5. MENTAL HEALTH: International Trends in Mental Health.

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examined closely. Evaluative scales and factor scores were the most stable; potency and activity were unstable; the three groups of patients did not differ among themselves in stability characteristics. The semantic differential was shown to be a valid index of attitude to clinically important concepts, as judged by psychiatrists' ratings of overt attitude. There is good evidence, therefore, both from the present investigation and from previous work, that in psychiatric patients the semantic differential is a valuable measure of clinically meaningful areas of functioning at a level involving both thought-content and affective response. The patterns of meaning on personal and emotional concepts disclosed by factor analysis of the resulting data showed that the dominant element in semantic judgment was a general evaluative factor. There were a number of clear-cut differences between the three clinical groups. Personal concepts were the sharpest discriminators : compared to controls, obsessionals had a disturbed self-concept, whilst psychopaths had disturbances in both selfand parental-concepts. In the emotional areas, there was some increased fear ofangerand hostility-concepts in psychopaths, and of anxiety-concepts in both obsessionals and psychopaths. Psychiatric patients, in both groups, linked hostilityand anxiety-concepts more closely than did controls. Of the conclusions which emerge from the study, the two most striking provide a challenge for some of the cherished dogmas of clinical practice. Study of these groups of in-patients showed no support for the assertions that obsessional symptoms are associated with abnormal aggressive feelings and that psycho paths have no feelings of guilt or conscience. Perhaps the most important result of Dr. Marks' work, however, is his demonstration of the stability, clinical validity and practical value of the semantic differential as an instrument for investigating the differential significance of key concepts in contrasting groups of patients. He has added impressively to previous work on the subject and provided a model for future applications of the method to the study of concept-formation in psychiatric patients. It would have been valuable to know more about Dr. Marks' views on the value of the technique to the furtherance of psychiatric theory and practice. In one of the last chapters, headed “¿ Vistas―, the author does not relinquish his commendably cautious analysis of his own and previous work. The reviewer would have welcomed a measure of imaginative extrapolation at this stage; it seems not unlikely that further development of techniques such as the semantic differential may ultimately advance our awareness of salient aspects of the relationship between form and content in neurotic illnesses and their treatment. Furthermore, it provides a means for constructing and testing several hypotheses con cerning the dynamics of abnormal behaviour. The book contains useful reviews of the literature on the theory and practice of the semantic differential technique as applied to psychiatry, and on relevant aspects of obsessional illness and psychopathic behaviour. Dr. Marks writes with clarity on his complex subject ; the methodology of his research is impeccable, and his commentary is in the scholarly, critical, and reflective tradition set by previous Maudsley Monographs. This is an important publication, and essential reading for psychiatrists and psychologists who wish to pursue their interests in identifying attitudes, meanings and thought processes associated with abnormal behaviour.