Recent losses occurring in the two years before onset of depression in women are distinguished from past losses occurring at any time before this. Of past losses only loss of mother before 11 is associated with greater risk of depression—both among women treated by psychiatrists and among women found to be suffering from depression in a random sample of 458 women living in London. Past loss of a father or sibling before 17 (or a mother between 11 and 17), or a child or husband, is not associated with a greater chance of developing depression. However, among patients all types of past loss by death are associated with psychotic-like depressive symptoms (and their severity) and other types of past loss with neurotic-type depressive symptoms (and their severity). It is argued that these associations probably reflect direct causal links, and a socio-psychological theory to explain them is discussed.

An account is given of attachment theory as a way of conceptualizing the propensity of human beings to make strong affectional bonds to particular others and of explaining the many forms of emotional distress and personality disturbance, including anxiety, anger, depression and emotional detachment, to which unwilling separation and loss give rise. Though it incorporates much psychoanalytic thinking, many of its principles derive from ethology, cognitive psychology and control theory. It conforms to the ordinary criteria of a scientific discipline.

Certain common patterns of personality development, both healthy and pathological, are described in these terms, and also some of the common patterns of parenting that contribute to them.

In three recent articles, Slater (1972, 1973, 1975) has made certain claims concerning the nature of science, especially as it applies to psychiatry. Most recently (Slater, 1975), he has applied his criteria for assessing science to psychoanalysis, and has found it seriously lacking. In this article Slater's criticisms of psychoanalysis are used as a foil to attack his criteria for science. It is argued that his methodological criteria are extremely conservative and would be likely to cause the demise of scientific activity if at all seriously applied. Further, it is argued that psychoanalysis is a science on any reasonable application of Slater's criteria.

The literature on the purely psychiatric aspects of mental handicap is remarkably limited. In the third edition of Mayer-Gross, Slater and Roth's Clinical Psychiatry, apart from one or two brief incidental mentions elsewhere in the text, the main references consist of just one paragraph on psychoses and two short paragraphs on neuroses included in the section on ‘The Association of Mental Subnormality with Other Syndromes’! Similarly the only reference to mental illness in mental handicap in the eighth edition of Henderson and Gillespie's Text-Book of Psychiatry was a mere four lines on psychosis; by the ninth edition, this had grown to seven lines covering both neuroses and psychoses, but with two of those lines devoted to an admission by the authors of their own lack of knowledge.

This Committee, under the Chairmanship of Mrs Peggy Jay, J.P., was appointed in July 1975, with the following terms of reference: ‘To consider Recommendation 74 of the Report of the Committee on Nursing (Briggs Committee), in particular to enquire into the nursing and care of the mentally handicapped in the light of developing policies, to examine the roles and aims of nurses and residential care staff required by the health and personal social services for the care of mentally handicapped adults and children; the inter-relationship between them and other health and personal social services staff; how existing staff can best fulfil these roles and aims; in the interest of making the best use of available skills and experience, the possibilities of the career movement of staff from one sector or category to another; the implications for recruitment and training; and to make recommendations.’

A principal advantage of establishing the .R.C.Psych. diploma is the opportunity this has provided to improve training by the constructive approval of hospitals and units. The word instructive’ is used because the Approval Exercise, sed upon visits by College Panels, is much more an a series of emotionally detached olympian pections. It is a two-way process of exchange of ronnation, ideas and views about the best ways of omoting training in a particular setting. Above all it provides, through the sanction of possible non-approval, a powerful lever and stimulus to Health Authorities, trainers and trainees to generate the resources and to organize these into a programme of training in both the theoretical and practical fields.

An account is given of how a clinician guided by attachment theory approaches the clinical conditions to which the theory is held to apply, which include states of anxiety, depression and emotional detachment. Assessment of a patient is in terms of the patterns of attachment and caregiving behaviour which he commonly shows and of the events and situations, both recent and past, which may have precipitated or exacerbated his symptoms. The problems posed by relevant information being suppressed or falsified are noted.

Viewed in this perspective a psychotherapist is seen to have a number of interrelated tasks: (a) to provide the patient with a secure base from which he, the patient, can explore himself and his relationships; (b) and (c) to examine with the patient the ways in which he tends to construe current interpersonal relationships, including that with the therapist, and the resulting predictions he makes and actions he takes, and the extent to which some may be inappropriate; (d) to help him consider whether his tendencies to misconstrue, and as a result to act misguidedly, can be understood by reference to the experiences he had with attachment figures during his childhood and adolescence, and perhaps may still be having.

The Royal College of Psychiatrists feels that the national Health Service does not meet the needs of the community, particularly in the field of mental health, where even minimum standards have not been reached.

This paper attempts to define the areas of applicability of behavioural and mentalistic explanations of neurotic behaviour. It is argued that intentional behaviour requires mental concepts for its explanation on the grounds that the statement of reasons which form the basis of intentions cannot be submitted to a stimulus-response analysis. This argument applies to situations in which the therapist uncovers the reasons for purposeful action of which the agent may initially be unaware. It is further argued that behaviour of this kind is rule-conforming and not law-abiding and therefore is not susceptible to explanations of the kind that are available in other areas of science. It is nevertheless argued that causal explanations can be given in terms of reasons for action.

Parasuicide admissions to the Regional Poisoning Treatment Centre in Edinburgh are reviewed over the seven year period 1968–74. Special emphasis is given to trends in parasuicide rates for Edinburgh City, but social and clinical data are also described. Though the mean annual increase for admissions is 10 · 6 per cent, recent years have shown a fall in the rates for men and a levelling off for women. There have been increases in the rates for the young, for men in social classes 4 and 5 and for divorced women, and in poisonings with psychotropic drugs and alcohol consumption among women. At the same time it is important to note variables which have not changed: the relative risks by age and sex, repetition rates, the diagnostic picture, poisoning with non-prescribed drugs, and the rank order of municipal ward rates: and variables which have diminished: the rates for divorced men, overcrowding, domestic gas and barbiturate poisoning, and drug misuse. A comprehensive explanation of parasuicide in the contemporary scene would have to explain both the consistencies and the changing trends. The answer to the central question of why parasuicide is changing remains elusive.

The existence of a nation-wide twin register and central psychiatric register has made possible a catamnestic investigation of an unselected and representative sample of twins with manic-depressive disorders.

From a total population of 11,288 same-sexed twin pairs born 1870–1920 in Denmark 126 probands from no pairs were ascertained. Among the co-twins of 69 monozygotic probands there were found 46 with manic-depressive disorders, and a further 14 had presented other psychoses or marked affective personality disorders or had committed suicide, yielding a proband rate of strict concordance, C1 = 0·67 and of broad, partial concordance, C2 = 0·87. The corresponding direct pairwise concordance rates were 32/55 = 0·58 and 46/55 = 0·84 respectively. For the dizygotic twins the proband concordance rate of C1 was 11/54 = 0·20 and of C2 20/54 = 0·37, and the direct pairwise rates were 9/52 = 0·17 and 18/52 = 0·35 respectively. The differences between the pairwise rates for the monozygotic and dizygotic twins are significant (P < 0·001 at χ2 analysis). This finding is in accordance with previous twin studies of manic-depressive disorders and confirms the evidence of a strong genetic factor. The concordance with respect to unipolar and bipolar forms was not in contradiction to recent evidence of a genetic difference between the bipolar and unipolar form, the latter probably related to the female sex.