The Main Problem.

The subject to be treated by me on this occasion may perhaps seem to some people almost presumptuous. For psychology is not without severe critics. I can hear one of these saying that, before it takes upon itself to teach others, it would do well to put its own house in order. Is it not, by general admission, passing through a “crisis”? Have not half-a-dozen theories arisen, each of which claims to be the “new” psychology, whereby all the older views are now to be finally superseded?

Studies of the mind of man and of the heart of the frog, though normally deeply divided, can be bridged when two postulates are granted. The first postulate is that the quality of excitability, on which nerve-cell activity is based, can be studied in any other excitable tissue; the second is that mental activity, as we know it, depends on the presence of excitable nerve-cells in the brain. The postulates being granted, it becomes legitimate to apply the results of experiments on excitability performed with the frog's heart in explanation of the mode of working of the brain and mind.

In the previous paper on the subconscious and conscious mind it was tacitly assumed throughout that excitation processes, though capable of activating the responding organ, yet are kept within the limits of that organ's capacity to respond. In the case of the heart, however, it was definitely pointed out that the responding organ had a limited capacity to give a normal response; also that the intensity of excitation processes could exceed this capacity (1, 3).

In considering the significance of double nerve supplies, we shall limit our outlook to the heart, and leave to others the task of applying the results to the wider problems of vagotonia, etc.

Recent decisions in the Law Courts leave the law relating to improper or negligent certification in a very unsatisfactory position; and that not only from the point of view of the medical practitioner. The effect of the decision in Harnett v. Fisher ([1927] Appeal Cases 573) is that a person of sound mind who has been improperly certified as insane through the negligence of the certifying physician, and has as a result of that negligence been deprived of his liberty for a period exceeding six years during which it has been impossible for him to take legal proceedings, is by his failure to do so—in other words, by the very gravity of the wrong that he has suffered—deprived of any remedy for that wrong against the person to whose negligence it is traceable.

The value of sunlight in the maintenance of health has been recognized from early ages, and history records sun-worship by many nations in the past as well as at the present time. In Europe records exist of the use of the light of the sun for medical and surgical purposes since before the Christian era, but it was only towards the end of the last century that its possibilities began to be studied and the value of the electric arc lamp as a substitute recognized. In 1893 Finsen demonstrated the value of sunlight and electric arc radiation in the treatment of lupus, and at the beginning of the present century Bernhard of Samaden treated wounds and tuberculous lesions with sunlight. In 1903 Rollier opened his first clinic at Leysin, where he obtained excellent results in the treatment of tuberculosis, especially of the surgical type, by insolation in the brilliant Alpine sunshine. In 1908 Gauvain introduced heliotherapy at Hayling Island and at Alton. Nagelschmidt used the air-cooled quartz mercury vapour lamp for general irradiation in the same year, and in 1913 Reyn commenced the use of the carbon arc for the same purpose. The value of ultra-violet rays in the cure of rickets was not recognized till demonstrated by Huldschinsky in 1918, though Palm (1), as early as 1890, urged that deficiency of sunshine was a cause of the condition.

Within the last year a series of papers has been issued (1, 2, 3) from this laboratory indicating that in the psychotic there exists a disturbed regulation of the respiratory mechanism for the control of acid-base equilibrium, which, in the cases examined, mainly depressed psychoses, manifested itself as an inexcitability of the respiratory centre, shown by a failure of response to CO2 stimulation. The work was done on uncertified borderline cases of insanity; it has since been confirmed by Marsh (4) on certified patients, and his results in 73 cases confirm the original findings and indicate plainly that dementia præcox and depressive psychoses fall into a group showing a variable inexcitability of the respiratory centre. The question naturally arises whether this condition is a cause or an effect of the mental state, and, from the point of view of cause, whether it is due to the drug-like action of some substance arising from faulty metabolism, or is an exhaustion effect. The question of intestinal toxæmia obviously needs investigation in this respect. This subject has been freely discussed in the literature and its significance becomes of greater importance in relation to psychoses owing to the work of Buscaino (5, 6) and Scheiner (7, 8) in Italy, and of Stewart (9) in this country. Buscaino describes a reaction of the urine with silver nitrate in certain psychotic cases, alcoholic insanities and dementia præcox, and from this assumes the existence of a toxic substance from liver derangement in these cases. He further describes lesions of the small intestine of mental patients which may result in undue permeability of its walls; it is not proposed to discuss this latter aspect of his work, but to deal with his silver nitrate reaction.

[The following is an almost verbatim transcription of some impromptu remarks made before an informal discussion at a meeting of a local group of the Psychopathology Sub-Committee. These remarks are, therefore, very sketchy and unoriginal, and the reason for committing them to paper at all in such an unvarnished form, is briefly this:

Few medical officers in mental hospitals wish to master all the intricacies of psycho-analysis, but many seek some concise, elementary knowledge concerning psycho-analysis as a body of theories (rather than psycho-analysis as a technique). It is for these that the following recapitulation is being published, largely in accordance with the suggestion of members present at the original group meeting, and in the hope of encouraging others, equally unversed in the finer details of the subject, to come forward and discuss these problems.]

“It is at least conceivable that our present complacent assurance that every individual must live and act within the arbitrary limits assigned by conventional and purely artificial standards of conduct, or else be segregated from society, may be fallacious and inimical to the best development of the race.”

The points raised here have been brought up by the occurrence, side by side, of a number of cases showing the same peculiar factors in ætiology and course. The existence of such cases has been for long well recognized, but the clear-cut nature of the whole process has in those here mentioned been so marked that they have been selected to illustrate the operation of a mechanism shown in a lesser degree in very many of our hospital cases, and too often lost sight of.

” In a recent murder trial at Los Angeles, California, one William Edward Hickman was indicted for the murder of a young schoolgirl. At the trial an attempt, which appears to have been unsuccessful, was made to set up a defence of insanity (dementia praecox).

I have read with interest and appreciation the brief paper on “Focal Infection in Relation to Mental Disease “(vide Journ. Ment. Sci., April, 1929, p. 267) contributed by Drs. Kopeloff and Kirby, whose work, along with that of their colleague, Dr. Cheney, is familiar to English and American psychiatrists.

Some of you may be wondering why a man who writes novels should be asked to make a speech on behalf of the Tavistock Square Clinic, and I must admit that I have been cudgelling my brains to find a satisfactory answer. The reason, however, is now clear to me. This Clinic, as you know, deals with functional nervous disorders. That also seems to be the province of the modern novelist, judging from the character of our library fiction. Some of these Constant Nymphs, these Lily Christines, the heroes and heroines of our Flaming Youth and Young Anarchy, are in urgent need of treatment by Dr. Crichton Miller and his colleagues. Readers of Mr. Michael Arlen and Mr. Aldous Huxley must imagine that passion of the most disordered kind is running riot in society and the suburbs, and that morals have been abandoned from Mayfair to Mitcham.