No abstract

Psychiatrists differentiate types of abnormal personality in practice by assigning a descriptive label to indicate the chief way in which the patient's behaviour deviates from what is usual in society. The use by psychiatrists of such a category system for diagnosing abnormal personality has been discussed in two previous papers (Walton et al., 1970; Walton and Presly, 1973). The diagnostic system evaluated was one which included categories contained in the American Psychiatric Association classification (1968) and in the relevant section of the International Classification of Diseases (1965).

Two hundred years ago Joseph Cox published his book on the treatment of insanity. His novel technique was rotating the body in a specially designed chair. Initially modest and later extravagant claims were made for the therapeutic benefit of 'Cox's chair'. It was widely adopted in Europe in the first decades of the nineteenth century, but lost favour thereafter. Its benefits have proved to be scientific rather than medical because it was adopted by students of the senses to investigate vertigo; a century later it re-emerged as the Bárány chair for the clinical assessment of vestibular function. The legacy of Cox's chair, and its related treatment of swinging, are to be found in funfairs throughout the world.

From beginnings in imaginative literature and philosophy, the study of abnormal personality was taken up by clinicians who founded their investigations on the methods of observation and intuition. On the basis of case notes, experience and recollection, the pioneering psychiatrists constructed descriptive classifications which served as an initial taxonomy and enabled diagnostic and therapeutic work to proceed.

This study attempted to assess the applicability of the Clinical Interview Schedule (Goldberg et al., 1970) to mentally handicapped patients in a hospital. Twenty-seven patients were rated simultaneously by three raters. Of the 31 items assessed for reliability, 11 were completely satisfactory, 8 were satisfactory, 6 unsatisfactory and 6 'not proven'. Ratings made by all raters for overall severity of psychiatric illness correlated significantly with similar ratings made by the consultants responsible for the patients.