Psychosurgery has always been, and is likely to remain, a controversial subject. Blind operations lack precision and can lead to adverse personality changes or other serious side-effects. Open surgery is becoming less acceptable because of the difficulties of accurately assessing the extent of a lesion and its exact location. The introduction of stereotactic techniques enables far smaller lesions to be placed with a high degree of accuracy, and increased knowledge of the limbic system has contributed to advances in this field.

I am no expert in the field of mental handicap and what I have to say derives from a general rather than a special acquaintance with the subject you are to discuss. That may be no bad thing, because much of the extensive change which has come over the psychiatric field in the past twenty years has been due to a change of outlook by those outside psychiatry, giving better opportunities for those within.

The world as a whole, and to a lesser extent this country, is confronted with the strong possibility of an unprecedented increase in its population. Pressure of population will produce tensions which will pose problems to psychiatrists. But other social events will give rise to generally similar tensions which will thus have multiple causes. It will then be difficult to separate the effects of population pressure from the effects of other causes and there may be illjustified swings of opinion such as we have seen in the past.

For the purposes of this paper the South-East Asia region has been taken to include India, Ceylon, Burma, Thailand, Indonesia and the Philippines. The region thus demarcated is not merely an area of geographic contiguity but also comprised almost entirely of developing countries involved in a process of social change as a result, principally, of exposure to the West. The traditional economy of agricultural self-sufficiency in all these countries is coming to be replaced increasingly by an industrial economy which is essentially tied up with world trade. Most of the countries in the region have emerged from a colonial status into independent states with a renascent and sensitized nationalism. There is in these countries abundant enthusiasm for new goals set up after achieving independence; but this is dampened with a sense of self-doubt that prevails as much amidst the leaders as amidst the led. Thus in this region a generation of people appears to be trying to outlive its history and live on hopes for a new future.

Psychiatric disturbances in a student population span a broad spectrum and include overt illness, a heterogeneous group of psychosocial problems with varied and changing symptomatology and normal crises of development. Complaints of work difficulty often form part of the symptomatology of all these groups, and not infrequently may be the presenting symptom. Quantification is difficult because the symptoms vary in degree and form, and change over time. They may be unreported or voiced only to friends or tutors. Their prevalence and significance is therefore hard to assess. In a cohort study spanning a four year period, Lucas (unpublished data) found that of the 15 per cent of the cohort who received brief psychotherapy, more than three-quarters had a work difficulty of some kind. Of the 26 per cent of the cohort who never attended the Student Health Centre nearly half replied ‘yes' to a question asking whether they had experienced recurring work difficulty.

The following Mmwrandum in reply to the Questionnaire from the Sub-Committee of the Standing Mental Health Advisory Committee on the ‘Role of Psychologists in the Health Service’ has been approved by Council and has been submitted lo the Sub-Committee. It was recognized thot the Specialist Sections might wish lo make additional comments and, if so, these will be submitted separately. (See under ‘Child Psychiatry Section’ below.)

This paper represents part of a study into what determines the action taken by individuals in distress. More specifically we were concerned to elucidate why some people attempt to find relief by seeking support and guidance from an appropriate agency, while others resort to self-aggressive behaviour. Two groups of subjects have been investigated, one consisting of certain clients seeking help from the Telephone Samaritans organization, while the other comprises patients who had engaged in acts generally described as ‘attempted suicide’ but better termed ‘parasuicide’ (Kreitman et al., 1969) or ‘deliberate self-poisoning or self-injury’ (Kessel, 1965).

When a Western-trained doctor first encounters the practice of medicine in the Third World, he cannot fail to be impressed by the apparently limitless sea of morbidity—infection, faulty sanitation, malnutrition, congenital and acquired malformations—with which a very small number of trained personnel have to cope, as best they can. In public health planning of these countries priority has to be given to arresting the killing diseases, such as malaria, tuberculosis and other deadly infections, and to the provision of basic hygiene, of pure water, and of adequate nutrition. The next priority goes to deploying preventive measures against debilitating disease, wherever such measures are known, and their application has been shown to be feasible; and finally when the expectation of life has been satisfactorily increased, attention is given to interventions which improve the quality of life.

This paper outlines one method of investigating the phenomenology of spontaneous hallucinations in a mental hospital population; and considers the possibility of using the method as an aid to differential diagnosis.

The neurophysiological aspects and operative technique of stereotactic limbic leucotomy have been described in a previous paper (Kelly, Richardson and Mitchell-Heggs, 1973). The present investigation is a prospective study designed to assess the results of such surgery in a group of 40 severely ill psychiatric patients, who had failed to respond satisfactorily to every other type of treatment. The results have been assessed clinically, psychologically and physiologically, in a very detailed way, at six weeks; a similar follow-up at one year is in progress. A comparison is made between the results of the present series and those of a previous: study (Kelly et al., 1972), in which more extensive leucotomy operations were carried out, and similar means of assessment were employed.

This phase of the study was concerned only with the 93 parasuicides already described in Part I. It was designed to ascertain their knowledge of help-giving services, and to elucidate their attitudes towards help-seeking both in general and in the specific context of their parasuicidal behaviour.