Various investigations into the effects of brain injury on psychological test performance (Weisenburg and McBride, 1935; Patterson and Zangwill, 1944; Anderson, 1951; McFie and Piercy, 1952; Bauer and Becka, 1954; Milner, 1954) suggest the overall conclusion that patients with left hemisphere lesions are relatively poor at verbal tasks, while those with right-sided lesions do worst at practical tasks, particularly the manipulation of spatial or spatio-temporal relationships. Heilbfun's (1956) study confirmed that verbal deficits result from left-sided lesions but his left and right hemisphere groups produced almost identical scores on spatial tests. In so far as these workers paid attention to the specific sites of the lesions, their findings indicate that the pattern of test performance is a function of the hemisphere in which the lesion occurs rather than of its specific locus.

The last five years have seen the beginning of a remarkable new development in the pharmacological approach to psychiatry. Pharmacological treatment for mental disorder is not, of course, new; drugs like hellebore, opium, camphor, bromides, paraldehyde and the barbiturates cover a large part of the history of psychiatric therapy. Since 1951 a number of new drugs with the generic title of tranquillizers have been introduced, of which the two best known are chlorpromazine and reserpine. They have the characteristic effect of producing sedation without producing sleep.

The following case of Folie à Trois, in which a married couple and the husband's brother shared a system of paranoid delusions, is being reported firstly because of the rarity of the condition, and secondly because it presents several unique features which it is hoped will shed further light on the nature of induced psychosis.

Few people would be inclined to underrate the actual, and, even more, the potential contribution which the study of the effects of drugs on personality can make to psychiatry. The large number of research papers in this field contributed both by psychiatrists and psychologists bears witness to the interest in this field, as does also the testimony of Freud, who is reported by Ernest Jones to have given it as his opinion that in due course pharmacological treatment of psychiatric disorders would oust all others.

One of the ways in which the psychiatrist differs from others who work with delinquents is in the importance attached to the sexual history of the offender. The contribution of psychiatrists in this respect has been mainly confined to a description of the emotional and dynamic aspects of sexual adjustment. But it is reasonable to suppose that if these emotional differences are as important as they seem to be from a study of individual cases, they would be reflected in differences in objective sexual behaviour, which are sufficiently definite to be used by criminologists in their more systematic studies. In the case of emotional relationships within the family, for example, psychiatric emphasis has induced criminologists to consider “broken homes” or “maternal separation” in a systematic way, but very few attempts have been made to relate the objective aspects of sexual behaviour and development with criminal behaviour. Even in the Gluecks' exhaustive study of five hundred delinquents and controls, which included psychiatric examination, sexual behaviour was not recorded, but only the presence or absence of sexual conflicts.

It is well known that obsessive-compulsive symptoms may occur in the prodromal phase or in the course of schizophrenia, and that schizophrenic symptoms may supervene in a long-standing obsessional neurosis. Stengel (1945) has reviewed much of the earlier literature concerning the relationships between obsessional neurosis and schizophrenia. The question whether obsessional neurosis could develop into schizophrenia has often been discussed. Pilcz (1922), Legewie (1923) and Schneider (1925) distinguished between genuine obsessions which were symptoms of an obsessional neurosis, and symptomatic obsessional ideas which could occur in various conditions. These authors, as well as Stekel (1950), doubted whether a genuine obsessional neurosis could develop into schizophrenia. Bleuler (1911) thought that some patients suffering with chronic obsessional symptoms were in fact schizophrenic, especially where a schizophrenic psychosis had been observed in the family. Mayer-Gross (1932) expressed the view that cases of obsessive-compulsive neurosis existing over decades without change and presenting marked autism were often schizophrenics. Together with Bleuler, Mayer-Gross suspected that many of Janet's “psychasthenic” patients had been schizophrenic. Janet (1903) had observed 3,000 cases of psychasthenia, of which 12 developed into psychosis, and two into hebephrenia, but Janet's psychasthenia probably included cases other than obsessional neurosis. There is a well-known case which showed how in the course of a long-standing obsessional neurosis, paranoid schizophrenic symptoms may make their appearance. This is the patient described by Freud (1918) in “The History of an Infantile Neurosis”, who, many years after he had been treated by Freud for obsessional symptoms, was treated for a paranoid state by Ruth Mack Brunswick (1928).

In a previous study, Shapiro, Post, Lofving and Inglis (10) found that a modified version of the Bender Visual-Motor Gestalt Test differentiated, at a high level of confidence, three groups of elderly psychiatric patients: brain-damaged patients, functionals and a group of doubtful diagnosis. This level of confidence was far higher than that of any of the other 24 tests used. Furthermore, a number of recent studies have shown that the Bender test differentiated Organic from non-Organic subjects (2, 4, 6, 7, 8). In our own Department Yates (13) found significant differences on measures of the reproductions of other designs between Organics and Functionals. In view of these findings we decided to investigate our own results further. Our general purpose was to measure and control some of the variables appearing relevant in the performance of the task and in this way make possible testable explanations for the results.

Recently D. S. Trouton and A. E. Maxwell (7) reported the results of a factorial analysis of 45 variables derived from an Item Sheet used at the Bethlem Royal and Maudsley Hospitals. Their sample consisted of 819 male hospitalized patients aged 16-59 having non-organic psychiatric disorders. The variables included the major symptoms and past history notations of psychotic and neurotic patients. Their analysis yielded six factors, the first two of which were identified as “psychoticism” and “neuroticism”. The authors conclude that their findings support the view that the varied symptom patterns of mental illness can be accounted for by these independent components.

The diagnostic criteria of descriptive psychiatry inevitably vary between the generations and even from decade to decade. New hypotheses imply new selections from the quite illimitable mass of data which may be collected from any patient. Hence new pictures may emerge whose relation to the old may be only partial, and whose inclusion under traditional rubrics may give rise to confusion, or pose problems which are verbal rather than clinical.

Golla, Hutton and Grey Walter (1943) made an attempt to use the EEG as an objective means of assessing imagery. They concluded that there were three types of alpha rhythm which corresponded to three different kinds of imagery processes: M or minus type whose alpha rhythms were almost non-existent and who used mainly visual imagery in thinking; the P or persistent type whose alpha rhythms continue even during mental activity, and who used mainly vocal kinaesthetic imagery; the R or responsive type with a good resting alpha rhythm which blocked readily during mental activity, and whose imagery was mixed. Though they were attempting to find an objective means ofassessing imagery an ultimate appeal is made to introspection as a validating criterion, and the tasks given to the subjects were such as to present difficult problems in the way of introspection. For instance, they were asked to think over to themselves the story of Red Riding Hood, to think over to themselves their plans for some definite day, to think over the argument for and against some abstract proposition such as “honestyis the best policy” or “the existence of free will”. It is felt that if an attempt is to be made to find an objective means of assessing imagery some at tempt should first of all be made to control the kind of imagery that will be used.

Some neurotic patients exhibit such a complex symptomatology that it is often difficult to determine, by present methods, which problems or areas of difficulty are fundamental. Much time may therefore be lost through the treatment of superficial rather than basic sources of difficulty.

A statistical study of large numbers of chronic mental patients may seem to have no direct bearing on the problem of how to treat the individual patient and prevent chronicity. Yet the collection and analysis of mass data form an essential part of epidemiological studies which have made possible many notable advances in preventive medicine. Much of the statistical information at present available in various official documents such as the annual reports of the Ministry of Health and the Board of Control, the Registrar-General's Statistical Review, are so generalized and fragmentary as to be almost meaningless (Lancet, 1955). A few mental hospitals publish annual reports containing broad statistical information; but the detailed facts needed for proper assessment of the size and nature of the problem and for any rational reform are almost invariably lacking. Throughout the field of psychiatry, particularly in connection with the development and effect of chronicity, the existing vital statistics are incomplete and inconclusive.

A paper by Shapiro, Post, Lofving, and Inglis (12) has reported on the relationship of certain aspects of mental functioning to the psychiatric illnesses of old age. This study confirmed that performance on some tasks which appeared to involve “memory function” is relatively more impaired in elderly patients with organic brain pathology than in elderly patients with functional psychiatric disorders. It was also shown, however, that the difference between functional and organic groups on these memory tests was not as great as might be expected on the basis of the commonly held psychiatric hypothesis that memory disorder is one of the leading features of early cerebral involvement in old age. The relatively poorer performance on these memory tests of the organic patients could not be accounted for in terms of, for example, lower intelligence, since the memory tests produced significant differences between the organic and functional groups whereas the intelligence tests did not. A process of correlational analysis (Inglis, Shapiro, and Post (8)) showed that these tests did seem to have some psychological function in common which could usefully be labelled “memory”.

A group of adolescent girl thieves have been examined by means of the Object Relations Test, in an attempt to estimate some of the psychodynamic factors determining their thieving. These girls are all at an Approved School where psychiatric treatment is given. They are all of average or superior intelligence and from materially good homes and their delinquency has been considered to be neurotic in origin. The age range is from 15 to 19 years.

The Malleus Maleficarum, the standard textbook of medieval witch-hunting published in 1484 (2), already mentions that “an illusion of sight and touch can be caused … by the summoning to the fancy or imagination of certain forms and ideas latent in the mind”, and continues by saying that “(the fifth) method of delusion of the devil is by working in the imaginative power, and by a disturbance of the humours effecting a transmutation in the forms perceived by the senses”. This might be the first working hypothesis ascribing certain behavioural changes of an apparently schizophrenic nature to biochemical influences.

In our clinical ward programmes we have utilized music rhythm instruments in rhythm groups to stimulate long-term schizophrenic patients and to induce their participation in social group endeavour. These clinical experiences together with various observations in this same connection, heightened our interest in the actual physiologic and motoric response of the schizophrenic patient to music rhythms. The evidence is strong that mentally “normal” persons do respond behaviourally and physiologically to music and its rhythms. Does the long-term schizophrenic patient manifest an objectively measurable response to such rhythm? If it could be demonstrated that the activity and the physiological functioning of the schizophrenic did respond to musical rhythms, then these stimuli might constitute a valid method for the modification of the behaviour of the schizophrenic patient.

Psychotherapy and what we understand by it today is commonly considered as entirely a product of the last fifty years of psychological and psychiatric development. The psychiatry of the past century is looked upon as a savage and uncultivated field which does not appear to warrant any attention. In a previously published paper I pointed out the strange contradictory development which the field of psychiatry has undergone during the past two hundred years, interchanging material-physicological periods with those primarily psychological. Each period has violently rejected the previous one and with it the total earlier development. This explains why the earlier development seems to be so completely forgotten. Only a few names are known which are pointed upon as forerunners, but no one has seriously attempted to go back over the last contradictory period into the preceding one with a similar basic attitude, for instance the psychologistical period of the first quarter of the past century. This should be of considerable interest to the psychological period we have been experiencing during the past decades.