Disturbances of ego, self-concept and body-image have always been regarded as central in the psychopathology of schizophrenia. The passivity phenomena, automatisme superieur of the French authors, are indeed very common in this disease. There is a disturbance of the self which is shown in depersonalization and in feelings of influence and passivity. The boundaries of the self become loose or blurred and the patient may feel, for example, that parts of his body do not belong to him or that he is part of the plants, animals, clouds, other people or of the whole world and that they are part of him. He may feel at one with the whole of mankind. Self-concept is closely related to what has been termed “body image” or “perceived body”. Head (29, 30) has shown that what he called “body schema” is very important for motor co-ordination and performance of purposeful movements and also for orientation in space. Schilder (53) in his monograph has analysed the problem of body-image in great detail. He has found in the idea of the body image the basis for the body or physical ego. He follows Head in stating that the body image consists of the proprioceptions of the whole body and that it changes with the body's varying postures. Yet neither Head's body schema nor Schilder's body image are identical with the body ego. The body schema represents the constant mental knowledge of one's body; the body image is the changing presentation of the body in one's mind. Throughout the changes of the body image there is an awareness of continuity of one's body, a sense of basic identity and oneness. This constitutes the bodily or physical ego. The body ego in its turn is the basis of a wider “self” which can be called self-concept or selfhood. This self-concept or selfhood contains, in addition to the awareness of the continuity and the identity of one's own body in spite of its constant change, the awareness of the continuity of one's self as a person in spite of constantly changing relationship with the external world, and in spite of the playing and taking different “roles” in social interactions. According to Mead (38) and Coutu (16), selfhood is a social phenomenon and emerges only through interaction with other people, through “taking their roles” and viewing oneself from their point of view.

The handicap of the single as compared with the married state in respect of the first admission rates to mental hospitals has been demonstrated by several workers. Dayton (1939), Malzberg (1940) and 0degaard (1946), to mention but a few, have all shown that the admission rates for single persons are greater than those for married persons of the same age. Hospital first admission rates for mental disorders are more likely to give reliable estimates of the incidence of mental disease than are hospital rates for other types of illness, nevertheless hospital admissions are but a sample of the sick population in the community and, generally speaking, there is no means of knowing whether or not it is a representative sample of the total sick population. For this reason, in this paper it is only the effect of marital status on the hospital care of the mentally sick that it is to be considered. This appears to be a necessary restriction in view of the fact that the data analysed here relate only to hospital admissions, but ⊘degaard (1946) categorically stated, although his data, too, were derived from mental hospitals:

“It is shown beyond doubt that the incidence of mental disease is much higher in the single than in the married, and that this ‘predominance of the single’ among our insane is no statistical figment caused by such factors as differences in age distribution or in the tendency to hospitalize the insane.”

The purpose of this paper is not to discuss differential admission rates between single and married, although some data will be presented to show that the difference exists here as well as in Scandinavia and the United States, for I have dealt with that problem elsewhere.∗ The very great differences between the first admission rates for single and married persons led me to ask the question: “What other differences arise between single and married persons with respect to mental hospital care?” The data of a statistical study of mental hospital admissions which I have already completed provide some information on this point.

The idea of trying to replace the irregular major fits of epilepsy by convulsions, artificially induced under controlled conditions of time and place, is an eminently reasonable one; but there has so far been no systematic investigation of the therapeutic possibilities of this procedure. The present work, which has been carried out over a period of two years, is intended to clear the ground for such a study; and this report includes an account of the effect of electrical convulsion therapy not only on the frequency of the fits, but also on the psychotic symptoms which were associated with the epilepsy in many of the patients.

Although the clinical tests of sensorium (CTS) are widely used as a quick check of mental efficiency (Slater and Roth, 1969), they have come together in a haphazard way and their validity has been questioned (Shapiro et al., 1956). For example, a patient may be able to perform well on so-called memory tests such as Digit Span and Babcock Sentence and still have a florid memory disturbance (Roth and Hopkins, 1953; Zangwill, 1946).

As a treatment for tardive dyskinesia, sodium valproate was tested in a double-blind placebo-controlled parallel group trial, with 6-week base-line observation period followed by 6 weeks of treatment. Sodium valproate was not found to be an effective treatment for either tardive dyskinesia or drug-induced Parkinsonism, and did not affect mental state or behaviour.

Psychological and social difficulties are common amongst both medical and surgical patients, but psychiatrists are able to see only a very small proportion, and though hospital doctors have the main responsibility for psychological treatment, very little is known of what they actually do. Physicians and surgeons in Oxford answered a questionnaire on their attitudes and clinical practice: virtually all believed that emotional care is important, but what they do and what they would like to do in the assessment, treatment, and referral of their patients varied widely. There were associations with the extent of responsibility for chronic care, speciality, and seniority.

Severity of psychiatric illness was assessed using standardised clinical and social measures in 69 in-patients and 41 day patients admitted consecutively from the community. Day and in-patients differed little in terms of psychiatric symptoms and social disability, especially if compulsory admissions were excluded. Protection of self or others was a common reason for in-patient admission given by clinicians, who were otherwise prepared to treat seriously ill patients in the day hospital. Very few of the day patients had to be transferred to the in-patient facility, and at three months and one year the two groups showed similar improvements. It is concluded that day treatment is feasible for some seriously ill psychiatric patients, but a random-allocation study is required to assess more completely the efficacy of day treatment, and define the characteristics of those who require in-patient admission.

Forty-three patients with non-endogenous depressive disorders were assessed shortly after psychiatric referral, and reassessed at six and at 20 weeks. The pattern of improvement appeared to be set shortly after the initial consultation, but could be most clearly predicted by the degree of improvement at the end of the third week. Key baseline factors predicting a more marked improvement at each follow-up were a more severe depression, the break-up of an intimate relationship, and the presence of weight loss. Positive life events occuring after the initial assessment predicted improvement at six and at 20 weeks, while the presence of a neutralising event (which negated an earlier threatening life event) predicted improvement at 20 weeks.

Fifteen children who developed anorexia nervosa aged 13 years or less were followed up at least three years later (mean 5.3 years). Outcome measures included the Morgan & Russell Outcome Schedule and the PSE. The general outcome was good in seven, intermediate in four, and poor in four, one of whom had died. A high incidence of psychiatric symptoms at follow-up, which has been suggested in other studies, was not confirmed in the 11 subjects who completed the PSE. Where onset was very early (11 years and under) and where hospital stay was prolonged, outcome tended to be poor.

Headache sufferers (n = 30) reported significantly more immediate family members with headache, compared to controls (n = 22). Sensitivity, specificity, and efficiency analyses revealed that knowledge of family headache history has predictive value. The results are consistent with findings with other pain disorders.

A comparison was made of the social and domestic background, prepsychotic personality and symptomatology of deaf (‘hard of hearing’) and non-deaf patients aged 50 or over with paranoid or affective psychoses. The deaf patients were found to be a very heterogeneous group in respect of age of onset, duration, severity and pathological basis of their deafness, but there was a substantial subgroup of paranoid patients with deafness beginning before the age of 45 in whom the personality appeared to have been less deviating than in the remainder. It was thought that the deafness in this subgroup had possibly played a relatively specific role in causing the psychosis. Some problems in identifying deafness and assessing its significance are discussed.

“Very early schizophrenia still constitutes a relatively unexplored territory. Entry into this territory calls for new ideas on the social problems involved in bringing the early schizophrenic promptly under treatment, or where the treatment should be carried out and in what it should consist.” D. Ewen Cameron (1938)

This study investigated the validity of the Fould & Bedford hierarchical model of psychiatric illness, as compared to hierarchical models based upon prevalence and severity of disorder. The DSSI was administered to 52 American psychiatric in-patients with severe disturbances. The reports of symptoms in this sample conformed to the Foulds hierarchy in 90% of cases, while 94% of cases conformed to a model based upon prevalence. When a cross-method validation was investigated, the Foulds & Bedford classification demonstrated good discriminative capacity, while models based upon prevalence and severity failed to achieve significance. These results suggest that the Foulds & Bedford model is a useful taxonomy of symptomatology in psychiatric illness.

Social interactions are fundamental for human development, and disordered social interactions are pervasive in many psychiatric disorders. Recent advances in ‘two-person neuroscience’ have provided new tools for characterising social interactions. Accordingly, interaction-based ‘sociometrics’ hold great promise for developmental psychology and psychiatry, particularly in the early identification of social disorders.

Guidelines for good medical practice do not reflect the complex reality of the ethical problems that arise in prison. Perhaps the best a doctor working in prison can do is realise that there are ethical dilemmas everywhere, try to recognise them and feel the tension.

Gender inequality and discrimination, as well as violence and victimisation towards women, have recently hit the headlines creating a media furore. We provide a timely discussion surrounding the impact of these issues on women's mental health and a discussion of the role of psychiatry in this context.