Psychiatry and psychology.—In his preface to The Pathology of Mind, Henry Maudsley commented on the peculiarly isolated way in which the study of mental illness had developed during the previous fifty years. “Treatises on mental disorders,” he said, “deal with their subject as if it belonged to a science entirely distinct from that which is concerned with the sound mind.” This, he continued, is as though a pathologist were to discuss cardiac and respiratory disease, with little or no knowledge of current work on the physiology of the heart or the lungs. And it was one of his chief aims “to put a happy end to the inauspicious divorce between the two sciences.” Partly in the hope of bringing them into closer touch, his discussion of pathological conditions was prefaced by a systematic account of the normal mind: and in the first edition of his work (1867) the two topics were included in a single volume. Nevertheless, in spite of Maudsley's arguments and his excellent example, few writers on mental pathology have, until quite recently, paid much attention to advances in general psychology. When they describe mental processes or characteristics, they constantly fall back on popular concepts or on out-of-date terms which present an incongruous mixture of an obsolete faculty psychology with an antiquated associationism—doctrines that were already under heavy criticism when Maudsley himself was writing.

About one year ago, with the encouragement of the Editor-in-Chief, a short paper appeared in this Journal entitled “Schizophrenia; A New Approach” (18). In this paper it was noted that mescaline and adrenaline have a similar biochemical structure. It was suggested that one of the aetiological agents in schizophrenia might be a substance or substances lying between these two; with the psychological properties of mescaline but effective in concentrations nearer those of adrenaline. Dr. Harley Mason elaborated this suggestion from the biochemical standpoint. For convenience these hypothetical substances were called, collectively, M substance. If M substance occurred in the body, it would account for the group of illnesses usually referred to as schizophrenia better than any hypothesis so far advanced. It has been the good fortune of the co-authors of that first paper (J. R. S. and H. O.) to be able to join forces with the third author of this paper (A. H.) to test the hypothsis. It is with the efforts of the last year that this paper is concerned.

Recent interest in the surgical alleviation of mental disorders has centred in the trial of new and different operations. Fairly early in the development of the subject Freeman and Watts (1944) themselves reported the fairly constant observation that under local anaesthesia gross mental change did not occur until certain stab incisions had been made deep in the infero-medial quadrants. Marked mental change, with confusion, unresponsiveness and disorientation, seemed to occur on section of a small bundle of fibres located interiorly close to the midline. Most of the modifications of Moniz's original procedure have, however, been made on an essentially empirical basis.

In 1947 the Board of Control published its report on the results of 1,000 leucotomies, citing therein a mortality of 6 per cent. Five years later Dr. W. S. Maclay, in his Presidential Address to the Section of Psychiatry of the Royal Society of Medicine, referred to 180 deaths during the interval, a mortality of approximately 2 per cent. Although this is a striking improvement there is still cause for apprehension, for by far the greatest proportion of fatalities arise out of haemorrhage. The second causative factor in fatal issues is infection. Something must be done to put psycho-surgery on a yet safer basis.

Hemispherectomy in man (ablation of the cortex, the underlying white matter and nucleus lentiformis) was performed first by Dandy (1928, 1933), later by Gardner (1939) and a few others, on adult patients suffering from large infiltrating tumours of the subdominant hemisphere, with one exception (Zollinger, 1935). It was carried out by McKenzie (1939) apparently on a patient suffering from infantile hemiplegia with epilepsy. Krynauw (1950a, b) began systematic work of this nature on cases of infantile hemiplegia with epilepsy and personality disturbances. Apart from its therapeutic value, in carefully selected infantile hemiplegics, in the hope of lessening or curing epilepsy, and exerting a beneficial influence on behaviour and further mental development, the comparatively small loss of functions after removal of one hemisphere is most remarkable.

A focused beam of ultrasound can be used to produce selective accurately localized lesions in central nervous systems which are quantitatively reproducible from one animal to another.

Goal-seeking behaviour, once a great mystery, is now beginning to be understood. In its simplest forms it is, in fact, understood to-day almost completely. Thus the theory of the simple regulator, such as the thermostat, not only includes an extensive repertoire of techniques, but the elementary principles, of the necessity for negative feedback for instance, are becoming scientific commonplaces. In getting to know, however, about these simple systems and their principles, we should not make the mistake of thinking that there is nothing more to be learned. On the contrary, in real life many an important goal is to be achieved only through some quite complex pattern of behaviour, a pattern for which the simple concept of “negative feedback” is quite inadequate. It is of these more complex patterns that I wish to speak to-day.

The present paper is concerned with some aspects of stability and of steady periodical changes in dynamical systems. After a brief survey of the classical theory due to Poincaré, I shall sum up some of my recent work relating to a certain class of systems not considered in that theory. It is, of course, assumed that this work is relevant to the main subject of this meeting; in fact, in the course of writing down these notes I was fortunate enough to be able to look (although far too cursorily) through Dr. Ashby's book, Design for a Brain, and have been struck by what appeared to me to be a remarkable parallelism between our lines of thought. The arrangement of the subject-matter has been avowedly influenced by this assumption of relevancy; however, I shall keep to my legitimate grounds as a physicist and shall leave it to you to fill in what ever “psychological” conclusions you may think justified.

At the moment, cybernetics cannot point to any established triumph for, as a science, it is very young and is being applied to psychiatry in few laboratories. Nevertheless, I hope to show that there are good reasons for thinking that its relation to psychiatry is close, and that its application will eventually yield a rich harvest.

Peripheral neuro-effector sites within and outside the autonomic nervous system form useful reference points for the study of the central effects of some agents. Nevertheless, ready analogies between peripheral neurohumoral mediation, and central synaptic transmission may be grossly misleading, and reliance must solely be placed on data derived from within the central nervous system itself.

D-Lysergic acid diethylamide (L.S.D.-25) was first prepared by Stoll and Hoffmann in 1938 (35) as a derivative of rye ergot. Its profound effects in minute doses were discovered accidentally by Hoffmann and reported by Stoll (34) along with additional observations by the latter on 16 healthy controls and six schizophrenic patients. With a dose of 30–130 γ (0.03–0.13 mgm.) Stoll (34) noted motor inco-ordination, disturbances of visual perception with illusions and hallucinations, clouding of consciousness, and affective changes principally in the direction of euphoria and distractibility. Subsequent clinical reports have confirmed these findings (6, 38). Becker (1) using doses of 30–40 γ in healthy controls attempted to predict the quality of the resulting psychosis from the constitutional somatotype of the subject; he contrasted maniacal hyperkinetic states with those showing inhibition and depersonalization and drew attention to the pattern of the visual perceptual disturbances, which were principally those of differences in size, clarity and perspective. Becker's attempts at somatotypological correlation were less successful than those of Condreau (4) who used mentally ill patients as well as healthy subjects and found that L.S.D.-25 did tend to reinforce pre-existing personality characteristics, especially with regard to mood changes. Rinkel and others (30, 7) with doses of 20–90 γ in mixed healthy and psychiatrically disturbed populations stressed the scotopic nature of the hallucinations and the greater frequency of illusions of rippling or wavy lines evolving at times into geometrical designs. Affective blunting with a lack of spontaneity was commoner than the production of major delusions. In epilepsy apparently visual hallucinations are more frequently concomitants of L.S.D.-25 administration than in other mental disorders (31).

Quick (1931) first reported on the conjugation of benzoic acid in man and recorded the hippuric acid excretion rate as a test for liver function. Quastel and Wales (1938) found faulty detoxication in catatonic schizophrenic patients and later (1940) a return to normal values after clinical remission. A number of other workers, particularly Georgi, Fischer, Weber and Weiss (1948–49) described this disturbed benzoic acid detoxication as a general syndrome in all schizophrenics. When giving glycine simultaneously with the benzoic acid they noticed a normalized and increased hippuric acid excretion rate in patients who originally showed decreased hippuric acid excretion. The Quick test, modified in this way, was used in order to prove that the decreased hippuric acid excretion rate is not the expression of a disturbance in the coupling mechanism between benzoic acid and glycine but rather a disturbed ability of the organism to mobilize glycine. Mall and Jünemann (1952) have lately confirmed the results of Georgi et al. in extensive investigations. They reached the conclusion that variations in the hippuric acid excretion rate are mainly due to a disturbance of the ability to dispose of glycine in the schizophrenic organism. They confirmed previous results of Georgi according to whom treatment of the patients, which was carried out partly from the point of view of disturbed liver function only, partly combined with insulin and electroshock, leads to improvement of the detoxication rate. Persky, Gamm, and Grinker (1952) have also recently seen decreased hippuric acid excretion values in catatonic schizophrenic subjects, and have reported a return of the hippuric acid excretion to normal after successful psychiatric treatment. In their series patients who manifested free anxiety symptoms, excreted elevated amounts of hippuric acid; the excretion rate returning to normal levels after successful psychiatric treatment.

The relationship of neuro-psychiatric disorders to electro-physiology and biochemistry has a vast literature, review of which is not within the scope of this preliminary report. The report itself concerns a study of an aspect of this relationship based on 30 unselected neuro-psychiatric cases. Each case had an electroencephalographic (E.E.G.) and a cerebrospinal fluid (C.S.F.) investigation, the latter with reference to the presence of amino-acids.

To research workers in personality measurement the advance of routine testing procedures in clinical psychology has seemed peculiarly sluggish. Whereas solid theoretical foundations have been found for an account of the normal personality structure in factor analytic terms (5, 6, 7) and a rich variety of new tests has been created (8, 9, 14), the clinicians have confined themselves to one or two “gadget” tests, conceived with no more explicit relation to personality structure than a patent medicine has to modern physiological principles. The present research aims to bring factor structure measurement in a clinical population into relation with that found in normals and to provide a first, reproducible, test battery covering at least a dozen factors for use in clinics able to give sufficient time for valid and reliable measures of the primary personality dimensions.

Since the interviewing process, or the process of two people talking to each other is an extremely complex phenomenon, it seemed advisable to begin its analysis at the elementary and quantitative level, by first of all measuring the duration both of periods of continuous speech, and of the pauses and then after investigating their various relations and rhythmic alternation, to work up through grammatical analysis to the more complex phenomena.

It is rare for someone at my time of life to be in a position to make really original contributions to knowledge, though it does occasionally happen. More often we feel that we have something to offer that is generally called the “wisdom of experience,” but it is a gift that a younger generation is apt to look at askance. There is, however, one field in which old age has an undisputed prerogative, and that is in being able to recall happenings in which younger people could have had no share. I propose to-day to confine myself to this modest claim and I shall be content if the illustrating of it arouses some interest in you.

Although endocrines have often been used in the treatment of various psychiatric states, the measure of success has been small. Oestrogens have improved certain forms of involutional depression, and thyroid has been successful in the treatment of cretins, depression secondary to myxoedema, and in periodic catatonia. The following reports on the use of dehydro-isoandrosterone (diandrone) and oestrogens suggest a useful development in endocrine methods, either singly, or in certain cases, in combination.

The main object of this investigation is to verify the claim of Pauline Davis (1941) that manic-depressive depressed psychotics (M.D.D.s) tend to possess frequencies of alpha rhythm in the E.E.G. at 10 c./sec. or slower, whilst manic-depressive manic patients (M.D.M.s) tend to show alpha frequencies at 10 c./sec. or faster; furthermore that there is no shift in alpha frequency corresponding to change in psychotic phase or in degree of phase. These claims are of importance in relation to a recent paper by Mundy-Castle (1951b) in which a significant correlation was reported between ratings of the Heymans-Wiersma temperament variable secondary function and mean frequencies of alpha rhythm in normal adults, since both Heymans (1929) and Wiersma (1932) maintained that M.D.D.s possessed a high degree of secondary function and M.D.M.s a low degree of this variable. To explain this in more detail, secondary function is postulated as being present in individuals in different degrees varying over a continuous scale ranging from domination of the conscious field by secondary function to domination by primary experience (relative lack of secondary function). Individuals displaying the former may be referred to as secondary functioning, their behaviour being characterized by steadiness of action, continuity of interest, evenness of mood and psychic tempo, reduced stimulability and a tendency for mental events to perseverate. Individuals in whom secondary function is relatively lacking (it can never be wholly absent) may be termed primary functioning, their behaviour being characterized by impulsiveness, mobility, high stimulability and a quick and variable psychic tempo. The Heymans-Wiersma temperament scheme has been developed extensively by Biesheuvel (1935, 1949). Mundy-Castle's study revealed that subjects rated as secondary functioning possessed low alpha frequencies whilst those rated as primary functioning possessed high alpha frequencies. The present investigation should help to elucidate the view of Heymans and Wiersma concerning secondary function and manic-depressive psychosis.

We have reported a follow-up study of patients first admitted to London County Council Mental Hospitals in 1930 (Harris and Lubin, 1952, Harris and Norris, in press). The present paper deals with a group of similar patients, i.e., psychotics from whom epileptics, known organic cases, ascertained mental defectives, those over the age of 40 and those who had been admitted to a mental hospital previously were excluded, who were transferred to mental hospitals from St. Francis Observation Ward during the period May 1940 to May 1942. The main differences between this group and the 1930 one were: (a) The Mental Treatment Act of 1930 had come into operation and many were admitted to mental hospitals as voluntary patients; (b) modern physical methods of treatment were in use; (c) in most cases the history was known.

The purpose of this paper is to report on a small series of cases treated with mysoline (5-phenyl-5-ethyl-hexahydropyrimidine-4:6-dione) and to contrast the results with those obtained with the established anticonvulsants phenobarbitone and soluble phenytoin.