In his presidential address to the first International Congress of Neuropathology in Rome, Gozzano (1952) raised the question of the future of neuropathology. In his opinion neuropathology was a relatively young branch of pathology and had started with the discoveries of Golgi, Cajal, Weigert and Nissl. Golgi invented “la reazione nera” in 1873; it was applied to the nervous system only a decade later. The first Weigert preparations for myelin were demonstrated in 1884 (Wallenberg, 1925). Nissl, inspired by Weigert's success with aniline dyes in nerve fibres, introduced his method for nerve cells in 1885, using first magenta red, later methylene blue and finally toluidine blue. Cajal made his first scientific appearance in 1889, at a meeting of the German Society of Anatomists.

In view of the promise attached to the recent attempts to integrate learning and personality theory (Eysenck, 1957), and the suggestion that drug addiction might be a learned response, it would appear profitable to consider the relevance of this integration to a better understanding of addiction, a suggestion reinforced by two recent papers by Partridge (1959a, b). On the basis of a clinical survey of addiction he came to the conclusion that the extent and severity of addiction was dependent on “… the extent to which the particular personality can tolerate them (i.e. the symptoms, such as anxiety, which would arise without the drug) … patients with a low tolerance of discomforts and frustrations are those more likely to be addicts, just as they are more likely to turn to drugs in the first place … the development of addiction, in fact, depends much on the personality … the form of addiction depends more on the circumstances and opportunities with which the particular personality has been confronted.” Such considerations and conclusions can be conceptualized within and predicted from the theoretical framework to be proposed later in the present review.

“Thought-disorder” in schizophrenia was initially a psychiatric concept derived from clinical observation. As crystallized in standard psychiatric authorities, say Mayer-Gross, Slater and Roth (1954) the primary features of the talk (and inferentially the thinking) of thought-disordered schizophrenic patients are:

1. (i) Inconsequential following of side issues.

2. (ii) Tendencies for the thought to be directed by alliterations, analogies, clang associations, associations with accidents of the speaker's environment, symbolic meanings, and the condensation of several (perhaps mutually contradictory) ideas into one.

3. (iii) Words used out of context, e.g. concrete meanings taken where abstract meanings would be appropriate.

4. (iv) Clinging to unimportant detail.

5. (v) The use of laconic answers, e.g. I don't know, maybe, perhaps—indicative of emptiness and vagueness of ideas.

6. (vi) Thought is generally marked by gaps, poverty, indefiniteness and vagueness.

7. (vii) Indications of thought-blocking.

8. (viii) Indications of pressure of thoughts.

Although there have been many attempts to discover in the body fluids, chemical peculiarities characteristic of schizophrenic illness, the outcome of most of these investigations has been inconclusive (see for example Altschule, 1953; Kety, 1959). Little attention has been paid, however, to purine metabolism until the recent studies of Kishimoto (1958) who reported peculiarities in the absorption spectra of body fluids in schizophrenia which he attributed to abnormalities in the conversion of adenine through hypoxanthine and xanthine to uric acid. These findings appeared to be supported by evidence which included the determination of urinary xanthine by a xanthine oxidase method based on that of Williams (1950).

In a series of papers concerned with the problems of repeated psychopathic and delinquent behaviour, use has been made of a loose theory which interprets the social behaviour or habit as being a particular learned response to stress, anxiety or emotional disturbance, or to stressor stimuli not necessarily activating physiological stress (190-200). This theoretical position was adopted on account of its relative simplicity, its similarity to many clinical theories, and its ease of access for laboratory and operational studies. In a mainly adult hospital setting, the area chosen for research has been the differentiation of stable and unstable patients, the determination of methods which allow for accurate prognosis of future stability or instability and the form which future instability might take. The objective also contains the assumption that an explanation of instability should be in a form which permits therapeutic endeavour or at least indicates some basic principles for therapy to adopt, and utilizes variables which change as the patient changes.

Culture in its anthropological sense has been described as “a configuration of learned behaviour and results of behaviour whose component elements are shared and transmitted by members of a particular society” (Linton, 1936); in other words, a way of life. It has long been understood that more than one type of culture may be found in any one society. All societies are stratified and in an industrial society people of different levels have different ways of life. These are subcultures.

In this paper we have tried to demonstrate some of the ways in which social selection operates in the ascertainment of dull and subnormal children. In England backward children, by the terms of the Education Act of 1944, may be referred by their teachers for medical examination and “ascertained” as educationally subnormal, thereby qualifying for special educational treatment. Alternatively, they may be classed as mental defectives (or now, severely subnormal) and excluded from the schools altogether.

This paper deals with some effects of family and culture on intelligence, as studied in a sample of 50 young adults who had been ascertained as educationally subnormal at school.

The main purpose of this paper is to report our experience in developing a psychiatric in-patient unit for adolescent boys. The Unit is known as Beech House and contains 16 beds and has been operating since January, 1959. It is a non-statutory ward and is the first treatment unit of this kind attached to a large provincial mental hospital such as St. Augustine's. Its catchment area is limited to the South-East Metropolitan region which comprises Kent and part of East Sussex. Only exceptionally are cases from outside these two counties accepted into the unit.

The frequency of suicide differs between communities, countries, and historical periods. Though, in individuals, personal crises and peculiarities of personality structure are important in the causation of suicide, the differences in frequency referred to above are related to differing religious and social attitudes toward suicide and particularly to the degree of the individual's integration into a stable social group. This last influence, it has been suggested, is chiefly responsible for the difference between the suicidal tendencies of urban and rural areas.

Picture material may be “described” or “interpreted”. This distinction (further discussed in the section on Analysis of Results) is related in part to the complexity of the material, in part to the kind of response that is required. Defective description of pictures in cases of brain lesion has aroused little comment and has not been claimed to exist as an isolated disability. In contrast impaired interpretation of picture material has been more frequently found in association with disease or injury of the cerebral hemispheres. Moreover there is little agreement concerning the nature of this disability.

The court hearing (Bolam v. Friern Hospital Management Committee) showed that British psychiatrists disagreed about the best technique of administering electroplexy. The implications of this were discussed in a recent communication (1), which also contained an extensive review of the literature showing a similar disagreement amongst previous authorities. In order to ascertain which E.C.T. techniques were most widely practised in this country, a questionnaire was circulated to a number of mental and teaching hospitals and the results of this, which were reported in full (1, 3), are summarized in Table I.

The nature of consciousness is a central theoretical problem for psychology, psychiatry and psychosomatic medicine. Attempts to deal with this problem in these fields have led to precarious relationships with philosophy on the one hand and with neurophysiology on the other. The result is both conceptually and semantically unsatisfactory. For example, is “consciousness” to be taken to mean some general state or level of awareness which is capable of being altered or reduced? Or is there no general consciousness but only states of being conscious of specific things? This paper discusses some of the philosophical problems involved in the term “consciousness” and outlines ways in which recent neurophysiological advances have contributed to clinical knowledge about the general or specific nature of consciousness.

The study of thyroid function as the uptake of radioiodine (I131) is a well-established test. Since the half-life of the isotope is long (8 days) it is unreasonable to make frequent repeated tests in the same person because of the cumulative radiation risk and the complexity of interpretation when residual radioactive iodine is still present in the body. However, in psychiatry daily or twice daily measurements of thyroid function might be very useful in studying patients who show sudden or rapid mental changes (Sands, 1958), and a radioiodine isotope with a half-life of only 2·26 hours which has become more readily available (I132), deserves trial. The primary aim of the present work was to make daily measurements on one man through several short (6-day) cycles of behavioural change. He was predominantly manic-depressive in type and has already been described in detail (Crammer, 1959). To discover how variable the measurement could be, repeated observations were also made on a group of 20 chronic male patients living together and showing an unchanging clinical picture. Observations were repeated on them after three months of chlorpromazine treatment to see whether this would have altered the values obtained for thyroid uptake.

This paper is based upon an investigation that I carried out some years ago into the intellectual changes that resulted in a group of 71 men following wounds of the brain (Jarvie, 1954). These men had been wounded, by high-velocity missiles, during the late War or in the Korean Campaign, and damage to most areas of the brain were represented in the series; the wounds showed all degrees of severity from small areas of cortical contusion up to extensive destruction within the hemispheres.

The manifest contents of most phobias concern dangers coming from the environment. It is the degree of those neurotic fears rather than their objects which makes them appear unrealistic. Fears of dangers coming from outside the environment in which the patient lives, such as fear of cosmic happenings, have usually been found to be associated with schizophrenia. Recently the knowledge of our physical environment and the scope of its exploration have been undergoing fundamental changes. This has been reflected in the symptomatology of phobias. The following four patients seen in the psychiatric outpatient department of the United Sheffield Hospitals during the last eighteen months illustrate how a change in the popular concept of physical reality can produce a new type of neurotic fear. The first case is given in greater detail than the others, because the patient's power of verbalization was above average.

Attempted suicide is a non-fatal act of self-damage carried out with the conscious intention of self-destruction. This is the only definition about which clinicians can be expected to agree. Attempted suicide was, until recently, regarded only as an abortive or unsuccessful suicide. Consequently, it was studied purely retrospectively, which is appropriate for events which mark the ultimate end of an individual. Motives, methods, clinical diagnosis, social factors leading to the suicidal attempts were examined and the available figures were interpreted in the same way as the suicide figures. In the published studies, the number of attempted suicides used to be smaller or did not greatly exceed those of suicides occurring in the same population. It is not surprising that nonmedical research workers should have accepted them as reliable approximations to the true incidence of suicidal attempts, but many psychiatrists have done the same, which illustrates the deceptive magic of figures.

The subject of the present communication arose from an incidental observation made during an attempt to establish a Symptom: Sign Inventory for use with all types of mental patients. For some time past all cases diagnosed by psychiatrists as suffering from depression, whether psychotic or neurotic, have been given this inventory. The observation made was that, within the group diagnosed as psychotic, those over 60 years of age did not appear from the inventory to have the same symptoms as those under 60.

In deep coma the patient usually lies still, without moving. Why doesn't he move? Many will answer, “Because he is unconscious”. This is on the assumption, which seems eminently reasonable, that motor centres are under the control of a higher centre for mind. On voluntary movement, according to this assumption, motor centres receive and obey impulses from the psychic centre. When the psychic centre is paralysed, as in coma, the motor centres lie idle, like men in a factory marking time because the foreman is away and there is no one to tell them what to do.

In the course of the past few decades various controversial theories have been elaborated on the aetiology of mongolism in an attempt to solve the complexity of this interesting clinical entity.