Controversy has raged for over half a century as to whether schizophrenia, the most severe of all mental illnesses, could have an organic basis or whether its origin lay strictly in the psyche. Over the years, physiologists have probed into almost every aspect of the soma in the quest for some abnormality which would account for the schizophrenic syndrome. Many possibilities have been considered, investigated to a degree and then abandoned when definitive answers were not forthcoming. A dominant approach throughout has been the search for some psychotoxic material circulating in schizophrenic body fluids. Activity has been spurred by the recurrent recognition that chemical agents such as the ergot alkaloids, mescaline, bulbocapnine and lysergic acid diethylamide (LSD-25), could induce in normal persons transient mental disturbances similar to those seen in schizophrenia.

Fashion is more deep-rooted than contemporary custom will allow, and the current enthusiasm for drug treatment in psychiatry is no evanescent fad. The Greeks made good use of the pharmacopœia, prescribing borage, buglosse, marigold, polypodie and epithyme for melancholy, more specifically recommending wormwood, centaury and pennyroll for the hypochondriac malady. Burton (a) discussing black hellebor, relates that its virtues were extolled by Galen, Pliny and Coelius Aurelianus, the mentally afflicted being sent to the Anticyrae, or to Phocis in Achaia to be purged, the plant growing there in abundance. Burton (b) describes how the Melangoga, or melancholy purging medicines, were classified as simple or compound, purging upwards or downwards. Asarum, brassivola, laurel, scilla, white hellebor, and antimony purged upwards, whereas polypodie, epithyme, black hellebor, lapis lazuli and aloes purged downwards. Sceptics throve then, no doubt, as they do now. Meryon (1861) mentions Asclepiades—dismissed by Pliny as an impudent quack, who contended that drugs injured the stomach and induced complaints more dangerous than those which they were intended to cure.

This paper is an attempt to clarify and give content to the concept of inadequacy of the personality, for the concept has gained considerable currency in psychiatry as a hypothesis to account for difficultieg encountered in diagnosis, prognosis and treatment. Before the theory can be evaluated, it should be stated in a reasonably precise form. This enquiry starts from a very general statement about the idea of inadequacy as usually encountered in psychiatric practice, and proceeds towards a formulation in more exact terms.

There is very little experimental evidence about the combined effects of alcohol and phenobarbitone, administered at or about the same time. Similarities in their actions suggest that the effects of the drugs are likely at least to summate in some respects (for example, in depressing the respiratory centre); and there are experimental and forensic observations which suggest that death has sometimes occurred after a dose of ethanol and phenobarbitone, neither of which would have been fatal by itself (Jetter and Maclean, 1943; Fisher, Walker and Plummer, 1948). Phenobarbitone and other barbiturates are widely prescribed (Dunlop, Henderson and Inch, 1952), usually without reference to the habitual alcohol consumption of the patient, and potentiation as well as summation has been reported to occur between some barbiturates and alcohol (Rachek, 1944; Sandberg, 1950).

It would probably be true to say that the present position in the psychiatric treatment of neurotic disorders is characterized by the following features. (1) With the exception of electroshock, the only method of treatment at all widely used is psychotherapy. (2) In practically all its manifestations, psychotherapy is based on Freudian theories. (3) With the exception of intelligence testing, psychological contributions consist almost entirely in the administration and interpretation of projective tests, usually along psycho-analytic lines. I have argued in the past, and quoted numerous experiments in support of these arguments, that (1) there is little evidence for the practical efficacy of psychotherapy, whether strictly Freudian or “eclectic” (8, 17); (2) that Freudian theories are outside the realm of science because of their failure to be consistent, or to generate testable deductions (10); and (3), that projective tests are so unreliable and lacking in validity that their use, except in research, cannot be defended (16). I shall not here argue these points again; the evidence on which these views are based is quite strong, and is growing in strength every year. I shall instead try to make a somewhat more constructive contribution by discussing an alternative theory of neurosis, an alternative method of treatment, and an alternative way of using the knowledge and competence of psychologists in the attempted cure of neurotic disorders. It need hardly be emphasized that the brief time at my disposal will make it inevitable that what I have to say will sound much more dogmatic than I would like it to be; I have to ask your indulgence in this respect, and request you to bear in mind all the obvious qualifying clauses which, if included in this paper, would swell it to three times its present size.

This is a reply to a critique by Karon and Saunders (9) of the Eysenck and Prell work on the inheritance of neuroticism (6). This paper is a curious combination of sophisticated statistical analysis and argument by irrelevant association. Thus the authors mention the fact that we found a strong heredity predisposition but go on to say that “the results are so much at variance with general clinical experience that doubts arise in the minds of many psychologists … particularly those who have investigated, in a therapeutic situation, the source and development of neurotic reactions”. The authors do not indicate how it is possible through general clinical experience or in the therapeutic situation, to find an answer to one of the most difficult and complex problems in the whole field of psychology. Whether neurotic predisposition is largely inherited or has little hereditary basis, would not seem to be capable of being discerned simply by giving psychotherapy to a few neurotics.

The present report deals with two effects of movement variability as a function of practice in the drawing from memory of visually presented patterns. The first effect is found in initial practice stages only and appears to be related to the neurotic dichotomy of hysteria/dysthymia. The second effect is specific to late practice stages and related to schizophrenics as against neurotics and controls. Results are mainly discussed to illuminate the problem of score complexity in motor learning. The aim is to show how, in learning involving motor activity, the extent and variability of movement components may affect the validity of learning scores in their relation to personality.

Geographically, Iran is for the most part a plateau at an average altitude of about a thousand metres; the terrain—the near-jungle conditions of the Caspian littoral excepted—is arid semi-desert and the typical landscape one of limestone mountain ranges between which lie flat plains. It is bordered by Iraq, Turkey, the U.S.S.R., the Caspian Sea, Afghanistan, Pakistan and the Persian Gulf. Except during spring the vegetation in most areas is sun-shrivelled on the bare treeless earth; after five months of burning heat the winter rainfall washes off the topsoil, and river-beds, dry throughout the summer, overflow with muddy torrents. Although the soil is dry and powdery there are abundant watercourses below the surface and with irrigation the land is very productive. The country has great mineral resources; apart from the oil-fields they are un-exploited due to lack of coal and road and rail communications. The people are mainly feudal villagers or nomadic tribesfolk but Tehran is a modern city of a million population and the provincial capitals are also semi-Westernized.

One of the most important questions in dealing with psychopaths is the prognosis. In 1948 two of us made a study (Stafford-Clark, Pond, Lovett-Doust, 1951) of a number of criminal psychopaths and a control group of ordinary criminals in prison by clinical and EEG methods, with the object of revealing the characteristics which most significantly distinguished psychopaths from others, and which were, therefore, most crucial in diagnosis. The psychopaths were carefully chosen in collaboration with two experienced prison medical officers. The later criminal behaviour of these psychopaths and controls is equally interesting, however, if we are to understand what the diagnosis implies (Gibbens, 1951). The third author (T.C.N.G.) has therefore been conducting a continuous follow-up, with the collaboration of the Prison Commission and Criminal Records Office. The results of the first follow-up, from 1948–1953, have been published (Gibbens, Pond and Stafford-Clark, 1955), and were reproduced in the transactions of the Royal Commission on the Law relating to Mental Illness (1957). The present paper deals with a further period of study, so that the follow-up is now from 1948-June, 1957.

In a recent paper Slater and Meyer (in press) have pointed out that the nature of Robert Schumann's final psychiatric illness has never been satisfactorily explained. Moebius (1906) diagnosed it as dementia praecox, while Gruhle (1906) favoured an organic disease of the brain, probably paretic dementia. Subsequent opinion has been evenly divided between these two diagnoses but recent writers have inclined more to a diagnosis of schizophrenia. Slater and Meyer, however, on critically re-examining the available evidence, have definitely come down on the side of Gruhle.

The older psychiatric literature has here and there valuable reports about mental illnesses amongst African, Asian and other societies which are very different from Europe. These authors normally express opinions or speculations based on chance experiences rather than systematic observations. It is only in recent years that more extensive mental health work has been done in these countries, which also has enabled many workers to collect a great deal of information. This is important not only for the countries concerned, so as to help them to plan an appropriate health service, but also for psychiatry as a whole. It gives an impetus to comparative psychiatry, one of the most important basic sciences to clinical psychiatry.

In the present investigation verbal statements of certainty, or confidence in the performance of immediate recall and recognition, were related to the neurotic/schizophrenic dichotomy and, within the neurotic group, to personality questionnaires of rigidity, extreme response set, extraversion and neuroticism. The aim was to find pointers to conditions favourable for the investigation of individual differences in certainty and to assess the relative validity of a number of independent personality criteria. Statements of certainty analysed are derived from an immediate recall experiment, the results of which have already been reported (6). An analysis of the interaction between certainty and other measures derived from the same experiment is to be presented at a later date.

For some years now it has been recognized that the symptoms induced by hypoglycaemia may resemble narcolepsy. Cases of islet-celled pancreatic adenomas simulating narcolepsy have been described by Harris (7), Delay (4) and Wyke (18). The resemblance may be a superficial one, however, and Wyke observed in his case during a “sleepy attack” that “the EEG pattern bore no resemblance to that of natural or artificial sleep”. In a more recent paper Ziegler and Presthus (19) described thirteen patients who showed normal EEGs at blood glucose levels (induced by fasting and intravenous insulin) of from under 15 mg. per cent. to 54 mg. per cent. In eight of these patients there were no clinical symptoms; in the remaining five patients the symptoms were described as follows: “feel like a ton of lead”, “warm and sleepy”, “tired”, “drowsy and sweaty” and “dizzy and tired”. It seems, in fact, that the clinical description of drowsiness in hypoglycaemia may correspond either to no EEG changes or to various degrees of slowing rather than to the typical recurrent light sleep patterns characteristic of narcolepsy. It will be recalled that hypnosis too is ushered in by a sense of drowsiness but that the EEG changes are not those of sleep (1, 2, 5). Many hysterical trance states—often loosely, and unfortunately, described as narcolepsy—come into this category. In short, it is apparent that all that sleeps is not narcolepsy (6, 12, 13, 14).

Since Evarts, Fabing and Marrazzi reported on bufotenine and Szára on N-N dimethyltryptamine (DMT) the tryptamine derivatives have been arousing increased interest. A team of the above Institute was the first to test DMT and N-N diethyltryptamine (DET) in man. These compounds were synthesized by Szára, by the method of Speeter and Anthony. DET was then synthesized again and analysed pharmacologically by Borsi and Lénárt.

The word “depression” has come to be used in psychiatry to denote both a syndrome (or symptom:sign cluster) and one or more of the symptoms commonly occurring in this cluster. This attribution of two meanings to one term has led to considerable confusion. Thus it is often claimed that depression may be present in almost any mental illness. This statement may be true in the sense that the mood of depression may occur in almost any mental illness; but it cannot be true in the sense that the depressive syndrome may enter into almost any mental illness, since the term depressive syndrome has already, at least by implication, been used to denote a particular symptom:sign cluster which differentiates it from all other symptom:sign clusters. To deny this would be to deny the original principles of division.

In two previous studies (3 and 4) certain psychological effects of single doses of chlorpromazine and secobarbital (quinalbarbitone) were studied in young normal subjects. It was found that 100 and 200 mg. of chlorpromazine had a greater effect on tests of motor co-ordination than did 100 and 200 mg. of secobarbital, respectively, and that 200 mg. of secobarbital had a greater effect on a test related to intellectual functioning than did 200 mg. of chlorpromazine. The results in our study of the effects of single doses of chlorpromazine differed from the results of studies of the effects of chronic administration of chlorpromazine by Lehmann and Hanrahan (5) and Shaten et al. (7). These investigators found that chronic administration of chlorpromazine to schizophrenic patients was followed by improvement or only slight impairment in performance on most of the psychological tests used. The differences between the results we have obtained following administration of single doses of chlorpromazine to normal subjects, and the results of Lehmann and Hanrahan and Shaten et al. could be attributed either to differences between the effects of chronic and acute administration of chlorpromazine or to differences in the response between normal subjects and schizophrenic patients.

Vespral, or triflupromazine Squibb, is a new phenothiazine derivative. Chemically the compound is 10-(3-dimethylaminopropyl)-2-(trifluoro methyl) phenothiazine hydrochloride. Its structural formula compares with that of chlorpromazine as follows:

Until recently “Vespral” has been available in this country only for clinical trials, but its supposed therapeutic effects have been investigated fairly extensively in the United States and Canada (Goldman; Gallagher and Pfeiffer; Niswander, Lind and Schlesinger; Freed; Azima; Pennington; Saunders; Freyhan; Cahn and Levy).

Frenquel, α-(4-piperidyl) benzhydrol hydrochloride, generically known as Azacyclonal hydrochloride was introduced commercially into this country in the early part of 1957 although it had already been available in the United States of America for several months previously. Sargant (1956) obtained a supply of Azacyclonal from America and in his paper on Chemical Tranquillizers he refers to Azacyclonal as “an interesting drug”. Azacyclonal was thought to be the first drug to possess a specific anti-hallucinatory effect.

The use of tranquillizers in mental deficiency has shown a divergency of effects. Noce, Williams and Rapaport (1) claimed that reserpine produced some improvement in all their thirteen adult hyperactive low-grades, and Rettig (2) reported that chlorpromazine produced decreased hyperactivity in twenty-three of his twenty-seven adult defectives of all grades. Blair and Herold (3), using ten “matched-pairs” of hyperactive defective children, found behaviour improvements in nine of them on chlorpromazine, with an average I.Q. gain of 10.4. Using six different tranquillizers on twenty-five adult defectives of all grades, Rudy, Himwich and Rinaldi (4), found that all gave some benefit, with chlorpromazine the most effective. Fischer (5) showed that twenty out of his twenty-two low-grade adult defectives (many with psychotic overlay) were improved in behaviour on reserpine. Using sixteen “matched-pairs” of E.S.N. children, Segal and Tansley (6) claimed that hydroxyzine produced improved scholastic performance in fourteen of them, and Bergin and Bergin (7) stated that the epileptics in particular in their thirty-four low-grades were improved by promazine hydrochloride.

In recent issues of The Journal of Mental Science there have appeared two critical papers (5, 7) dealing with some aspects of the dimensional analysis of personality which the writer has put forward. As replies to these papers separately would seem to require a good deal of repetition, it seemed better to frame a joint reply. This has been kept rather short on purpose, primarily because the writer does not believe that arguments are very helpful to the advancement of science, unless they are accompanied by new data of an experimental kind. In the main, therefore, this reply has restricted itself to simply pointing out that many of the points raised are factually incorrect, or, although they might be correct in themselves, are not relevant to the theory they are criticizing.