“That the deceased took his life while the balance of his mind was temporarily disturbed” has been the Coroner's traditional verdict in cases of suicide; a verdict adopted to circumvent retribution by society and particularly to allow of burial in consecrated ground and avoid forfeiture of property to the Crown (Williams, 1958). There is a distinction between such a finding with its legal import and that of the psychiatric assessment, and this must necessarily affect psychiatric studies undertaken in the endeavour to understand the state of mind of the person who encompasses his own death, or to examine the wider implications of suicide in relation to the epidemiology of mental illness. Public opinion and cultural pressures have their effects on coroners' verdicts; and guilt or shame on the part of relatives or medical attendants may result in distortion or concealment of information.

A study was made of 57 suicides committed by mental hospital patients in Helsinki in the period 1952 to 1963 (Achté, Stenback and Teräväinen, 1965). This report is concerned with the frequency of physical disease, hypochondria, and alcoholism in these 57 suicides.

An earlier paper (Kay, Beamish and Roth, 1964b) described 26 features that differentiated significantly between mentally normal and functionally ill subjects over the age of 65, or between normals and those with organic mental illness. These features were found to fall into four main groups concerned with (i) physical disability, (ii) social isolation, (iii) personality deviation, (iv) social and income status. Many of the features appeared clearly to be inter related, but to an unknown degree, and this complicated the interpretation of the results. In the hope of shedding some light on this problem, a factorial analysis of 34 features, including most of the 26 previously described, was carried out. Because of missing items, the number of patients was reduced by 27 to 267, consisting of 152 mentally normal subjects, 88 subjects with functional illness, and 27 with organic mental illness. This report is complementary to the two previous articles (Kay, Beamish and Roth, 1964a, 1964b), in which the method of selecting the subjects and the definitions of organic and functional disorder are fully described.

The last twenty years have seen the rise and dominance in institutional psychiatry of a remarkable notion—“the therapeutic Community”. It is both an attitude and a method, a system of treatment and a battle cry, a charm and a password. I have been fortunate to take some part in applying this notion to one part of the field of inpatient psychiatric treatment and have attempted, while doing so, to study the effects of what we did.

St. Wulstan's Hospital, Malvern, opened in November, 1961. It is the first hospital in Great Britain to be given the specific function of rehabilitating selected chronic psychiatric patients from other hospitals. The original plans for its use were made by the Mental Health Services Advisory Panel of the Birmingham Regional Hospital Board. In 1959 this panel was confronted with overcrowding in the Board's twelve existing mental hospitals; it was offered the use of a tuberculosis sanatorium that would shortly be closing for lack of patients, and it was impressed by the results reported from other hospitals of giving chronic patients industrial work to do. Accordingly the panel formulated plans to reopen the former sanatorium as a psychiatric rehabilitation hospital. The execution and development of these plans are described in this paper.

The terms “macrocosm” and “microcosm” have been taken by Jung from the traditions of the alchemists and the philosophy of Leibnitz for expressing his theories, but they are not often used elsewhere in psychiatry or psychology so it may be as well to define them when introducing them here.

All forms of Repertory Grid technique are derivatives of an original proposed by G. A. Kelly (1955) as an integral part of the development of Personal Construct Theory (summarized Bannister, 1962). In essence, repertory grids are forms of sorting test. They differ from conventional sorting tests in that there are no standard sorting materials or sorting categories nor is there any standard single form of administration or scoring procedure. Their unique characteristics are that:

On first inspection, there may seem to be little difference between a simple experimental post-hypnotic suggestion (p.h.s.) and a simple therapeutic post-hypnotic suggestion. The difference is not so much between the form of the experimental and the form of the therapeutic p.h.s., but between the patterns of behavioural tendencies on which the experimental and the therapeutic post-hypnotic suggestions are respectively superimposed. The experimental p.h.s. is superimposed on the behavioural tendencies dictated by the subject's views of the experiment, and his motives probably often include a wish to “perform well”. The experimental subject will seldom have strong motivation to disobey the hypnotist. In the therapeutic setting the situation is entirely different; the therapeutic p.h.s. is frequently superimposed on strong preexisting conscious or sub-conscious tendencies which run counter to the acceptance of the suggestion.

In a previous investigation we showed that large doses of DL-tryptophan (214 mg./kg. body weight) given to depressed patients receiving tranylcypromine (a monoamine oxidase inhibitor) potentiated the antidepressive effects of the drug (Coppen, Shaw and Farrell, 1963). This procedure increases the level of brain 5-hydroxytryptamine (5 HT) and tryptamine in the rat (Hess and Doepfner, 1961). Reserpine reduces the level of these amines in the brain, and it is known that patients being treated for hypertension with this drug often become depressed. Thus there is evidence that increasing certain brain amines may alleviate, and depleting brain amines may induce, a depressive illness. We therefore decided to study tryptophan metabolism in depressed patients. The pathways with which we were concerned are shown below.

Increase in serum gamma globulin concentration with reciprocal reduction in serum albumin concentration is commonly found in patients suffering from Down's syndrome (mongolism) (Carver et al., 1959; Nelson, 1961; Pritham et al., 1963). It is possible that gamma globulin of relatively less effective composition than normal is produced, and that hospitalized living increases production of this faulty protein (Pritham et al., 1963). On the other hand, Polani (1962) suggested that in Down's syndrome there is either exaggerated or diminished response to drugs and hormones, and the raised gamma globulin levels could result from an excessive production of normal gamma globulin, possibly in response to infection.

Altered serum proteins in mental illness have been reported by workers in various parts of the world, and a review of these studies has led to the consideration of an autoimmune mechanism in the pathogenesis of some functional psychoses (Fessel, 1962a). Several reports have appeared in recent years which suggest the presence of antibodies in the serum of certain psychiatric patients to central nervous system tissue. Many of these have been reviewed by Vartanyan (1963). Fessel (1962b, 1963) demonstrated agglutination of latex particles coated with monkey brain extract and agglutination of tanned sheep red blood cells coated with human brain extract, but no precipitins in double diffusion in agar of the sera against monkey brain extract. As an alternative to antibrain antibodies he suggested a less specific physicochemical abnormality of the serum which caused the agglutination. Yokoyama, Trams, and Brady (1962), using a sheep red blood cell haemagglutination technique, showed the presence of anti-asialoganglioside antibodies in the sera of 3 of 14 schizophrenic patients and anti-ganglioside antibody in the serum of another. Kuznetzova and Semenov (1961), by complement fixation, demonstrated antibodies in the sera of 22 of 84 schizophrenics, mainly to human brain and not to other organs. The antibodies appeared more frequently in the later stages of the illness (Semenov, Morozov, and Kuznetzova, 1961). Skalickova and Jezkova (1961), also with a complement fixation technique, demonstrated blood and cerebrospinal fluid antibodies to grey and white matter during the “infectious” onset of schizophrenia, but not in the chronic, demented phase.