The object of this paper is to set out some of the difficulties experienced in early training in Psychotherapy.

Undergraduate teaching tends to present the student with a view of the patient as a machine with a faulty part rather than as a person. This is reinforced during his period as a houseman. In order to function efficiently, he learns from his senior colleagues how to detach himself from patients so that he can cope with the dying or with investigations which are painful and frightening, or with patients who are chronically sick.

During a nine-month period (1974–75), 1,050 students (846 male, 204 female) at Ain Shams University, Cairo, attended the Student Health Centre. Fifty-two per cent were referred there by their general practitioners, 5 per cent by their families and 3 per cent through their faculties; the remainder (41 per cent) were self-referred.

Male patients represented 2·8 per cent of the male students, but female patients only 0·9 per cent of the female students. In faculties dealing with practical subjects the male-female ratio was higher than in those dealing with more theoretical subjects. The diagnoses included anxiety neurosis (36 per cent of the cases), schizophrenia (18 per cent), depression (15 per cent) and neurotic depression (12 per cent).

The survey of 140 children under 16 in two subnormality hospitals showed that 3 per cent of the children had definitely been rendered mentally handicapped as a consequence of violent abuse, and that a possible maximum total of 11 per cent might have been thus rendered mentally handicapped. In 24 per cent of the children, neglect was considered to be a contributory factor in reducing intellectual potential.

Impairment of intellect from abuse and neglect, especially in those with ‘vulnerable’ brains due to pre-existing abnormality, may be much commoner in children than is generally realized.

The views I express in this paper are my personal views and not those of either the Department of Health and Social Security or the National Development Group, but they are, nevertheless, based on established services and views expressed to me by colleagues in various parts of the country.

In an investigation of the relation between life events (stressors) and illness, 87 medical students reported on a prospective basis their health and life events history over a three year period. There were a few positive findings, e.g. that subjects who reported more life events during the period also reported more illnesses during that period. Overall, however, the study showed a lack of statistically significant association between life events and illness.

A survey of 1,811 mentally handicapped males in eighteen hospitals is described. Males discovered with supernumerary Y chromosomes numbered 15, of whom 12 were 47,XYY. Some of the physical, social, psychological and psychiatric findings are described and compared with groups matched for IQ and height.

The main psychiatric findings are diminished intelligence, retardation in development of secondary sexual characteristics, and poor emotional control leading to inadequate social adaptive patterns which are described and discussed.

A retrospective comparison was made between two groups, each consisting of 30 depressed patients, one in which the outcome following discharge had been good, the other where it had been poor. A previous psychiatric history, earlier admission for psychiatric illness, particularly for affective disorders and a poorer performance on routine intelligence tests were found in the poor prognosis group. In this group the duration of the index admission was longer and the condition of the patient was less improved at the time of discharge. Several symptom variables also discriminated between the groups. These findings are discussed.

A Special Committee of the College was appointed in May 1976 after the President had received a request from Dr Porter, the Regional Medical Officer of the SE Thames Regional Health Authority, for the College's advice on the problems of administration of ECT, especially when consent is withheld or given reluctantly. Although the Regional Authority had been concerned earlier with the problem, the situation which prompted further action was the publication in March of the Report of the Inquiry on St Augustine's Hospital, pages 63–71 of which dealt with the administration of ECT and recommended that the College ‘should give urgent consideration to these problems and issue clear guidance’.

The possible ill-effects of cannabis on the peripheral nervous system were examined in 27 male subjects with respect to their motor and sensory nerve conduction. They were classified by their previous cannabis use into casual and heavy users. The nerve conduction studies were done after a baseline period of five days and then repeated after a three-week period during which the subjects could acquire and smoke standardized cannabis cigarettes. The casual users smoked a mean of 54·3 and the heavy users a mean of 109·5, cigarettes during the smoking period. No deterioration of peripheral nerve function could be demonstrated.

Forty-six mentally ill women with radiologically verified hyperostosis frontalis interna (HFI) were compared with 46 matched mentally ill women without HFI in respect of mental morbidity among the full siblings of the two groups. It was found that mental morbidity was lower among the siblings of mentally ill women with HFI than among those of similar mentally ill women without HFI. A reasonable interpretation of these findings is that the combination mental illness-HFI is more often exogenously determined than other forms of mental illness.