Electroshock therapy, first introduced to this country by Fleming, Golla and Grey Walter in 1939, has long passed its period of probation and is now universally accepted as active and effective. Yet its mode of action is still unknown. The variety of theories propounded to explain its action establishes only the degree of our uncertainty. To advance our knowledge of its mode of action has been the aim of the work described in this paper.

It is a well-known principle in psychology that the effects of sensory stimulation do not cease when the stimulus itself ceases. The so-called visual after-images are probably the best known of these after-effects, but almost equally well known are those induced by a rotating spiral. If a normal person fixates the centre of the rotating spiral for a period of time, and if then the motion of this spiral is suddenly stopped, an after-sensation of movement is well nigh universal. This after-sensation is opposite to the original motion in direction, just as the after-image produced by the fixation of a colour is usually the complementary colour to that which caused the original perception. There is little doubt that while peripheral factors play some part in these after-effects, central features also play a part, and it becomes tempting, therefore, to use phenomena of this type in attempts to verify or disprove the drug action hypotheses advanced by one of us in a previous paper. This hypothesis stated that stimulant drugs increased excitatory potential and decreased inhibitory potential, while depressant drugs decreased excitatory potential and increased inhibitory potential. The question now arises as to how this general postulate can be applied to the phenomena under discussion.

The relationship between mental disorders and diabetes is studied as shown by 30 cases of mental disorder associated with diabetes, 93 cases of uncomplicated diabetes and 400 uncomplicated cases of mental disorder. This study covers, first, the psychological picture in diabetes; second, the types and courses of mental disorder associated with diabetes; and third, the mental symptoms with hypoglycæmia.

The purpose of this survey was to assess the intellectual and social status of 150 children of 73 certified mental defectives. It is proposed to discuss the mothers in this paper and the children in a further one. The mothers in this group were all at one time patients at the Fountain Hospital. Much of the initial work was done by Mrs. L. Mundy, the Senior Psychologist, who had already tested most of the mothers, and Miss Kerry, the social worker, who had maintained contact with many of the discharged mothers and their children. One of the main factors which have made the research easier has been the general good feeling towards the Fountain felt by our ex-patients. They want the Fountain in general and the Physician Superintendent in particular to know how they are and what they are doing. Dr. Hilliard's “somewhatunorthodox procedure with difficult cases” (1956) and his views on feeblemindedness have now become fairly generally accepted. His view that many of these women can work successfully in the community has been substantiated already. It is hoped that this survey will help to avoid the inhuman and expensive administration process whereby an allegedly feebleminded mother is permanently separated from her child.

Adolf Meyer writes, “In the end our task is the amplification and specification of the complaint, expressed in the most factual objective and potent terms”. Robert Hutchison also emphasizes the importance of the complaint when he stresses the presenting symptom in his treatment of medicine. A patient always comes to his physician with some complaint, which it is the duty of the physician to investigate and treat. In the majority of cases the complaint is a bodily one; the patient goes to his physician complaining of an ache or pain or some other bodily discomfort. This bodily complaint may or may not be due to some physical illness. In Sir Walter Langdon Brown's words, “Some are unhappy through illness, some are ill through unhappiness”. This paper deals with those patients who have bodily complaints for which no adequate physical basis can be found. This condition is now known as hypochondriasis.

The growing adoption of ECT given unilaterally to the right hemisphere in right-handed patients, in preference to the classical bilateral treatment, is due to its shortening of the duration of post-treatment confusion, to its superiority in preserving memory and learning assessed three months after the start of treatment (Halliday et al., 1968) and to its therapeutic equivalence. (For a critical assessment of published results, see d'Elia, 1970.)

Although pure word deafness (p.w.d.) is a well-defined clinical picture it usually occurs as part of a more complex syndrome. Almost invariably there is some degree of aphasia and as a rule other auditory disturbances, such as imperception of specific sounds including musical tones, also occur. These associated symptoms tend to diminish or even disappear in time while the deafness for word sounds usually persists in its initial intensity. In the case we describe most of the associated symptoms, especially the aphasia, soon abated leaving an almost pure word deafness. Subsequently this too improved slowly and because of the partial recovery we were able to obtain data which are rarely available in these cases.

In a case control study, 32 onset cases of depression, separated into PSE-CATEGO Categories N and R, were compared with individually matched symptom free general practice attenders. Combining both categories of depressives together a significantly greater number reported an Undesirable Life Event and a Threatening Life Event in the six months prior to onset, compared with their matched controls. Significantly more CATEGO R (retarded or endogenous) depressives reported an Independent Threatening event than their matched controls. These findings do not support the view that depression secondary to a major life event is more likely to be mild in character.

In 1955 an epidemic occurred among the staff of a London Teaching Hospital group. The nature of the epidemic remains uncertain. One view is that the illness was a viral encephalomyelitis (Medical Staff Report, 1957); an alternative is that it was a manifestation of anxiety spreading through a population consisting largely of young women (McEvedy and Beard, 1970). This paper reports the results from the follow-up study carried out in 1968–69 on the nuclear group affected by the epidemic and on a matched series of controls.

A review of all known schizophrenics (n = 142) in Nithsdale, Scotland, found 50% were living with relatives or friends. Of these, 32% had high contact with a relative showing high expressed emotion (EE); put another way, 87% of all Nithsdale schizophrenics were not living in a high contact/high EE family. Parents were more critical than spouses, and more showed emotional over-involvement. A retrospective review showed a trend, not of statistical significance, towards a higher admission rate to in-patient care in patients from high EE homes. Of relatives believed by a consultant psychiatrist to be neither critical nor hostile, 80% fell into the low EE category, but only 44% thought hostile or critical belonged to the high EE category; that is, the clinician had a wider view of high EE than the Camberwell Family Interview. Relatives' scores on a short patient-rejection scale were higher in high EE than in low EE relatives, but the wide scatter of scores suggested the scale could not be used to identify an individual relative with high EE.

There is evidence that dependence can develop to tranquillizers and that they can cause states of physical dependence similar to those obtained with barbiturates. Withdrawal manifestations are usually less severe and of shorter duration. They include agitation, restlessness, tremor, muscle twitching, insomnia, anxiety, depression and confusional states with disorientation. After high doses hallucinations, delirium and convulsions can occur.

The Survey Psychiatric Assessment Schedule (SPAS) was used in a survey of elderly people living at home and in institutions to examine its reliability in determining mental state. A psychiatrist assessed the same subjects using the Geriatric Mental State Schedule (GMSS) and classified psychiatric disorder into three broad groups: organic disorders, schizophrenia and paranoid disorders, and affective disorders and psychoneuroses. The agreement between the psychiatrist's classification of mental state and the classification derived from SPAS was found to be satisfactory for organic disorders and less satisfactory for functional disorders. The limitations of this method of identifying psychiatric illness are examined.

Differences in the clinical characteristics of clients have not been found to account for the interprofessional differences in community psychiatric nurses' and mental health social workers' practice in Salford. We found the consultant-attached mental health social workers, who worked closely with the specialist psychiatric team and who received supportive supervision from their professional managers, maintained stable case-loads, but the primary-care attached community psychiatric nurses, who were isolated from the specialist psychiatric team, and who received little supportive supervision from their professional managers, carried case-loads of increasing size. Failure to improve the way in which services for the mentally ill in the community are co-ordinated is likely to perpetuate the worst characteristics of life in the old back wards into the era of ‘community care’.

Thirty-six patients with infantile autism and various neurological disorders underwent computerized tomographic (CT) scanning of the brain. All CT scans were assessed blindly and independently by a diagnostic radiologist. Two techniques modified from two previous studies were used for measuring parieto-occipital asymmetry. The frequency of reversed asymmetry in autistic patients was the same as that in patients with various neurological disorders, and there was no significant association between reversed asymmetry and delayed language development. The study does not support the concept that unfavourable morphological asymmetries of the brain near the posterior language zone may contribute to the difficulties autistic children experience in acquiring language. Methodological difficulties and the design of new studies are discussed.

In determining the diagnostic value of psychological tests the usual external criterion is the psychiatric diagnosis. This criterion has suffered a steady decline in prestige among both psychiatrists and psychologists. The following remarks by Noyes (1953) would be endorsed by many psychiatrists: “The principal value of classification is not in the categorizing of a disease entity but in quickly eliminating those considerations which will be least useful in understanding the patient and in directing attention to those which are likely to be relevant. Except in organic disorders a classificatory diagnosis is less important than a psychodynamic study of the personality. The psychiatrist should be interested in processes, not in labels … we should endeavour not so much to fit the symptoms into a classificatory scheme as to understand the sick person in terms of his life experience.”