Problem

The existence of impairment in abstract ability for certain abnormal groups has been well documented in the clinical literature (Goldstein, 1936, 1943; Goldstein and Sheerer, 1941). The concept of “abstract ability” involves various types of abilities which may or may not be related to each other in specific ways. For example, the ability to solve syllogisms need not necessarily require the same order of skill as elucidating proverbs, although persons gifted in abstract capabilities may excel in both. Nevertheless, groups of abilities variously referred to as “abstract” seem to undergo appreciable modifications in organic and functional pathologies and disorders.

In July 1745 Swedenborg returned to Sweden, and soon afterwards resigned his assessorship, so that he might be at liberty to devote himself to the new function to which he imagined that he had been especially called. Accordingly, all scientific studies and pursuits he now abandoned entirely; all worldly honours and interests he counted worthless; he devoted himself to that sacred office “to which the Lord Himself has called me, who was graciously pleased to manifest Himself to me, His unworthy servant, in a personal appearance in the year 1743; to open in me a sight of the spiritual world, and to enable me to converse with spirits and angels. … Hence it has been permitted me to hear and see things in another life which are astonishing, and which have never come to the knowledge of any man, nor entered into his imagination. I have been there instructed concerning different kinds of spirits, and the state of souls after death—concerning Hell, or the lamentable state of the unfaithful—concerning Heaven, or the most happy state of the faithful, and particularly concerning the doctrine of faith, which is acknowledged throughout Heaven.” He is well aware that many persons will affirm that such intercourse is impossible, and that it must be mere fancy and illusion on his part, but for all this he cares not, seeing that “he has seen, heard, and had sensible experience” of what he declares.

The proliferation of large-scale organisations is a phenomenon of modern society. As Etzioni (1968) puts it, “We are born in organisations, educated by organisations and most of us spend much of our lives working for organisations”. Most public organisations in modern society are bureaucracies and the field of psychiatry is no exception: a trend toward growing bureaucratisation, of both public and private mental health services organisations, can be observed everywhere. To a large extent, this is because, as standards of care become regulated and quality controls increase, the tasks that mental health professionals and administrators perform become better understood, more predictable, and more programmed. There is still room for creativity and innovation, but only in incremental, well controlled steps.

Daniel Paul Schreber's Memoirs of my Nervous Illness profoundly influenced many key figures of modern psychiatry, including Bleuler and Jaspers, Freud and Jung. Author Elias Canetti described it as the ‘most important document in psychiatric literature’. To read this work – typically considered a paradigmatic expression of paranoid schizophrenia – is to risk a shaking of one's complacency, especially concerning the key symptom of delusion. For me personally, it was a revelation.

Renal dysfunction is so commonly present in cases of mental breakdown that it is of interest to know whether it is especially associated with any definite clinical type or types of mental disorder. In an endeavour to ascertain this, cases have been selected from recent admissions in which the form of disorder from a clinical point of view appeared to be sufficiently marked to warrant placing them in a definite category. Many cases present such a mixture of cycloid, schizoid, confusional or paranoid indications that in an investigation of this nature the selection of sufficiently clear-cut types from a clinical standpoint is not altogether an easy matter. To determine the degree of concentration and polyuria, Rosenberg's modification of the Volhard test has been adopted. It involves little discomfort to the patient and is as follows:—