In recent years it has become widely known that behaviour therapy (conditioning therapy) is effective in the treatment of neuroses. However, in many minds, this knowledge has come to be hedged by some erroneous qualifications, of which the commonest are: (a) that behaviour therapy leaves the “deep” cause of neurosis untouched, and (b) that it is successful with “monosymptomatic” and allegedly simple cases like phobias, but not with more complex neuroses, such as obsessions and “character neuroses”.

The constellation of symptoms which is termed depersonalization is often as perplexing to the doctor as to the patient. It is more easily diagnosed than defined, and much of the controversy over its nosological position can be attributed to this vagueness of outline. Saperstein (1949) reviewed the historical development of the concept and concluded that the essential feature is the experience of a sense of strangeness or unreality to the individual of his personality, his body or the external environment. Other symptoms of cerebral dysfunction, such as perceptual distortion of the body image, déjà vu experiences, olfactory and auditory hallucinations, metamorphopsia, autoscopy and a disordered time sense, are frequently, but not necessarily, associated (Antoni, 1946; Roth, 1959). The difficulty of expressing unusual subjective events in words gives rise to descriptions remarkable for their rich and often bizarre metaphor (e.g. Lewis, 1934; Bockner, 1949; Roth, 1959). Saperstein (1949) and Bird (1958) emphasize the “as if” qualification of these accounts, which distinguishes them from the delusional experiences of depression and schizophrenia.

The study reported in this paper derived from an experimental investigation of anomalies of attention and perception found in schizophrenic patients (Chapman and McGhie, 1961, 1962). The application of an experimental battery of tests to a group of schizophrenic patients had shown that the short-term memory of schizophrenics is particularly vulnerable to interference by irrelevant stimuli. These tests assessed the schizophrenic patient's capacity to perceive and recall a series of non-meaningful auditory and visual stimuli, and therefore did not deal with conditions approximating to normal speech. The clinical material gathered from young schizophrenic patients in the course of our investigations did however amply illustrate some of their difficulties in the perception of speech. Since the present study was to a large extent suggested by the reports made by these patients, it may be pertinent to present here a selection of the verbatim accounts of how they found difficulty in comprehending other people's speech. These comments are selected from tape-recorded interviews with schizophrenic patients, each account having been given by a different patient.

A previous paper (Lippold and Redfearn, 1964) described various mental changes which occur when small direct currents are passed through the brain in human subjects. Some beneficial effects often followed this procedure and it appeared worthwhile to carry out a controlled double-blind clinical trial.

Current planning in the field of the community mental health services places considerable emphasis on the after-care of patients discharged from hospital. This is partly in response to the high re-admission rates experienced as a result of the “revolving door” policy, partly to a scepticism about the present state of knowledge regarding factors amenable to primary prevention techniques, and partly to a belief that keeping the patient in the community is in itself beneficial both to the patient and to the community. The benefits of such a policy are felt to lie in avoidance of institutionalization and furthering of rehabilitation, and in preventing a re-distribution of roles within the family to exclude the patient. The primary purpose of the policy is not necessarily to cut short the illness of the patient, at least as measured by time under treatment, and evidence will be given below to suggest that in fact time in treatment is prolonged. This study focusses on one issue. Can aftercare in fact prevent re-admission to hospital to any significant extent? In view of the complex nature of the decision to select which patients are to receive after-care and which not, a factor in itself likely to prejudice any results, successive discharges from a psychiatric hospital falling within selected categories were randomly allocated to psychiatric after-care and to their general practitioner, and followed for a six-month period. A null hypothesis was set up that the re-admission rate during the follow-up period would not significantly differ in the two groups.

To Shakespeare's famous question: “Can'st thou not minister to a mind diseased?”, Eysenck (10) gave a decided negative answer. Hebb (11) has also asserted that “There is no body of fact to show that psychotherapy is valuable”. From 1954 onwards, Rogers (12) has taken up the challenge and shown that changes occur in psychotherapy which do not occur without it, and has suggested that these changes are valuable.

Case records of 42 consecutive cases of obsessional states (seen between January, 1958 and April, 1962) were taken for detailed socioclinical analysis at the Psychiatric Clinic, Irwin Hospital, New Delhi. The case-taking, diagnostic, prognostic and therapeutic evaluations were made by the same psychiatrist, i.e. the author. The sample constituted only about 2 per cent. of the total new attendance of the clinic during the period.

In a previous paper (Kay, Beamish and Roth, 1963) we studied the prevalence of various kinds of psychiatric disorder in a random sample of old people living at home in Newcastle upon Tyne. During the interviews, special attention was paid to the collection of social data. For, as Townsend (1957a) pointed out, old age is an epoch of diminishing social contacts and domestic support, and isolated old people make disproportionately heavy demands on the institutions of the Health and Welfare Services. By comparing the medical status and social circumstances of subjects with organic brain syndromes, those with functional disorders, and those without psychiatric abnormality, we have attempted to explore further the relative importance of these factors in the two main groups of mental disorders in old age.

Two surveys of mental hospital in-patients, one by Gore and Jones (1961) the other by Cooper and Early (1961) resulted in different conclusions when the present and future need for psychiatric accommodation was considered.

Many of the changes which make up the revolution in the treatment of the mentally ill in large hospitals in recent years have been facilitated by the use of new drugs, the tranquillizers. A patient who takes his tranquillizer responds better to other treatment, the staff becomes more friendly and helpful: such an anti-vicious cycle hastens recovery. A patient who refuses to take his medication in tablets or capsules is given it in liquid form, the ingestion of which can be more easily checked.

I have been interested in the conflicting attitudes of the legal and psychiatric branches of the Service towards homosexuality. The legal branch sees homosexuality as a crime which still carries severe penalties. As a Service psychiatrist I have been impressed by the seemingly genuine desire to be cured shown by many homosexuals who come to me for help and I was struck by the high incidence of neurotic symptoms in them. To find out how many of the homosexuals seen by me were ill and to learn about the aetiology of homosexuality as seen in the Armed Forces I compared 50 consecutive homosexuals with 50 neurotics picked at random from my out-patients during the same period (1958–59).

During the past decade so many psycho tropic drugs have been produced that the psychiatrist is often faced with a bewildering choice; for some mental disorders no fewer than a dozen preparations claim to remove or alleviate the symptoms. The work of La Verne (1962, 1963) and Jacobsen (1963) has been of considerable value in providing a “compendium of psychopharmacological agents”—a comprehensive classification of psychiatric drugs to assist the prescriber. Nevertheless, there are seldom any clear or universally accepted indications within a class (e.g. antidepressives or antipsychotics) why one drug should be prescribed rather than another. Many preparations share a common basic chemical formula, such as the phenothiazines, and/or a common biochemical function, like the monoamine oxidase inhibitors. The manufacturers themselves, anxious to cover every therapeutic possibility, suggest such a wide range of possible indications that their product often becomes a broad spectrum panacea, inviting increasing scepticism from the physician and concealing any potential advantage it may have for alleviating a particular symptom. Since personal experience determines choice more positively than any number of published reports, the psychiatrist gives most new products an informal trial, but tends to settle down with a limited few of proved usefulness and empirically confirmed indications. This is not a particularly efficient method for obtaining one's personal range of chemotherapeutics, but it is the one most generally used in practice. Its disadvantage lies in the idiosyncratic nature of some drugs, which may work well in one patient but ineffectively, or even adversely, in the next. On the basis of a few short and unsatisfactory trials, sometimes of only one, a potentially useful preparation may be discarded in favour of an older well-tried alternative which may be less therapeutically effective in the long run.

The problem of treating the “back ward” chronic schizophrenic is likely to remain for some years to come, and with it the problem of establishing the genuine effectiveness of particular treatments. Disentangling effective from non-effective therapeutic techniques in “total-push” programmes is particularly complicated. What precisely is responsible for the minimal improvements observed: some subtle change in “ward climate”, the altered medication or the new music therapist? Writers who view mental illness primarily as a breakdown in normal interactional relationships with other persons have stressed the therapeutic importance of certain types of social milieu (e.g. Martin, 1962). Others (e.g. Greenblatt et al., 1955) have suggested that the success of even the physical treatments can be explained in terms of the optimism and enthusiasm with which they are carried out. However, there are few systematic research attempts to disentangle the physiological from the psychological variables.