When choosing a title for this Lecture, I hesitated between two possible ones, the one above which I selected finally and another, termed ‘Links between Adult Psychiatry and Child Psychiatry’ Although in wording they seem different enough from each other, I hope to show in what follows where the two subject-matters meet.

At the meeting of Council on 16 June the following statement on behalf of the Section was read by the Chairman, Dr Valerie Cowie:

‘The Mental Deficiency Section wishes to express its serious concern about the grave situation facing mental deficiency services in England and Wales. A large part of these services come within the ambit of the National Health Service, and psychiatrists in that sector are facing a crisis for a number of reasons.

To psychiatrists who entered clinical practice in the decade 1955–65, ‘behaviour therapy’ probably conjures up the names of Eysenck, Lazarus and Wolpe; the invocation of learned maladaptive anxiety as the basis of most neurotic illness; desensitization by graduated exposure in imagination and real life to anxiety evoking situations. Neurotic ‘symptoms' were maladaptive habits and the ‘symptoms' were the disease, not merely outward manifestations of underlying disorder. Eysenck (1959) described behaviour therapy as all methods of treatment which were based on ‘modern learning theory‘. The ‘bell and pad’ treatment for enuresis and aversion therapy for alcoholism were appropriated and refined. Operant conditioning crossed the Atlantic and the application of Skinnerian principles was illustrated by Krasner and Ullman (1965). In the early sixties, at the very least behaviour therapy offered a possible treatment for a small proportion of psychiatric patients, for example those with phobias, tics or alcoholism, a group for whom other treatments were of little value.

A large part of medical practice is complicated by two problems; the degree to which treatments are specific (the placebo problem) and the extent to which they are implemented (the adherence problem). Depending on setting and circumstance, up to half of the benefits of treatment are either non-specific or never obtained. This review considers the problem of adherence in the context of use of medication in psychiatry.

A brief historical introduction traces the evolution of the concept of hypochondriasis. It is suggested that the term should now be used only as a descriptive adjective when there is a morbid preoccupation with health or body. Social and cultural factors are outlined, as well as problems of measurement. The psychopathology, as formulated by Freud and others, is also described. Clinical aspects are discussed under the headings of general symptoms, pain, smell, bodily appearance, sexual, gastro-intestinal, cardio-respiratory, eyes, and ears, nose and throat. Psychiatric syndromes mentioned are: hypochondria as a possible primary state, personality disorders, phobic-anxiety state, neurasthenia, obsessional neurosis, hysteria, depression, paranoid psychosis and organic. In general, hypochondriacal symptoms seem to make the prognosis rather worse. Treatment is to be aimed at the primary condition, which is most commonly depression, anxiety state or conversion reaction.

The study of the sexual disorders has made considerable strides during the past 90 years since Krafft-Ebing published his Psychopathia Sexualis in 1886. There were earlier beginnings which had provided very important insights into the nature of abnormal sexual behaviour, but it fell to Krafft-Ebing to bring sex research into the discipline of medicine, thereby giving it a methodology and a framework within which to unfold. The subsequent history has been described by Wettley and Leibbrand (1959) and constitutes the development of the basis of modern ‘sexology'—a translation of the term ‘Sexualwissenschaft’ created by Iwan Bloch in 1906. The period from the Psychopathia Sexualis to the time of the First World War saw the development of ideas which are still important for modern sexology, although the discipline has since matured into an experimental science using the methodologies of the biological as well as the behavioural sciences—psychology, sociology and anthropology.

Psychodrama, a method of human relations training and psychotherapy, is traced from its creation by Moreno fifty years ago to its present resurgence with the growth of ‘humanistic’ psychology. The basic techniques are described, together with Moreno's concepts of social interaction, e.g. encounter, spontaneity, the moment, catharsis and role playing. Its uses and limitations are discussed briefly.

The effects on patients, volunteers and staff of using volunteer adolescents in adolescent group therapy are examined. From 40 candidates eight volunteers were selected and oriented to the group process. Four volunteers and four patients were placed in each of two groups, and eight patients were placed in the third group. Patients and volunteers were aware of their identities in the first group session. Attendance in the groups with volunteers was better than in the group without. The volunteers themselves gained new knowledge and skills, and their presence was even helpful to the group leaders.

A comparison was made of the social and domestic background, prepsychotic personality and symptomatology of deaf (‘hard of hearing’) and non-deaf patients aged 50 or over with paranoid or affective psychoses. The deaf patients were found to be a very heterogeneous group in respect of age of onset, duration, severity and pathological basis of their deafness, but there was a substantial subgroup of paranoid patients with deafness beginning before the age of 45 in whom the personality appeared to have been less deviating than in the remainder. It was thought that the deafness in this subgroup had possibly played a relatively specific role in causing the psychosis. Some problems in identifying deafness and assessing its significance are discussed.

Let us try to project ourselves back into the places and minds of physicians and psychiatrists in, say, 1900. When they spoke of disease, what did they mean? They meant, typically, something like syphilis. ‘Know syphilis in all its manifestations and relations,’ declared Sir William Osler (1849–1919), ‘and all things clinical will be added unto you.’ (1). Obviously, this is no longer true. Indeed, how many cases of syphilis do modern medical students see between the time they enroll in school and the time they graduate? In the United States, Osier's maxim has been replaced by another which asserts that ‘mental illness is our number one health problem‘. This would make schizophrenia—the most common and most disabling of the so-called mental diseases—the successor of Osier's syphilis, showing us immediately what a gulf separates us from him. For, clearly, a physician may know all there is to know about schizophrenia, and yet be totally ignorant of medicine.

During the last fifty years, and particularly the last twenty, innumerable different classifications of depressive illness have been proposed, and several disputes are smouldering away between the protagonists of rival schools. Much of this is too well known to need, or bear, repetition. But the conflicting claims and proposals are now so numerous, and methodological problems loom so large, that those who are not intimately involved have increasing difficulty in understanding what is going on; while those who are involved are mostly too intent on developing and promoting their own particular schema to review the overall situation in any broader context. This article is an attempt to describe the main elements in a confusing situation, to outline the important problems, and to indicate the areas of agreement that are beginning to emerge, without advocating any particular solution.