Psychiatrists have for long paid attention to mental illness in different communities and cultures. In Java, Kraepelin noted that melancholia and mania were rare and that depressive reactions rarely contained elements of sinfulness (9). Later, Bleuler commented upon differences between English and Irish patients and between Bavarian and Saxon patients (2). Others have described various “culture-bound” syndromes such as amok, the windigo psychosis of the Cree, Salteaux and Ojibwa, latah and Arctic hysteria (23, 5, 8, 11, 26). More recently Tooth has described a special category of “delusional” states in West Africans while Carothers has reported on “ill-defined” states and “primitive” psychoses among the West Africans (22, 4). Other workers have stressed the significance of cultural factors in the distribution of mental illness. Seligman noted in 1929 that confusional states were more common than systematized insanities among the Papuans of New Guinea and could not find any cases of manic depressive illness (17). Berne noted that toxic confusional psychoses rather than the schizophrenias were the predominant illness among hospitalized Malay (1). Carothers related Westernization to an increase in manifest paranoid behaviour among patients in Kenya (4). Similarly Spiro noted that the Ifaluk in the Carolines had violent paranoid outbursts only after Japanese occupation and Slotkin emphasized the paranoid schizophrenia phenomena among acculturated Menomini (20, 19). Opler found that lower class Filipinos had a high proportion of affective disorders and catatonic confusional states among the Hawaiian hospitalized, while Carothers and Tooth in Africa both found statistically low incidences of depression and suicidal states with relatively high rates of confusional states among African natives (13, 4, 22).

Behaviour therapy is defined as the application of the principles of modern learning theory to the treatment of neurotic disorders (Eysenck, 1960a, 1963). It defines neurotic “symptoms” as unadaptive conditioned autonomic responses, or the skeletal and muscular activities instrumental in moderating these conditioned autonomic responses. Treatment consists essentially in the extinction of autonomic, skeletal and muscular responses of this type. This extinction may be produced in a great variety of ways, but experience has shown that the most useful and important is probably the method of counterconditioning or “reciprocal inhibition” (Wolpe, 1958). This method takes two forms, according to the nature of the symptom. (1) When the symptom is of a dysthymic character (anxieties, phobias, depression, obsessive-compulsive reactions, etc.) it is assumed that the disorder consists of conditioned sympathetic reactions, and the treatment consists of reconditioning the stimulus (or stimuli) to produce parasympathetic reactions which, being antagonistic to the sympathetic ones, will weaken and finally extinguish them. These disorders we will here call “disorders of the first kind”. (2) When the symptom is of a socially disapproved type in which the conditioned stimulus evokes parasympathetic responses (alcoholism, fetishism, homosexuality), or where there is an entire absence of an appropriate conditioned response (enuresis, psychopathic behaviour), treatment (aversion therapy) consists of the pairing of the stimulus in question with strong aversive stimuli producing sympathetic reactions. These disorders we will call “disorders of the second kind”. (In putting the distinction between these two types of treatment in this very abbreviated form, we have used the terms “sympathetic” and “parasympathetic” in a rather inexact shorthand notation to refer to hedonically positive and negative experiences respectively; the reader familiar with the complexities of autonomic reactions will no doubt be able to translate these blanket statements into more precise language appropriate to each individual case. We have retained this use of the terms here because it aids in the general description given, and indicates the physiological basis assumed to exist for the hedonic reactions.)

In the investigation of prognostic factors relevant to remission in schizophrenia little attention has been paid to positive heredity for affective psychosis. One result of this relative disinterest has been to foster the opinion that heredity is of no prognostic value. Although his own work (8) supports the assumption that manic-depressive heredity is of good prognostic import in schizophrenia, Langfeldt (8) cautions:

Attempted suicide has been described as the prime emergency of general practice. Although this may represent a slightly exaggerated claim, the present writers have certainly found attempted suicide to be a frequent reason for the referral of patients to the psychiatric department of a general hospital. The expression “attempted suicide” is usually taken to refer to an unsuccessful attempt to kill oneself: yet such a description is often somewhat inappropriate to describe a dramatic episode of behaviour, during which an assault upon the self occurs as the result of a mood of despair or rage. Death may not be consciously sought and it is more satisfactory to define attempted suicide as a non-fatal act of self-damage.

There are a number of established forms of treatment for neurotic symptoms. In some patients symptoms are relieved by drugs which control anxiety, in others by antidepressant drugs (Sargant and Dally, 1962), still others appear to respond to some form of individual or group psychotherapy. More recently behaviour therapy has been introduced, and there are now a number of reports which claim that it is successful in a variety of neurotic disorders (Eysenck, 1960a).

In 1879 Sturge described a patient with hemiparesis, epilepsy and a facial naevus. He ascribed the neurological condition to a naevus of the brain similar to that on the patient's face. Weber gained the distinction of providing the other half of the eponym by describing the radiological appearances of a similar case. In 1955, however, he advanced the self-effacing descriptive term “encephalofacial angiomatosis”. The essential pathological features of the disorder are facial naevus and leptomeningeal angiomatosis. It is generally agreed that buphthalmos (present in Sturge's original case) is not a necessary component.

Cross, Harrington and Mayer-Gross (1957), in a survey of the long-stay population of a Birmingham mental hospital, came to the conclusion that “only very small proportions required constant vigilance and about two-thirds required routine care only…. The large majority of patients were ambulant the whole day” but almost one-third had physical diseases of some kind. The major problem was the “large number of passive, indolent and harmless chronic schizophrenics”. The authors specifically made the point that, “to avoid chronicity and utilize every sign of improved behaviour and better adaptation which may lead to discharge, well-trained nursing staff and specialized knowledge is as much needed as in the treatment of earlier patients”.

Many experiments have been reported suggesting that the serum of schizophrenic patients differs in some way from the serum of non-schizophrenic subjects, either in respect of some specific constituent or of the alterations in function which it can produce when added to various biological systems (Heath, 1957; Walaszek, 1960; Bergen, Koella, Czicman and Hoagland, 1961). These reports suggest that schizophrenia is a pathological mental condition resulting from some disorder of metabolism or of biochemical processes, and it would be logical to expect that this disorder would be most manifest as a disturbance of the neurological activity in the cerebrum—perhaps more specifically in the cerebral cortex—since the clinical picture in schizophrenia is primarily one of gross derangement of the processes of perception, attention and thinking.

The investigation reported compares a group of patients in whom the onset of psychiatric illness was associated with acute environmental stress with another group of patients of similar age and sex in whom no such precipitating stresses were found. The aims were to see what differences, if any, were apparent between the two groups.

Scientific interest in Antarctica has increased greatly since the inception of the International Geophysical Year, but relatively little attention has so far been paid to psychological aspects of adjustment amongst personnel.

Penrose (1935), in describing the first British patients with phenylketonuria, noted in their unaffected relatives a high incidence of paranoid illness in later life, and suggested that the heterozygous state might predispose to such breakdown. The 47 phenylketonuric families reported by Munro (1947) showed in unaffected relatives a similar high incidence of psychotic illness, which he (Munro, 1957) categorized as endogenous depression with paranoid features.

Depersonalization has been so frequently reported in connection with incipient schizophrenia that some diagnosticians have regarded it as a pathognomonic sign of schizophrenia. More generally, however, it is regarded as a non-specific psychiatric syndrome since it has been reported in a variety of psychotic, neurotic and neurological disturbances (Ackner, 1954).

Slowly but surely the emphasis of the mental health service is moving from the mental hospital into the community which it serves. The trend of these community developments can be seen as far back as the establishment of psychiatric out-patient clinics at general hospitals under the Mental Treatment Act, 1930, together with arrangements for after care, and continued by mental hospitals and regional hospital boards since the advent of the National Health Service. While the new era in British psychiatry awaits the implementation by local health authorities of their mandatory functions under the Mental Health Act, 1959, much can still be done within the hospital services proper to shift the emphasis into the community. One such method is described in this study of a Day Hospital developed within a large general hospital.

Depressive states have long been classified by various dichotomies into reactive versus endogenous, agitated versus retarded and neurotic versus psychotic. The reactive-endogenous dichotomy is an aetiological classification, whereas the agitated-retarded and neurotic-psychotic divisions are symptomatological ones. It is generally considered that there is much correlation between these different classifications, although it is agreed that there may be some overlapping and various points of difference.

In the Children's Department of the Maudsley Hospital an “Item Sheet” is routinely completed in respect of each child who attends. The items on this sheet (or “check-list”) cover a wide range of possible features in a child's personality, history, background and environment, as well as in his psychological and physical condition, and symptomatology.

A number of samples of these Item Sheets have been submitted to statistical analysis, with a view to identifying any common factors that may be present in the case data they summarize. The various samples have been arrived at according to age and sex of the children concerned. An earlier paper (1) has described the results of this procedure in respect of two such samples, boys and girls between eight and ten years of age. A subsequent paper will give an account of the results in respect of thirteen to fifteen year olds. The present report gives the results that emerged for the younger ages of referral to the clinic, boys and girls between approximately five and seven years of age.

The facilities for dealing with the psychiatric patient who presents at the Casualty Department leave much to be desired.

The extent and nature of this problem is shown by the following study, in which one Junior Casualty Officer, who received 1,224 patients presenting with a new complaint over a period of three months, recorded the number of cases which he considered to be suffering from a primarily psychiatric condition. This amounted to 82 (6.6 per cent.), and, allowing for the fact that he was one of three Casualty Officers performing identical duties, this means that 984 such patients can be expected in the year. This is double the number of new cases referred to the Psychiatric Out-Patient clinic of this same hospital.

It is claimed that there is an association between the occurrence of depersonalization and obsessional personality (Mayer-Gross, Slater and Roth, 1960). The above authors in their textbook quote Shorvon (1946), who found that in his sixty-six cases of depersonalization (forty-six female, twenty male, with an age of onset distribution of twenty under 20 years, thirty between 20 and 30 years, sixteen between 30 and 40 years), no less than 88 per cent. showed obsessional traits in their personalities. Shorvon excluded involutional depression and severe psychotics from his case material. Mayer-Gross commenting on the above paper stated, “While obsessional personalities are preponderant among his cases, he apparently only included a few cases of cyclothymic temperament. In the latter this symptom is frequent, in fact one-third of my own patients were of this type.” He (1935) had in fact drawn attention to the relatively large numbers of extraverted hypomanic characters, who were subject to depersonalization (one-third of his twenty-six cases), but he also found seven out of twenty-six with obsessional personality. (Mayer-Gross found a striking uniformity of age at the beginning of the syndrome, average 26.6 years, distribution two under 20, eighteen between 20 and 30, six between 30 and 40 and a preponderance of women, twenty out of twenty-six.) On the other hand Anderson (1936) found an incidence of 30 per cent. of depersonalization in a series of fifty cases of depression of later life, drawing attention to the often-remarked upon association between depersonalization and depression.

Various authors have reported that alterations in urine volume are associated with alterations in urinary adrenaline and noradrenaline output. (Perman 1961 and Leroy and de Schaepdryver 1961. Weil-Malherbe and Ström-Olsen (1958) reported alterations in urinary adrenaline and noradrenaline excretion associated with mood changes in a group of patients with manic-depressive psychosis. In three of the patients studied, there was also during the manic phase an increased urine volume.

Kuwait, the country with the world's highest per capita income,∗ has a population of roughly 325,000, of whom only half are ethnically Kuwaiti. The original settlers left the Nejd in Central Arabia about 1710 because of a severe drought, and after wandering about for several years with their herds and flocks eventually settled at the head of the Persian Gulf. The country they founded, about the size of Northern Ireland or of the State of New Jersey, is wedged in between Iraq and Saudi Arabia. Next to the Kuwaiti, the second largest group of inhabitants is the Bedouins who “are recognizable by their particular Arabic accent, their characteristic smell, and their long hair and beard”, according to a resident of Kuwait City. The Bedouin women can also be recognized easily because the black “thaub” which covers them completely from head to foot is made of solid cloth with narrow slits for the eyes, whereas the “thaub” of the Kuwaiti women has a black veil built into it.

The use of amphetamine and its analogues as stimulants and for the control of appetite in the obese is well known. It is not so widely appreciated that they can produce both acute psychiatric disturbances and addiction. In spite of various publications drawing attention to amphetamine psychoses, the frequency of such states does not yet seem to be widely recognized, even among psychiatrists. Scant attention has been paid to the less alarming effects of these drugs, yet they cause a con siderable amount of ill-health. Addiction occurs and patients will go to great lengths to maintain their supplies.