Tics or habit spasms have been described in various ways, but perhaps the most useful definition is that of Kanner (1937) that they are “quick, sudden and frequently repeated movements of circumscribed groups of muscles, serving no apparent purpose”. Children with this symptom not infrequently present to the paediatrician or child psychiatrist with accompanying symptoms of emotional disturbance, and by the age of seven years approximately five per cent of children have a history of such movements (Kellmer Pringle et al., 1967). Less commonly, adolescents who have suffered with tics from an earlier age develop vocal tics and coprolalia (compulsive swearing) symptomatic of Gilles de la Tourette's syndrome. Tiqueurs are rarely seen for treatment in adult life, except in a few well-documented cases where Gilles de la Tourette's syndrome persists (Fernando 1967).

In 1962, Perley and Guze introduced specific criteria for the diagnosis of hysteria based on clinical observations made in 1951 by Purtell, Robins and Cohen. A number of reports have been published since 1962 evaluating the limits and usefulness of these criteria. A recent paper by Guze (1967) summarizes a large part of this work and explores various problems of definition and methodology. In 1968, two papers appeared in this journal evaluating the criteria for hysteria by applying them to women with chronic medical illnesses (Woodruff) and to normal women (Farley, Woodruff and Guze). The present study is an extension of the method used in those reports.

Systematic psychiatric studies of tattooed men are rare. Lander and Kohn (1943) noted that they had a higher rate of rejection for military service on psychiatric grounds than non-tattooed men. Yamamoto et al. (1963) studied the male population of a Veterans Hospital. They compared the 65 (15 per cent) men who were tattooed with the 368 who were not. They found that the percentage of tattooed men on the psychiatric wards was not significantly higher than that on the general medical or surgical wards; the tattooed men, however, exhibited significantly more evidence of personality deviation than the non-tattooed men.

Interesting accounts of injuries resulting from self-applied constricting bands have been given by Thurston (1963, 1967), Little (1965), Cutler (1967), Turney (1967) and Glew (1967). Callum (1967), Noott (1967) and Webb (1968) have reported injuries in babies where the band was presumably not self-applied. Cohen (1967) noted lesions in mental defectives produced by self-applied elastic bands round the teeth.

The aim of the present study was to examine more closely than has previously been done some widely accepted generalizations about the ritualistic behaviour of patients suffering from obsessional neurosis. Observation of such patients had suggested that their behaviour is less consistent and is governed by a much greater complexity of factors than is normally assumed. In addition it seemed that such over-simplification has led to the construction of inadequate theoretical models to explain ritualistic behaviour. Moreover it appeared that this over-simplification was linked to the fact that there have been very few systematic studies of the obsessional ritual itself: most descriptions of obsessionals' behaviour seem to be based on the retrospective and rather general accounts, given by the patients themselves in the relative calm and detachment of the consulting-room situation. Observation of patients actually performing rituals suggested that such accounts might well be misleading. Therefore, it seemed likely that it would be profitable to study the rituals of individual obsessional patients systematically and in some detail. In the investigation reported here, three such studies were carried out. The first two, which are reported briefly, were relatively uncontrolled and had as their aim the derivation of more specific hypotheses to be tested in a later investigation. The third study, which is reported more fully, was concerned with testing out these hypotheses by the more rigorous investigation and manipulation of the rituals of a further obsessional patient.

The syndrome of autoerythrocyte sensitization is characterized by painful ecchymotic lesions of the skin that develop in a very stereotypic manner. Onset occurs in a palm-sized skin region, usually on the limbs, with a stinging and burning sensation. After varying lengths of time, in general 2–6 hours, the skin becomes red, hot, oedematous and tender. This inflammatory phase may last anything up to twenty-four hours. Over the next few days the rubescent heated infiltration turns into an ecchymosis which spreads annularly at the same time as the tenderness and swelling diminish. Originally described by Gardner and Diamond (1955), thirty-one cases of the syndrome have now been reported. Up to the present all reported cases have come from North America and Australia and been confined to women with an age at onset of between 15 and 66 years.

The relationship between mental illness and physical disease in elderly patients has been the subject of a number of studies, notably those by Kay and Roth (1955) and Roth and Kay (1956). Stenstedt (1952, 1959) reported a high mortality rate among patients with manic-depressive psychosis and involutional melancholia, which he attributed to ‘the high frequency of suicide and to the fact that several patients had died in a mental hospital’. In a survey of elderly people living in the community, Kay and Bergmann (1966) demonstrated a relationship between physical illness and diminished life expectancy on the one hand and functional psychiatric disorders on the other. Shepherd et al. (1964), in a general practice survey in London, found a 'strongly marked association between psychiatric disorder and chronic organic illness'.

The prognosis for patients with senile dementia after admission to hospital has generally been regarded as poor, it being thought that by the time the illness reached a stage necessitating admission life expectation was very low. Figures obtained by Roth (1955) support this view; only 18 per cent of his patients with senile dementia survived for more than two years. The prognosis for atherosclerotic dementia was rather better, with approximately 27 per cent still alive at the end of two years.

George A. Kelly graduated in engineering with psychology as a subsidiary subject at the time when the boom of the ‘twenties in the United States was collapsing into the depression of the early ‘thirties. He found it impossible to obtain employment as an engineer and went to practise psychology in an impoverished, inaccessible area on the border of the dust-bowl. There he had to do the best he could to diagnose and treat the peculiar psychological problems of his patients by himself without the advice or assistance of any medically qualified psychiatrist or other psychologist within reach for consultation. He found little help in the popular psychologies of the period, behaviourism and psychoanalysis. Through trying many experimental approaches he gradually developed a homespun psychology which he expounded in a two-volume book, The Psychology of Personal Constructs (1955) and elaborated in a very large number of other publications after he entered the academic world.

Psychotherapists, who by temperament are likely to be tender-minded, have up to now largely failed to devote “attention to the problems of quantitative assessment” (Sutherland et al., 1967), and have perhaps been too prone to regard the complaints of tough-minded critics as manifestations of unconscious resistance. If, as most therapists do, one retains the conviction that patients are altered by the experience of psychotherapy, it should be possible to demonstrate and measure such alteration. The fact that attempts to measure change are often unconvincing is probably a function of the crudity or irrelevance of many of the measuring instruments used.

One of the most attractive features of the Repertory Grid Technique from the clinician's point of view is that it provides a quantifiable test of hypotheses concerning data which are not readily measurable by more traditional standardized instruments (such as questionnaires). An example of such a situation as this would be where the psychologist wishes to measure change in a person's construing of his world before and after psychotherapy. This immediately involves, however, questions concerning the “reliability” and “validity” of the particular grid or grids used. How do we know whether reasonably stable psychological processes within the individual are reflected in equally stable mathematical relationships between constructs, and how do we know that we have chosen, or elicited, those constructs which really are most psychologically meaningful to the subject, or indeed psychologically meaningful at all ?

The background, methodology, and general results of a comprehensive survey of treated psychiatric illness in Lebanon have been described in an earlier report (4). The investigation consisted of obtaining biographical and diagnostic data on all patients seen by psychiatrists in Lebanon over a six-month period (15 February 1964 to 15 August 1964) and was carried out with the collaboration of all three psychiatric hospitals in the country and twenty of the twenty-one psychiatrists practising within and outside these institutions.

Makerere University College is the oldest institution of higher education in East Africa. Situated in Kampala, Uganda, it lies not far from the northern shore of Lake Victoria, and draws its student population from those countries around the lake shores—Kenya and Tanzania, as well as Uganda itself. Eighty-five per cent of the enrolled students are of African origin, the remainder being Asians.