Some time ago one could have said both truly and succinctly that hospitals are the places where patients are, and from this basic premise it would have been fairly easy to work out a presentable picture of the role of hospitals in research. Now, however, epidemiologists tell us that many mentally sick people are not admitted to hospital, and clinicians stress that if admission occurs it is likely to represent a recurrent episode in a long programme of management in which important therapeutic influences are brought to bear on the patient at work or in other places remote from hospital. It therefore seems reasonable to conclude that certain types or phases of research which might once have been carried out in hospital must now be done elsewhere.

At one time the doctor used to treat both the patient and his illness; with the understanding of aetiology comes the possibility of ignoring the patient, saying only ‘take the pills and you will recover’. Since such treatments have become all too easy, both doctors and patients have turned away from them to personality problems and the symptoms of psychogenic disorders, so much more difficult, more time-consuming and more interesting.

Gross somatic illnesses and psychotic reactions associated with pregnancy, parturition and the puerperium are well known, but it is only in recent years that attention has been paid in any systematic way to milder neurotic reactions post partum. During the last decade reports have appeared from several centres on woman's reactions to pregnancy, studied from various viewpoints. As regards psychological reactions it is obvious that the modern Western woman has to a considerable extent an ambivalent attitude to maternity. It is therefore hardly surprising if this attitude, together with the sometimes pronounced somatic strain of pregnancy, results in a high frequency of emotional disturbances during and after pregnancy.

The first part of this study of female monozygous twins discordant for childbirth covered intrapair differences before pregnancy (Kaij and Malmquist, 1970). This part is focused on the influence of motherhood on health, presented as intrapair differences in gynaecological, other somatic, and psychiatric morbidity after pregnancy.

Recent clinical studies of families with schizophrenic offspring have reported a variety of abnormalities, some of which—such as abnormalities of individual development, family roles and cognitive processes—appear to relate to the development of schizophrenia in a given child. The precise nature and mechanism of these possible relationships, however, have not yet been definitively established. It is to this end that we have been studying a series of families with identical twins discordant for schizophrenia. Previous reports have described the sample, methodology, and findings with regard to life history differences between the schizophrenic and non-schizophrenic twins (Pollin et al., 1965, 1966), biological variables (Stabenau et al., 1968, 1969; Stabenau and Pollin, 1967b, 1968a), parental illness (Guggenheim et al., 1969), and the interaction of constitutional and psychological variables (Pollin and Stabenau, 1967, 1968, and Stabenau and Pollin, 1967a). This paper describes an attempt to further clarify the relationships among four variables in our sample of families: (a) psychopathology; (b) identification; (c) thinking and ‘cognitive’ style; and (d) dominance-submissiveness.

The difficulty of examining separately the genetic and environmental factors responsible for mental illness has resulted in different approaches to surmount this obstacle.

Previous papers in this series have concentrated on concepts which relate to the communications brought by the patient and to the factors, in both patient and therapist, which either facilitate or hinder the free flow and understanding of these communications. However, in the discussion of working through (Sandler, Dare and Holder, 1970a) reference was made to those interventions of the analyst which aim at bringing about enduring changes in the patient, and to the need for continual elaboration and reinforcement of the analyst's interventions. Whilst the term ‘interpretation’ is often used in a general sense to refer to these interventions (at least, to the extent that they are verbal) it seems appropriate to examine the concept in some detail.

Whatever will be the verdict of posterity on the scientific value of psychoanalysis, its place in the history of thought and of psychiatry is assured. A profuse psycho-analytic literature exists and many eulogies of Freud have been published, but there are few first hand accounts of what went on behind the scenes of the various psychoanalytic societies that train and give professional status to analysts.

Psychotherapy is the art of relieving psychiatric problems by psychological means. Which problems are psychiatric and which means of treatment are psychological could be debated at length. The boundaries of psychotherapy impinge on many areas—faith-healing, religious counselling, the many caring professions, psycho-pharmacology and neurophysiology. Numerous ideas and methods are subsumed under the term psychotherapy. Some psychotherapists confine their view of psychotherapy to a limited theory and technique, while others are more comprehensive in their practice and encompass a variety of viewpoints. In the past many different schools of thought proliferated, each claiming the superiority of its own methods and its theory, while being neglectful of other techniques and ideas. New ideas would often be treated as heresy, while pragmatism would be regarded with suspicion.

Half the prison admissions for England and Wales are of persons on drunkenness charges (BMJ 1968). Ratcliff (1966) records that there were, in one year, 1,180 occasions in Scotland when a man was actually imprisoned as a result of a drinking offence. He found that on average the offender had seven previous sentences for the same alcoholic offence. An important factor for prison alcoholics is the extent to which they resemble or differ from alcoholics who are receiving psychiatric treatment.

In the treatment of alcoholism our aim should be to adapt the treatment to the individual patient. It is recognized that alcohol addiction is a manifestation of a multitude of differing neurotic or personality disorders and that radical treatment must focus on the underlying disorder.

In the past two decades revolutionary scientific advances and social developments have changed our attitude to the management of conditions associated with severe mental subnormality. Therapeutic achievement has admittedly been on a limited scale, and in terms of medical treatment in the conventional medical sense is likely to remain so. Very great hope lies, however, in the use of our newly-gained knowledge and expertise for prevention rather than cure.

The technique of systematic desensitization employing methohexitone-induced relaxation was first described in 1966 (Friedman, 1966) and a review of results of treatment by this technique at six-month follow-up was encouraging since 15 of 18 patients continued to show marked improvement (Friedman and Silverstone, 1967). The present study reviews 124 patients treated by the same method.

Schizophrenic patients are referred to frequently as immunologically incompetent or poor antibody responders. However, if the literature comparing the response of immunized chronic schizophrenics with non-schizophrenic controls is examined, contradictory results may be found (1). Development of allergic responsiveness in schizophrenics as compared to control subjects was also studied with controversial results (4, 2). No studies have been reported in which the antibody response of schizophrenic patients was measured quantitatively simultaneously with the development of an allergic skin reaction following sensitization.

Lang (1960) has reported that in his own data and in that of Jensch (1941) the sex ratios of the maternal half-sibs of homosexual index cases was low and the sex ratio of paternal half-sibs was high (see Table). I should like to offer a possible explanation of this phenomenon.