In 1895, as many people here are likely to know, Henry Maudsley combined two of his earlier books into his famous Pathology of Mind. Very near the beginning of this volume, he laid unusual emphasis upon the paramount importance of a study of social conditions in relation to human conduct in general and the varied forms of mental illness in particular. “The study of the individual as an element of social pathology,” he declared, “will plainly be a long, laborious, and difficult business of the future.” He was right. Fifty years have gone and, in spite of many notable contributions, it is a study still in its infancy.

More than ten years have elapsed since insulin therapy was first introduced in this country as a treatment for schizophrenia. This should gradually enable us to form a more accurate opinion as to its value. An enormous literature has accumulated on the subject. Only some samples of it, representing the different views expressed, can therefore be mentioned. It is here attempted to apply some common criteria which are indispensable for the assessment of the effects of treatment, which it is hoped may lead to a clarification of the present position of insulin therapy.

In this paper are given the histories of ten patients who have been treated by means of leucotomy, particular attention being paid to the study of character and personality traits.

The records are compiled from the information given by a relative or relatives, supplemented in some cases by data supplied by the patient as well. This method undoubtedly has serious disadvantages, for the information must inevitably be dependent upon the informant's veracity, powers of observation and description, memory, and conscious and unconscious subjective bias. In every case the interview took place at the patient's home, so that the interviewer could obtain a personal impression of the patient's home environment. Furthermore, the information regarding the pre-morbid personality was only obtained after the illness, operation, and recovery, and in some cases it was difficult to ascertain when the morbid changes actually began.

Section I.—Introduction.

Interest in the psychological concomitants of flying was greatly stimulated by the outbreak of war in 1939. The rapid increase in size of the Royal Air Force and the ever-increasing “airmindedness” of the general public led to a far wider realization of the growing importance of this comparatively new field of enquiry.

Depersonalization, or feeling of unreality, is a symptom which may occur as part of several psychiatric conditions, such as hysteria, anxiety and obsessional states, and some forms of schizophrenia and endogenous depression. The true derealization-depersonalization syndrome, however, in which the unreality symptom is the primary disturbance, is a quite peculiar and distinctive condition, which has received scant attention in most psychiatric textbooks and which appears to be becoming increasingly common in practice.

Writer's cramp, crampe des écrivains, scrivener's palsy, graphospasm or mogigraphia may be defined as a condition of inco-ordination of the small muscles of the hand which appears only when attempting to write. The various names given to this condition emphasize that cramp or spasm is the predominant feature, and Osler thought that it was an early symptom. As the principal nerves and muscles are often intact and movements of a wider range can be carried out efficiently, the condition appears to be a functional disturbance of co-ordination.

The intelligence of epileptics has been studied by many investigators. Some of these studies were confined to children, some to patients in institutions, others to out-patients and a few to private patients. Some studies included institutionalized and non-institutionalized patients with no effort made to consider the two groups separately. The out-patient material was assumed to represent the best cross section of epileptics, but as Somerfeld-Ziskind and Ziskind (1) point out, patients who are not helped by the treatment tend to stop attending clinics. This bias in the material is reflected in the wide variations of the results; for example there is a range in the reported mean I.Qs. of from 113.5 to 78. There appeared to be a definite need for a study based on a wider group, representing all types of epileptics. Examination of whole sections of the population, carried out during the recent war, afford a unique opportunity for this study, for the group was absolute, and there were no selective factors except sex, age and institutionalization.

It would seem that the overwhelming success of convulsion therapy in depressive syndromes has retarded recognition of the use of this treatment in states of excitement. Little has been written in this country on E.C.T. in mania, and apart from a report that the condition is refractory and frequently relapses, there is scant guidance on the subject. The object of this paper is to draw attention to the real value of E.C.T. in mania, when given in adequate quantity at the beginning, and followed up by frequent spacing of shocks to prevent relapse. For this purpose, “intensive therapy” is regarded as that which commences with several shocks daily until the excited state is suppressed, and by this method the most maniacal patient can be rapidly and dramatically brought under control.

The characteristic trait of the doctor's medical activity, compared with the quack's, is that the doctor is guided by two theoretical and practical postulates. The first one is diagnostic, and implies that the doctor must try to state the nature of the disease. If this is not possible, he must at least make an analysis of the symptoms in order to establish their patho-physiological connection, so that he knows which are the most important and most susceptible to treatment.

In June, 1940, the first Area Psychiatrists in the United Kingdom, of whom I was one, were appointed. Although at first we were told that there were not many psychiatric cases, and in spite of the lack of encouragement in some areas, clinics were set up, and very soon the psychiatrists were overwhelmed by the number of patients sent, both officers and men. It became apparent to all of us who were doing the work that many of the men could have been eliminated at the source, for by going into the history of the individual patient, and giving him intelligence tests, one could have foretold fairly accurately his future in the army, i.e. whether he would be able to be trained as a soldier in a particular arm, and his length of service before his breakdown. But the process was that of elimination. The psychiatrist working alone managed to sort out the soldier, but there was at that time no disposal method except to hospital, which was not very useful for the dull and backward, and the chronic anxiety states. At the end of 1940, at the suggestion of a Command Psychiatrist, a Directorate of Officer Selection Personnel was set up, so that men joining the army would have their intelligence tested, and be interviewed by a personnel selection officer, and the dull and backward and the difficult cases interviewed by the psychiatrist, either for rejection from the army or for transfer to the unarmed or armed Pioneer Corps, or to any arm which was considered suitable. This process has continued since then, and has made great strides. At present no man is posted to any particular arm, but he comes into the army to primary training centres, where he is tested and interviewed, and after six weeks' general training is then posted to the arm most suitable for him. This procedure helped the problem of “other ranks,” and it was hoped that the incidence of psychological illnesses in the army would be lowered, and the number of men sent to the psychiatrist brought within reasonable limits. Till then, the psychiatrist in the army had been working very fast, seeing as many as thirty to one hundred men a day.