It has been said that any drug which is active and produces an effect which is beneficial must also, under similar or different circumstances, have side-effects which are neither beneficial nor desired (Hamilton, 1965). It is the balance between desired and undesired actions which determines the usefulness of any drug. Such a balance varies according to the individual patient's needs. Thus a life-saving drug will be given even if it has serious side effects, while this would not be justifiable for a drug with only a marginally therapeutic effect. Scrutiny of past results may enable clinicians to make finer predictions as to which patient will benefit from a certain drug and which will suffer unacceptable side-effects. Phenothiazines are one group of drugs whose efficacies and dangers have been discussed in this way.

The aim of this paper is to present an enumerative survey of abuse of heroin and methadone by persons of 30 years of age and under, known to have resided at some time within the Oxford City boundaries during the year 1969.

In the development of the MMPI, one of the original purposes of this self-report inventory was to assist the physician in the detection of neuroses in his patients. Dahlstrom and Welsh (i), however, raise the question… ‘can a person who is physically deformed, handicapped, or sick get appreciable score elevations on the profile merely by giving a factual description of his disorder … (p. 274)?’

During recent years interest in transcultural psychiatry, particularly Anglo-American differences in diagnostic practice and treatment, has increased considerably. In 1965 Willis and Bannister reported the results of a questionnaire study of the opinion of 'senior’ British psychiatrists on the diagnosis and treatment of schizophrenia. Acknowledging the many disadvantages of a postal enquiry of this kind, the present author thought that their study would form the basis for a useful and relatively inexpensive Anglo-American comparison. Consequently, in 1968 an almost identical questionnaire was circulated to six hundred 'senior’ American psychiatrists.

The term ‘therapeutic community’ has been increasingly employed in recent years. The W.H.O. Report (1953) used it to describe a general approach of Freedom, Activity and Responsibility—a humane, liberal approach marked by full occupation, open doors, active rehabilitation programmes and increased community involvement—repeating and developing many of the features of the ‘moral treatment’ of the early nineteenth-century (Rees, 1957). This has now been widely adopted in Britain, U.S.A. and in Western Europe.

There have been a number of reports of psychiatric referrals in general hospitals. The most recent papers have been by Guy Edwards and Angus (1968) from Bergen Pines County Hospital, New Jersey; Crisp (1968) from the Middlesex Hospital, London; Bridges et al. (1966) from King's College Hospital, London; and MacLeod and Walton (1969) at the Western General Hospital, Edinburgh. The last report from Guy's Hospital, London, was over a five-year period from 1955–60 by Fleminger and Mallett (1962). It was therefore thought useful to review psychiatric referrals from the general wards at Guy's over a recent period of one year, approximately ten years after the first study, to see if there had been any change in the pattern or nature of the referrals.

In the clinical evaluation of drug treatment, medical practitioners have long appreciated the fact that the response does not merely reflect the pharmacological effect of the drug. The manner in which the treatment is presented to the patient by his therapist is important and there is ample proof in the literature of the therapeutic effects of inert substances—the so-called placebo effects (1, 2). In psychiatric practice particularly, the halo effects of such factors are of considerable importance.

Thus the mind is not large enough to contain itself: but where can that part of it be which it does not contain?

In discussions of schizophrenia, ‘thought disorder’ has a traditional place of prominence. Eugen Bleuler (2) believed ‘disturbances of association’ of ideas to be a fundamental symptom in schizophrenia, and among more recent authors Cameron (3) introduced the concept of ‘over-inclusiveness' to explain not only the thought process disorder, but many other symptoms of this condition.

In peripheral hospitals and their crowded outpatient clinics many neurotics are treated, sometimes for a number of years, with sedatives or tranquillizers, a few words of sympathy and encouragement and, often electroplexy. The reasons often given for failure to offer psychotherapy are that it is of doubtful benefit or that it is too time-consuming.

Learning is said to be state-dependent when a response which is learned in a given internal state shows disproportionate decrement in retention when the internal state of the learner is changed. Research on this phenomenon has a long history. It was first noted by investigators who were concerned with the problem of whether overt responses were necessary for the formation of classically conditioned responses. Curare was used to eliminate the overt response, and it was found that:

During the past two decades the psychosocial environments of psychiatric wards have become of increasing concern. Different investigators have described the importance of the therapeutic milieu of such wards and have implied that treatment environment strongly influences treatment outcome. At first there were detailed observations and naturalistic descriptions indicating the importance of ward social structure in facilitating or hindering treatment goals (Stanton and Schwartz, 1954; Caudill, 1958). Then came a variety of different types of ward programmes designed to use the ward environment as an important treatment modality (Jones, 1953; Cumming and Cumming, 1962; Fairweather, 1962). These different approaches present quite different specific recommendations about the most effective types of treatment environments; however, they do all agree on one essential point: that the immediate psychosocial environment in which patients function is an important determinant of the outcome of the treatment process.

Cameron (1938, 1939) suggested that schizophrenic thought disorder is largely the result of overinclusive thinking, which he defined as the inability to preserve conceptual boundaries. Payne, Matussek and George (1959) developed a battery of objective measures of overinclusive thinking, which they found differentiated between an acute schizophrenic and a neurotic control group. Payne and Hewlett (1960) found that a battery of tests of overinclusive thinking intercorrelated as expected. They were able to obtain a factor score from their overinclusion test battery which differentiated a group of acute schizophrenic patients from control groups of depressives, neurotics and normal subjects. Payne and Friedlander (1962), on the basis of this factorial study, suggested a short battery of three measures of overinclusive thinking consisting of the number of ‘Non-A’ or unusual responses to the Object Classification Test (Payne, 1962), the average number of words used in explaining the Benjamin Proverbs given under special 'stress free’ instructions, and the average number of objects classified together in the ‘handing over’ section of the Goldstein-Scheerer Object Sorting Test. This standard test battery has been the operational definition of overinclusive thinking in a number of studies. Only one study of the reliability of this test battery appears to have been carried out. Hawks and Payne (1971) report the correlations obtained from a group of 54 psychiatric inpatients who were retested after a 4-day interval. The test-retest correlation coefficient (uncorrected) obtained from the Combined Transformed score (Payne and Friedlander, 1962) was 0 · 87. The reliabilities of the individual tests ranged from 0·77 to 0·86.

The management of sexual delinquents, especially those with compulsive putting into action of aggressive sexual impulses, poses great problems for the medical profession from the therapeutic as well as the moral standpoint. In the past thirty years or so numerous different approaches have been tried with varying degrees of success. A much abridged list of more recent treatment procedures includes: surgical castration (Stürup, 1968), sedative and/or tranquillizer drugs (Litkey and Feniczy, 1967; Bartholomew, 1968), female sex hormones (Allen, 1970); psychological measures such as psychotherapy (Ellis, 1956; Mayerson and Lief, 1965; Allen, 1970) and/or behaviour (‘aversion’) therapy (MacCulloch and Feldman, 1967) and ‘right up-to-date’ hypothalamotomy (B.M. J., 1969). Unfortunately surgery, which is the most reliably effective of these treatments, may have unpleasant sequelae; its use, which (in Britain at least) is beset with ethical problems, is therefore justified in only the most recalcitrant and/or dangerous types of offender, and only then when other methods have failed.