Last Autumn, the Institute of Psychiatry celebrated its jubilee, that is to say, the fiftieth anniversary of the recognition by the University of London of the Maudsley Hospital as one of its medical schools. Most suitably, the occasion was marked by our acting as hosts to the Royal College of Psychiatrists’ Quarterly Meeting, during which our Chairman, Lord Justice Ormrod, f.r.c.p., gave the College’s annual Maudsley Lecture.

Psychiatric diagnosis in the elderly has been examined in order to extract the information which leads to later modification of the diagnosis. Initial diagnoses of neuroses and toxic states were least stable, 14 out of 29 changing to a different category. Information from relatives and further interviews contributed most to the modification of the initial diagnosis, though affective and neurotic syndromes were particularly susceptible to change resulting from conceptual differences, and dementia to change consequent on physical examination.

It is concluded that an adequate initial interview of a patient and his next of kin will achieve a diagnosiswhich iscorrectin itsmajor categoryon 95 per cent ofoccasions.

Psychiatric problems were assessed in two groups of adoptees by interviewing the adopting parents. One group of 59 adoptees, the ‘experimental’, were born of psychiatrically disturbed biological parents; the other group, the ‘control’ of 54 adoptees, had psychiatrically ‘normal’ biological parents. Both groups had been separated from biological parents at birth.

The incidence of psychiatric conditions requiring professional care was significantly higher in the experimentais than in the controls (37 per cent vs. 14 per cent). In the experimental group more males than females were disturbed (59 per cent vs. 30 per cent). Most of the excess of disordered males were diagnosed hyperactive. There was some evidence of correlation of the type of psychiatric diagnosis of the biological parent with that of the adoptee.

Mental and psychomotor speed scores were obtained for three affectively ill groups of bipolar depression, unipolar depression and bipolar mania, and three corresponding recovered groups.

Comparisons were made among ill groups, among recovered groups, and between ill and recovered groups for each illness type. The following conclusions were drawn:

1. 1. Though manic patients solve problems quicker than those of either depressed group, they do not differ much from normals.

2. 2. With stress to work faster, the patients in the two depressed groups can quicken their speed of work and bring it up to the level of the manic patients, even though the latter also increase their speed.

3. 3. On a psychomotor speed task, the bipolar depressives are significantly slower than the manics and the unipolar depressives, who do not differ. ‘Internal distraction’ causes a slight increase in speed in all three groups, with no significant difference, but ‘external distraction’ speeds up the bipolar groups and slows down the unipolar depressives, resulting in significant differences between the bipolars on the one hand and the unipolars on the other.

4. 4. All recovered groups perform at the same level on all measures.

5. 5. Comparison between ill and recovered groups seems to indicate that a manic illness does not affect mental or psychomotor speed significantly when tested objectively. Unipolar depression also does not seem to affect speed functions very significantly, but bipolar depression does decrease both mental and psychomotor speed significantly. Thus only bipolar depressive patients seem to show true retardation, and manic patients do not show the opposite of retardation.

The basic controversy in criminology at present is that between the psychiatric school and the sociological school. Members of the latter school recognize that psychogenic factors must be taken into account in the explanation of criminal behaviour, and members of the psychiatric school have recognized the importance of social and cultural conditions. But there is disagreement on the extent to which ‘Personality’ and ‘Culture’ should be emphasized in criminological theories.

Of five judges, three have answered in the negative and two in the affirmative the question put to them by the House of Lords in the Mordaunt case, namely whether the insanity of one of the parties in a divorce suit should preclude the other party from going on with this suit. Lady Mordaunt having been pronounced insane, the Divorce judge had decided that the insanity was a bar to the husband’s prosecution of his suit for divorce on the ground of adultery; and this ruling was confirmed by a majority of judges in the full Court. Sir Charles appealed to the House of Lords, which called in the assistance of the judges, who have illustrated their perplexity by delivering elaborate judgements on opposite sides of the question.

The recommendations on postgraduate training made by the World Health Organization, the Nuffield Provincial Hospitals Trust and the Royal Medico-Psychological Association are examined in the light of modern concepts of educational objectives. In this country no well defined, specific, assessable and detailed objectives have yet been formulated for postgraduate training in psychiatry.

For the past decade there has been extensive interest in the hypothesized association between brain amine function and disturbances in mood (either depression or mania). The more influential theories have postulated that clinical depression is associated with a decrease in aminergic function (either norepinephrine, dopamine or serotonin) while mania is associated with increased activity of these amines. This essentially ‘bipolar’ approach has tended to dominate most studies in this area. Evidence supporting these theories has been extensively reviewed (11, 61, 70) and need not be detailed here.

Premenstrual tension (PMT) has hitherto not been accurately defined. The term refers to a cluster of symptoms, both psychological and physical, which appear episodically in relation to the phases of the menstrual cycle—either strictly in the premenstruum (Rees, 1953), or also at other times, such as at ovulation (Dalton, 1964). Most previous studies of the syndrome have been ‘retrospective’, i.e. women have been asked to report the presence of PMT during a previous cycle. McCance, Luff and Widdowson (1937) and Altman, Knowles and Bull (1941), who required their subjects to chart mood state daily, pointed to a discrepancy between the frequency of the condition as reported in studies using retrospective questioning and in their own findings. It is hardly surprising that there is controversy concerning the prevalence of a condition which is so poorly defined as is PMT.

Although psychiatrists trained in the United States and the British Isles pick out the same areas of psychopathology, American psychiatrists display a tendency, greater than British psychiatrists, to use high ratings of pathology when asked to rate a videotaped clinical interview (Kendell et al., 1971; Sharpe et al., 1974). Within the British Isles Maudsley-trained psychiatrists rated lower than psychiatrists trained at other centres (Copeland et al., 1971).

Over the past year the Society has submitted evidence to the Trethowan Committee, the Lane Committee and the D.H.S.S. Committee considering the ethical aspects of behavioural modification programmes. In each instance the evidence has been based on questionnaires or on draft statements amended in the light of members’ invited comments.

Likewise, early draft reports of Study Groups are submitted to all members for comment and rewritten to accommodate views expressed. The Study Group finally passes the Report to the Executive Committee for further amendment or approval prior to distribution as a Study Group Report to all psychiatrists in the British Isles and to members overseas.

This paper reports the initial analysis of a series of observations of a number of depressed patients communicating with their spouses and with a third party. This is part of a larger study which arose out of our dissatisfaction with the traditional ways of thinking about depressed patients. By and large there is general agreement about the people who are called ‘depressed’; there are constellations of symptoms and signs which can be evaluated by using one of the many rating scales for depression which have a degree of reliability and consistency. However, we feel that most of the thinking which underlies these efforts is based on presuppositions which would place ‘the depression’ within the patient, that is to say that there is something wrong within the patient which causes the symptoms and gives rise to the signs. These views are reductionist in character and we have by contrast attempted to reexamine certain aspects of depression using non-reductionist ideas.