The majority of “behaviourally oriented” treatments for non-consummation due to vaginismus combine (a) teaching the patient how to relax the perineal muscles, (b) simultaneous vaginal exploration and dilatation, preferably performed by the patient herself, and (c) some form of psychotherapy (Lazarus, 1963; Malleson, 1942; Friedman, 1962; Brady, 1966). Surprisingly perhaps, active participation by the male spouse is considered unnecessary by some experts (Malleson, 1942; Friedman, 1962). Friedman has shown there was no statistical relationship between actively involving the male in therapy and the outcome of treatment.

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 ?

In an authoritative paper, Sandler and Hazari (1960) examined the responses of 100 neurotic patients to a personality questionnaire. The latter was in fact the Tavistock Self-Assessment Inventory, which consists of 867 statements each of which the subject is required to mark as “True” or “False” in regard to himself. Sandler and Hazari extracted responses to forty of these statements which were regarded as having reference to obsessive/compulsive character traits and symptoms, and subjected the data to factor analysis. Two factors were identified, and the original items were then classified according to their projection on two reference vectors, A and B, obtained through rotation of the Centroid factor axes through 45°. The two groups of items represented “two tendencies which, in their appearance in this group of patients, appear to be more or less unrelated”.

A psychotic v. neurotic scale has been presented in the manual of the Symptom-Sign Inventory (Foulds and Hope, 1968). This scale was constructed after comparing each of four female neurotic groups with each of four female psychotic groups and each of four male neurotic groups with each of four male psychotic groups. For an item to be included in the scale 14 of the 16 comparisons within each sex had to show differences significant at least at the 5 per cent. level. On 18 items the psychotic groups had frequencies in excess of the neurotic; on only one item was it the other way round. The scale score is the sum of these 18 items minus the one.

Tests of thought-disorder may perhaps all be measuring a common entity, but the degree to which this is true has yet to be established.

The purpose of this study was to investigate those entrants to a Ministry of Labour Industrial Rehabilitation Unit whose entry documents categorized them as “no disability” or “able-bodied”.

There is ample evidence that placebo can cause most, if not all, of the effects due to any active drug (Beecher, 1962; Honigfeld, 1964). A detailed case history of apparent dependence on a placebo can be added to these, in the form of the following clinical experience.

Many neurotic patterns of behaviour are considered to be adaptations to the environment, although often thought of as “maladaptive” in the sense of not being the optimum adaptation, and as reflecting pathological needs and expectations.

The decade following the end of World War II saw a progressive rise in the admission rate to mental hospitals in this country. The population of mental hospitals rose to a peak of 152,000 in England and Wales in 1954, since when there has been a steady decline. These fluctuations have been analysed by such authors as Norton (1961) and Tooth and Brooke (1961). The latter attributed the more recent decline to increased efficiency of treatment and rehabilitation, and predicted a continued fall so reducing the mental hospital patients by about 1970 that they would be covered by an allocation of 1 · 8 beds per thousand population. Maclay (1963) believed this prediction to err if anything on the conservative side and the Ministry of Health (1962) based its plans for psychiatric beds upon this ratio. In these plans the Ministry accepted the thesis that short-stay psychiatric patients should preferably be treated in general hospital units near to their homes whilst patients needing a longer hospital stay should be catered for in specialized hospitals for that purpose. The prediction in the Ministry of Health's Hospital Plan (1962) that there would be a steadily declining mental hospital population has been severely criticized by Gore and Jones (1961) but supported by Orwin and Sim (1965) in their analysis of the effects of the provision of acute general hospital psychiatric units in the Birmingham area. The importance of accurately assessing the psychiatric hospital bed needs over the next twenty years, given a full range medical and ancillary services, is vital to future planning and has been much in the author's mind when writing this paper.

In his Upjohn lecture Professor G. W. Harris (1964) reviewed experiments on the effects of gonadal hormones on the sexual behaviour of animals. He compared sexual behaviour patterns of male rats castrated on the first day of life with those of adult castrates. When fully grown, these day-old castrates were either primed with oestrogen and progesterone and tested for female mating behaviour, or they were given testosterone and tested for male behaviour with receptive females. Thus, Harris was able to demonstrate bisexual behaviour (mediated through hypothalamic-pituitary pathways) with female type activity cycles occurring in male rats. These experiments suggest that gonadal hormones exert a dual effect. During the early phase of development they act inductively, and later in the adult they exert an excitatory action on the central nervous system.

Most clinical psychiatrists would agree that many but not all schizophrenic subjects show abnormalities in the field of language. Many use neologisms, i.e. new words for old referents, and some chronic patients talk in a more or less private language which at times degenerates into a word salad. The following features have been noted in the schizophrenic's verbal productions—alliteration, condensation, over-inclusiveness and the personal distortion of the symbol-referent tie. Stuart Chase said: “The point of every discussion is to find the referent. When it is found emotional factors dissolve in mutual understanding.” Psychiatrists often assume that they have identified the referent which ties in with the symbol the patient is using, but sometimes the patient uses new symbols, as “Bill” did the other week when he astonished the other group members by announcing that he was “troubled by warpations and distressed by ignorances”.

Industrial rehabilitation of mentally ill patients was pioneered by Early in his highly successful Industrial Therapy Organization at Bristol. In this organization patients are first industrially trained in the hospital and then progress to a training factory situated in the community.

Future psychiatrists are likely to be recruited from the segment of the medical student body expressing an interest in psychiatry as a future career. This investigation deals with the personality differences found in students according to their positive or negative attitude to psychiatry.

This paper summarizes the experiences of five years of treating sexual disorders with behavioural methods. The simplicity of the methods used made it easier to adhere to the principles of accurate timing than has appeared to be the case where a more complicated set-up has been used. The only elaboration of the basic method was its prolongation into a maintenance phase.

Burgess and Harrington (1964), Hoenig and Ragg (1965), and Errera et al. (1965) studied failure to keep initial appointments at psychiatric clinics. The present study is concerned with non-attendance at a follow-up clinic.

Wing and Freudenberg (1961) assessed the response of schizophrenic subjects to regimes of active and passive encouragement. Their findings suggest that a subgroup of very inactive patients exists and that this group responds dramatically to incentives. The purpose of this study is to re-examine the behaviour and attempt to define this subgroup. Such an examination may provide information which could be applied to treatment programmes. It may also contribute to a better understanding of the nature of the schizophrenic's volitional defect.

One major characteristic of behaviour disorder is persistent hostility towards authority. Those offenders who appear repeatedly before the Courts and are eventually diagnosed as cases of behaviour disorder, almost uniformly exhibit histories of difficulties with authority (8). Indeed, when a study was made of 87 case-notes of patients in a hospital for the mentally subnormal who were admitted as suffering from behaviour disorder, in order to discover those features of their previous histories which were common to all, it was found that every one showed a persistently troublesome relationship with authority figures (9).

The case history is reported here of a woman who has developed involuntary movements while having prolonged phenothiazine therapy. The disorder has developed gradually and is apparently irreversible. It has some unusual features.

A number of searching studies on transsexualism have been published during recent years (Roth and Ball, 1964; Benjamin, 1966; Wålinder, 1967). In the present paper we shall attempt to demonstrate that transsexualism has another direct social consequence besides the large risk of suicide which one of us has already demonstrated (Wålinder, 1967). Our study was prompted by our experience that transsexuals change their address unusually often in comparison with others.

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.