Difficulty occurs at times in the diagnostic differentiation between the manifestations of organic cerebral disease and those of hysteria, particularly in patients who suffer from symptoms which are largely subjective in nature, and which are not accompanied by physical signs. An attempt is made in this paper to discuss behaviour reactions which are characteristic of organic cerebral disease, and which, if present, exclude the possibility of the disease being “hysterical” in nature.

This review is based on neuropathological contributions which have either a direct or indirect relation to mental disease or are of major general interest. Notwithstanding these restrictions the field which had to be covered remains vast, and no claim can be made that the survey of the literature is complete, although it is hoped that it is, to some extent, representative. In order to counteract this defect, recent reviews or comprehensive papers on special problems have been recommended, whenever they were available. They will enable the reader to trace references which for lack of space had to be suppressed. For the same reason of economy, a number of quotations have been made from reviews. This does not mean that the original papers have not been consulted.

In the July 1964 issue of The Atlantic, William Sargant (6), made some controversial comments on American psychiatry. “Freudian converts”, he said, fear “allowing any other methods of psychiatric treatment to gain any real recognition and acceptance in … teaching centers” where physical and biochemical treatments are “dismissed” as “symptomatic” and “second-rate”. He argued, furthermore, that psychoanalysts' views are unrealistic because these practitioners are experienced merely with the “very mildest forms of mental illness”. “Only psychoanalysis holds out any real hope in treatment” is the credo which Dr. Sargant attributes to U.S. psychoanalysts. If these opinions were solely those of one author, they might be overlooked, but they are held by many European and American psychiatrists (1).

We have it on the word of Justinian, that “by the law of nature all men were born free.” Yet the Blue Book of the Commissioners in Lunacy, recently published, shows that 36,871 Englishmen are deprived of their liberty, and confined in lunatic asylums. And if we compare these numbers with those in the Report for 1869 it will be found that during the year 1870 the insane of all classes have increased in number by 2,042, or 174 private and 1,868 pauper patients. This increase is not exceptional, but has been going on for many years.

That our convict prisons should be the theatres upon whose stage are enacted day by day a varied round of farces and burlesques of a more or less tragical significance, is a thought whose development may be interesting, or simply amusing, according to the direction in which our fancy for the time being leads us.

Comparative studies of first admission rates to psychiatric hospitals have revealed significant differences in the rates of diagnoses of functional psychoses between the United Kingdom and the United States of America.

The present study examined the diagnoses of indigenous patients born between 1921 and 1955 and first admitted to hospitals in New South Wales, Australia, and England and Wales. Admission rates for mania were in striking agreement. The rate in New South Wales for schizophrenia was slighdy higher and for psychotic depression considerably less than in England and Wales.

A similar trend in diagnostic dissonance would appear to exist between England and Wales and New South Wales as between England and Wales and the United States for schizophrenia and psychotic depression, but this is considerably less in degree.

There is probably no disease to which human flesh is heir that attracts, every now and again, such a degree of public attention—that begets such a keenness of personal dread—that so frequently forms the subject of sensational narrative or comment in the public press—that causes to be exhibited so disgraceful an amount and kind of ignorance, superstition, credulity, and cruelty—as hydrophobia. Even cholera is not so formidable a disorder in the public esteem. Its cramps are not always present; and when they are, they are not comparable with the convulsions of hydrophobia. Nor is there any terrifying mental disorder in the case of cholera; whereas, in hydrophobia the morbid mental phenomena are more prominent, serious, and impressive than the motor ones. Moreover, cholera is not popularly believed to be necessarily and in all cases fatal; whereas it is currently supposed that there is no chance of escape from hydrophobia.