Many investigators have pointed out the social and psychological meanings of broken homes and their effects on individuals' behaviour. Goldfarb (3) stressed the importance of normal parental relationships both in ego formation and in the transfer of ego functions from parent to child. Thompson (16) maintains that the loss of a familiar perceptual framework may be as equally important as the loss of a love-object. Bowlby (2) points out that love deprivation and superficial relationships frequently lead to maladjustment and delinquency. Kardiner (4) emphasizes the importance of the social and cultural values of tender emotion as the basis of social cohesion and culture. Several research workers have found high incidences of broken homes among schizophrenics (Pollack et al., 10; Lidz, 5; Oltman et al., 8) and among neurotics (Madow and Hardy, 6; McGregor, 7). Other research workers have been concerned with the incidence of broken homes among individuals who attempt suicide (Palmer, 9; Reitman, 11; Sainsbury, 12; Batchelor and Napier, 1; Stengel and Cook, 14; Walton, 18; Teichner, 15; Toolan, 17; Simon, 13). However, the majority of the latter group of studies have lacked comparative control groups. The present study investigates several factors of social disorganization which distinguish a group of attempted suicides with a history of broken homes from a group of psychiatric out-patients who have not attempted suicide but have a history of broken homes. All comparisons will be between attempted suicides and psychiatric out-patients from broken homes.

This paper reports the work of a clinical team on 100 consecutive first admissions to a unit constructed for the treatment of psychopaths at Balderton Hospital, Newark, Notts, and opened 1958–61. To prevent bias all male admission with behaviour disorder admitted between 1958–60 are here reported except: five admitted for observation of less than a week, twenty-two admitted only for remand, and those with a Wechsler or Stanford Binet I.Q. less than 56. The unit specialized in delinquents with mental disorder, and received admissions from all over Britain.

The problem of drug addiction is numerically a relatively minor one in this country at the present time, although the effects on the patients concerned, particularly as a considerable proportion belong to the medical and allied professions, are profound. The Interdepartmental Committee on Drug Addiction in its Report (1961) attributed our relative freedom from the problem largely to the present attitude of the public towards drugs and to the systematic enforcement of the current Dangerous Drugs legislation. In the U.S.A., on the other hand, drug addiction is a matter of national concern and there the hand of the physician treating drug addiction is controlled by Federal legislation. Tremendous efforts have been made, with only a limited degree of success, to diminish its incidence particularly during the past twenty years. Legislative measures, notably the Harrison Act of 1914, have been introduced; national committees have been set up to discuss the problem; and two hospitals (Lexington, in Kentucky, and Fort Worth) both entirely devoted to the treatment of drug addiction, have been established. As a direct result of these efforts a considerable amount of valuable information concerning drug addiction has become available, particularly as a result of the work of Isbell and his colleagues at Lexington Hospital. The addictive properties of new preparations have been assessed; the metabolic, pharmacological and biochemical aspects of drug addiction have been investigated, and research into the psychological mechanisms underlying drug addiction has been carried out.

Social medicine seeks to discover and tries to remedy pathogenic influences arising from poor housing, poverty, and occupational hazards. Similarly, social psychiatry has shown much concern with the prevalence and incidence of mental disorders in different socio-economic classes, in urban as against rural surroundings, and especially in conditions of relative social isolation or integration, which have often been found to be linked with certain areas of towns and cities. The limitations of this ecological approach have been summarized by Clausen and Kohn (1954). They were highly critical of many of the assumptions made by ecological workers, and they felt that their approach was too coarsegrained. The units studied were too big, and they suggested that a study of family relations and of more intimate interpersonal interactions would be more rewarding and more likely to shed some light on the social aspects of mental ill-health. They might have added that it would also be much more difficult.

The Underwood Report (12) drew attention to the need for some system of classification in child psychiatry. This paper presents the results of a statistical study which was undertaken as relevant to that general enquiry.

The relationship in the same patient of epilepsy and psychosis is little understood. Although patients with temporal lobe epilepsy especially tend to show more psychiatric disturbances than do other epileptics, it is still not agreed whether an “epileptic psychosis” exists in its own right, any more than whether there is such an entity as the “epileptic personality”. The literature is full of contradictory statements and hypotheses. This is inevitable considering that epilepsy is a symptom-complex of diverse aetiology. However, within the total population of epileptics, it is possible to define groups with one or more common characteristics, e.g., similar pathology, localization, symptomatology, or inheritance. In studying the psychiatric manifestations it is probably better to try to relate them to such sub-groupings than to epileptics as a whole. The problem is of practical concern, for the incidence of epilepsy is between 0·4 and 0·5 per cent. of the general population (College of General Practitioners, 1960), while Pond and Bidwell (1959) in their survey of the practices of 14 family doctors pointed out that about a third of the epileptic patients had psychological difficulties.

Headache alone is estimated to be the chief and central complaint of eight million people (8). In one series of five hundred cases only ninety-six were found to have an organic basis (4).

Although there is general agreement that the neuroses constitute a major public health problem there is little reliable information about their distribution. The difficulty is largely one of definition. As most people experience emotional conflict of some sort, the concept of neurosis can be widened so readily as to rob it of much value for medical purposes. Epidemiological enquiries have been hampered by disagreement about the nature of neurosis and by the lack of screening techniques (Shepherd, 1960). In consequence formal morbidity surveys have proved difficult to conduct and their results still harder to interpret.

Towards the end of 1961, the authors undertook a survey of the state of development of Industrial Therapy in mental hospitals of England and Wales (1). The results showed that already, of the 181 hospitals taking part in the survey 47·5% currently have Industrial Units and a further 15% are proposing to open them in the near future. This paper is a statement of some of the advantages and difficulties in opening an Industrial Therapy Unit. In discussing these problems we have drawn upon the experience we have gained over the past 6 years, the first 2 years of which we carried out sub-contract work and the last 4 years in running a commercially self-contained manufacturing business. The type of workshop that we have in mind is one dealing with a wide range of mental disability. The aims of the Unit will therefore be directed on many levels: the two principal levels being (1) preparing some patients for resettlement and (2) the occupational rehabilitation of patients with poor clinical prognosis within the walls of the hospital.

In a recent report (Reidy, 1960) of experiences in running a newly opened Centre for disturbed pre-adolescents, it was found that the majority of cases had presented as emergencies. The author goes on to state that “To my knowledge there has been little written on what constitutes a psychiatric emergency in pre-adolescent children. The dangers of suicide and homicide, the main reason for emergency hospitalization of adults, are, according to the literature, rarely present in pre-adolescents.”

In the course of urine-testing with Phenistix in a survey∗ of the inmates of remand homes, classifying schools and approved schools, only one positive result has been obtained from 2,300 boys and 541 girls tested so far in the London area. This was obtained with the urine of a boy who proved not to be Phenylketonuric, and further investigations were carried out in his case and with members of his family.

The purpose of this paper is to describe the manner in which psycho-analytical concepts and theory may contribute to the difficult problem of diagnosis in schizophrenic reactions. At the present time there is an increasing realization that the criteria which are used in the diagnosis of these conditions are unsatisfactory, not only because they have a low prognostic significance but also because they fail to provide the research worker with discrete clinical concepts which he can use in physiological or psychological investigations. As Stengel (1960) has pointed out, the criteria employed in the diagnosis can vary extensively within the same hospital quite apart from the inevitable differences which exist within the one country and from country to country. It is the wide variation in what is called schizophrenia which has vitiated so much important and worthwhile research in clinical psychiatry.

Owing to the use of other therapeutic measures in mental hospitals, interest in brain operations undertaken for the relief of psychotic symptoms has fallen to a minimum. Hence, opportunities for studying the mental effects of such cerebral lesions are now practically non-existent. The investigation by Aaron Smith (1960) of the residual deficits as shown by the Porteus Maze Test in cases who had suffered topectomies eight years previously, as reported in this Journal in July, 1960, may very well be the last word on the subject. The time seems opportune, therefore, to make a brief summary of the results of a test that is now considered to be the most sensitive to frontal brain damage.

Patients are occasionally encountered who spend much of their lives gaining admission to hospitals apparently suffering from acute surgical and medical conditions. They elaborate long and complicated histories which are full of falsifications, and may submit to operations which they do not require. Consequently an extensively scarred abdomen is characteristically seen in those who undergo repeated laparotomies, but seldom is anything found at operation to account for their symptoms, although adhesions from former operations are occasionally noticed. Usually they leave hospital against medical advice, or discharge themselves while investigations are still in progress or before their operation wounds have fully healed.