This paper aims at introducing a series of articles on basic psychoanalytic concepts. Many concepts which have developed within psychoanalysis have been extended for use within other frames of reference and in very different settings. If psychoanalytic concepts have validity such extension should be possible and useful, but it seems inevitable that in the process of extension changes in their meaning will occur, and it is one of the purposes of this series of papers to examine a number of concepts from this point of view. The philosophical implications of change of meaning when concepts are transferred from their original context has recently been discussed by a number of writers, e.g. Kaplan (1964) and Schon (1963). In this connection psychoanalytic theory presents special problems of its own. It is often regarded as being a completely integrated and consistent system of thought, but this is far from being the case. Psychoanalytic concepts are not all well defined, and changes in their meaning have occurred as psychoanalysis has developed and its theories have changed. We hope to show some of these changes in the papers which follow. Further, the same term has been used with different meanings even at the same point in the development of psychoanalysis. A prime example of this is the multiple meaning of the term ego (Hartmann, 1956), or of terms such as identification and introjection (Sandier, 1960). We find a situation existing within psychoanalysis at the present time in which the meaning of a concept is often only fully discernible from an examination of the context in which it is used. The situation is complicated still further by the fact that different schools of psychodynamic thought have inherited (and then modified for their own use) much of the same basic terminology.

In a previous publication (Brown and Birley, 1968) we have presented some findings which suggest that life changes and crises frequently precipitate the acute onset, relapse or exacerbation of schizophrenic states. To summarize : consecutively admitted patients diagnosed as suffering from schizophrenia were seen at mental hospitals serving a known catchment area. The first fifty whose onsets occurred within three months of admission and could be accurately dated within a week were included. Both the patient and at least one other informant were interviewed about the occurrence of certain previously defined and datable events occurring to the patient or to close relatives. These included such events as moving house, starting or leaving a job, admission to hospital, birth, marriage or death during the twelve weeks prior to onset. These were classified, according to their apparent independence of the patient's control, as ‘independent’ or ‘possibly independent’. The former were those which could be regarded as outside his control, e.g. discovering a burglary or hearing of a brother's serious illness. ‘Possibly independent’ events were those which were considered to have been within the patient's control but which had not been brought about by any unusual behaviour on the patient's part. They were chiefly changes of job, or of opposite sex friends. (Loss of job would, under certain circumstances, be rated as ‘independent’, e.g. when a whole firm closed down).

The catecholamine hypothesis of affective disorders proposes that 'some-if not all-depressions are associated with an absolute or relative decrease in catecholamines, particularly norepinephrine, available at central adrenergic receptor sites. Elation, conversely, may be associated with an excess of such amines' (Schildkraut, 1965).

The reports on the emotional reactions and adjustment of patients to chronic haemodialysis are often contradictory; nevertheless, all agree that this treatment is stressful.

Patients not uncommonly attend psychiatric clinics with the primary complaint of a cos metic defect in their appearance, e.g. that their nose is big or somehow conspicuous, or that their chin is protuberant or receding. Of the various features concerned, complaints about the nose are by far the most frequent. Such patients also consult plastic surgeons requesting the operation of cosmetic rhinoplasty and it is not unusual for the surgeon to seek a psychiatric opinion about some of the cases he sees, as it has been thought that the motivation of such requests is sometimes complex and the desire for operation may be indicative of psychological disturbance. The surgeons would appear to refer those cases where the defect is minimal or, of course, where severe psychological disturbance is obvious even quite superficially.

In a typical classification problem each subject in a sample of N subjects is allocated to one or other of k exhaustive and mutually exclusive categories. For example, a sample of families may be classified into social-class groupings in accordance with the Registrar General's classification based on the occupation of the father or father substitute. Or a sample of psychiatric patients may be classified into one or other of the diagnostic categories recommended by the W.H.O. Now it occasionally happens that the same sample of subjects is classified, for a given set of categories, independently by two different agents. For example in the Plowden Reports, Appendix 3 Table 29, a sample of children is classified into types of secondary school, Grammar, Comprehensive, Technical, etc., on the one hand according to the parent's ambition for their children and on the other hand according to the type of school in which the children were eventually placed. In situations such as the latter a k k classification table evolves in which, when the categories are arranged in the same order, the matches between the two separate classifications appear in the cells of the main diagonal of the table and the mismatches appear in the off-diagonal cells (see Table I below). The question then arises as to how to compare the two separate classifications and to measure in quantitative terms the degree of agreement between them.

Previous studies from our laboratory (2) indicated that treatment of depressed patients with electric convulsive therapy (ECT) or imipramine was associated with significant decrease of urinary calcium excretion. The studies described in this report were undertaken to find out whether the decreased urinary calcium observed during ECT or treatment with irnipramine was accompanied by changes in the excretion of other urinary metabolites such as phosphate, magnesium, sodium and potassium.

A programme was undertaken to study the attitudes of visitors to mental hospitals. Initially a series of individual non-directive tape-recorded interviews were conducted on a small sample of visitors, who freely discussed various topics, including staff attitude, visiting problems and difficulties in having a mentally ill relative. A provisional questionnaire was constructed from the significant points of the recorded interviews and was used on another sample of visitors in a pilot study, on the basis of which a final ‘multiple choice’ questionnaire was designed incorporating 28 items. Copies of the final questionnaire were then distributed from the wards of two mental hospitals to consecutive visitors, with a stamped envelope addressed to Nottingham University, informing them that the study was in connection with an independent survey. The distribution continued until few new visitors attended. Of the two hospitals, the first, The Pastures (Hospital A), serves a wide county catchment area and has an ‘unrestricted visiting hours' policy; the second, Kingsway (Hospital B), on the other hand, has a ‘limited visiting hours' policy and serves a compact urban catchment area. Altogether 510 questionnaires (75 per cent) were returned completed, 306 (8o per cent) for Hospital A and 204 (70 per cent) for Hospital B at the end of the study. The rest of the paper is confined to the analysis of these 510 questionnaires in relation to the question on the effect of unrestricted visiting, which has already been studied by Barton et al., from the nurses' point of view. The particular question asked by us was, 'some hospitals allow visitors to visit at any convenient time. What effect do you think this would have on (1) the patients, (2) the visitors, (3) the nursing staff, (4) the doctors?’ The replies were to be given on a five point scale for each question. The scale was ‘Very good-Good-No effect-Poor-Very poor.’ the graded adjectives being determined from the earlier tape-recordings.

Weckowicz (1960), using pictures of common objects with superimposed lines, found that schizophrenics were less able to see the hidden figures than normal subjects and other patients. Unfortimately the task turned out to be too easy; most of the normal subjects and more than a third of the acute schizophrenics obtained the maximum possible score. Such a distribution of scores makes it difficult to carry out further analysis of the results. The aim of the present study was, using a more difficult task to obtain a better distribution, to confirm the lowered capacity of schizophrenics and to relate it to other variables. The task used was the ‘Gottschaldt Figures Test’, published by the University of California Institute of Personality Assessment and Research. This consists of the identification of two simple geometrical figures embedded in complex designs. The score (maximum = 20) is the number of figures correctly identified on two sheets, 2 minutes being allowed for each sheet. To ascertain how this task is ‘normally’ related to certain major personality variables, a group of neurotic patients was used, since they would not be expected to have any special disability on a task of this type.

Psychiatry and other medical disciplines have been paying increasing attention in recent years to the relationship between patient and doctor, and psychoanalytic concepts have been applied in order to formulate various aspects of this relationship. One of those most commonly applied is that of transference, which is now often loosely used as a synonym for relationship in general. The concept of transference will be discussed in detail in a further paper in this series, but a distinction has always been made within clinical psychonanalysis between transference ‘proper’ and another aspect of the patient's relation to the doctor which has been referred to in recent years as the ‘therapeutic alliance’, ‘working alliance’ or ‘treatment alliance’ (Zetzel, 1956; Loewald, 1960; Stone, 1961, 1967; Gitelson, 1962; Tarachow, 1963; Greenson, 1965, 1967; Friedman, 1969). The concept has been used in connection with the psychoanalytic treatment situation to describe aspects of what is familiar to all as the ‘therapeutic contract’ between the patient and his doctor (Menninger, 1958), and has been defined as ‘the non-neurotic, rational, reasonable rapport which the patient has with his analyst and which enables him to work purposefully in the analytic situation …’ (Greenson and Wexler, 1969). As far as the psychoanalytic situation is concerned, it has been maintained that the recognition of the difference between treatment alliance and other aspects of the patient-analyst interaction (such as transference) leads to an increased understanding of the processes which occur in that situation and, in particular, of those which enter into therapeutic failure. It is the purpose of this paper to examine the treatment alliance concept as it has developed within psychoanalysis and to consider its applicability outside the psychoanalytic treatment situation (Sandier, Dare and Holder, 1970).

In a recent article (Hope, 1969a) the author has demonstrated the theoretical relations between what psychologists call the analysis of persons and the analysis of tests. The demonstration was illustrated by an analysis of a hypothetical matrix M whose rows were called entities and whose columns were called variables. It was shown that, by combining Slater's (1964) method of spherical co-ordinate mapping with a method of numerical taxonomy suggested by the author, it is possible to perform a comprehensive and self-consistent pair of analyses whose conclusions can be read off three diagrams: a map of variables, a dendrogram of entities, and a profile diagram of the multivariate means of groups of entities.

Recently much interest has been shown in the screening of populations for the presence of disease, either latent or overt (Wilson and Junger, 1968). In psychiatric practice the importance has been recorded of screening patients for the presence of avitaminosis B12 as a possible cause of psychiatric abnormality (Henderson et al 1966). Several methods of estimating serum vitamin-B12 levels have been evaluated, but the microbiological assay remains the most suitable method for use in a routine laboratory.

It is generally assumed that depressions are accompanied by sleep disturbances. We have combined staff objective ratings and patients' subjective responses to study sleep in depressed and hypomanic or manic patients. We report on ten nights only, because during that period all patients were on placebo medication.

Favourable results have been reported from the use of lysergide in a wide variety of psychiatric conditions, but controlled studies (2, 3, 4) have not confirmed the existence of a therapeutic effect. In this experiment, alcoholics and neurotics who had been referred by Saskatoon psychiatrists for LSD treatment were allocated at random to Treatment and Control groups after undergoing a series of psychological tests. The members of the Treatment group were offered up to five LSD experiences at intervals of two weeks, whereas those in the Control group were informed that this type of therapy would be made available to them after a twelve-month waiting period. Accounts of the LSD experiences were sent to the referring psychiatrists, who were expected to continue to provide standard treatment to the members of both groups.

Many of the links in the chain of circumstances leading to anorexia nervosa are still not clear. Ever since Sir William Gull in 1868 first described and in, 874 named the condition, investigators have put most of the blame for it on psychological circumstances, such as an adverse relationship between mother and daughter. Tolstrup (1967), after reviewing the observations of a long list of authors, concluded that no physical explanation of note was forth-coming. Another of the many adherents of the psychogenetic school is Thomä (1961).