For the use of the term “affective disorder” there is good literary warrant. Shakespeare, writing in the last decade of the sixteenth century, or just before it, uses the word thus:

This investigation is not concerned with the clinical indications or results of prefrontal leucotomy, but attempts to re-examine changes following the operation, especially in regard to the impairment of some of the manifestations of the highest integrative psychophysiological functions of the central nervous system that may bring about such alterations. Amongst these we were primarily interested in cognitive changes, but the interpretation of apparent cognitive changes led to the consideration of orectic alterations as well. Such changes have so far been impossible to localize exactly, but are considered to be partly related to the phylogenetically more recent parts of the cerebral cortex. Masserman (1946) compared the mechanism of shock treatment and leucotomy with the effects of alcohol and states that “its main actions are those of a cortical depressant,” as manifested by impairment of finer perceptions and discriminations and a “constriction of the integrative field.” He believes that shock therapies and leucotomy partly produce their results by temporary or permanent decorticating effects, “rendering the individual no longer capable of fine spun fantasies or elaborate delusions.” These decorticating effects can be assumed to be reflected in cognitive, conative and emotional alterations following the operation. The interpretation of change following leucotomy presents many difficulties, one of them being that only dysfunction can be related to structural damage of the frontal lobe and not function. Another is that psychotics or severe neurotics operated upon usually do not have a sufficiently intact pre-operative personality to draw conclusions about the normal functions.

Delinquency is one of those vague but fashionable words that are becoming very difficult to define. Originally it appears to have been used to describe minor infringements of the social, moral or legal code, with special reference to acts of omission rather than acts of commission. It is now often used to describe any kind of anti-social conduct, whether trivial or serious, while some use it as a harmless euphemism for crime, although the word crime, in its technical meaning of an act or omission punishable by law, is inoffensive, and has no reference to the question of moral guilt or culpability. It is therefore perhaps advisable for me to say what meaning I attach to the word to-day. For the purpose of this paper I am using the word in the general sense of criminality, that is to say, I am confining my remarks to the more serious types of anti-social conduct shown by mentally defective persons.

In 1872 Wm. Ireland, of Scotland, attempted a classification of mental deficiency based on pathological conditions. His twelve group's were: Genetous, Microcephalic, Hydrocephalic, Eclampsic, Epileptic, Paralytic, Traumatic, Inflammatory, Sclerotic, Syphilitic, Cretinous and Deprivative.

The Hospital System.—In all three Scandinavian countries there are two main types of hospital catering for psychiatric patients, the mental hospital proper resembling closely in its style and function the institutions of that name to which we are accustomed in Great Britain and the psychiatric clinic, a department of a general hospital. All three countries also have institutions for the mentally defective, Denmark and Sweden ones for criminal psychopaths and Sweden ones for the treatment of alcoholic addiction.

The close relation of aphasia to lesions of particular brain areas may be responsible for the fact that factors other than lingual in their effects upon aphasic reactions have long been neglected. Pierre Marie (1906) came to the conclusion that in true aphasia the defect in language is regularly accompanied by a general intellectual defect. This opinion found little recognition; his statement was too general, and was not found to be in agreement with clinical experience. Head (1926) made a more elaborate attempt to break with the traditional ideas when he introduced the conception of symbolic expression and formulation, and viewed the clinical pictures of aphasia which came under his observation from a more general angle. Goldstein (1924, 1926), in applying the Gestalt conception to aphasic disorders, brought the brain function as a whole into the picture. He found the basis of aphasie disorders in the inability of figure-background formation and categorical behaviour. Such extra-lingual factors have consequently been considered in the analysis of particular cases by several authors (Woerkom, 1925, 1931), Bowman and Gruenbaum (1925), Klein (1929, 1931, 1932). Demonstrated on two aphasic patients, they are also the subject of this paper.

Psychiatric disorder, according to the recently published statistical report on the Health of the Army, constituted one of the most common medical causes of discharge of A.T.S. from the Army, and was among the most frequent causes of admission to hospital.

The swallowing of foreign bodies is more prevalent in prisons than in mental hospitals. Is it that there is something in the prison environment which causes some prisoners to swallow foreign bodies, or should the clue be sought for in the personalities of the swallowers? A few prison swallowers are insane, the great majority are not.

I cannot tell whether it is purely a matter of chance that in Uppsala, a university town, I have had to treat difficulties at school in children of average or superior intelligence to a greater extent than in Stockholm where I practised earlier. It is obvious that everywhere the most usual cause of such difficulties is either subnormal intelligence or special difficulties in reading and writing, that can be classed among the aphasic disturbances, most commonly in the form of dyslexia. In Uppsala, however, I have encountered a relatively large number of cases with difficulties of other kinds that are not described, or only mentioned, in current textbooks on child psychiatry.

Thiamine or aneurine has for many years been known as the anti-neuritic vitamin, although action of this substance in organic nervous trouble is not established. Less well-known is its action on the higher cerebral processes, but results of investigations appear to show that it has a definite effect on these. M. V. Dias (1947) found that the application of thiamine hydrochloride solution to the motor cortex of unanaesthetized dogs produced clonic contractions of the appropriate muscles, and Harrell (1946) reports striking psychological results on normal children.

The treatment of depression with desoxyephedrine (pervitin or methedrine) is not new. In 1943 Davidoff reported a comparison of the effect of this preparation with amphetamine and dextroamphetamine on 8 normal and 8 depressed individuals. He found that desoxyephedrine gave the most rapid results, acted the longest and produced the greatest motor activity the most often.

The loss of consciousness in hypoglycaemia is generally regarded as a direct consequence of the fact that the brain cells are being increasingly deprived of glucose, their principal fuel. The prompt relief of symptoms by glucose administration led to a number of investigations on the effect of other substrates known to sustain the respiration of surviving brain slices in vitro. Amongst these are various mono- and disaccharides, and such acids as lactic, pyruvic, succinic or glutamic acid which may be formed from glucose in the course of its metabolism. It appeared, however, that, in contrast to their in vitro action, most of these substances, including glutamic acid, were unable to relieve the symptoms of hypoglycaemia in eviscerated or hepatectomized animals (Bollmann and Mann, 1931; Maddock, Hawkins and Holmes, 1939). Similarly, lactic and pyruvic acids were found to have no effect on the oxygen consumption of the brain or the comatose state of hypoglycaemic patients undergoing insulin shock therapy (Wortis and Goldfarb, 1940; Goldfarb and Wort is, 1941). It has been shown for several substrates, including glutamic acid, that their rate of diffusion from the blood stream into brain tissue was markedly slower than that of glucose, and that therefore the concentration necessary for the maintenance of nervous function was not reached (Klein, Hurwitz and Olsen, 1946; Klein and Olsen, 1947). In harmony with this are the observations of Fried berg and Greenberg (1947), and of Waelsch, Schwerin and Bessman (1949) that intravenously injected glutamic acid is not taken up by brain tissue. The differences between the in vitro and in vivo results seemed to be adequately explained by these experiments.

The finger-prints of mental defectives have been investigated by Bonnevie (1927), Poll (1935) and M⊘ller (1935). It was found that the frequency of whorls was less in the feeble-minded and imbeciles than in the general population but there was no correlation between intelligence quotients and quantitative values of patterns among defectives. Very little investigation has been carried out on the epidermal ridges of palms in mental defectives except in the case of mongoloid imbeciles, where Cummins (1939) and Workman (1939) have investigated the main patterns. Penrose (1949) has measured the angles subtended at triradius t by triradii a and b, and the present writer has counted the epidermal ridges between the a and b triradii.

I am indebted to you for giving me this opportunity to put before you certain tentative conclusions at which I have arrived as a result of working at the problem of physiological instability on a group of 525 children between the ages of 6 and 14. Like so many investigations of this type, it began on a presumption that was not borne out by further experience, and because of this it caused me to revise certain views I held on the subject.

In my student days, after the first world war, teachers and text-books still used the term dementia praecox. It was looked upon as a disease sui generis, and descriptions were entirely in terms of clear-cut asylum cases with the usual classification into simple, hebephrenic, katatonic and paranoid. There was no psychopathology worth noting, and no anticipation of the immense gap waiting to be explored between “normality” and complete mental breakdown. In effect this meant that there was no half-way house in diagnosis: it was either dementia praecox or nothing. The revolutionary change in diagnostic approach began with Bleuler's highly original conception of the disorder as a progressive splitting of the psyche, indicated by the name schizophrenia which he gave to it, and which now holds the field. Added to this there are the researches of the psycho-analytical schools (the Jungians in particular) which have succeeded in opening up a huge and fascinating borderland on the fringe of normality, with a corresponding enlargement of our notions of schizophrenic disorders.

This paper presents an example of the depersonalization syndrome as experienced and described by an intelligent patient. Considering the frequency of its occurrence, this syndrome has not been as often recognized nor as adequately described as would be expected. The syndrome was first described by Mayer-Gross (1935), later by Gordon (1936), Shorvon (1946, 1947) and Tayleur Stockings (1947). The psychopathology of depersonalization was given in analytical terms by Oberndorf (1935, 1936) and Feigenbaum (1937); Galdston has recently discussed this aspect (1947). As a symptom of organic brain disease, depersonalization offers an interesting field in the long-disputed question of body-mind relationship. Reidl (1942) described this symptom in a case of carbon monoxide poisoning, and Brock and Weisel (1942) discussed its occurrence in organic cerebral disease. Guttman and Maclay (1936) described the interesting relationship between mescaline intoxication and depersonalization. Cerebral anatomical localization was discussed in an anatomico-clinical study by Dide (1938).

There are few studies relating electroencephalographic characters with mental deterioration. Romano and Engel (1) (2) made an EEG and clinical study of “delirium” which they defined as the “toxic-infective state or psychosis associated with somatic disease” which was accompanied by “fluctuation in the level of awareness” and “intellectual, emotional and motor regressive behaviour”; the group included cases of chronic and acute cardiac decompensation, chronic alcoholism, hypertensive states, and severe Addison's disease. These authors considered that the EEG changes could be graded into three main groups, in order of severity: firstly,” decrease in frequency,” with increase of slow 4–7 frequencies and normal blocking responses to visual attention; next, “disorganization,” with irregular slow 2–7 frequencies and poor blocking responses; and finally,” reorganization at a lower energy level,” with moderately high voltage slow 3–7 c./sec. activity, few or no normal frequencies, and absent blocking response to visual attention. This latter stage was, in some cases, found to be irreversible. Previously, Engel and Margolin (3) had published the results of an investigation into the effect of both oxygen and glucose-deprivation on the human electro-encephalogram. Both these conditions produced bursts of diffuse generalized 3–6 c./sec. activity which, in those cases with an acute onset, reverted to normal rhythms as clinical improvement occurred. However, 4 patients with chronic cerebral anoxaemia were examined (end-stages of chronic bronchitis with right-sided heart-failure) in whom the EEG abnormalities persisted; at an early stage, activity with a frequency of 5–6 c./sec. appeared, and still later the records became completely disorganized. There was one patient who ultimately recovered whose EEG showed a regular dominant alpha rhythm with a frequency of 7.5 to 8 c./sec. It had already been noticed that, in a few cases where the EEG had apparently returned to normal in prolonged anoxic and hypoglycaemic cases, there yet remained some degree of intellectual deficit on psychological testing. Hill (4) had observed that a type of EEG with a slower dominant alpha-rhythm than the normal 8–13 c./sec. (i.e. a rhythm at 6–8c./sec.) was frequently associated with mental deterioration. An investigation was accordingly instituted to determine to what degree mental deterioration and slowing of the dominant rhythm in the post-central areas (alpha-rhythm) were associated.