The purpose of psychotherapy does not differ essentially from that of the treatment of sickness generally. It is to relieve distress and promote efficiency of mind while improving the patient's adaptation to the group in which he lives, to their mutual benefit. Before psychotherapy can be prescribed or undertaken, a diagnostic review is necessary of the relationship between the patient's psychophysical constitution and the stresses to which he has been and is being exposed. This relationship is a complex one which involves the effects of previous stresses and the way in which they have been surmounted or have left their mark. The introduction of a third complex entity, the method and personality of the therapist, renders the total situation too involved for detailed comprehension and logical analysis, especially if the therapy is to be of the causal-anamnestic or comprehensive kind which is not content simply to deal with symptoms and their immediate causes. In the presence of this degree of complexity—well beyond the range of mental encompassment by one mind at one time—the psychotherapist must walk in humility, for he can rarely feel justified in thinking that he knows exactly what is going on.

Disturbances of ego, self-concept and body-image have always been regarded as central in the psychopathology of schizophrenia. The passivity phenomena, automatisme superieur of the French authors, are indeed very common in this disease. There is a disturbance of the self which is shown in depersonalization and in feelings of influence and passivity. The boundaries of the self become loose or blurred and the patient may feel, for example, that parts of his body do not belong to him or that he is part of the plants, animals, clouds, other people or of the whole world and that they are part of him. He may feel at one with the whole of mankind. Self-concept is closely related to what has been termed “body image” or “perceived body”. Head (29, 30) has shown that what he called “body schema” is very important for motor co-ordination and performance of purposeful movements and also for orientation in space. Schilder (53) in his monograph has analysed the problem of body-image in great detail. He has found in the idea of the body image the basis for the body or physical ego. He follows Head in stating that the body image consists of the proprioceptions of the whole body and that it changes with the body's varying postures. Yet neither Head's body schema nor Schilder's body image are identical with the body ego. The body schema represents the constant mental knowledge of one's body; the body image is the changing presentation of the body in one's mind. Throughout the changes of the body image there is an awareness of continuity of one's body, a sense of basic identity and oneness. This constitutes the bodily or physical ego. The body ego in its turn is the basis of a wider “self” which can be called self-concept or selfhood. This self-concept or selfhood contains, in addition to the awareness of the continuity and the identity of one's own body in spite of its constant change, the awareness of the continuity of one's self as a person in spite of constantly changing relationship with the external world, and in spite of the playing and taking different “roles” in social interactions. According to Mead (38) and Coutu (16), selfhood is a social phenomenon and emerges only through interaction with other people, through “taking their roles” and viewing oneself from their point of view.

Since the introduction of chlorpromazine for the treatment of mental illnesses a number of other tranquillizing drugs, belonging to the phenothiazine group, have come into use. Experience has shown that the first of a new kind of drug is not necessarily the best and it is important that “variations on a theme” should be properly tested.

The need to clarify the “confusion in neurology and allied disciplines between the body image, the body schema, the body concept and the perceived body” was emphasized by Smythies (1953). For the neuropsychiatrist it is perhaps the disorders of the body schema and perceived body which are of the greatest interest and importance, but the confusion which still exists between the body concept and the body percept make it probable that a definition and examination of the body concept would clarify thinking about all Body Image problems.

Nearly one hundred years ago, Anstie (1864) wrote: “Among the too frequent instances which are to be found in medical nomenclature, of confusion and uncertainty in the application of descriptive terms, there is none, perhaps, more striking than is occupied by the words Narcotic and Stimulant.” Both classes of substance embrace drugs of antiquity. Thus of the depressants, alcohol dates from the time of the Thracian god, Dionysus, while the earliest use of stimulants such as caffeine and xanthine is lost in the obscurity of the past (Goodman and Gilman, 1955a). Even today, there exists no systematized codification of response to the two classes of drug, although it is implicitly assumed that stimulants and depressants are invariably and mutually antagonistic in their effect on the central nervous system. Advantage was therefore taken of phenomena arising during drug intoxications to categorize abnormal features in the central nervous system common to each of the two classes of intoxicant and to essay a comparison, the one with the other.

The history of mediaeval medicine shows clearly that the decline of a science takes place whenever the tendency to theorize overruns the desire to observe and measure. Psychiatry with its shorter medical history has suffered from this tendency until fairly recent times. Even now, it is possible to estimate the efficiency of a nation's psychiatric progress by comparing the amount of factual research with the emphasis placed on unproven theoretical concepts in clinical practice.

The phenomena of “spirit-communication” in mediumistic trance, of “spirit-possession” and of “demonopathy” are closely related, and known to both East and West. Clinical psychiatrists, however, have taken little interest in them, with the exception of some French and a few Spanish authors. These conditions nevertheless do present themselves to the psychiatrist in many countries and it is misconceived to think that they are to be found only in outlandish cultures, the preserve of the field worker in ethnology. It is true that M. J. Herskovits (1951, 1958) has argued that certain kinds of behaviour categorized in terms of culture-bound concepts cannot be applied to other societies, so that African and Afro-American spirit possession, for example, cannot be compared with apparently similar “psychopathological seizures” in the West. No doubt such behaviour receives different cultural definitions according to their respective backgrounds, but this does not exclude the possibility of a specific psychological mechanism being common to them all.

Medical research is simpler and generally more productive when it becomes possible to use models. This experimental method is available to psychiatrists who find that certain chemicals called hallucinogens (13) produce in subjects experiences which resemble those described by patients who now have schizophrenia or by those who have recovered. Lewin (19), Kluver (18) and Stockings (31) suggested many years ago that these compounds could be used in this way. However, the differences between these model experiences and schizophrenia rather than their similarities impressed many leading psychiatrists. Thus Bleuler (4) as late as 1956 maintained that lysergic acid diethylamide (LSD-25) produced a toxic delirium and therefore this experience had little to offer to the students of schizophrenia. The fallacy of this argument was discussed by Osmond (23) who with Smythies (24) stressed many points of similarity between schizophrenia and the mescaline experience. The consensus today of research psychiatrists such as Rinkel (26, 27, 28, 29), Hoch (10, 11) and others is that the similarities are adequate, provided generalizations remain within the limits imposed by the data.

Despite the good results reported in recent years in many cases of chronic schizophrenia following the use of tranquillizing drugs, there remains in mental hospitals a group of chronic and often deteriorated patients who have shown a strong resistance to all forms of treatment. In many such cases disturbances of behaviour are modified and sometimes controlled by such drugs as chlorpromazine and reserpine. Nevertheless, the overall situation is far from satisfactory and the search for more effective drugs continues.

In several recent experiments involving motor performance (1), learning (7), immediate recall (2), expressive movement (5) and confidence in performance (3), significant relationships with a questionnaire measure of rigidity have been obtained. In view of the fact that despite a considerable amount of work no general trait of rigidity has hitherto been recognized, it was decided to clarify the reasons for the above results. Two steps are undertaken. The first step, published separately, is concerned with a systematic analysis of the experimental variables which yielded significant correlations with rigidity. In a series of investigations, the attempt is made to discover the experimental conditions necessary for a significant interaction of rigidity with test responses to occur.

This brief report draws attention to some recent results showing that questionnaire measures of rigidity and extreme response set, which are regarded as closely related variables, are likely to possess a much higher degree of generality than usually accepted and that they play an important part in the measurement of normal and abnormal personality.

Iproniazid (1-isonicotinyl, 2-isopropyl hydrazine phosphate) was discovered by Fox and Gibas (1953) whilst working on new synthetic compounds for the treatment of tuberculosis.

Basic research into the aetiology, physiology and psychopathology of schizophrenia can usually be applied to schizophrenic illnesses wherever they may occur. Each mental hospital however is unique in the area which it serves, the class of patient admitted, and the treatment services and social atmosphere it provides. This means that the results of research projects concerned with the treatment for schizophrenia cannot be transferred so readily from one hospital to another. Hospitals treating different groups of patients in a different social atmosphere can produce widely differing results. To some extent therefore each hospital has to determine its own treatment policy, which will be dependent upon its own particular problems and facilities.

Although modern opinion recognizes that there is no such entity as puerperal insanity, views on the part played by the pregnancy in producing mental illness are not so unanimous. The fact that the onset of a patient's illness is related to the puerperium is considered by some authors to have a favourable, and others an unfavourable, prognostic significance. Puerperal mental illness achieves the distinction of separate identification in the International Nomenclature of Disease, not as “Schizophrenia in association with the Puerperium” or “Manic depressive psychosis in association with the Puerperium” but as Puerperal Psychosis, 688.1.

The critical evaluation of new drugs or remedies against inert substances or nonspecific procedures has led to the recognition that responses to a placebo are important in their own right. Such responses may be dramatic and persistent and they can be associated with quite definite physiological changes (Wolf and Pinsky, 1954). The placebo response may well be an important component of many established treatments both physical and psychological, and does in itself constitute a means of therapy (Roberts and Hamilton, 1958; Gliedman et al., 1958).

The psychometric assessment of memory presents special problems in that inferences regarding this function seem to be markedly dependent upon the conditions under which it is measured. Thus, following exposure to experience X, it is problematic whether a single statement regarding a person's ability to remember X can be made. His ability would likely be a function of the time between exposure and reinstatement (Ebbinghaus, 1913; Luh, 1922; Postman and Rau, 1957) and whether assessment involved recognition, free recall, or relearning (Luh, 1922; Postman and Rau, 1957). Beyond these, the importance of the sensory channel involved in the initial experience or in reinstatement (Thurstone, 1938, p. 86) and the nature of the content to be retained (Benton, 1945) remains relatively unexplored. All of these considerations dictate against accepting differing psychological test measures of memory as equivalent and, conversely, suggest that any generalized statements regarding memory ability should be based upon several different measures.

The illness which was first described by Kraepelin and which he called dementia praecox was more correctly designated as a Zerfallskrankheit (disintegrative illness) by Eugen Bleuler, who called the illness schizophrenia. In this disease, or rather group of diseases, not only does one find characteristic symptoms and symptoms which occur in other functional psychoses, but, if suitable methods of examination are employed, symptoms which are found in gross brain diseases, especially those associated with focal lesions, are also elicited. Apart from this, many other symptoms acquire a new aspect when viewed from the standpoint of neuropathology. This may justify our attempt to consider all schizophrenic symptomatology from the point of view of neuropathology. I attempted to do this in my “Report on Cerebral Pathology and its Importance for Neurology and Psychiatry” which I delivered 21 years ago at the annual meeting of the Association of German Neurologists and Psychiatrists at Frankfort-on-Main. Not much space was devoted to the problem of schizophrenia in this report. However, since that time more neuropathological knowledge has been acquired as a result of the Second World War, and this has added to the not inconsiderable knowledge of neuropathology which we already had in 1936 as a result of the First World War. The increasing number of brain injuries due to road accidents has also increased our knowledge of neuropathology. New approaches to the schizophrenic syndromes have been made possible by this growth of our knowledge of the effects of brain injury. Apart from this, I was able, in collaboration with Professor Leonhard and others, to finish a few years ago the clinical follow-up studies on schizophrenia which I began in 1936. In this work we encountered a large number of schizophrenic symptoms which had neurological characteristics.

The advent of the various tranquillizing drugs during the past few years and their increasing use in mental hospitals have had the effect of drastically decreasing the number of lobotomies performed. At our hospital, e.g., the last lobotomy was performed in November, 1954; previous to that time 131 such operations had been done in seven years. To all intents and purposes lobotomy is a therapeutic procedure no longer used for psychiatric purposes. This may change, of course—it may be decided that for certain patients a lobotomy is still the treatment of choice. Or, it may be that in the years to come lobotomy will be of interest chiefly to medical historians.

This report is based on a survey of 1,716 Chinese patients admitted to the Peking Municipal Psychopathic Hospital during the years 1933–1943. It is mainly concerned with a statistical presentation of the relative frequency of the various mental disorders and with certain other data which may be of interest to psychiatrists and other members of the medical profession.

Any particular system which is being conditioned is likely to maintain a certain level of background activity throughout the experimental procedure; either of a discontinuous nature, as, for example, with eyeblink, heart rate and respiratory cycle, or continuously, as in the case of basal skin resistance and muscle tonus. This background activity or level of arousal does not remain constant but usually varies in time, presumably as a result of underlying neural excitation or inhibition. It may increase throughout an experiment if the subject becomes highly motivated, as with the gradients of muscle action potentials observed by Bartoshuk (1955), or decrease, if the subject becomes more relaxed and familiar with the set-up, as Duffy and Lacey (1946) found with level of skin conductance.