The possibility of understanding self and others through the use of drugs has entertained and intrigued the imagination of man for centuries. The accidental discovery of d-lysergic acid diethylamide-25 (LSD) by Hofman in 1943 brought this possibility closer to realization than ever before.

Between 1962 and 1970, the male parasuicide (attempted suicide) rate in Edinburgh has doubled, and the rate for women shows a 70 per cent increase (Kreitman, 1972). Of those who are admitted following a parasuicidal act a substantial proportion are readmitted—approximately 15 per cent within 12 months and 25 per cent within three years. Parasuicide is a sign of severe distress, and repetition indicates that the distress has not been adequately alleviated. A means of early identification of the potential repeaters would be valuable.

The success of an in-patient therapeutic programme depends, in many instances, on the willingness of the patient to co-operate with medical and nursing staff, and to react positively to the permissive regime characteristic of the modern psychiatric hospital.

Very little research has been conducted on drug-takers in the community. Goode (1970) and Reeves (1973) are notable American and British exceptions. Both used non-random methods to collect information from drug-takers in non-clinical settings. In the present study, carried out in Cheltenham, I used participant observation as a means of approaching drug-takers in their ‘natural’ settings. I employed an anthropological technique called ‘snowballing’. This involved introducing myself to a few drug-takers. These individuals, when satisfied about my identity and intentions, introduced me to their drug-taking friends, who in turn introduced me to the network of other drug-takers whom they knew. During the period August 1970–October 1972, I was able, informally, to observe the life-styles and drug-taking behaviour of a number of drug-taking groups within the community. In addition, I collected statistical information about the biographical characteristics of 200 individuals I encountered. A standardized interview schedule was used which investigated family backgrounds, employment, education, social relationships, delinquency, drug histories, living conditions, ideology and sexual behaviour.

How far are the traditional skills of psychiatry relevant to the everyday problems of our time? Or, put differently, do the goals of psychiatry reach beyond identifying someone as mentally ill and treating such an individual?

The development of techniques for studying sex chromatin from oral mucosa (Moore and Barr, 1955; Marberger at al., 1955), and chromosomes from peripheral blood (Moorhead et al., 1960), has made it possible to undertake population surveys to identify individuals with abnormal sex chromosomes. The present knowledge of psychiatric effects of the sex chromosome abnormalities has been derived mainly from comparing their frequency in the psychiatric population with that in the general population.

A new benzodiazepine, bromazepam, 6 mg. three times a day was compared in a double-blind trial with medazepam, 10 mg. three times a day and with chlordiazepoxide, 10 mg. three times a day. Each drug was given for two weeks. The first 50 cases attending the out-patient department were selected. All were suffering from neurotic anxiety and were comparable to those patients for whom sedation is commonly and properly prescribed in general practice. There was no selection for either age or sex.

Where preventable causes of a disorder are unknown, the epidemiologist will be concerned to search for an association between an environmental factor and some attribute of the disorder, commonly its incidence. In choosing what environmental factors to study, the epidemiologist will be attracted, firstly to those which on current hypotheses seem likely to have a causal role, and secondly to those for which the necessary data are easily collected. No doubt it is for the second of these reasons that studies have been made on the relation between schizophrenia and season of birth: the date of birth of a patient is rarely unknown, and the information, which may be accepted as being accurate in the great majority of instances, is routinely recorded in the case notes of most hospitals and clinics. All that the investigator has to do (it would seem) is to count the numbers of patients born in the different seasons of the year and compare these with the numbers to be expected from the season-of-birth distribution of the general population.

The increasing awareness of the social needs of young patients in a mental hospital where the care of elderly people is the major task started with comments from visiting medical students, and eventually met with a response from hospital personnel and community volunteers.

Exposure treatments such as flooding are being used increasingly for phobic and obsessive-compulsive disorders (reviewed by Marks, 1972). The shortage of treatment personnel has led to a search for ways to save therapist time. An obvious way of economizing is to expose a number of patients simultaneously in groups, instead of individually, to the real life situation which they fear.

Despite the Department of Health and Social Security's disclaimer in paragraph 10 of H.M. 71/90, the earnings of psychiatric patients for work done in hospital were effectively limited to a maximum of £2 between the years 1958 and 1972. The progressive decline in the value of money during this period led to mounting agitation for the limit to be raised (e.g. Wansbrough, 1971, p. 29). Hospitals were notified of the decision to raise the limit in a letter (reference no. DS. 214/72) from D.H.S.S. dated August 1972, the first paragraph of which reads: ‘The National Insurance Act 1972 raises the maximum amount a person may earn whilst in receipt of National Insurance benefit from £2.00 to £4.50 a week for work carried out under medical supervision as part of his treatment as a patient of a hospital or similar institution. This takes effect from 5th October 1972.’

The results of treating psychopaths and other mentally abnormal offenders at Balderton Hospital, Nottinghamshire, and in North Wales (Tables I, II and III), have shown that there is a small intractable group who react explosively when in the company of less disturbed patients, and who are best treated in a long-term unit specially designed for their needs. The small group surveyed here are mentally abnormal offenders of dull-normal or average ability whose aggression or inadequacy, sometimes combined with schizophrenia or resulting from brain damage, makes them prone to repeated convictions for violent acts, arson, sexual offences or drunkenness.

Since Schiavone and Kaldor (16) reported the incidental finding of increased creatine Phosphokinase (CPK) in patients with schizophrenia a number of studies of the enzyme have appeared in the literature. Bengzon et al. (2), reported among a group of 30 schizophrenics, CPK elevations, which returned to normal during the course of treatment with phenothiazines. These authors investigated a second group of 60 untreated patients who were ‘acutely psychotic’ and found abnormally high CPK levels in half of them. However no mention was made of diagnostic criteria, nor of attempts to control for extraneous circumstances known to elevate the enzyme.