The psychiatric aspects of multiple sclerosis (MS) have been given considerable attention in the literature over the past 130 years. There has, however, been little unanimity of opinion as to the incidence, severity and nature of the changes seen in the mental state of sufferers from this disease. Early investigators regarded intellectual deficits as the main disturbance, and noted that emotional lability was not infrequently present.

In previous studies the estimation of the incidence of intellectual changes in multiple sclerosis has varied from as low as 2 per cent. (Cottrell and Wilson, 1926) to as high as 72 per cent. (Ombredane, 1929). In order to establish the incidence accurately, the most satisfactory method would clearly be a long-term follow-up (covering lifetime) of a sample of multiple sclerosis patients. Any cross-sectional study would include patients in varying degrees of advancement of the disease, and patients found to be free of intellectual deficits at the time of investigation would not necessarily remain so. Also, the indirect psychometric assessment of intellectual loss is notoriously difficult, and the direct method of follow-up would give much more accurate results. The only direct study up to date has been that of Canter (1951), who found a highly significant (i.e. 13·48 points) loss on re-testing multiple sclerosis patients on the Army General Classification Test after a four-year period. Even after such a short period as six months he found slight losses on most Wechsler-Bellevue subtests, in contrast to an average gain of six full IQ points of the control group.

In recent years, studies on patients suffering from manic-depressive and depressive illness have shown that these patients have certain psychological and biochemical characteristics and also abnormalities in body-build and body-composition. Some of these characteristics are clearly concomitants of the illness itself, as they revert to normal after clinical recovery. However, some remain abnormal even after recovery, and the question arises: are these constitutional characteristics perhaps genetically determined, or are they the persisting result of the illness itself?

Although there is a voluminous psychiatric literature concerned with obsessional personality disorder, there are very few psychological studies of the condition. In particular, whilst the thinking of anankasts has been classically and perceptively described by many psychiatric authorities, only a handful of psychological experiments exclusively concerned with anankastic cognition have been reported (cf. Skoog, 1964). It is suggested that this is largely because interest has centred on the content of obsessional behaviour at the expense of its form. The present study is a brief report of one among several investigations suggested by consideration of the formal qualities of obsessional thought as opposed to its “dynamic” or symbolic features. The hypothesis (Reed, 1968) is that the formal characteristics of anankastic cognition are directly related to functional impairment in the spontaneous organization and integration of experience. It is postulated that this failure is expressed in the over-structuring of input and in the maladaptive over-defining of categories and boundaries. From this may be derived the prediction that, given a classificatory or conceptual task, the anankast will be over-specific in his interpretation of the given class and therefore too strict in his acceptance of appropriate class members and attributes.

The hypothesis has been proposed (Reed, 1968) that the formal characteristics of anankastic cognition are directly related to functional impairment in the spontaneous organization and integration of experience. It is postulated that this impairment is expressed in the over-structuring of input and in the maladaptive over-defining of categories and boundaries. In a previous communication, Reed (1969) has reported results from a verbal conceptual test which support one prediction derived from the hypothesis—namely, that given a classificatory or conceptual task the anankast will be over-specific in his interpretation of the given class and therefore too strict in his acceptance of appropriate class members.

In a comparative study (Vinoda, 1966) of personality characteristics of 50 female attempted suicides and an individually matched group of 50 psychiatric controls and 50 normals, it was observed that the attempted suicides differed from the psychiatric and normal controls on measures of hostility, guilt, rigidity and neuroticism. Attempted suicides (AS) were significantly more hostile and rigid than both psychiatric controls (PC) and normal controls (NC), and they were significantly more personally ill (neurotic) than normal controls but not more than psychiatric controls. On the basis of previous researches it was hypothesized that the group of attempted suicides would be more hysteroid in their personality and intropunitive in the direction of their punitiveness than the control groups. The first study (Vinoda, 1966) did not reveal such differences. The scrutiny of results showed that there were more or less equal numbers of hysteroid and obsessoid personalities among attempted suicides and similarly a more or less equal number of persons who were intropunitive or extrapunitive in the direction of their aggression. This led the author to hypothesize that these variables might be more related to the nature of suicidal attempts in terms of seriousness of the attempts made.

Emotional change during pregnancy and the postpartum period is very common (37, 42); mental illness of psychotic proportions occurs more frequently in the postpartum period than in the period of pregnancy (33). These psychotic illnesses occurring in the postpartum period have remained an area of controversy for several reasons. The clinical phenomenology of these psychotic reactions seems unusually rich in confusional and delirious features (19), even when reported by those who contend they are no different from the usual run of psychotic illness (41). The fact that 80 per cent. of these serious reactions occur in the first 30 days postpartum (33) has raised doubt in the minds of some that these reactions merely represent the stress of pregnancy falling on a predisposed personality. An alternative hypothesis might be that the interaction of psychological and endocrine factors at the end of pregnancy makes this a particularly stressful period. The delirious and confusional symptoms might also be better explained as being related to endocrine dysfunction of some kind.

Psychiatric patients frequently make somatic complaints which are not related to physical pathology, but this is often not fully appreciated by medical practitioners other than psychiatrists. Dowling and Knox (1964) have shown that depressive patients are often diagnosed as physically ill, especially if they have had a notable physical illness in the previous five years. Stoeckle and Davidson (1962) note that depressive patients are frequently referred to medical and surgical clinics and sometimes receive inappropriate treatment as a result. Sainsbury (1960) showed that gynaecological patients are, on average, more neurotic than normal. The present author (Munro, 1964) found that depressive women were excessively liable to have undergone a gynaecological operation in the year preceding their admission to psychiatric hospital.

Folklore has had more to say than science about the relation between the outcome of a pregnancy and the psychological history of the parturient: our culture interprets a legitimate stillbirth as the sign of a sick marriage. And sceptics may think that accretions of folklore are with us yet in the form of facile psychoanalytic explanations. Helene Deutsch (1945) ably expounds the case: spontaneous abortion differs from induced abortion, she tells us, in that “the inducing agent is the psyche, and the pregnant woman who resorts to the help of this agent does not act from conscious will or in accordance with conscious wishes”.

The diagnosis of anorexia nervosa is not always straightforward. Bliss and Branch (1960) regard all non-organic conditions causing anorexia as anorexia nervosa. However, more recent authors like Dally and Sargant (1960), King (1963), Crisp (1965b) and Bruch (1965) limit the use of the diagnostic label anorexia nervosa to a highly specific entity. Many patients who present with loss of weight and/or loss of appetite fit easily into this classical anorexia nervosa category, whilst many others are equally easily excluded.

Most clinical psychiatrists would agree that many but not all schizophrenic subjects show abnormalities in the field of language. Many use neologisms, i.e. new words for old referents, and some chronic patients talk in a more or less private language which at times degenerates into a word salad. The following features have been noted in the schizophrenic's verbal productions—alliteration, condensation, over-inclusiveness and the personal distortion of the symbol-referent tie. Stuart Chase said: “The point of every discussion is to find the referent. When it is found emotional factors dissolve in mutual understanding.” Psychiatrists often assume that they have identified the referent which ties in with the symbol the patient is using, but sometimes the patient uses new symbols, as “Bill” did the other week when he astonished the other group members by announcing that he was “troubled by warpations and distressed by ignorances”.

Wing and Freudenberg (1961) assessed the response of schizophrenic subjects to regimes of active and passive encouragement. Their findings suggest that a subgroup of very inactive patients exists and that this group responds dramatically to incentives. The purpose of this study is to re-examine the behaviour and attempt to define this subgroup. Such an examination may provide information which could be applied to treatment programmes. It may also contribute to a better understanding of the nature of the schizophrenic's volitional defect.

The therapeutic optimism which accompanied widespread introduction of milieu therapy has now been tempered, but there is still little doubt that it makes a substantial contribution to the treatment of the chronic schizophrenic. Much the same has been said about drug treatment. However, Hordern and Hamilton (1963) suggested that the results obtained with phenothiazines were no better than the findings of those pioneers who introduced moral therapy over a century ago. They further claimed that reports of a beneficial drug effect came from those places where resources were most meagre. If their view is correct it may mean that drugs and certain environmental factors have a therapeutic action in common on chronic mental hospital patients. These chronic patients, who are in large part schizophrenics, usually show the symptom of volitional defect more prominently than any other single symptom. It is possible therefore that both moral therapy and drugs may be acting primarily on this symptom. The present experiments aimed at examining this proposition.