Depression is a serious illness in Western Europe and the United States of America. It is estimated that in 1957 the combined total of suicides in the United States, Britain, France and Western Germany was approximately 30, 000 (1). The attempted suicide rate is considered to be six or seven times as great, which could give a grand total of 200, 000 suicide attempts in that year in these countries. Many of these patients are depressives, as stated in a recent British Medical Journal leading article (2).

In view of the recent revival of interest in deconditioning, the treatment of a series of 35 cases of anxiety by this method may be of interest. This series has not been recorded previously although the treatment was carried out 20 years ago.

While abilities and attitudes are frequently subjected to measurement, motivation has largely escaped the attention of experimental psychologists and psycho-metrists. Attempts to use subjective and interpretive techniques have not met with any notable success, and it would seem that this whole area represents one of the most neglected fields of psychology, in spite of its obvious major importance both from the fundamental and from the applied points of view. We would argue that the objective measurement of motivation or drive in human beings is an essential requirement for clinical psychology, and we would further suggest that such objective measurement can only be accomplished in terms of some theoretical system in which drive has a recognized place and mode of interaction with measurable variables. It has been suggested by Eysenck and Maxwell (1961) that only the Hullian system provides such an account, and some evidence is to hand (Kimble, 1950; Wasserman, 1951; Claridge, 1960; Eysenck and Maxwell, 1961) to reinforce the view that deductions can be made from this system which will generate testable hypotheses relating to the measurement of motivation.

Recently many new anti-depressive drugs have flooded the market, the objective being initially to assist and finally to replace E.C.T. as the treatment of choice for depressive states. One such preparation is Tofranil (N-(γ-Dimethyl-aminopropyl)-iminodibenzyl hydrochloride or imipramine). It was first favourably reported on by Azima (1) and Kuhn (2).

Dr. Scott has outlined the varieties of treatment which have been suggested for psychopaths and some of the varieties which may be suitable for certain methods.

The Day Hospital approach in adult psychiatry appears to have begun with the original conception of Cameron in Montreal. He stated (Cameron, 1958) that both the original concept and its further development sprang from growing appreciation of the possibilities of new methods of treatment and diagnosis: at this time the rapid rise of the cost of in-patient treatment took place and there was increasing realization of the importance of the treatment milieu. At the same time as Cameron was setting up his Day Hospital in Montreal, Bierer was setting up the Marlborough Day Hospital in London (Bierer, 1951) and he discussed the theory and practice of Psychiatric Day Hospitals later (Bierer, 1959). Harris (1957) also discussed the implications of Day Hospitals and Night Hospitals in psychiatry with regard to the adult patient.

In psychiatry we often use different kinds of psychology without being aware of doing so. Before we consider existentialist psychiatry in detail we must discuss the three different kinds of psychology, namely, explanatory psychology, understanding psychology and interpretive psychology.

The discovery by Kuhn (1957) that an iminodibenzyl derivative (imipramine) was therapeutically successful in depressive illnesses aroused great interest and stimulated clinical trials with the drug in many parts of the world. The results of some of the published reports are given in summarized form in Table I.

The pharmacological treatment of depression was quite limited in efficacy before the discovery of iproniazid and imipramine (Rees, 1960).

A number of synthetic drugs have recently been introduced as specific antidepressants in psychiatry. Isocarboxazid (Marplan) is an analogue of iproniazid (Marsilid). Both belong to the monoamine oxidase inhibitor group of antidepressants. Isocarboxazid is said to be less toxic but of equal potency for a lesser dose than iproniazid. A controlled clinical trial of isocarboxazid was therefore undertaken to assess this drug in the treatment of depression. The results of this trial are reported in this paper together with the results of an uncontrolled trial in a further group of patients (group M) who received isocarboxazid only.