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.

Most people suffer from so-called ‘nervous symptoms' sometime during life, and their activity is influenced in varying degrees by these symptoms. There are a number of works reporting high prevalence of so-called neurotic symptoms: Rennie and his collaborators studied a sample of the population in the age range 20–59 of the central residential area of New York City and found that 75 per cent manifested significant symptoms of anxiety and that only 11 per cent of the lower class and 29 per cent of the upper class were psychiatrically symptom-free respondents (Rennie, Srole, Opler and Langner, 1957). Leighton found the life-time prevalence (after the age of 18) of psychoneurotic symptoms in a small town (population about 3,000) to be 67 per cent (Leighton, 1956). Winter interviewed 200 apparently healthy workers (mean age 36·6 years, 141 males and 59 females) of various social strata of Berlin, and found only 18 per cent free from so-called neurotic symptoms, i.e. anxiety, phobia, insomnia, headache and other psychosomatic symptoms (Winter, 1959). Agras, Sylvester and Oliveau found the prevalence of fear of storms, enclosures and journeying alone in females of Burlington to be 31 per cent, 14 per cent and 10 per cent respectively, and noted that psychiatrists saw only a small percentage of the phobic population (Agras, Sylvester and Oliveau, 1969). In all of these surveys, the authors noted that the majority of those with symptoms appeared to function well in the society. In Japan, a comparable survey is lacking, but Kasahara and Sakamoto investigated by questionnaire 2,481 students who entered Kyoto University in 1967 and found 24·1 per cent suffering from headache and 18 · 5 per cent from difficulty in falling asleep (Kasahara and Sakamoto, 1970). On 30 August 1970, N.H.K. (Japanese Broadcasting Corporation) invited to the studio 100 males who had graduated in 1945 from a single metropolitan all-male middle school for a programme entided ‘Age Forty’, in which health, economical and social status of this age group was enquired into. Among these, 26 ‘often suffered from palpitation and shortness of breath without significant exertion’, and 34 often awoke in the middle of the night or too early in the morning and could not get back to sleep again.

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.

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.

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.

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.