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.

This note is intended to supplement Professor Zangwill's communication (1953) under this title in the centenary number of this journal, in which “disorientation for age” as described by Weinstein and Kahn (1950 and 1951) is illustrated as persistent and stable in two cases of alcoholic Korsakov psychosis.

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.

Since the publication of Bender's (3) “Visual-Motor Gestalt Test and its Clinical Use” many attempts have been undertaken to validate the clinical findings which she outlined in her Monograph.

In his “Tentative Guide to the Administration of the Bender-Gestalt Test” Hutt (7) did more than anyone else to put into practice the clinical use of the Bender-Gestalt, but his finding on Psychoneurotics have not been confirmed by empirical studies. However, it is of interest and encouraging to find many of the subsequent empirical studies substantiating most of the original clinical uses outlined by Bender and Hutt.

Personality characteristics of patients suffering from bronchial asthma have attracted considerable attention. Most clinical observations suggest that asthmatics present a characteristic difficulty in emotional expression. Reporting on the behaviour of 23 children with either asthma or eczema, Rogerson, Duguid and Hardcastle (5) state that these children were more shy than others in play therapy. Harris et al. (3) compared asthmatic children to children with allergic rhinitis. They suggested that half of the asthmatic group showed more difficulties than the rhinitic group in crying and confiding to the mother. These observations were made on children. On the adult side we have the inferences of French and Alexander (2) (based on psychoanalytical situations) that the asthmatic attack is the equivalent of a suppressed cry. However, as Leigh (4) has pointed out in his recent review of the psychiatric aspects of asthma, little valid evidence has in fact been presented that this feature of personality or any other is characteristic of asthmatics. This paper is a report on findings which may be related to this lack of evidence.

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.

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.

The object of this paper is to present a preliminary report on an experimental unit within the grounds of the mental hospital, but outside the Mental Treatment Acts, for patients suffering from the psychoneuroses. It is necessary, by way of introduction, to give some account of the way in which this unit came into being. One year before it was opened, we became particularly conscious of the problem of institutionalization, and attempted to study the forces active within the mental hospital which lead a patient, for the most part unconsciously, into a state of institutionalization. This is, of course, no new problem; in every mental hospital there is a nucleus of patients, of varying diagnostic categories, who no longer need to remain in hospital on account of the original symptoms or illness which brought them there, but who, under the subtle influence of the institutional life, have become quite incapable of returning to the outside world. This process of institutionalization cannot be dealt with extensively here, but briefly, the forces at work in bringing about this state are felt to be, firstly, those that tend in many minor or subtle ways to relieve the patient of all responsibility for himself, so that he ceases to be aware of the need to tackle his problems seriously, and, secondly, the authoritarian basis of staff and staff-patient relationships which, however benign, requires an attitude of submission on the part of the patient which readily leads to loss of initiative, and to institutionalization. It was, therefore, decided to reverse this process as completely as possible with a small group of patients, to see what further light could be thrown upon the problem.

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.

As Bleuler (1925) pointed out, all our relationships with our human environment are regulated through language. For this, auditory perception is essential, this can only take place if the peripheral auditory mechanism (viz., the tympanic membrane, ossicles, spiral ganglion of Corti and VIIIth nerve) is not diseased. When a person becomes deaf through disease of any of the latter, it does not matter which one of the peripheral mechanisms is involved, the result is always the same. Often not knowing what his fellow men are saying he becomes doubtful about them: losing auditory contact with them he has to rely on an inner world of auditory memories and images; he misinterprets auditory sense impressions which have been distorted by disease, and incorporates tinnitus caused by such disease into his world of inner phantasy. He projects his inner feelings of inferiority caused by his deafness on to his environment and develops ideas of reference. Systematization soon follows, with active delusions of persecution. If the personality is sufficiently unstable a psychotic illness results.

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 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.

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.

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.