Physiological research has shown the fundamental importance of electrolytes in the functioning of the cell. According to the ionic theory, the resting and action potentials of nerve and muscle cells depend on potassium, sodium, chloride and other ions having a different concentration inside the cell to the concentration they have in the extracellular fluid. The cell membrane is freely permeable to potassium and chloride, but is much less permeable to sodium, and there is active transport of sodium which keeps the sodium concentration within the cell at about 1/10 of the concentration of sodium in the extracellular space. Because of this uneven distribution of sodium and the presence within the cell of impermeable anions (such as glutamic acid), potassium and chlorine are also unevenly divided between the cell and the extracellular fluid; potassium has a very high intracellular concentration and chlorine a low intracellular concentration compared to their concentration in the extracellular space.

The year 1957 heralded a significant advance in the treatment of depressive states. It was then that Loomer et al. (1957), and Crane (1957), published their findings on the use of iproniazid, and Kuhn (1957), published his findings on the use of imipramine. Iproniazid was the first of a series of monoamine oxidase inhibitors which were rapidly developed and used in the treatment of depressive states. In the last few years, their use, especially in “endogenous” depression, has been eclipsed by the iminodibenzyl derivatives; first imipramine, then amitriptyline and later the demethylated derivatives, desipramine and nortriptyline. However, the later monoamine oxidase inhibitors are still widely used, especially in “reactive” depression and some neurotic states.

A new drug, trimipramine (Surmontil, 7162 R.P.), has been found to have a specific antidepressant effect (Lambert et al., 1961), and has been used in France for two years; hitherto no controlled trial of trimipramine has been published. This paper reports a three weeks' comparative trial between this drug and imipramine (Tofranil), in the treatment of psychotic depression, using the statistical method of sequential analysis, the actual design used was that at the 5 per cent. chance level (Armitage, 1960).

Androgyny is an expression of relative masculinity and femininity in body-build. Tanner (1962) states “Androgyny can be perhaps best measured by means of scales constructed so as to give the best discrimination between men and women, and the simplest of such scales measures a masculinity score as 3 Biacromial—1 Bi-iliac diameter. This score gives men a mean of around ninety-three units with a standard deviation of about five, and women a mean of about seventy-eight with a similar standard deviation”.

Variations in the attitude of psychiatrists to schizophrenia range from the precise and confident pronouncement of Sargant and Slater (1963) “Chlorpromazine seems to bring the schizophrenic process to a rapid halt, and to lessen the chance of chronicity and deterioration of personality” to the fundamental doubts expressed by Szasz (1957) “The problem of schizophrenia, which many consider to be the core-problem of psychiatry today, may be truly akin to the ‘problem of the ether‘. To put it simply, there is no such problem.” The literature abounds in varying, conflicting and even irreconcilable treatment suggestions. One has only to compare the physical treatment schedules recommended by Sargant (1963) with the advocacy of psychotherapy put forward by Arieti (1959); or the views on drugs of Kalinowski (1958) with the Hordern and Hamilton (1963) assertion that drug results have not been shown to be superior to the effects of “moral treatment” of a century ago. Similar comparisons in the social field might be made between the views of Hamilton and Salmon (1962) and Hamilton (1964) on sheltered workshops and the difficulties of rehabilitation programmes demonstrated by Catterson et al. (1963).

Oxypertine (also known as WIN 18,501–2) is a member of a new series of indolylalkylphenyl-piperazines synthesized by Archer et al (1). It resembles serotonin in respect of its indole nucleus, and the piperazine side-chain indicates a structural relationship with some of the major phenothiazines. Pharmacological studies by Wylie and Archer (17) showed oxypertine to have tranquillizing properties, and following preliminary human tolerance investigations (15) the psychotherapeutic nature of the agent was investigated by various workers in the United States and Europe.

Sutton and Sykes (1956) studied the characteristics of the tremor superimposed on a voluntary muscular contraction under two conditions; (a) when the subjects were provided with a visual display of the accuracy with which they were maintaining a constant force, and (b) when they carried out the same task with the eyes closed. It was observed that when the subjects' eyes were closed, the tremor amplitude at 8–9 c/s (cycles per second) was sometimes relatively much diminished. In some subjects there was evidence of a smaller reduction in amplitude at other frequencies. Young (1933) had made similar findings using a less satisfactory technique. The findings of these workers have been confirmed and extended in another investigation (Carrie, 1965).

A number of writers have drawn attention to the importance of emotional factors in phantom limb pain (Kolb, 1950, 1952; Simmel, 1956; Russell, 1959; Von Hagen, 1963). Kolb (1950, 1952) reported an association between the discussion of certain emotionally loaded topics and accesses of pain in the phantom. Stengel (1965), in his Maudsley Lecture, discussed the role played in these experiences by the psychological mechanism of identification with others. He briefly referred to the patient whom we have studied.

This study has arisen from an almost universal clinical observation that many mothers during the first few days of the puerperium show evidence of disturbed emotion. This has been variously described by such terms as “labile emotional reactions” (Millar, 1962), a hysteroid reaction (Robin, 1962), “an emotional lability and a tendency to a mild depression” (James, 1959). It would appear that obstetricians and midwives view these reactions as a natural phenomenon associated with childbirth.

The observations recorded in this paper were made on 72 patients referred to a neurological clinic on account of headache who proved to have no evidence of organic disease and whose symptoms were not migrainous in nature. They were, therefore, suffering from the type of headache described as psychogenic headache, tension headache, stress headache, or common headache.

According to Wolpe (1964b) “conditioning therapists as a rule undertake treatment of all cases of neurosis“. However, some limitations in the application of conditioning therapies must be recognized, and the nature of their difference from psychotherapy requires definition. Considering the problem of unconditioned anxiety, which Wolpe (1964a) defines as occurring with an ongoing conflict situation when there are simultaneous impulses to opposing actions, we observe that Wolpe does not claim that conditioning therapies are applicable here. But behaviour therapists do not believe that anxiety generated by conflict plays a part in the causation of neurosis, and wholly discount the significance of repression. In general, mature personalities tend to resolve their conflicts, motivated by the driving force of anxiety, but in neurotically ill individuals, often unable to face problems arising out of personal shortcomings, these conflicts are not always in full awareness, though they may not be very deeply “repressed”. Quite rightly, behaviour therapists point out that in their case material, where conditioned neurotic reactions constitute the main symptoms, the patient may recover, though the forgotten incidents remain forgotten, as for instance in functional amnesia. Accordingly they conclude that resolution of repression is not a prerequisite for recovery. But, as even many psychoanalysts concede, the detail of the forgotten memory, the repressed incident, is of less importance than are the associated affects and attitudes, and it is these which often cannot be squarely faced by the neurotic patient. Unconditioned anxiety aroused by conflict comes indeed within the orbit of psychoneurosis. Wolpe (1964b) alludes to this as follows: “You may find a person who is in a chronic conflict situation … which arouses emotional tension, perhaps all the time; … treatment of neurotic anxiety reactions may be much impeded by emotional disturbance due to the life circumstances. But the behaviour therapist can often instigate action leading to the resolution of difficult situations.” How Wolpe (1964a) accomplishes this is described when he deals by behaviouristic analysis with reactions in which “crucial stimulus antecedents are obscure”. Claiming that it is possible to establish the stimulus antecedents of reactions in every variety of neurosis, he states that the patient may simply be unaware of certain of his reactions, because of “conditioned inhibition of awareness of particular responses”. He quotes a case of unacknowledged rebellion of a patient against domination by her husband, in whom the complete exposure of this set of attitudes within her led to the possibility of their expression and to therapeutic change. Although Wolpe (1958) denies that this type of phenomenon constitutes repression, he appears to imply a very similar event when he discusses “conditioned inhibition of awareness”. It seems pedantic to insist that these are conceptually quite different and to claim that behaviour therapists are unique and original in trying to uncover underlying attitudes and affects.

The recent development of industrial therapy (Early 1960 and 1963; Wadsworth 1958, 1961, 1962 and Smith 1963) in British mental hospitals reflects our current therapeutic optimism and takes advantage of a period of full employment in industry. Industrial therapy has been found to be an important weapon in the prevention or cure of institutional neurosis (Barton 1959). It is, of course, well known that during the past two decades institutional neurosis has been markedly reduced by a more permissive and non-authoritarian approach to patients, including amongst other things greater freedom, more enlightened nursing and the use of group techniques and occupational therapy in various forms. However, if patients are to be rehabilitated and the best use made of their personality resources, their lives within the hospital should be as close as possible to normal life in the community, and it follows that like normal citizens they should be employed at productive, useful and satisfying work for which they should receive proper economic rewards. This work may be in a factory setting, but need not exclude in some circumstances work in certain hospital departments. However, in order to prevent confusion the term industrial therapy should only be used when “patients are employed in factory-type work under medical and nursing supervision which aims at their rehabilitation and/or resettlement, the nature of the work being related to the needs of the individual patient, giving him both psychological and economic satisfaction”. It appears that in the United States the traditional employment of patients in hospital departments without pay (except token payments in kind) is now being called industrial therapy; it is likely, however that American interest in the totally different British concept of industrial therapy will lead there to a change in approach. It should, therefore, be stressed that an integral part of industrial therapy is financial reward for work done according to ability, motivation and production. Thus “economic satisfaction” is an essential part of any definition.

The present paper is a three months survey of psychiatric referrals from the hospitals constituting the in-patient services of the Mayo Clinic, and discusses some clinical and administrative implications. The data were obtained from November 1st, 1961, to January 31st, 1962 inclusive. All referrals were seen by one of three consultants, two of whom (including the author) were responsible for the in-patient unit of 50 beds.

One of the most interesting parallels between the functioning of brain and mind is provided by Hughlings Jackson's Doctrine of Dissolution and Freud's theory of psychological regression. Basically, they each imply that under certain circumstances the organism partially or wholly reverts to an earlier stage of functional organization, the one in the bodily and the other in the mental sphere. At first sight the parallel would seem to end here, for neurological dissolution is usually regarded as a passive process, an unmasking of lower levels of functioning by organic disease, while regresson consists of an active withdrawal to an earlier stage of mental development, usually, but not always, brought about by difficulties in external adjustment. Nevertheless, we can attempt a reconciliation between the two if we regard the ‘positive” symptoms of nervous dissolution as representing attempts on the part of a crippled nervous system to adjust to a normal environment. Viewed from this angle both neurological dissolution and psychological regression present themselves as dynamic reactions to stress, promoted in the one instance by internal and in the other by external difficulties. That the two mechanisms are in fact related is suggested by two facts: first, that the symptoms of nervous dissolution can be made worse by environmental difficulties (Cf. Goldstein's “catastrophic reaction”), and second, that regression occurs regularly in sleep, which is surely organically determined.