There have been relatively few studies concerning the occurrence of depersonalization phenomena in normal subjects. Roberts (1960) and Dixon (1963) studied college students and reported a high incidence of brief depersonalization experiences in their samples. The aim of the present study is to investigate the relationship between depersonalization, the conditions under which it occurred and a measure of extraversion/ introversion in a group of normal subjects.

Time judgments of various kinds are often disturbed in schizophrenia, but a review of the literature (Orme, 1962) suggests the disturbance is not characteristic in type. The present writer has studied (Orme, 1964) the verbal estimation of an elapsed “filled” interval with various clinical groups. Subjects were asked, after 30 minutes of interviewing, “How long have we been together, how long does it seem to you?” A summary of the distribution of time estimates is given in Table I. The most statistically significant feature (see Orme, 1964 for details) is the contrast between the hysteric, psychopathic and manic groups on the one hand, and the melancholic, anxious and depressed neurotic on the other. Individual variations in estimates appear unrelated to age, sex and intelligence.

Many mental hospitals are practising some form of group treatment either intra- or extra-murally or both. (Martin, 1962; Clark, 1964; Freeman and Farndale, 1961). Thus, ward meetings with as many as 60 patients and staff (Jones and Hollingsworth, 1963), small therapeutic groups of selected patients limited to 8 or 10 individuals (Foulkes and Anthony, 1965), family groups involving single families or several families taken as one group, follow-up groups with ex-patients and many other patterns are being developed. Most of the literature available and most of the training is based on the classical model (Bion, 1961) of the psychoanalytically-orientated group of selected patients, mainly cases of psycho-neurosis and character disorders, who have been suitable for this type of therapy.

Recently the 1959 Mental Health Act has been criticized because of an apparent increase of psychiatric referrals from courts and prisons, and it has been suggested that there has been an increase of social pathology since the passing of this Act (Rollin, 1963). A previous study (West, Bearcroft and Smith, 1960) showed that men were remanded in custody rather than on bail for psychiatric reports largely for social reasons, and in a more recent study (Bearcroft and Donovan, 1965) the incidence of criminal behaviour in the mentally ill seemed to depend, to some extent, upon social factors.

The experience of hearing a “voice” or “loud thoughts” within the head or some other part of the body is not infrequently reported by psychiatric patients. Schneider (1959) has stipulated that “certain modes of hearing voices are of special diagnostic importance for assuming a schizophrenia: hearing one's own thoughts (or thoughts being audible), voices conversing with one another, and voices that keep up a running commentary on the patient's behaviour”. This paper is primarily concerned with the phenomena of “loud” or “audible” thoughts, “inner voices” and similar experiences. It attempts to show that various phenomena superficially resemble the schizophrenic experience of “thoughts becoming audible”, but that distinction is possible on phenomenological grounds.

In view of recommendations for the establishment of Units for the treatment of addiction to Heroin and Cocaine (H & C) (1) and (2), it may be of interest to relate our experiences of treating addicts to H & C and to alcohol in an Addiction Unit.

The purpose of this paper is to describe the routine admission of children below school age with their mothers, it being postulated that this would be to the benefit of both and that the emotional needs of the children would continue to be met during the mothers' treatment. Modern paediatric practice emphasizes the maintenance of the close emotional bond between mother and child, and it was felt that if a mother is mentally ill, the resulting psychological trauma to her child should not be made worse by separating them.

A physiological index of anxiety would be of considerable value if it could evaluate objectively the diminution in anxiety which follows drug treatment, psychotherapy, deconditioning and prefrontal leucotomy. Anxiety is an unpleasant subjective experience of tension, apprehension or anticipation imposed by the expectation of danger or distress or the need for a special effort. The components of the accompanying physiological response lend themselves to objective measurement and are worthy of study since they reflect the emotional changes which defy direct measurement.

Psychiatric consultation in many general hospitals is regarded in much the same light as the French Revolution; it has its hazards and its critics, but tends finally to be accepted as “a Good Thing”. Various aspects of consultation have been discussed, (1) (2) (3) (4) (5) (6) (7) (9), but the findings of Mendelson and Meyer are of particular interest, for they point out the high degree of social and family disruption in the patients seen. Elsewhere, the same authors indicate that the impetus for consultation comes, not from the patient, but from the physician, and that disturbed behaviour leads to the psychiatrist being called in (8).

This report is published with the blessing of the College authorities, although they would challenge one or two elements in it. The main points of contention would be, first, the definition of wastage (it is understood that some of the students who are classified in the report as “wasted” did in fact go on to degree courses in other subjects elsewhere, having realized that they had chosen the wrong subject at first); second, that to quote a single year's figures may be misleading, since there are reasons for thinking that the picture may be changing for the better; and third, that academic inadequacy and idleness are thought to be at least as prevalent, as reasons for failure, as psychological disturbance, whereas this investigation concentrates almost exclusively on the latter.

Obsessions may appear for the first time during the course of a depression without having been present before the onset of the depression. Such cases (hereinafter called “Gainers”) have been noted by Esquirol (1827), Prichard (1835), Marc (1840), Schüle (1886), Gordon (1925), Saunders (1932), Lewis (1934), Woolley (1937), Muncie and White (1937), Lion (1942), Stengel (1948), Terhune (1949), Sargant and Slater (1950), Pollitt (1956), Reda and Paretti (1958), and Skoog (1959). The frequency of this phenomenon, however, remains uncertain. Heilbronner (1912) described 22 cases of melancholia with obsessions of whom 18 were “Gainers”. Vurpas and Corman (1933) described 27 cases of depression with obsessions (two organically based) of whom 24 were “Gainers”.

The number of married schizophrenic women living at home may be expected to increase owing to the effectiveness of modern pharmacotherapeutic methods and the trend towards social rehabilitation. Hospital admissions will be limited to short periods, thus providing greater opportunity for the schizophrenic patient to become pregnant. As each additional attack of the illness may result in further deterioration, which will increase the mother's inability to care for her children, the relationship between the schizophrenic disease process and the stresses of pregnancy and childbirth needs investigation and evaluation. The practical clinical significance of this question is mainly relevant to married women suffering from schizophrenia of an acute onset or schizophrenia which follows a more benign course, which would allow them to function at home at various intervals.

Characteristics which are wholly genetically determined are distributed at random among all the members of a sibship. Dependence of the distribution on birth rank (i.e. maternal parity at the birth of the subjects) or on position within the sibship provides presumptive evidence of non-genetic causes and may give some indication of their nature (McKeown and Record, 1956). Investigations on the birth order of schizophrenics (Tables VI and VII) have to date given no clear and consistent results, and further study appears to be indicated.

Recently Kay, Beamish and Roth (1964) have shown that there is only a small fraction of old people with psychiatric disorder being cared for either as hospital in-patients or as residents in Homes. Their investigation was carried out in Newcastle-on-Tyne. They pointed out that various other reports concur with the view that medical services at the present time deal only with the visible part of the “iceberg” of mental disorder and handicap.

The Sturge-Weber syndrome belongs to the relatively uncommon group of ailments known as heredodegenerative disorders. In 1879 Sturge described a case of epilepsy in a young girl who exhibited a congenital glaucoma and a facial angioma or naevus flammeus. Sturge speculated that the patient's convulsions were caused by a similar naevus formation in the brain. Kalischer (1897, 1901) discovered angiomatotic changes in the meninges, and later the typical calcium deposits corresponding to these angio-mata were found in X-ray examinations by Weber (1922), Dimitri (1923), and Krabbe (1934). The appellation of the Sturge-Weber syndrome varies, owing to the number of its investigators. Levison (1953) calls attention to this question of nomenclature.

It has been suggested (Mednick, 1958) that high drive acting “upon remote response tendencies is a major root of the disordered thinking of schizophrenics”. Thought disorder would be a product of a high level of drive, increasing generalization and reducing discrimination. The relevant drive in this context is anxiety.

The importance of personality in determining the likelihood and form of psychiatric and psychosomatic disease is recognized, but relatively little attention has been paid to the intimate personal relationships of adults which both express and to some extent modify their personalities. The neglect of this field in psychiatry has been underlined recently by Post and Wardle (1962) and by Kreitman (1964).

Introduction

“I can't concentrate, doctor” is a common complaint among psychiatric patients. The phrase is usually applied in a general sense to describe a state in which the patient has ceased to read the newspapers or watch the television and can no longer cope adequately with his work. In clinical practice the performance of the “serial sevens” test has been thought to give an indication of impairment of this function, whatever it may be (Mayer-Gross, Slater and Roth, 1960). As the symptom is so common, a measure of its severity may be of some value. This paper describes an attempt to develop such a measure and discusses the possible implications of its failure.

Since the initial observations of a relationship between depression and an increase in urinary adrenal glucocorticoids in psychiatric patients by Reiss (1953) and Rizzo et al. (1954), there have been a number of studies confirming this relationship using various chemical techniques (Board et al., 1957; Bunney et al., 1964 and 1965; Gibbons, Gibbons, Maxwell and Wilcox, 1960; Gibbons and McHugh, 1962; Gibbons, 1964; Kurland, 1964a and 1964b; Pryce 1964). One of the questions that immediately comes to mind in reviewing this work has to do with the specificity of this relationship. Perhaps the rise of urine corticoids in depression is a non-specific response to disturbance, as has been demonstrated in various forms of psychological stress (Hamburg, 1962) and in severe psychiatric disturbances such as acute schizophrenic episodes (Sachar et al., 1963). On the other hand it is tempting to hope that there may be a more specific relationship demonstrable between the complex psychobiological phenomenon of depression and some kind of neuroendocrine activation analagous to a syndrome like “periodic hypothalamic discharge” (Wolff et al., 1964). This syndrome is manifested by periodic episodes (lasting several days) of withdrawal and depression associated with marked elevations in 17-hydroxycorticoid excretion. Mandell et al. (1963) have recently demonstrated that subthreshold stimulation of limbic sites intimately related to hypothalamic modulation produces marked changes in plasma 17-hydroxycorticoids in man. Limbic areas have been related to affectual phenomena on a speculative basis since the classical papers of Papez (1937).