The literature of the psychological effects of brain injury is extensive and disconnected. It abounds in inadequate definitions, incompatible theories and disagreements as to appropriate methods of investigation. This situation results partly from the variety of disciplines which guide different investigators; but it results too from the great logical difficulties encountered by anybody who seeks to throw light on normal intelligent behaviour by studying the effects of cerebral lesions. Some have even argued that such attempts are always unprofitable (47, 77).

Speech has been called a socio-economic device for saving effort in the attainment of objectives (Whitehorn and Zipf, 1943). One of its earliest and most fundamental purposes is to orientate the individual within the community. This socializing effect operates early in childhood, and in a phylogenetic sense it was perhaps one of the greatest factors in the origin of speech in primitive man. As maturity is slowly achieved in the individual as in the genus, the use of language becomes inextricably interwoven within the warp and woof of the organism, as exemplified not only by thinking processes, but also by the complicated structure of personality. The development of speech during the pre-hominoid stage synchronizes with the gradual elaboration of communal life: with cries and calls serving as a “sound-tool”: and with the beginnings of delegation of labour. Thus language is primarily a vocal actualization of the tendency to see reality symbolically (Sapir). The same is true ontogenetically. As the child gradually acquires speech, the organization of his thinking slowly changes; it evolves by intricate steps from ego-centric to socialized activity; and as he begins more and more to employ pronouns of the second and third person, he also utters fewer “action words”. We readily agree with Fillmore Sanford (1942) that “there are many indications that language is a vehicle of personality as well as of thought, for when a person speaks, he tells us not only about the world, but also, through both form and content, about himself”. The same author quoted Ben Jonson: “Language most showeth a man; speak that I may see thee.”

The term echopraxia refers to the automatic repetition by an individual of visually perceived actions of others. It has been reported to occur in a variety of pathological mental states (Stengel, 1947). Descriptions of the phenomenon as it occurs in schizophrenia tend to be limited to a brief reference to its presence in catatonic patients, and it is not generally recognized to be a feature of the early stages of the illness. The purpose of this paper is to make an attempt to analyse the phenomenon, in discussing the subjective reports of a number of young schizophrenic patients who were interviewed in the early stages of their illness. Before proceeding to these reports it may be useful to examine briefly echopractic behaviour first as it is reported in normal development and then in clinical conditions, particularly chronic schizophrenia.

The study reported in this paper derived from an experimental investigation of anomalies of attention and perception found in schizophrenic patients (Chapman and McGhie, 1961, 1962). The application of an experimental battery of tests to a group of schizophrenic patients had shown that the short-term memory of schizophrenics is particularly vulnerable to interference by irrelevant stimuli. These tests assessed the schizophrenic patient's capacity to perceive and recall a series of non-meaningful auditory and visual stimuli, and therefore did not deal with conditions approximating to normal speech. The clinical material gathered from young schizophrenic patients in the course of our investigations did however amply illustrate some of their difficulties in the perception of speech. Since the present study was to a large extent suggested by the reports made by these patients, it may be pertinent to present here a selection of the verbatim accounts of how they found difficulty in comprehending other people's speech. These comments are selected from tape-recorded interviews with schizophrenic patients, each account having been given by a different patient.

I have been interested in the conflicting attitudes of the legal and psychiatric branches of the Service towards homosexuality. The legal branch sees homosexuality as a crime which still carries severe penalties. As a Service psychiatrist I have been impressed by the seemingly genuine desire to be cured shown by many homosexuals who come to me for help and I was struck by the high incidence of neurotic symptoms in them. To find out how many of the homosexuals seen by me were ill and to learn about the aetiology of homosexuality as seen in the Armed Forces I compared 50 consecutive homosexuals with 50 neurotics picked at random from my out-patients during the same period (1958–59).

This paper reports the result of an investigation into the hypothesis that severity of personality disturbance is positively related to the frequency of certain early adverse childhood influences.

Common observation indicates that some chronic schizophrenics are more extraverted than others. According to Eysenck (1960, p. 11) neuroticism is a distinct factor from psychoticism; one would therefore expect it to manifest itself to a varying extent in different chronic schizophrenics. These considerations suggested that it would be of interest to discover whether extraversion and neuroticism in a sample of chronic schizophrenics, as measured by their extraversion and neuroticism scores on the Eysenck Personality Inventory (Eysenck and Eysenck, 1963), a modified form of the Maudsley Personality Inventory (Eysenck, 1956), were significantly related to their psychiatric symptoms and to other characteristics such as sex, age and work efficiency.

Despite the important place occupied by delusional thinking in psychiatric theory, comparatively little experimental work has been undertaken on this particular form of thought disorder. This is perhaps surprising considering its relevance to reasoning and belief as a social process, the role of the delusion in differential diagnosis, and the number of deluded patients available for investigation. Most investigators have been concerned with the content of delusions rather than their force, for the type of delusion has an undoubted influence on behaviour—quite clearly the patient with grandiose delusions acts differently from the paranoid individual; nevertheless, the available evidence suggests that the type of delusion reflects the individual's social history rather than the nature or degree of his psychopathology. More relevant to the latter is the degree of belief expressed by the patient in his delusions, the transitory (and malleable) ideas of an early depressive illness often contrasting with the implacable beliefs found in a condition of chronic melancholia. Some longitudinal studies have been undertaken recently in which the degree of delusional belief has been examined in terms of its resistance to manipulation, and this avenue of approach offers an extremely valuable scale of assessment of the individual psychiatric patient.

This contribution is based on observations made in the course of the psycho-analytic treatment of thirty-six adolescents, 24 boys and 12 girls. These are pardy cases I have treated and supervised myself; but to a greater extent relate to material brought together over the past three years by many colleagues and students co-operating in the study of adolescents in treatment at the Hampstead Child Therapy Clinic. The study includes young people between puberty and late adolescence with neurotic or borderline psychotic disturbances. Cases are not included which presented a clear picture of delinquent personalities from the outset, though this does not mean that in the course of treatment such features have not appeared. The appearance of impulsive and delinquent features in clinical pictures where we would not expect them in other age groups belongs to the typical experiences and problems of treatment during this phase.

The need for the assessment of phenothiazines and other drugs used in mental conditions is increasing as new products are described. Testing these drugs on patients is cumbersome and time-consuming. It would be valuable if a preliminary test could be made on some animal in which the effect on the nervous system can be easily assessed.

Cosaldon has been fairly widely used on the Continent in the treatment of dementia and toxic confusional states. Meyer (1957), Leube (1959), Sperling (1960), Schmidt (1960), and Donati (1960) consider the drug to be of particular value in the treatment of arteriosclerotic dementia, and stress that the earlier the treatment is commenced the more favourable is the response.

A comparison of imipramine and electroplexy in 31 depressed patients selected for the latter treatment has already been reported (Robin and Harris, 1962). The following study concerns depressed patients chosen for conservative measures.

The literature contains only a few reports on plasma 17-hydroxycorticosteroids (17-OHCS) in mental patients (Bliss, Migeon, Branch and Samuels, 1955; Freeman, Steed, Hoegemeier, Wheeler, Savage and Wadeson, 1956; Board, Wadeson and Persky, 1957; Hoagland and Freeman, 1959). According to these investigators the mean values in schizophrenic patients do not differ significantly from values found in normal subjects.

In our unit open heart surgery has provided sufficient stress to precipitate post-operative psychological disturbances in a high proportion of patients. In the year before this investigation was begun, 21 of 108 patients developed obvious mental abnormalities post-operatively. Blickenstorfer (1) reported post-operative psychosis in 3 per cent, of 300 patients subjected to open heart surgery, and the same incidence, 3 per cent., was reported by Bolton and Bailey (3) following closed and open heart surgery on 1,500 adult patients. The incidence of mental disturbance in our unit was so much higher that a detailed study of all patients (141) operated on in the unit during a 10-month period appeared to be indicated.