I was asked in the early months of 1952 to deliver this lecture towards the end of 1953. Of course I realized that it was a great honour to be asked, for I knew something of the work of the late Dr. Maudsley, and I was aware of the immense contribution he had made in the treatment of the insane.

It is only proper that I should begin this paper with a disclaimer. I am not a psychotherapist, nor am I one who has devoted much of his time to the physical methods of treatment. My only qualification to carry this burden at all is that I believe I am somewhat in a neutral position and have not been fired alone by either set of enthusiasms—neither those which activate the physical treatment experts, nor those which sustain the psychopathologists. Necessarily therefore what I have to say will be from a personal viewpoint, although of course not a detached one and I will apologize once for this and not again. The subject of this talk is obviously an important one and must be the concern of psychiatrists of all persuasions. Those who are psychotherapists cannot ignore the fact that the main mental disorders which constitute the serious core of psychiatric disability in the community are treated first and foremost by physical methods, insulin coma, E.C.T. and surgery, while those who are non-analytical psychiatrists cannot ignore the fact that the less serious but enormously more prevalent conditions are treated in the main by psychological methods. The question might be asked, are there then two types of psychiatric disorder, the one only treatable by a physical method, the other by a psychological method ? But this is a superficial view; with the greater sophistication of physical methods more and more patients who formerly were treated by psychotherapy are now subjected to some physical treatment, and conversely—and this is particularly evident from the American literature—more and more patients, particularly schizophrenics, formerly treated by insulin or surgery are now being subjected to psychoanalysis. Each side is therefore invading the territory of the other, but there is no common language or ground for discussion between them. Now of course there are many different forms of physical treatment, just as there are many different types of psychotherapy. Let me take the physical treatments first. We can I think divide them roughly into two classes. There are those which by their universal use for a special type of mental state or special group of symptoms have come to be regarded, rightly or wrongly, as almost a radical treatment for such conditions. For this group no psychopathological preconception regarding the patient, his problems, his methods of adaptation and defence are necessary. All that is needed is a clear statement of his symptomatology, its duration and course to enable the physician to determine the type of treatment. In this group therefore we can place insulin comas, E.C.T., and cerebral surgery of the leucotomy type. It is only necessary to demonstrate schizophrenic thought disorder and primary delusions of recent onset to arrive at the view that insulin treatment is advisable; on the other hand depressive affect, depressive sleep disorder and loss of weight, continuing beyond the reasonable period following a stress situation or the absence of a stress situation particularly in the involutional period of life will lead many to recommend E.C.T. without more ado. For chronic obsessional tension, rumination or distressing psychotic ideas interfering with adaptation, leucotomy or some modified form of surgery come to mind.

There has been much discussion about the possible occurrence of reversible and irreversible histological changes in the brain following the convulsive treatment of mental disorder. Most investigations have been carried out either on experimental animals—with results not easily comparable to man—or in deceased patients in whom the picture is usually obscured by the presence of complications. The various causes of death following convulsive treatment have recently been reviewed by Maclay (1953).

The purpose of this paper is to investigate one of the basic assumptions of the Szondi test, namely, that in selecting pictures in the test subjects tend to assign consistent meanings to the pictures, although these meanings are not explicitly stated. In the following experiments, this assumption was tested by obtaining explicit reactions to the pictures in the form of identifications, using two different experimental methods. Similar studies have been made by Klopfer and Borstelmann (1950), Rabin (1950a), Fosberg (1951), Davis and Raimy (1952), and by Dudek and Patterson (1952). In all these investigations, American subjects with some experience of psychology or psychiatry were used. The most extensive work was done by Klopfer and Borstelmann, who used a sample of American psychology students, and suggested that their methods might be employed on “other segments of the population”. In the following experiments, their methods have been largely adopted for English subjects, of varying ages and occupations, including students.

If the standards of psychotherapy approximated to those in vogue in the field of organic medicine a lecture on the indications for psycho-analysis would be a comparatively brief and possibly tedious affair. Since, however, there is no uniform diagnosis of mental disorders, no exact account of the rationale of psycho-analytic treatment and no assented list of the modifications of treatment required in different forms of disorder, it is obvious that before we can usefully discuss indications for psycho-analysis or in other words the scope of psychoanalytic treatment we must arrive at a certain amount of agreement regarding the diagnosis and prognosis of mental disorders and the nature of psychoanalytic therapy.

During the last few years it has become more and more apparent that there exists a considerable impatience and even intolerance between traditional religious thought, and certain assertions on the part of social sciences and psychology, which have become influenced by psychoanalysis. Psychoanalysis, as is generally known, was born out of psychopathology and both sociology and psychopathology joined hands recently to make friends with one another and with anthropology. The result of all this is the almost emphatic claim that psychopathology and social sciences have become scientific disciplines—or that they have become more influenced by the scientific method than by philosophy. To a certain extent this claim is justified; yet and almost in spite of this there is a far cry between the modern meaning of the term anthropology and the meaning which anthropologia had originally. Instead of being the science of man, it has become more the science of human institutions and social relationships; it has fallen under the heavy weight of statistical averages, which are still mistakenly accepted as the best entering wedge into the field of true (scientific!) knowledge.

I—The Problem. II—Method: (i) General Outline; (ii) Apparatus; (iii) Test procedure. III—Subjects. IV—Results: (i) Correction for arbitrary zero; (ii) Analysis. V—Discussion. VI—Summary. References.

The following paper is concerned with the statistical analysis of the clinical data about nearly 500 schizophrenic patients. About half of these received insulin treatment, while the others did not. The patients were followed up for periods of between 5 and 10 years, so that the material is also classifiable by good and bad outcome. A full account of this clinical material, collected and studied at the University Psychiatric Clinic at Lisbon by one of us (P.P.), has already been published in the Portuguese language (Polonio, 1950).

In her sociological study of suicide Cavan (1928) commented that “up to date no adequate studies have been made of the relation of the habit of drinking to suicidal tendencies”. Ten years later, Merrill Moore (1939) makes a similar complaint: “What relation, if any, is there between alcoholism and suicide? This question has never been definitely answered and little has been written about it… In the entire literature of medicine hardly more than twenty acceptable articles on this subject are recorded.” Little has been written on the topic since then.

A number of studies on reaction time (R.T.) latency to visual and auditory stimuli in psychotic patients has been reported since the first investigations on the personal equation were carried out. The general trends from the work up to 1943 are well summarized by Hunt (1944), while Granger's (1953) review of “Personality and visual perception” contains a summary of the studies on R.T. to visual stimuli.

Depressive states occurring in the involutional period are among the most common syndromes encountered in psychiatric practice. Since the introduction of electroshock therapy, this has been the treatment of choice for these conditions. Unfortunately not every patient who is treated remains in good health, and every mental hospital has a certain number of chronic involutional depressions who remain refractory to further electroshock therapy.

D-lysergic acid diethylamide (LSD 25) was first prepared in 1938 by Stoll and Hofmann. It is the synthetic amide of d-lysergic acid with a secondary amine, diethylamine and belongs to the ergonovine group of ergot alkaloids all of which have lysergic acid as a base. After its ingestion in minute doses, it induces psychic states in which the subject becomes aware of repressed memories and other unconscious material in a setting of clear consciousness. This preliminary paper describes the results obtained from the use of the drug in 36 psychoneurotic patients over a period of one year. We consider that the drug will find a significant place in the treatment of the psychoneuroses and allied mental illnesses.

Recent work by the author and his colleagues (Sandison, Spencer and Whitelaw, 1954) has established that lysergic acid diethylamide is of great value in the psychotherapy of the neuroses. This paper attempts to examine in rather more detail the possible mechanism of action of the drug in terms of dynamic psychology. It is now generally accepted that the psychoneuroses are the result of a faulty relationship between the conscious and the unconscious, leading to a one-sided or prejudiced conscious point of view. Any discussion which follows this observation must be preceded by a definition of the writer's conception of the unconscious, and in this paper the standpoint adopted by Jungian analytical psychology will be preferred.

During the Spring of 1952 in the course of my work with adult male defectives, I made a practice of taking groups of them for walks and short cycling trips outside the grounds of the Institution. I decided it might be worth while to undertake a prolonged tour. In June, Dr. Curran gave me permission to take seven high grade defective adult males on a two weeks' cycling tour.

The study of actual instances of psychosis among non-literate peoples can enhance our understanding of the relationship between mental illness and the society in which it occurs. Analysis of case histories may enable us to see how social, biological and psychological factors reciprocally influence each other to produce mental disease. Some light may be thrown on the question whether or not there is a common nucleus of aberration which is universally manifested.

The biochemical aspects of manic-depressive psychosis have been adequately, reviewed by McFarland and Goldstein (1939). From previous investigations, it is apparent that there is a marked alteration in carbohydrate metabolism mainly associated with a change in glucose tolerance. This phenomenon is related to alterations in emotional state and there is no suggestion that it is the cause of the mood swings which occur periodically in this type of psychosis. Apart from these variations in the control of carbohydrate metabolism, it has so far not been possible to demonstrate any changes in the blood levels of any products derived from carbohydrate metabolism.

The possible psychiatric applications of chlorpromazine hydrochloride (Largactil) have been discussed by various authors in Continental journals; particularly by Delay et al (1952) and Sigwald and Bouttier (1953)—the latter including in their paper a summary of publications devoted to this aspect of the drug's activity.

The opinion is sometimes expressed that patterns constructed by socially maladjusted individuals (e.g. in woodcarving, needlework, arrangement of flowers, etc.) are less symmetrical than those of the adequately adjusted. It is even held that the amount of asymmetry bears some relationship to the degree of maladjustment. Evidently, other factors besides maladjustment are involved in this question. The primary aim of the inquiry reported here was to investigate the effects of differences in sex, intelligence and level of social adjustment on the symmetrical construction of patterns. The technique employed for this purpose was akin to that of the mosaic test of Lowenfeld (1949) but of a more delimited character and with simplified material.

The prognosis as to life in cases of mongoloidism is universally recognized as being notoriously bad. It would appear that the majority die in infancy and that many of those surviving this period succumb during the second decade. A small proportion reach the third decade, and a still smaller one survive till middle age. Brousseau in 1928 stated that few mongols reach the age of maturity, and that no mongol had reached old age. She stated that the oldest case found in medical literature at that time was a mongoloid female aged 57 reported by Langdon Down. In 1937 Tredgold stated that Langdon Down had then in his training institution at Normansfield 16 mongols over 21 years of age. Three of these were between 40 and 50, two between 50 and 60 and one male aged 63.