By time-honoured tradition one of the first duties of your newly-elected President is to inflict upon you a Presidential address. This is at once a very considerable responsibility and a privileged opportunity, but the feelings of awe and apprehension with which I face such a distinguished and erudite audience are mercifully lessened by the knowledge of the unwritten rule of our Association that no outspoken criticism of the subject matter of the address is permitted. I wish to ask you to bear with me, for a few minutes, whilst I put before you what I think may best be termed psychiatric reflections or ruminations, based on a certain amount of experience and, I can say quite sincerely, a true interest in the matters touched upon. I fear, however, that I have little or nothing original to offer you.

Since Alzheimer (1907) described the disease which bears his name there has been considerable controversy about its relationship to senile dementia and senility. In the course of years there has been little advance towards a solution of the problem.

Despite the precarious vulnerability of genetic theories to partisan distortion and abuse, a report on the progress of genetics in relation to mental disorders merits introduction on a fairly optimistic keynote. It seems that in quest of a better understanding of human behaviour deviations we have finally arrived at the threshold of the age of biology as a focal discipline. There are many indications that in searching for adequate methods of biological analysis, one of the key positions of science is held by human genetics.

This paper is based upon the data obtained in a survey undertaken to ascertain the incidence of mental deficiency in England and Wales. My observations will be restricted to those data that are of most interest to students of social medicine.

I am very grateful to the Committee of this Conference for giving me the opportunity to say a few words about the aims and methods of social surveys. I must, however, confess that I was somewhat astonished when I got the invitation, because everybody interested in this topic knows that the most eminent experts within this field are English. It would, therefore, seem unnecessary to ask a foreigner to read this paper, and after having heard the lectures of Dr. Lewis and Dr. Blacker I feel still more convinced that I shall not be able to add anything of importance to their excellent presentations.

In recent discussions of the subject by Curran and Mallinson (1) and by Kinberg (2), emphasis has very properly been laid on the inextricable confusion that at present prevails in the use of the term “Psychopathic Personality.” Very many attempts have been made, for instance by Henderson, Cleckley, Cheney, Levine, Bullard and others (1), to characterize a syndrome. The characteristics of the syndrome have been seen in the make-up of the personality and its social relationships. But every authority disagrees with every other, and if there is any feature in common in all the definitions that have been provided, it is a lasting, but otherwise unspecified, incapacity to build up satisfactory social relationships. The confusion has gone so far that Kinberg has suggested that the term should be dropped altogether, particularly as it promotes a fatalistic attitude in the clinician and does not dispose to enthusiasm in therapy.

Once it has been established that a child has, in fact, committed the offence with which he has been charged, the interest of a present-day juvenile court is centred not so much on the nature of the offence itself as on the nature of the child and of the influences which may have contributed to the unconventional or antisocial attitude of which his offence may be the outward and visible sign.

I do not think that anyone, professional or layman, will contradict the statement that the family unit is, at least in our culture, the best medium for the growing child. Yet, although there is tacit recognition of this fact, it is only in recent years that more attention is being paid to providing for children, who in infancy are left without parents, with this most suitable environment for their development. In this and other countries there are still vast institutions, insufficiently staffed, entrusted with the task of bringing up hundreds of children who, we know, will become unsatisfactory citizens.

“No collection of facts is ever complete because the Universe is without bounds, and no synthesis or interpretation is ever final, because there are always fresh facts to be found after the first collection has been provisionally arranged.”

A Complex is a group of emotionally invested ideas that have unconscious activities. Contrary though it be to the popular and sentimental idea of an overriding mother love, it is common, especially in child psychiatry, to find a mother's lively hatred and even homicidal wishes towards her child. I consider that this should be called “The Medea Complex.”

In some of our earliest investigations into the effect of leucotomy we used the Rorschach test, hoping thereby to obtain a fairly full and clear-cut picture of the personality changes produced by the operation, but it was found that this test had the disadvantage that, when repeated, memory of the previous test or tests to some extent minimizes the validity of the later interpretations.

The general importance of studying the mental health of British troops in the Far East is obvious enough. It is perhaps less obvious that this importance is unlikely to have diminished with the end of the war; for there are still many troops serving in the Far East, and presumably will be for some time.

At the beginning of the war part of the Maudsley Hospital moved to Mill Hill School, and a neurosis centre of 550 beds was established. During the six years of war some 20,000 neurotic patients, both forces and civilian, were treated at this centre. Within the centre a special unit for the study of Forces patients with effort syndrome (E.S.) was set up. This unit was in existence from 1939 to 1945, and during this period 2,324 cases of E.S. were treated. The writer was associated with this unit throughout, working in association with a cardiologist (Paul Wood (1)), and with other psychiatrists (Lewis (2), Guttmann (3), Gillespie (4)). Much of the material brought together in this thesis has already been published (Jones (3, 5, 6, 7, 8, 9, 10, 11, 12, 38, 43)). During most of the war years the writer was in receipt of a Medical Research Council grant.

Though twelve years have now passed since the first prefrontal leucotomy was performed, the status of this form of therapy is still far from settled. There are some who would never perform the operation at all; and some who would reserve it for the chronic sick; while others (Fleming, 1944) would advise its use at an early stage in the illness in cases where there were reasonable grounds for believing that recovery would not otherwise occur. With opposition of a purely emotional kind, the profession as a whole need hardly concern itself; for appeals that the integrity of the nervous system be maintained at all costs are unlikely to impress those whose daily work brings them into contact with the personality degradation of chronic mental illness. It is difficult to see why interference with the brain in order to save sight or to save life in the case of tumour should be regarded as either more or less wicked than interference designed to save human reason.

The neuropsychiatrist presenting evidence before Court will sooner or later be asked the question, “Was the accused, at the time of committing the offence, labouring under such defect of reason as that he did not know what he was doing, or if he knew what he was doing, he did not know it was wrong?”

In recent years many attempts have been made to improve methods of temperament testing, and to show the validity of the results by comparing test-scores of groups of subjects known to be differentiated with respect to certain traits (Cattell (1), Eysenck (2), Himmelweit (5)). Thus there has been found a very significant correlation between degree of neuroticism and suggestibility, and a correlation almost as high between degree of neuroticism and persistence. These results have suggested the possibility of using tests of this kind in an attempt to measure the neurotic tendencies of individual subjects, and to screen the more neurotic from types of occupation likely to impose too great a strain on them (Eysenck (3)).

Tests of the indefinable quality known as intelligence are legion. Many have been standardized satisfactorily, others have not. The validity of some tests is high, but results of different tests used on the same individuals have seldom been published.

Many difficulties confront the medical officer who has in his care large numbers of mental patients. In the first place, owing to the staffing problems which beset the majority of mental hospitals in this country, he is probably overworked. He has neither the time nor the energy to deal adequately with the mass of work which confronts him, and as a result his output is often not as efficient as it could be. Further, when dealing with large numbers, a physiological factor enters which is often overlooked. It is very difficult to register and retain the many small variations in behaviour which are so important in the understanding of a patient, when perhaps 350 or more patients have to be seen every day. There seems to be a definite saturation point beyond which images are not retained; indeed we know that this is so, but we rarely seem to take account of it. The very sameness of deteriorated and apathetic patients contributes to this state of affairs.