This Address tonight will mostly concern psychiatric treatment, and it must be quite exceptional, I think, for those of us, still in our late forties, to have lived through such a revolution in treatment as we have seen in the last twenty years in this country. In this revolution I believe we have seen Great Britain emerge as one of the countries now leading the world in the skilled, humane and all-round treatment of her mentally ill patients. There is obviously still very much that needs to be done, yet we must try not to underestimate what has already been achieved recently in this country.

The purpose of this survey was to assess the intellectual and social status of 150 children of 73 certified mental defectives. It is proposed to discuss the mothers in this paper and the children in a further one. The mothers in this group were all at one time patients at the Fountain Hospital. Much of the initial work was done by Mrs. L. Mundy, the Senior Psychologist, who had already tested most of the mothers, and Miss Kerry, the social worker, who had maintained contact with many of the discharged mothers and their children. One of the main factors which have made the research easier has been the general good feeling towards the Fountain felt by our ex-patients. They want the Fountain in general and the Physician Superintendent in particular to know how they are and what they are doing. Dr. Hilliard's “somewhatunorthodox procedure with difficult cases” (1956) and his views on feeblemindedness have now become fairly generally accepted. His view that many of these women can work successfully in the community has been substantiated already. It is hoped that this survey will help to avoid the inhuman and expensive administration process whereby an allegedly feebleminded mother is permanently separated from her child.

There seems little reason to believe that schizophrenia in the Bantu differs materially from the disease in other races, and no one thus far has produced conclusive evidence of fundamental differences between the symptoms of African and European schizophrenics. Nevertheless, certain diseases common in Europeans, are rare in Africans, others tend a different course, and the latter condition may perhaps apply to a somewhat variable disease like schizophrenia, especially considering the existence of certain factors which will be discussed.

Various investigations into the effects of brain injury on psychological test performance (Weisenburg and McBride, 1935; Patterson and Zangwill, 1944; Anderson, 1951; McFie and Piercy, 1952; Bauer and Becka, 1954; Milner, 1954) suggest the overall conclusion that patients with left hemisphere lesions are relatively poor at verbal tasks, while those with right-sided lesions do worst at practical tasks, particularly the manipulation of spatial or spatio-temporal relationships. Heilbfun's (1956) study confirmed that verbal deficits result from left-sided lesions but his left and right hemisphere groups produced almost identical scores on spatial tests. In so far as these workers paid attention to the specific sites of the lesions, their findings indicate that the pattern of test performance is a function of the hemisphere in which the lesion occurs rather than of its specific locus.

It is well known that obsessive-compulsive symptoms may occur in the prodromal phase or in the course of schizophrenia, and that schizophrenic symptoms may supervene in a long-standing obsessional neurosis. Stengel (1945) has reviewed much of the earlier literature concerning the relationships between obsessional neurosis and schizophrenia. The question whether obsessional neurosis could develop into schizophrenia has often been discussed. Pilcz (1922), Legewie (1923) and Schneider (1925) distinguished between genuine obsessions which were symptoms of an obsessional neurosis, and symptomatic obsessional ideas which could occur in various conditions. These authors, as well as Stekel (1950), doubted whether a genuine obsessional neurosis could develop into schizophrenia. Bleuler (1911) thought that some patients suffering with chronic obsessional symptoms were in fact schizophrenic, especially where a schizophrenic psychosis had been observed in the family. Mayer-Gross (1932) expressed the view that cases of obsessive-compulsive neurosis existing over decades without change and presenting marked autism were often schizophrenics. Together with Bleuler, Mayer-Gross suspected that many of Janet's “psychasthenic” patients had been schizophrenic. Janet (1903) had observed 3,000 cases of psychasthenia, of which 12 developed into psychosis, and two into hebephrenia, but Janet's psychasthenia probably included cases other than obsessional neurosis. There is a well-known case which showed how in the course of a long-standing obsessional neurosis, paranoid schizophrenic symptoms may make their appearance. This is the patient described by Freud (1918) in “The History of an Infantile Neurosis”, who, many years after he had been treated by Freud for obsessional symptoms, was treated for a paranoid state by Ruth Mack Brunswick (1928).

Golla, Hutton and Grey Walter (1943) made an attempt to use the EEG as an objective means of assessing imagery. They concluded that there were three types of alpha rhythm which corresponded to three different kinds of imagery processes: M or minus type whose alpha rhythms were almost non-existent and who used mainly visual imagery in thinking; the P or persistent type whose alpha rhythms continue even during mental activity, and who used mainly vocal kinaesthetic imagery; the R or responsive type with a good resting alpha rhythm which blocked readily during mental activity, and whose imagery was mixed. Though they were attempting to find an objective means ofassessing imagery an ultimate appeal is made to introspection as a validating criterion, and the tasks given to the subjects were such as to present difficult problems in the way of introspection. For instance, they were asked to think over to themselves the story of Red Riding Hood, to think over to themselves their plans for some definite day, to think over the argument for and against some abstract proposition such as “honestyis the best policy” or “the existence of free will”. It is felt that if an attempt is to be made to find an objective means of assessing imagery some at tempt should first of all be made to control the kind of imagery that will be used.

A paper by Shapiro, Post, Lofving, and Inglis (12) has reported on the relationship of certain aspects of mental functioning to the psychiatric illnesses of old age. This study confirmed that performance on some tasks which appeared to involve “memory function” is relatively more impaired in elderly patients with organic brain pathology than in elderly patients with functional psychiatric disorders. It was also shown, however, that the difference between functional and organic groups on these memory tests was not as great as might be expected on the basis of the commonly held psychiatric hypothesis that memory disorder is one of the leading features of early cerebral involvement in old age. The relatively poorer performance on these memory tests of the organic patients could not be accounted for in terms of, for example, lower intelligence, since the memory tests produced significant differences between the organic and functional groups whereas the intelligence tests did not. A process of correlational analysis (Inglis, Shapiro, and Post (8)) showed that these tests did seem to have some psychological function in common which could usefully be labelled “memory”.

Psychotherapy and what we understand by it today is commonly considered as entirely a product of the last fifty years of psychological and psychiatric development. The psychiatry of the past century is looked upon as a savage and uncultivated field which does not appear to warrant any attention. In a previously published paper I pointed out the strange contradictory development which the field of psychiatry has undergone during the past two hundred years, interchanging material-physicological periods with those primarily psychological. Each period has violently rejected the previous one and with it the total earlier development. This explains why the earlier development seems to be so completely forgotten. Only a few names are known which are pointed upon as forerunners, but no one has seriously attempted to go back over the last contradictory period into the preceding one with a similar basic attitude, for instance the psychologistical period of the first quarter of the past century. This should be of considerable interest to the psychological period we have been experiencing during the past decades.

Nicotinic acid, well known physiologically and chemically as a vitamin if administered in small quantities, has many interesting additional properties when given in relatively large amounts. Altschul (2, 3) found that it markedly decreased the levels of cholesterol in rabbits made hypercholesterolemic by diet, and Altschul, Hoffer and Stephen (4) found that in divided dosages of three grams per day this vitamin produced appreciable decreases in the cholesterol levels of healthy young subjects and in patients from a general hospital. The decrease was related linearly to the initial cholesterol levels while the percentage decrease increased as the initial cholesterol levels were elevated. The incorporation of nicotinic acid into atherogenic diets inhibited the development of arteriosclerosis in rabbits (Altschul (2)). Of seventeen animals tested, two showed intense arteriosclerosis, six showed mild change, and nine showed no arteriosclerosis. Without nicotinic acid, at least thirteen of the rabbits would have had severe arteriosclerosis on the basis of many previous studies by Altschul (2) and by many other investigators.

It is now generally conceded that slow wave activity tends to appear in the EEG as age advances. Attempts have been made with varying success to relate these slower rhythms to the presence of organic cerebral deterioration.

A Multi-Dimensional study of a consecutive series of female patients, aged 40–55,in whom psychiatric illness necessitated first admission to a mental hospital, has already been reported in its general and clinical aspects and in relation to the psychological test findings.

Ritalin (methylphenidate) is a drug which was developed by the firm of Ciba Limited. It resembles amphetamine in its central stimulant and sympathomimetic action but has quite a different chemical structure. Its general properties have been described by Meier et al. (1954) and by Drassdo and Schmidt (1954 a, b). Geller (1955) and Stier (1955) used Ritalin in the treatment of depressive states associated with apathy, while Ferguson (1955) found it of value in countering the depressive effects of reserpine therapy. Ferguson also notes that Ritalin seemed to have a beneficial action in cases of chronic schizophrenia and considered that his findings warranted a clinical trial.

Some years ago we began to evaluate steroidal compounds in the treatment of mental states and now report some results obtained with 6β-hydroxy-3:5-cyclopregnan-20-one (I), the most promising of the compounds studied.

Some workers have claimed that nalorphine is as potent an analgesic as morphine and does not lead to addiction.

This paper reports a double-blind type of clinical trial with hyperactive low-grade mental defectives. Chlorpromazine has previously been used with this group but a high incidence of toxic effects has been noted (McColl (1)). Reports on reserpine have been conflicting but a careful trial by Kirk and Bauer (2) reports the action of this drug if anything to be detrimental.

In recent years a number of new drugs have appeared, grouped together as so-called tranquillizing agents. The publication of three very encouraging papers describing the use of meprobamate prompted the present trial. Selling (1955) prescribed one 400 mg. tablet daily after each meal and one at bedtime in 187 cases, combined with psychotherapy, and found its use in anxiety and tension states was of considerable value (90 per cent and 95 per cent respectively improved or recovered). Borrus (1955) used one to six 400 mg. tablets daily in 104 cases. In 68 per cent of all cases, and 78 per cent of the anxiety states, there were favourable results. Lemere (1955) contrasting chlorpromazine and reserpine, found meprobamate (used in over 250 patients with at least 70 per cent good results) to be relatively uniform in its action, remarkably free from side reaction and more effective in the relief of insomnia. All three authors stressed the absence of toxicity.