There have been numerous reports on the survival rate after rupture of an intracranial aneurysm, but the actual quality of survival amongst those who recover has been little studied. In this paper the physical, emotional, and intellectual state of a group of 79 survivors from rupture of an anterior cerebral aneurysm is recorded.

This paper reports the results of a psychiatric study of the families and husbands of patients with hysteria. In a series of previous publications designed to clarify the diagnosis of hysteria, it was shown that certain clinical criteria will define a group of patients with a highly uniform clinical course and prognosis (3, 4, 5, 9). It was also suggested that the same clinical picture is seen among first-degree female relatives more frequently than among the general female population, and that alcoholism and sociopathy are seen more frequently among first-degree male relatives than among the general male population (1). We decided to extend the investigation to more cases, and to study the husbands of the index cases as well.

It is part of the magical aura of the physician that he must have some omnipotent tool with which he dramatically makes patients better. In individual psychotherapy the individual interview and the interpretation, like the surgeon's scalpel, provides such an omnipotent instrument. In therapeutic community practice it is often group therapy in the form of the daily ward meeting and the review that plays the role of the omnipotent therapeutic tool. But in our opinion it is the daily living situation and not the formally organized therapeutic meeting which provides the greatest potential for learning and growth on the part of patients and staff. We have found the crisis situation and its resolution to be potentially the most useful of these daily living situations.

This study illustrates some of the constitutional and psychological complications of being a twin, some difficulties that may arise in formal diagnosis and the therapeutic importance of separation.

Calculations based on Bellak's (1958) review of research into schizophrenia suggest that at that time well over 5,000 papers had been published. An index count of Psychological Abstracts since 1960 indicates that papers on schizophrenia have been produced at the rate of about 300 per year with a growth rate of 10 per cent. per annum. Yet few, viewing the problem of schizophrenia in perspective, feel that any kind of break-through has been made, and many would agree that the field is grossly confused. It may well be that the traditional cry that “more research is needed” misses the point, and that much of the research which has been carried out is of relatively little value because of our failure to meet the logical requirements for effective research within the area.

The Purpose of the Present Investigation

In their study “The relation between neurosis and psychosis: an analysis of symptoms and past history of 819 psychotics and neurotics”, Trouton and Maxwell (1956) were the first to apply the statistical technique of factor analysis to the isolation of clinical items representing the independent dimensions of ‘psychoticism’ and ‘neuroticism’. The findings were subsequently exploited for diagnostic purposes by other investigators (e.g. Richmond and Roberts, 1964), and the study and its results extensively quoted by Eysenck (1961) in his provocative review and critique of psychiatric classification to illustrate and lend support to his dimensional approach to psychiatric taxonomy.

The value of measuring changes in symptoms in a single patient has been discussed by a number of authors. (1, 3, 4.) The “self-controlled trial” (1) or the “multiple cross-over method”, i.e. the measurement of responses to repeated and systematic changes in treatment, appears to have advantages over the simple cross-over trial, but the method would be extremely time-consuming in group research with psychiatric patients if the ratings had to be carried out by research workers. The use of valid self-rating scales would make the multiple cross-over method feasible in drug trials with groups of psychiatric patients.

At the Massachusetts Mental Health Center (M.M.H.C.), a well-staffed university psychiatric hospital, an outbreak of alleged chlorpromazine-induced skin rashes recently occurred involving five dramatic young female patients. Investigation of the complaints led us to doubt whether medication was the cause. Why then did these women blame chlorpromazine? Thus, the central concern of this investigation: which patients are likely to complain of drug-induced side-effects and under what conditions? A second issue arising from our study and described in the literature is the need for care when differentiating the true from the alleged medication side-effect.

The work described in this paper began as just another drug trial. The authors' interest was aroused by the possibility of a new, fast-acting anti-depressant, unrelated to the monoamine oxidase inhibitors or tricyclic compounds.

Maternal age at parturition, birth order, and parental loss have all been extensively investigated as possible causal or concomitant factors in a wide variety of mental disorders. Thus, to take an extreme example, the influence of maternal age on one of the two main kinds of mongolism is well known and can hardly have other than a biological explanation, as is also true of a number of other causes of mental defect whose incidence is known to increase with maternal age (Penrose, 1963); and similarly much is now known of the biological effects of maternal age in animals (for a survey see Parsons, 1964).

Jenner, Gjessing, Cox, Davies-Jones, Hullin, and Hanna (1967) have presented some biochemical and clinical studies of a patient who showed a remarkably precisely timed manic-depressive psychosis. For the last eleven years the patient has been alternately depressed and lethargic for 24 hours, then elated for 24 hours, and so on almost without fail. Harding, Jeavons, Jenner, Drummond, Sheridan and Howells (1966) published electroencephalographic studies showing the 48-hour rhythm in the patient's electroencephalogram. The harmonic mean, the mean abundance and variability of the alpha rhythm all showed a striking 48-hour cycle. A number of similar patients have been described and are conveniently listed by Menninger-Lerchenthal (1960), Richter (1960), and Bunney and Hartmann (1965). Jenner (1965) made some suggestions about possibly heuristically helpful electronic analogues which might appropriately represent some of the underlying mechanisms of the 48-hour syndromes.

Lippold and Redfearn (1964) described the mental changes induced by the passage of small polarizing currents between two electrodes attached above the eyebrows and a single electrode on the right knee. When the forehead electrodes were positive with a total current flow of the order of 500 microamps, the mental changes consisted of an elevation of mood and an increased involvement in the environment. Forehead negative electrodes produced withdrawal and quietness. These observations were made on a group of hospitalized patients, the majority of whom were, or had been, mildly depressed. The authors state that “all would probably have been considered quite ‘normal’ by non-medical observers”.

The concept of the ‘body image’ rests on a broad foundation of neurological and psychological observations. Neurological observations of phantom limbs, agnosias, apraxias, and similar phenomena led to an initial formulation of the body image as a postural, spatial image of the body (2, 6). Schilder greatly expanded the concept by delineating the importance of libidinal (instinctual) and sociological factors in the make-up of the body image (7). Current psychiatric usage has (perhaps too loosely) equated the term body image with phrases such as 'self system’, 'self concept’, ‘ego identity’, etc. (8). The importance of the body image as a postural or spatial model, a ‘base of operations' from which a person extends himself into space, with its implications for movement and motor activity, is often overlooked but vividly evident in many endeavours, particularly aviation.

Though Young and Scoville (11) first described the paranoid schizophreniform psychoses associated with amphetamine ingestion in 1938, amphetamine-induced psychoses were not recognized as a major problem among English speaking nations until Connell (3) published his monograph in 1958. Connell's report of 42 cases documented the frequent presence of the syndrome and subsequent reporting of over 200 such cases has borne out the seriousness of the problem (5).