The present investigation belongs to a series of studies (1) in which an attempt has been made to contribute to an understanding of the mechanisms underlying those forms of therapy of mental diseases which directly involve physiological mechanisms.† In the previous work an experimental analysis was performed in order to determine the common factor involved in the various forms of so-called shock therapy. It was found that all forms of this therapy produced in the experimental animal an increased reactivity of the centres of the sympathetic system to direct (2) and reflex stimulation (3). Chronic experiments (4) also showed that these alterations in autonomic reactivity persisted for a long period of time if the “therapy” (e.g., electroshock) was applied repeatedly as it is commonly done in the human patient. Special experiments revealed that increased sympathetic reactivity can be demonstrated in the hypothalamus (5).

I. Problem and Method.

Recent work on the psychology of intelligence and thinking suggests that perceptual types of intelligence tests are inadequate for dealing with psychiatric cases, young children, old people, mental defectives, and primitive peoples. The argument is that, in these groups, intellectual processes have either deteriorated from or failed to develop to that level with which most perceptual intelligence tests are concerned. The methods of scoring also assume that the correct answers are always reached in the same way, but this is by no means always the case, as Goldstein and Scheerer (1941, p. 14) have pointed out. The studies of Werner (1948), Piaget (1951), Goldstein (1940), Hanfmann and Kasanin (1942), Rapaport (1951), Moursy (1952) et al. show convincing evidence that cognition can take place at different “levels.” The exact determination of the number, nature, and scope of the different levels remains a task for the future, since the present situation is confused, to say the least.

This is the third of a series of articles reporting an investigation of the block design rotation effect. This effect is shown by some patients when they are doing the Kohs' Blocks Test, which is known in other forms as the Block Design Test. In this test the subject has to reproduce patterns with the aid of diversely coloured one-inch cubes. It was observed that some patients, while they reproduced these patterns correctly, left their blocks in an obviously rotated position, apparently with no idea that anything was amiss (see Illus tration i). Such rotation can often be as great as 45°.

The importance and relevance of reaction to colour in the interpretation of Rorschach protocols has been so often and so vigorously stressed by proponents of the test that few psychologists can have remained unaffected by their views. It is the purpose of this paper to examine the validity of these views. Already the evidence pertinent to the hypothesis that certain reactions to the blots depend upon the indirect effect of colour, the so-called “colour-shock” signs, has been examined (Keehn, 14). Beyond repeating the general conclusion that such signs seem not to be dependent upon presence or absence of colour this topic will not be discussed, so restricting this paper solely to a consideration of the validity of the hypotheses concerning the direct reaction to colour on the cards. No better or succinct and documented statement of these hypotheses can be made than that of Hertz and Baker (10), who, after summarising numerous studies relating to the topic, conclude that— “There is general agreement that colour factors give a measure of the stability of the emotional life. They show the externally directed or expressed emotionality of an individual. FC represents emotional stability and adaptability, CF, emotional lability, excitability and lack of control, and C, lack of restraint and impulsiveness.”

Affective disturbances are a common consequence of organic brain lesions of varying aetiology, and it is to be expected that the differentiation between affective symptoms of “functional” origin and those resulting from organic lesions would become an increasingly difficult problem in an age-range which is particularly susceptible to pathological cerebral changes. In fact the classical accounts of mental disorder in old age convey the impression, by their emphasis on the depressive form of senile psychosis, that an affective disorder appearing in senescence is commonly the manifestation of some cerebral degenerative process. This is one of the sources of the widely prevalent view in contemporary clinical practice that there is a large group of cases in which dementia and a depressive (and less often a manic) symptom-complex are associated. The overlap being large, an ill-defined line of demarcation is held to exist in old age between the organic degenerative diseases and the affective illnesses of a “functional” kind.

The previous paper of this series (Roth and Hopkins, 1953) described test performance in senile and affective psychosis. The same tests have been administered to patients in three other diagnostic groups: paraphrenia, arteriosclerotic psychosis, and acute confusional states. These five clinical categories account for the majority of mental hospital admissions in patients over the age of 60.

The drug which is now known officially as Mephenesin (“Myanesin,” “Tolserol”) was introduced by Berger and Bradley (1946), who showed that it antagonizes strychnine convulsions, counteracts pre-narcotic excitement, and increases the duration of barbiturate anaesthesia. Small doses depress the reflex excitability of the spinal cord, and larger doses have an ascending depressant action on the central nervous system. When Berger (1947) found that doses with little effect on voluntary power restored deranged reciprocal innervation to normal, he suggested that mephenesin might be useful in spastic and hypertonic conditions.

When we pass under review the theoretical concepts of aggression three main types stand out clearly, which are fairly representative of prevalent opinions.

Perhaps most clinicians experienced in mental hospital work suspect, at least, that left-handedness and stuttering occur relatively frequently among hospitalized epileptics. However prevalent this impression may be, it remains to be tested systematically. There has been little study of dextrality among the different diagnostic groups. Defects of speech among some groups have been studied considerably, among other groups very little.

Scattered throughout the literature on the psychiatric aspects of asthma are reports of cases where the psychiatric disturbance was severe enough to be described as “psychotic” (Reichmann, 1922; Hansen, 1929; St. Saxl, 1933; Oberndorf, 1935). The term “psychotic” was used in the sense that the psychiatric diagnosis was either that of manic-depressive psychosis, schizophrenia, or paranoid psychosis. It has been postulated, moreover, that the co-existence of a psychosis and attacks of asthma was no chance relationship, and that there was an intimate link between the psychosis and the somatic disturbance. This relationship, it has been said, is of considerable theoretical significance. Appel and Rosen (1950), for example, consider that “there is a reciprocal relationship between the so-called physical manifestations of psychosomatic illness and the psychological manifestations of psychiatric illness.” This concept is also held to apply in disorders other than asthma—in ulcerative colitis, rheumatoid arthritis, and in certain skin disorders. The treatment of such disorders psycho-therapeutically is said to result at times in an alleviation of the physical disorder, but the concomitant development of a psychotic reaction (Appel and Rosen, 1950; Lindemann, 1950). During the past three years an investigation of patients suffering from asthmatic attacks has been in progress, and the opportunity has arisen to examine these points on a fairly large case material. The present paper reports an attempt to investigate scientifically some aspects of the relationship between asthma and psychosis.

During recent years renewed interest has been taken in the possible importance of adrenocortical function in psychiatric disorders. Psychiatric syndromes and symptoms associated with pathological functioning of the adrenal cortex found in Cushing's and Addison's diseases have been recognized for many years. The classical work of Selye (1949) and his school has elucidated the importance of the adrenal gland in the individual's reaction and adaptation to stress. Qualitative and quantitative abnormalities in adrenocortical responsivity to stresses and stimuli in various psychiatric disorders have been reported in recent years (Freeman et al., 1944; Hoagland et al., 1946; Pincus and Elmadjean, 1946; Pincus et al., 1949).

There is now considerable clinical and experimental evidence that the autonomic nervous system may play an important role in the pathogenesis of gastric and duodenal ulceration. Cushing (1932) reported the development of gastric ulcers after intracranial operations, and concluded from animal experiments that parasympathetic overactivity produced changes in the gastric mucosa conducive to ulcer formation. Experimental lesions in the hypothalamus were found to give rise to gastric ulcers by Watts and Fulton (1935) and Hoff and Shehan (1935). Davey, Kaada and Fulton (1950) found that increased gastric secretion resulted from stimulation of areas of the frontal cortex in monkeys and dogs. Furthermore, clinical reports have shown that lesions in the cerebral cortex, diencephalon and midbrain have been found to be associated with gastric ulcers (Bochus, 1949).

Because of the widespread incidence of neurosis and the comparative lack of psychiatrists, much thought and activity is being directed into the treatment of a number of patients simultaneously. Apart from economy in time, group therapy has virtues of its own and would have a place in treatment even if there were a sufficiency of trained psychiatric staff.

The amnestic-confabulatory symptom-complex to which the eponymous title of Korsakov's syndrome is usually given was probably first described by the Swedish physician Magnus Huss (1807–90), who spent the greater part of his lifetime in the study of alcoholism. There is, however, no doubt that Korsakov's (1890) paper on the subject gave an excellent description of the syndrome, and stressed the fact that whereas it often developed in patients with alcoholism and polyneuritis, numerous other metabolic and neurological disorders could be complicated by the characteristic mental changes. Indeed, in Korsakov's (1890) own series of cases alcoholics were in the minority. One of the neurological conditions in which the syndrome has been described significantly often is spontaneous subarachnoid haemorrhage. The first reports of the association were probably those of Flatau (1918 and 1921), and it was discussed in some detail by Goldflam (1923) and Herman (1925 and 1926). Each of these authors described the mental symptoms exhaustively but gave no actual case-histories; the first fully documented cases in the literature were the two reported by Hall (1929). Single cases have since been described by Cubitt (1930), Popow (1930) and Kulkow (1935), and in 1939 Tarachow gave an extensive review of the literature and reported an additional 3 cases. It is remarkable that since 1939 the association has received little attention, although it has been mentioned by Sands (1941) and Meadows (1951).

Interest in this problem on the part of parents, sociologists and paediatricians, among others, has grown of recent years. So much is this so that the casual observer might well conclude that there had been a real increase in backwardness, and that anxious parents now have a more genuine cause for anxiety on this score than was the case a generation ago. This view indeed is held by certain well established authorities in the fields of education and psychology, for example Burt and Professor Godfrey Thompson, who have expressed gloomy views about the intelligence of the nation. Moreover, considerable publicity by means of wireless broadcasts or otherwise has been given to these prognostications. It is not therefore surprising that many parents should be concerned as to whether their offspring will after all prove to be something less of a genius than they had anticipated. The smaller size of modern families is also a factor in increasing paternal anxiety. I say paternal advisedly, since it is more often the male parent, especially in middle-class circles, who has set his heart on his child being an infant prodigy. With only one string to his bow, the whole tension of paternal ambition is concentrated in a single object. Moreover in these days of compulsory examinations at the age of eleven, together with widespread coaching for the intelligence tests which form part of the examination, the unfortunate, innocent babe is barely able to lift a mug or a spoon when his rattle is whisked away and replaced by a host of constructional toys designed on similar lines to modern American intelligence tests. The slightest failure in performance or slackening of interest is liable to produce a state akin to panic in the proud parent, who has just been comparing notes about his prodigy with the owner of another (but naturally, somewhat inferior) budding genius next door.

Harris (1951) adequately summarizes the work done on nitrile compounds and their therapeutic use in psychiatric disorder. This work is highly controversial and the results contradictory. He adds a series of thirty cases of his own treated with dinitrile succinate (“Suxil” or “Psychil”), and concludes that no clear evidence of its therapeutic value was obtained. Twenty of his cases were treated by six or less injections of 0.1 gm. for the first, and 0.2 gm. for subsequent injections. He says: “Later, following representations by the manufacturers, this was extended to twelve.” He also comments on the suggestibility of some of his patients and the high spontaneous remission rate which make assessment of the efficacy of therapy peculiarly difficult. As far as can be seen from his paper, the assessments were made entirely impressionistically. Our preliminary trials, confirmed by our further experience with this drug, indicated (in complete harmony with Harris's opinion) that the drug is “safe, easy to administer, and quite free from toxic effects in the doses recommended.” We felt, therefore, that a further experimental trial was indicated.

Achondroplasia (micromelia, chondrodystrophia foetalis) has been defined as “an absence, arrest or perversion of the normal process of endochondral ossification of the most definite and universal character in every element of the skeleton, in which the process normally takes place during intrauterine life” (Symington and Thomson, 1892).

It has been suggested that mongolism results from damage to the germ plasm from gametic mutation or the fertilization of an abnormal ovum, the theory being mainly based on the study of twins, one or both of whom has been found to be mongoloid (Benda, 1947).

During a domiciliary visit one of us encountered a child who appeared to be a typical mongol and who nevertheless behaved remarkably intelligently. This child was later shown to numerous colleagues, among them the late Sir Leonard Parsons, who spontaneously suggested that she was a “mongol.” The combination of mongoloid features, which she exhibits, and normal intelligence is of sufficient interest, we feel, to be recorded.

In April, 1946, an experimental form of hospitalization for psychiatric patients was set up in Montreal.∗ This form of hospital, described by Ewen Cameron (1947), admitted any type of patient, the only criterion being that they should be well enough to stay at home over-night. To such an institution he gave the name of Day Hospital. At about the same time J. Bierer (1951) was experimenting in the same direction in this country. in connection with his attempt to extend the principles of “social psychiatry” to the everyday treatment of patients. Since then there have been several other short communications on the subject such as those of A. E. Moll (1951) and H. Gilmore (1952).