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The problem of treating the “back ward” chronic schizophrenic is likely to remain for some years to come, and with it the problem of establishing the genuine effectiveness of particular treatments. Disentangling effective from non-effective therapeutic techniques in “total-push” programmes is particularly complicated. What precisely is responsible for the minimal improvements observed: some subtle change in “ward climate”, the altered medication or the new music therapist? Writers who view mental illness primarily as a breakdown in normal interactional relationships with other persons have stressed the therapeutic importance of certain types of social milieu (e.g. Martin, 1962). Others (e.g. Greenblatt et al., 1955) have suggested that the success of even the physical treatments can be explained in terms of the optimism and enthusiasm with which they are carried out. However, there are few systematic research attempts to disentangle the physiological from the psychological variables.

up 49 out of 76 patients who had been on the waiting list for psychotherapy for three to seven years but had not received treatment. (Seven patients who had found treatment elsewhere in the meantime were excluded.) 65 per cent. were found to be â€oe¿ recovered― or â€oe¿ improved―. Criteria were: â€oe¿ Recovered: these were symptom free and in full employment, and had suffered no loss in socioeconomic status. Improved: these were troubled only by residual symptoms, were in full employment, and had suffered no loss in socioeconomic status.― (c) Saslow and Peters (5956) followed up 87 out of ioo consecutive patients who had been diagnosed as â€oe¿ behaviour disorder― andâ€"for any reasonâ€"had not had more than two interviews. Follow-up was one to seven years. Criteria used were those of Miles, Barrabee and Finesinger (595 i). @ per cent. were â€oe¿ apparently recovered― to â€oe¿ improved―. This study is rendered less valuable by the statement that 53 per cent. of the patients had had â€oe¿ continuous care of some kind― (nature not stated) since their original interview. 2. The second type of study is that in which untreated controls are compared with treated patients, or in which â€oe¿ less treated― or â€oe¿ less specifi cally treated― patients are compared with those who were â€oe¿ more treated―. The evidence from this type of study is equivocal. Studies in which little significant difference could be found between the two series are: (a) Barron and Leary (i@@@; criteria: changes in the M.M.P.I.; follow-up 7â€"8 months); (b) Brill (1966; criteria: M.M.P.I., clinical evaluation; follow-up about two years). This study contained a series of patients who were put on a waiting list but in fact never received treatment. (c) Endicott and Endicott (1963, and in press; criteria: many psychological tests, including M.M.P.I., and many clinical rating scales; follow-up 6 months for the waiting list controls). Studies in which significantly more improve ment was found in the treated patients were: (a) Rogers and Dymond (sg@; criteria: self * This includes Case i i, whose original complaint (vocational problems) had disappeared, though the word â€oe¿ symptom― is perhaps not entirely appropriate.

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