While there is general agreement that deafness, either congenital or acquired in early childhood, is psychologically damaging (Oléron, 1953; Furth, 1961; and Vernon, 1966), opinions are divided on the adverse effects that deafness beginning in adolescence or in adult life may have on mental health. For example, Furth (1966) has reported that the way of life of the adult deaf should not be all that different from people with normal hearing, although it has been generally held that deafness in adults predisposes to the development of irascibility and paranoid attitudes (Kraepelin, 1915; Slater et al., 1969). The relationship between deafness and paranoid illness has been investigated by Houston et al. (1964) and Kay et al. (1961).

The Manpower Sub-Committee of the Education Committee has been concerned about the future medical staffing structure in psychiatry, particularly with the future of the non-consultant medical grades, and whether there should be a place for a Medical Assistant or similar non-consultant career grade. A questionnaire was sent to all psychiatric consultants, and another questionnaire to all other grades of psychiatrists in order to obtain their views on this question. These questionnaires have now been analysed, and the detailed findings are presented.

Professor Penrose turned his attention to the subject of mongolism at a very early stage in his professional career and retained an undiminished interest in all facets of the problem for more than 40 years. His first publication in this sphere was in 1931 (1) and was entitled ‘The creases on the minimal digit in mongolism’. The observations he made in this publication are typical of some of his later ones. It reflected a mind alert to useful detail, in this case the fact that in some mongols there is only one flexion crease on the fifth digit instead of two. This peculiarity rarely occurs in the normal population and therefore provides an additional diagnostic criterion for mongolism. Particularly at a time when chromosomal examination could not be undertaken, this direct simple observation helped in the clinical delineation of a condition which is not always easily recognized.

While the beneficial effect of lysergic acid diethylamide (LSD) in the treatment of carefully selected patients as an adjunct to psychotherapy has been amply reported (Robinson et al., 1963), concern has been expressed regarding the damage to chromosomes in those taking the drug.

There is an increasingly evident and urgent need for child psychiatrists to scrutinize, to clarify and to communicate the nature of the task in which they are professionally engaged. This point is cogently made for the whole of psychiatry in a leading article in The Lancet entitled ‘Psychiatric Training in a Fog’. In it the author draws attention to the grave import for psychiatry of the implications of a number of recent studies. Gross deficiencies in many training programmes with respect to community work and psychotherapy have been shown by the report of the Royal Medico-Psychological Association Manpower and Education Project, by Peter Brook. Disquieting trends in the recruitment of trainees have been reported by Russell. Shepherd has emphasized the need for research in order to back up with established knowledge the expanding aims of contemporary psychiatry. All these studies, it is concluded, point to a need for a ‘fundamental assessment of the whole nature of what constitutes the practice of psychiatry’.

Although there have been several reports of investigations of speech perception in schizophrenia (Laffal, 1961; Lawson, McGhie and Chapman, 1964) in all cases the assumption was made that the patients’ difficulties arose, not from an inability to perceive the individual words, but from a deficiency in perceiving the words in a meaningful relationship to each other, as part of an organized pattern. In this study, however, instead of examining the performance of schizophrenic patients on a task involving the perception of sentences, as these earlier workers had done, we have used individual words as stimuli in a series of tests of speech perception.

Many inheritance models of schizophrenia have been proposed, in view of its variable age at onset, variable familial occurrence and the relevant influence of a great number of environmental factors (Gottsman and Shields, 1967; Heston, 1970; Ödegård, 1972). However, the real genetic predisposition to schizophrenia has not yet been experimentally verified, and genetic markers have to be looked for, i.e. we need some character, genetically determined, whose transmission is associated with schizophrenia transmission: the more polymorphous the character, the greater will be the probability of finding such associations.

Surreptitious ingestion of anticoagulant drugs is a rare condition which presents as an obscure bleeding tendency associated with gross depletion of the vitamin K dependent factors (factors II, VII, IX and X). In all previously reported cases the patients have denied taking drugs but chemical analysis of the plasma has shown the presence of members of the coumarin or indanedione groups.

Beginning with the work of Cameron (1944), the concept of overinclusive thinking has been used to describe or account for the thought disorder observed in schizophrenic patients. This is usually defined as an inability to preserve conceptual boundaries, perhaps based on a cerebral input dysfunction which causes difficulty in filtering stimuli (Payne et al., 1959; McGhie, 1970; Epstein, 1953; Broadbent, 1958). This leads the schizophrenic to make remote associations and to overgeneralize or overabstract.

The Howard League for Penal Reform

The Howard League have produced this new document questioning the logic of contemporary penal policy and the current prison building programme. The League starts from the assumption that everybody is agreed that it is useless to imprison petty offenders. They point out that the Prison Department is proposing to spend at least £100 million, over five years, on new buildings, in spite of the current staff shortage and recruitment problems. ‘We cannot accept’ says the document, ‘the logic of building more prisons, when the overcrowding is largely due to the imprisonment of people for whom provision could and should be made in the community, often at lower cost’. As a counter-argument the League puts forward the suggestion that ‘a major aim of penal policy should be to limit the prison population, during the next ten years, to those who present a serious danger to society’. They accept that a certain amount oi replacement of ‘Victorian slum fortresses’ is necessary, but warn against the danger that ‘by a penological Parkinson’s Law the number of prisoners will increase to fill the cells available for their detention’. They do not accept that prisons should be used as an expedient facility in the network of arrangements made for homeless men, and they express hope that the DHSS will soon provide the facilities to keep destitute alcoholics out of prison. Part of their counter-policy is to advocate ‘a substantial transfer of resources of finance and manpower from the custodial penal system to non-custodial measures’, to encourage sentencers ‘to make greater use of social and medical reports’, and to remove certain offences ‘such as those consequent upon homelessness and alcoholism’ from the criminal law or to make them non-imprisonable. One important suggestion they make which would affect almost every psychiatrist providing a district commitment is to extend outpatient facilities for medical reports ‘mandatorily if necessary’. In this vein they further suggest taking up a number of proposals made by the Standing Conference on London and South East Planning in its report Penal Establishments in the South East (1971) among which was a suggestion that prisons dealing with psychiatrically disturbed offenders should be accessible to good medical and consultant facilities.

(i) The powers available to the Courts for the disposal of offenders requiring psychiatric treatment should be flexible, offering the widest range of options. To this end, the facts having been established, the Courts should have the power to impose a ‘Court Treatment Order’ which would allow a possibility of treatment in a variety of settings according to need. With suitable upgrading of facilities (referred to later) a Court Treatment Order would allow treatment of a disturbed offender in designated prison hospitals (if a high degree of security was required), in hospital, Special Hospital, medium-secure or special treatment unit, and with supervision and after-care mandatory on release. This implies the power to impose a period of care for a fixed period or for an unlimited period of time. The existing parole system and appeals system could operate appropriately.

In his interesting account of the history of Brentry Hospital, Dr. Janear described what was done by Harold and Katherine Burden. They came to Bristol in 1895, when Mr. Burden was appointed chaplain to Horfield Prison. They had worked in the East End of London and were much influenced by the achievements of Octavia Hill. Now they turned their attention to the mentally subnormal, and Stoke Park Colony was opened in 1909. Much later, in 1933, this earlier work was furthered by Mr. Burden’s second wife, who established the Burden Mental Research Trust for the study of the causation and inheritance of normal and abnormal mentality. She also supported the foundation of the Burden Neurological Institute in 1939; its illustrious achievements have set a stamp of excellence on our national contribution to the scientific study of mental subnormality. The classical work of Professor Golia, Dr. R. M. Norman, Dr. Fraser Roberts and Dr. Grey Walter, to mention only four of the brilliant workers associated with Stoke Park and the Burden Neurological Institute, has laid solid foundations for the biological study of mental subnormality in this country. Among present workers of this group, Dr. Heaton-Ward and Dr. Janear have added their own remarkable contributions, including their textbooks on mental subnormality which have become classics in their own right.

Many theoretical accounts of the affective disorders, in particular those by writers of the psychodynamic schools, have emphasized the central role of hostility and aggression. However, there have been very few objective studies of the expression of aggression in patients with affective disorders. Of these, two have used the Hostility and Direction of Hostility Questionnaire (HDHQ,) of Foulds (Foulds et al., 1960; Foulds, 1965). Mayo (1967) tested 24 depressed patients before and after treatment and found a significant decrease after recovery, both in their level of general punitiveness and in their level of intropunitiveness. The psychotically depressed patients scored significantly higher than the neurotic depressives. Philip (1971) tested depressed women, and found that extra-punitiveness did not change over time, but that improved patients were less intropunitive than those who showed no improvement. No studies have reported the hostility pattern of manic patients.

Like other mental disorders, mental deficiency presents great problems in diagnosis. These diagnostic problems derive ultimately from the fact that a medical diagnosis can be made only in exceptional cases. Mental retardation is not a disease in itself, but only a symptom which may be found in a number of different conditions. It is true that there are a great number of oligophrenia syndromes with known aetiology, but together they represent a numerically small group. When one considers, in addition, that no clear cut distinction between the normally intelligent and the mentally retarded can be made, since the difference is merely quantitative, the difficulties of diagnosis become manifest.