The deep pleasure with which I received the invitation to deliver this lecture was tinged with dismay, for as a physiologist I am only too frequently reminded that the contributions which psychiatry has received from physiology are, in fact, almost negligible. I was therefore bound to ask myself very seriously whether I could honestly accept the honour without committing myself to stray far beyond the confines of my own subject. Finally, I satisfied my conscience by deciding that the invitation was issued in the spirit of hope rather than satisfaction, and I trust that I shall not be misinterpreting the intentions of this Royal and learned body if I feel encouraged to develop a speculative rather than a purely empiric theme. My aim is to outline the manner in which the study of brain physiology may conceivably enable us to define the physical parameters of mental experience, and the title which I first suggested for the lecture was “The Frame of Reason.” Vivid though the image may be for me, I admit that the more laconic title is better, for it does at least give us a landmark and a limit to our exploring.

This paper embodies an attempt to study paranoid conditions by the use of psychological tests of the “projection” type—here, the Thematic Apperception test (TAT) and the Ink-blot test of Rorschach. In giving a standardized projection test to a homogeneous group there is some hope that factors specific to the group may emerge. When the group has a common “mental disease” or psychiatric syndrome, it is possible that the results may throw light on the nature of its psychological processes—and hence, ultimately, on the nature of the disease.

The assessment of body build as an integral part of the total personality is now accepted as an important procedure in the practice of clinical psychiatry. Body build has been found to influence symptomatology, mental status, course and prognosis in neurotic and psychotic disorders (Betz, 1942; Mauz, 1930; Kisselew, 1931; Freudenberg, 1941; Rees, 1945, 1947). Whereas the delineation of physical types has now become an objective procedure by the use of anthropometric indices (Rees, 1949), it has long been recognized that the differentiation of physical types in women is much more difficult. Kretschmer (1921) pointed out that the types of physique described by him were less easily diagnosed in women, and Sheldon (1940) pays comparatively little attention to the variations of female body build.

Many workers on both sides of the Atlantic have done intensive work on the Rh factor since its discovery was first published in 1940. The great majority of these workers have been concerned essentially with its influence on physical disease, the mental aspects being either ignored entirely or only lightly touched upon.

There is still no agreement on the aetiology of schizophrenia, or general acceptance of its definition as a “functional psychosis.” There is agreement only on the complexity of the problem presented by an illness which involves every aspect of the personality, and is precipitated by a multiplicity of internal and external causes. This complexity suggests that an approach from many angles, clinical, genetic, sociological, statistical, or even a more remote biological or physiological approach may yield some information of value.

Between 11 October, 1942 and 31 December, 1947, the operation of prefrontal leucotomy was carried out on 345 patients at the Graylingwell Hospital, Chichester. The technique was similar to that of the standard method of Freeman and Watts: in each case the operation was performed by Mr. A. G. Ross. The paper reports the results of a clinical follow-up investigation in 330 of the cases; the remaining 15 could not be traced.

Sexuality is ambivalent because love is expressed biologically in the primitive terms of life—we kill or we die. Mating, according to the psychosomatic theory of family sexuality (Turner, 1947), is accomplished by a portrayal of the conditions of the hunt. The male portrays his hunting of the inferior species. The female in mating, therefore, is identified with the inferior species until the orgasm, when she is identified with the superior species which kills the hunting male. The female loves the male, who pledges his hunting, and the male loves the female, who pledges herself by enacting the environmental realities which he meets when hunting. Thus the young are provided for in ambivalence by a hunting father, and by a mother who teaches them to hunt by presenting to them the conditions of the hunt. Thus by further sublimation of the primitive ambivalence the father is the civilized breadwinner and the mother one's first guide, philosopher and friend.

During the first half of 1049 a battery of cognitive and personality tests was given to a sample of 104 adolescent and adult high-grade male defectives resident in Darenth Park, Dartford. The testing was carried out by N. O'Connor and the writer, in collaboration with Dr. J. M. Crawford, Deputy Superintendent of Darenth Park. The following report presents a summary of the cognitive and motor test findings, and discusses some of their implications.

The complex interpersonal relationships which establish themselves when people meet and interact reveal a number of bipolar aspects or trends, such as liking—dislike, competition—co-operation, dominance—subordination, identification—counter-identification, and others. Of these the relationships of friendliness and dominance have been selected for study, not because they are considered of greater intrinsic importance for the dynamics or therapeutic efficacy of groups than other interpersonal trends, but because they are accessible to a fair degree of measurement and numerical handling. They can thus render impressions which have been gained through group observation more definite and reliable; they may even correct them or point to aspects which had escaped notice.

There are few, I suppose, who would disagree with the view that we are passing through a period of social and cultural disintegration.

Prefrontal leucotomy as an operative method of treatment for mental disease greatly stimulated research into the functions of the frontal lobes. The operation was a direct result of the observation of Fulton and Jacobsen (1935) that rage reactions seen in monkeys in the course of increasingly difficult experimental tasks do not occur after extirpation of the frontal lobes.

In adult intelligence testing the Wechsler-Bellevue Intelligence Test is increasingly used and is gradually taking the place of the Terman-Merrill. Not only is its verbal part better adapted to adult life, but it has the added advantage of being at once a verbal and a performance test. A comparison of a subject's achievements in the two parts of the test often shows where his strength and weakness lie, and so sometimes affords a clue to difficulties which he may experience in his work or otherwise without being aware of their cause.

There appears to have been little investigation of the effects of local anaesthetic infiltration of the brain. Occasional reports mention the possibility of such procedures for diagnostic purposes.

There has recently been a plethora of new methods of psychosurgery. This has, we believe, created considerable bewilderment in the minds both of the clinical psychiatrists who have to decide which of the methods to choose and of the neurosurgeons who have to practise them. The aim of the present paper is to clarify and disentangle the situation as far as this can be done from the anatomical angle.