The aim of this study was to evaluate changes in selected personality variables following a form of leucotomy described as orbital undercutting (Knight, 1959) and to relate these findings to clinical observations.

This paper is one of two considering certain aspects of the Mental Health Act, 1959, in relation to subnormal patients; it is based on a report of a Working Party submitted to the Council of the British Psychological Society and is published with the Society's approval. (The second paper (Mittler and Castell, 1964) considers plans for hospital and community care.)

During the course of a morbidity study in two communities in the town of Croydon, carried out between 1960 and 1962, it proved possible to incorporate an investigation of the shortened version of the Maudsley Personality Inventory (M.P.I.). This twelve-item questionnaire, constructed by Eysenck (1958) for studies of this type, gives measures of neuroticism and extraversion as defined within his personality theory (Eysenck, 1959). Initially the inventory used was identical with that described by Eysenck. After a time (during which test-retest was carried out on 130 adults), however, it was felt that three of the questions relating to extraversion were rather cumbersome, and the following changes were made. Question D, “Are you happiest when you get involved in some project that calls for rapid action?”, was amended to “Are you happiest when you get involved in something that calls for rapid action?”. Question G, “Do you usually take the initiative in making new friends?”, was amended to “Do you usually take the first step in making new friends?”. Question L, “Would you be very unhappy if you were prevented from making numerous social contacts?”, was amended to “Would you be very unhappy if you were prevented from meeting lots of people ?”. It was assumed that these minor alterations would not significantly affect the extraversion scores, and this assumption is borne out by the fact that neither the means of scores nor the test-retest correlations were significantly different on comparison of the two versions. This present study reports the frequency distribution of M.P.I. scores in the population studied and the test-retest reliability of the inventory.

The Maudsley Personality Inventory (M.P.I.) is now established as one of the most widely used personality tests in the investigation of a variety of clinical, psychosomatic and genetical problems. When the M.P.I. is employed for such purposes it is most important to know how constant are the scores and how much they are altered by the changes in mental state which often occur in psychiatric patients over a period of days or weeks.

The assessment and measurement of the mental state in patients suffering from a depressive illness is important both in clinical psychiatry and in research. Clinical assessment by an experienced psychiatrist, even when it is quantified on the basis of a rating scale (e.g. Hamilton's Rating Scale for Depression) has the disadvantage of being dependent on the skill of the rater and on his clinical bias. These drawbacks make it somewhat difficult to compare meaningfully results obtained in different investigations.

There seems to be a series of conceptual problems regarding depressive illness and its classification. First, there is the problem of whether these illnesses have some biological function, whether they represent attempts on the part of human organisms to deal with or escape from situations of stress, or whether they should be thought of simply as psychologically meaningless events. Eysenck (1960) and Wolpe (1958) make it clear that they regard neurotic symptoms as meaningless, maladaptive patterns which can and should be removed by suggestion, deconditioning and behaviour therapy. Similarly, Mayer-Gross, Slater and Roth (1955) reject the suggestion that depressive illness may have an adaptive function. By contrast, clinical medicine, though resting heavily on the mechanistic causality models of physics and chemistry, does give some implicit recognition of biological purpose in physical illness. Thus, pneumonia represents not only the phenomenon of invasion of pulmonary tissue by infective agents, but also the phenomenon of bodily defence against such invasion. When such defence does not exist, the patient seldom gets to the physician in time to be diagnosed. That depressive illness might have an analogous biological function was suggested by Freud (1917) and elaborated in impressive detail by Lewis (1934). The converse view that depressive illness represents a breakdown in adaptive function is based on the views of Kraepelin (1913) who attributed the dominant place in the depressive group of illnesses to manic-depressive psychosis with its known hereditary basis. That hereditary factors do operate in the manic-depressive group proper seems to have been demonstrated more than adequately by Slater (1938) and Kallmann (1950). The evidence regarding other depressive reactions, whether recurrent or involutional, seems far from impressive. Nevertheless, Mayer-Gross et al. take the view that affective illness is primarily a question of constitution, that the content of the depression may be understandable in terms of the patient's life situation, but that the causes of breakdown given by relatives of patients are really symptoms of the oncoming illness. Interestingly enough, Henderson and Gillespie (1956) classify affective illness into manic-depressive and involutional depression, and note the importance of social factors (p. 276).

The syndrome of acute catatonic delirium associated with fever and usually with a fatal outcome was reported over hundred years ago. The first to describe it was Calmeil in 1832 (cit. after Aronson and Thompson, 1950). Kraepelin (1904) includes these states in the group of “akute Verwirrtheit”. Most authors emphasize the acuteness and high mortality of these states. Thus Claude and Cuel (1927), Guiraud and Saunet (1938), Golse and Morel (1953), call them “délire aigu”, de Simone (1962) “catatonie pernicieuse”, Stauder (1934) “tödliche Katatonie”, Huber (1954) “lebens-bedrohliche Katatone psychosen”, Knoll (1954) “perniziose Katatonien”. English writers call them “acute lethal catatonia” (Fisher and Greiner, 1960), Scandinavian “delirium acutum” (Lingjaerde, 1954). In Russian journals one finds them described as “delirium acutum” (Agieeva et al., 1955; Molokhov, 1962), “ostrij bried” (Rohlenko, 1961) or more recently “hypertoxic schizophrenia” (Romasienko, 1962).

Wing (1963) has recently reviewed the literature, mainly of the last five years, that has contributed much to our knowledge of the rehabilitation process, especially in long hospitalized schizophrenics. Over the same period there has been an increased discharge rate among this group of patients, and the continuation of this trend appears to be one of the expectations upon which plans for future mental hospital bed requirements have been based (Tooth and Brooke, 1961).

Transvestism is characterized by a repetitive morbid predilection to dress in the attire of the opposite sex. It is distinguishable from fetishism on the one hand and trans-sexualism on the other.

Common observation indicates that phobic patients tend to avoid the stimuli which are related to their phobia. This characteristic has suggested the analysis of traffic phobia in terms of avoidance learning theory. According to this theory, stimuli which have been associated with a noxious event (accidents in the case of traffic phobia) may acquire aversive properties (fear arousal) and responses which appear in an attempt to avoid these stimuli (accident situation) are reinforced by fear reduction (Skinner and Estes, 1941; Wynne and Solomon, 1955; Keehn, 1961). If the analysis of traffic phobia in terms of avoidance learning is correct, however, accidents would be expected to be a major source of such phobic reactions. The present study gives a clear illustration of a traffic phobia acquired through conditioning in accident situations and its satisfactory treatment by application of learning theory.

The inability in a woman to tolerate intercourse is a factor which causes tremendous strain in marriage and leads rapidly to dissension between husband and wife and often the eventual break-up of the union. It is therefore a condition which it is vital to treat quickly and successfully if the partnership is to be saved.