears that interest in psychoanalysis is antipathetic to the development of scientific attitudes conducive to research.

A distinction is drawn between ‘diagnostic decisions’ and ‘management (or treatment) decisions’, and a model for the process of making a management decision is suggested.

Evidence is reviewed which suggests that psychiatric diagnosis does not strongly predict treatment, and an extension of diagnosis, the problem oriented approach, is advocated.