It is a common clinical observation that schizophrenic subjects often exhibit abnormalities of verbal behaviour in both the spoken and the written modes. Such abnormalities may range from minor idiosyncrasy to gross linguistic deviance. Where the linguistic deviance is very obvious, this of itself may carry considerable diagnostic weight in the overall schizophrenic symptomatology. In general, two main questions have been asked concerning this phenomenon: (a) why do schizophrenics produce abnormal language?; (b) what precisely is the linguistic characteristic of the abnormality? For mainly historical reasons it has been the first question which until relatively recently has received the most attention. The past twenty years or so have seen a remarkable advance in linguistics and its vigorous hybrid, psycholinguistics, without which present attempts to analyse and quantify language deviance would have been impossible. All of this is relevant to question (b). Since the beginning of this century, however, psychodynamic models and theories have afforded sufficient frameworks for speculation over question (a).

Psychotherapists tend to view homosexuality as a neurosis or as a neurotic symptom (Sadger, 1909, 1921; Klein, 1932; Rado, 1940; Ellis, 1952, 1955; Bieber et al., 1962; Ovesey et al., 1963). In support of this viewpoint, several authors have observed that the frequency of typical neurotic phenomena in homosexual males is much higher than that in a heterosexual male population, and have concluded that homosexuality is one of the neurotic symptoms of their patients (Stekel, 1929; Henry, 1937; Ellis, 1959; Musaph, 1960; Doidge and Holtzman, 1960). However, an alternative interpretation is that such maladaptive patterns develop from the difficult situation of a homosexual male in a heterosexual society and from the general disapproval he encounters. Moreover, the finding of increased prevalence of neurotic symptoms in homosexual males has itself been challenged by Kronfeld (1923) and Hooker (1957), who pointed out that the investigated homosexual males represented a selection of people who sought psychiatric help. Hooker studied non-patient samples from homosexuals' clubs and did not find an abnormally high frequency of neurotic symptoms.

Psychiatrists differentiate types of abnormal personality in practice by assigning a descriptive label to indicate the chief way in which the patient's behaviour deviates from what is usual in society. The use by psychiatrists of such a category system for diagnosing abnormal personality has been discussed in two previous papers (Walton et al., 1970; Walton and Presly, 1973). The diagnostic system evaluated was one which included categories contained in the American Psychiatric Association classification (1968) and in the relevant section of the International Classification of Diseases (1965).

Among the various methods of assessing morbid anxiety the psychiatric interview remains pre-eminent. By this means, we attempt to elicit what patients actually feel—the criterion against which all other measurements are validated. Dissatisfaction with the subjective nature of psychiatric interviews and with their low reliability (Cattell and Scheier, 1958; Kreitman, Sainsbury, Morrissey, Towers, and Scrivener, 1961) has led, on the one hand, to the use of rating scales which quantify subjective clinical judgements (Kellner, Kelly and Sheffield, 1968), and, on the other, to the development of techniques which purport to measure anxiety objectively. The latter fall into two broad categories: (i) questionnaires such as the Manifest Anxiety Scale (Taylor, 1953) and the IPAT Anxiety Scale (Cattell and Scheier, 1963), and (ii) measurements of somatic correlates of anxiety, in particular the various endocrine and physiological responses reviewed by Mason (1968) and Lader (1969), respectively.

Brook (1973) in his report on ‘Psychiatrists in Training’ discovered that three-fifths of 150 doctors in training grades in three representative Hospital Regions in England had graduated overseas. At the present time the Department's figures (30 September 1971) show that 54 per cent (498) of all trainee psychiatrists (Senior Registrar, Registrar, Senior House Officer and House Officer) out of a total of 920 are overseas-born. The vast majority of these doctors come from India and Pakistan, lesser numbers from Ceylon, Malaysia, Singapore, the Middle Eastern countries and Bangladesh. Brook's report, as well as that by Russell and Walton, entitled ‘The Training of Psychiatrists’ (1970), are valuable documents that help one to get some background to the problems of psychiatric training of doctors from overseas.

Gilles de la Tourette's disease is a relatively rare condition characterized by multiple motor tics and an irresistible compulsion to swear. It was first described by Itard in 1825. Many years later, at the Salpêtrière under the tutelage of Charcot and Brissaud, Georges Gilles de la Tourette made a study of nine cases, including Itard's original one, and published his account of the disorder in 1885. He defined it as a nervous affliction characterized by motor incoordination accompanied by echolalia and coprolalia. He distinguished it from the large number of conditions which previously had been grouped under the heading of chorea. He pointed out similarities between this syndrome and the ‘jumping Frenchmen of Maine’ described by Beard in 1880 and the ‘myriachit’ of Siberia described by Hammond in 1884. Other authors however, question whether these conditions are really part of the same disorder.

In 1957, Lewis, writing about obsessional neurotic illness, stated: ‘There has been no marked increase in our state of knowledge of it in recent years, and indeed much of what can be found on the subject in current textbooks had already been fully stated and closely discussed in the first two decades of this century ….’ A recurrent theme in the literature is the supposed relationship between obsessional neurotic illness and ‘obsessional’ character traits. The psychoanalytic view that there is a strong association between obsessional symptoms and the ‘anal’ character traits was disputed by Lewis (1935). He found little evidence to support the existence of a well-marked constellation of character traits, or of a relationship between ‘obsessional’ traits and obsessional neurotic illness. Sandler and Hazari (1960) gave supportive evidence for the psychoanalytic view, but Reed (1970) doubted whether their conclusions were justified by the findings. Makhlouf-Norris (1968) summarized the literature in fourteen points, two of which are outlined below.

In a previous paper (Kniveton and Stephenson, 1970) we suggested that children with few interests of their own are likely to be more susceptible to the influence of filmed or television models than children with more extensive interests. However, neither we nor any other workers in this field have demonstrated that the tendency to imitate is a consistent behavioural characteristic. In fact, examination of the within-group scores for the subjects in the above-mentioned experiment reveals exceptionally large standard deviations for the amount of time spent imitating. These characterize both middle-class and working-class groups (Kniveton and Stephenson, 1972), although such groups differ consistently in their susceptibility to the filmed model used by the authors.

Respiratory relief (R.R.) appeared to be a simple and rapid treatment for specific phobias and for the phobic components of more complex neurotic conditions (Orwin, 1971). The basic hypothesis was that the R.R., satisfying an intense need to breathe, if simultaneous with the presentation of a phobic stimulus, would inhibit the degree of anxiety previously provoked and that this inhibition would persist. The need to breathe was induced by voluntary restriction up to maximum voluntary respiratory arrest (M.V.R.A.). As in conventional desensitization (Wolpe, 1958), a hierarchy was drawn up and the patients were desensitized using R.R. instead of relaxation. Carbon dioxide-oxygen mixtures were introduced because CO2 is known to stimulate respiration, and it was expected that by intensifying the need to breathe the speed and effectiveness of treatment would be increased by the augmented respiratory relief (A.R.R.).

It has been demonstrated that experience with alcohol leads to a decrease in its behavioural effects (Jellinek, 1960). There is also evidence that personality factors affect tolerance for alcohol; for example, psychological adjustment (Vogel, 1958), extraversion (Drew, Colquhoun and Long, 1958) and field dependence (Smith and Carpenter, 1966) have been reported to be associated with alcohol effects.

Intravenous diazepam is widely used both in general medicine and in psychiatry. It is used to produce sedation in psychiatric emergencies and to enhance systematic desensitization; it is also employed in the treatment of drug-induced dystonic reactions, status epilepticus and tetanus, and as an anaesthetic agent. Its property of relieving severe muscle spasm has been utilized to treat patients suffering from ‘stiff-man syndrome‘.