In 1926 Mapother stated that in manic depressive psychosis we are dealing with “a merely quantitative deviation” from the normal, morbid only in its undue prolongation or if disproportionate or disastrous in its degree. He included anxiety neuroses along with mania and all varieties of depression as members of the manic depressive group. Perhaps these beliefs reflected the inevitable pessimism of a period when therapy was largely expectant and custodial. Somewhat despondently Mapother goes on to say “sub-division serves little purpose unless the types discriminated are correlated with differences in the unknown—for example in causation, prognosis and treatment”.

This investigation is concerned with the prevalence of dysmenorrhoea and premenstrual symptoms in the general population and with their relationship to personality.

Many authors have expressed the opinion that such relationships exist, but we will confine our review here to those studies which have presented supporting data. Wittkower and Wilson (1940) studied 57 patients with primary dysmenorrhoea and found there was a history of childhood maladjustment four times as often in these patients as in a control group. They considered that patients with dysmenorrhoea could be classified into two main personality types: the first, “characterized by deep resentment of their feminine role”; the second, “obviously immature physically and either shy or shut-in or chronically anxious and complaintive”. Sainsbury (1960) observed a significantly raised neuroticism score on the Maudsley Personality Inventory for patients attending hospital for dysmenorrhoea. Such views as these are not universally held, and would certainly not be shared by many gynaecologists. Nor are they supported by the little evidence forthcoming from population studies.

I have been deeply moved by your invitation to deliver this year's Maudsley Lecture. Founded to commemorate so distinguished a man, it has become most properly one of the honours of psychiatry.

In the course of a study of families containing children of primary school age, we have collected detailed social and medical histories of the parents. In earlier papers (Ryle and Hamilton, 1962; Hamilton et al., 1962) based upon part of the population studied here, we have confirmed the reliability of the Cornell Medical Index (C.M.I.) as an indicator of neurosis. The aim of the present paper is to investigate whether social factors within a relatively homogeneous, largely working-class population, are related to neuroticism. While differences in the rate of neurosis between the social classes have often been described, interpretations of these differences are difficult because they may be due not only to variations in the rate of illness but also to differences in the mode of presentation, in symptomatology or in attitudes to medical treatment or to research enquiry. On the other hand, in studying a population such as ours, with small social class differences, the range of social factors available for measurement is reduced.

Doctors have climbed mountains with explorers and travelled the world with kings and statesmen; they have gone on humble journeys with sick folk, voyaged for money, fled from their enemies, sought new knowledge. We have travelled to learn about psychiatric opinion and practice abroad, and have greatly profited thereby.

Since its first formulation, the concept of manic-depressive illness has been subject to successive modification and, on the whole, to progressive enlargement. It was Kraepelin, following on the attempts of Baillarger, Falret and Magnan, who grouped together all the various nosographic forms distinguished by isolated depressive or manic crises, periodic or alternating (and even the form designated as involutional melancholia), including them all under the sole class name of manic-depressive psychosis. The morbid entity thus defined was regarded as distinguished by the periodicity of the crises, each with a tendency towards social remission. Aetiologically the causation was seen as preponderantly hereditary.

Numerous recent electroencephalographic studies have revealed the cyclical alternation of two distinct types of sleep (Dement and Kleitman, 1957a), which have been termed “fore-brain” and “hind-brain” sleep by Jouvet (1962). The former is accompanied by slow waves and spindles in the electroencephalogram (EEG) and the latter by a low-voltage, fairly fast EEG pattern; spasmodic, conjugate rapid eye movements (REMs); relaxation of neck and throat muscles in cat (Jouvet, 1962) and human (Berger, 1961); and recall of dreams following awakening (Dement and Kleitman, 1957b).

The last twenty years have seen great changes in British administrative psychiatry. Jones (1955, 1960) has described how the mentally ill began to be assembled into special institutions for their own good (and society's protection) some 150 years ago. The humanitarian revolution associated with the names of Pinel and Tuke and the philanthropic enthusiasm of Shaftesbury and the other early Commissioners in Lunacy led to the widespread building of asylums, especially after the Acts of 1845 and 1853. This was a period of great interest in administrative psychiatry, or asylum management, as the writings of Conolly (1847, 1856) and others show. During the latter half of the nineteenth century the enthusiasm was lost and the asylums became custodial. The consolidated Lunacy Acts of 1890 and 1891 fixed a pattern of humane custody scrutinized by Lunacy Commissioners which persisted little changed for 50 years. Custodial decline was also seen in the United States and some causes of it have been discussed by Bockoven (1956) and Ozarin (1954). In the last 20 years, however, and especially since the end of the 1939–45 War, there has been a marked change in the conditions of the mentally ill.

So little consideration is given in early medical writings to sexual disorders, that it seems that these were, for many centuries, hardly regarded as the concern of the physician. There are a few exceptions. For example: Hippocrates (Airs, Waters, Places XVII-XXII) discussed the part played by constitutional and environmental factors in the causation of impotence among the Scythians. Later, Caelius Aurelianus, according to Zilboorg (1941), while expressing disgust at the debauchery which characterized Imperial Rome, seems to have recognized that sexual perversions were illnesses which, at times, were epidemic in character. Subsequently, and in particular during medieval times, problems of this nature seem to have had a moral rather than a medical connotation. Indeed it was not until towards the close of the nineteenth century that any real insight into the medico-psychological nature of sexual difficulties and deviations became apparent. This new awareness reached its peak following the investigations of Havelock Ellis, Freud, Stekel and others, and the formulation of certain psychoanalytic hypotheses.

The present paper continues our study of the parents of children of primary school age, in a sample taken from one of the authors' N.H.S. list. The details of the selection of this population, the methods of data collection, and the absence of any relationship between various social factors and neuroticism, were described in a previous paper (Pond et al., 1963) and are not repeated here. In this paper we report upon the marital history and adjustment of the parents of these 100 families, and investigate the relationship between neuroticism and these factors.