“When we consider the immense human significance of sleep, the absolute necessity for us to spend a considerable part of our lives in abject mental annihilation, it is remarkable how little we know about it. …” In these words, Sir John Eccles introduced the recently published Ciba Foundation Symposium on “The Nature of Sleep” (3), in which are described many of the advances which have been made in recent years in our attempts to understand the phenomena which are involved in the state of sleep. In one of the papers included in this Symposium, Bremer (2) reviews the work which has been reported since 1954 on the neurophysiological mechanisms involved in sleep. The relationship of dreaming to the depth of sleep has been investigated by such workers as Kleitman (5), Dement (4) and Wolpert (11). These studies have been made possible by the application of modern techniques of measuring mental activity. The use of electroencephalographic methods has allowed an approximate classification of the different levels of sleep which enables different workers to adopt a standard frame of reference. Measurements of rapid eye movements and of changes in muscle potential during sleep have provided more objective methods of assessing dream activity. Other recent studies have attempted to make an objective assessment of the physical and mental effects of sleep deprivation (Morris et al., 7, Bliss et al., 1, Murray et al., 8, Wilkinson, 9, Williams et al., 10).

The role of phenothiazine derivatives in controlling the symptoms of mental diseases has been investigated by many workers by determining its site of action in the central nervous system.

Patients in the care of the Department of Psychological Medicine, Guy's Hospital, who are receiving moderate and large doses of phenothiazine drugs are regularly tested for evidence of hepatic or haematological disturbance. In the course of such an investigation, when the urine of a schizophrenic patient was tested with modified Ehrlich's reagent for urobilinogen, it was remarked that a deep blue colour was produced. The patient had been receiving 600 mg. of chloropromazine daily in divided doses for the previous 10 days, and as no other cause for this unusual result could be found, the phenothiazine was considered to be responsible.

Previous papers in this series (Shapiro, 2, 3, 4; Shapiro and Tizard, 6; Yates, 13 and 16) have been concerned with the investigation of an aspect of the reproduction of designs called the rotation effect. Rotation is the term used to describe the fact that subjects often, when copying a design, make their reproductions in an orientation which is different from that of the model (see Figure 1).

In the treatment of depression “in all comparisons it is necessary to bear in mind that electroplexy carries a negligible mortality rate and that there are relatively few physical contraindications to its application” (Shepherd, 1959). Bruce et al. (1960) compared electroplexy and imipramine in 50 consecutive admissions and at one month the former is shown to give better results. Rees et al. (1961), whose cases were suitable for electroplexy, show only 35 per cent. with total remission or marked improvement after three weeks treatment with imipramine—a much lower figure than one would expect with E.C.T.

The common ground between neurology and psychiatry is regrettably slight, but in either field there have been men who sought to bring about a rapprochement between them by evolving broad conceptions of the structure of mind. For example, Hughlings Jackson's concept of “levels” and Freud's description of the mind in terms of Ego, Super-Ego and Id are both essentially attempts to define and classify the intellectual and behavioural functions of the brain, so as to form a coherent basis for the study of the interactions and disorders of these functions.

There are conflicting psychiatric opinions about the value of separating depressive illnesses into several syndromes on clinical grounds, and so far experimental attempts to reach a classification of depression by distinguishing physiological or biochemical features which characterize one group rather than another have had only limited success. One interesting series of experiments in this area has been that of Shagass and his colleagues on the sedation threshold (Shagass et al., 1956, Shagass and Naiman, 1956, Shagass, 1954); they report that neurotic and psychotic depressions can be differentiated by means of EEG and other reactions to sodium amytal (amylobarbitone sodium) neurotics requiring greater amounts of the drug to reach the sedation threshold.

It has been suggested (Foulds, 1961b) that a double classificatory scheme, which takes account of both the more unstable symptom variables and the rather more enduring and stable personality variables, should increase the reliability of the psychiatric diagnosis.

Schizophrenic patients given LSD-25 show an increase of psychopathological phenomena and a regression to the prime stage of their psychosis, the manifestations of which seem to be more directly related to the life history of the patients.∗ It has also been observed that some “normal” experimental subjects show various paranoid symptoms with the same drug, but whether these are in any way determined by heredity is not known.

The treatment of mentally subnormal patients is often complicated by abnormal behaviour, usually consisting of a mixture of aggression towards either themselves or others, extreme noisiness, hyperkinesis and general anti-social conduct. Because this presents great difficulties, particularly from the nursing point of view, the aim of all whose task it is to care for these patients has been to improve this behaviour pattern. However, until recently the treatment has been largely custodial, coupled with large and frequent doses of sedatives, usually of the barbiturate group. The advent of “tranquillizing” drugs, particularly the phenothiazines, seems to offer the possibility of controlling these disorders without reducing the patient to a vegetative state.

The argument to be put forward in this paper is that the way in which psychometric tests are often employed in geriatric problems may be less useful and, indeed, less sensible than is generally supposed. This applies to straightforward “intelligence testing” as well as to so-called “diagnostic testing”. It is recommended that the principles and practices of experimental psychology should be applied to these problems instead.

This paper represents an attempt to measure the reliability of the clinical assessment of the reaction to pain and further to estimate the significance of this reaction in a group of chronic schizophrenic patients.

The possibility that schizophrenia is associated with a relative deficiency of neuraminic acid in the cerebrospinal fluid has been suggested by Bogoch (1) and confirmed by Chistoni and Zappoli (5).

In the introduction to his Chairman's address in 1959, Warren (24) reminded us that both Cameron (6) from this country and Kanner (17) from the United States, had, in recent years, surveyed the historical background of child psychiatry. Chairmen of this Section may thus deem themselves exempted from repeating that task for some years to come. Warren took as his theme some relationships between the psychiatry of childhood and that of adulthood. It seemed to me appropriate to follow his lead and to carry our thoughts a step further by considering the child and adult as members of the family group, and to study how far it would be useful to accept the nuclear family, rather than the individual patient, as the functional unit in psychiatry.

Psychotomimetic drugs have been used increasingly in the past decade for facilitating psychotherapy, most experience being with lysergic acid diethylamide (LSD-25) (Sandison, 3; Savage, 4; Abramson, 1; Cohen, 2). Few attempts have been made to study experimentally their effects on therapeutic interviews, largely because of technical difficulties.

In this country reserpine is not used extensively as a tranquillizer for disturbed mentally subnormal patients, and a phenothiazine is usually the first drug of choice. This is probably due to the undesirable side-effects of reserpine, of which lethargy, depression, hypotension and Parkinsonism are the most important. However, a number of hyperactive and disturbed patients have in our experience responded better to reserpine than to a phenothiazine. Consequently, when a compound said to have an essentially similar action but to be free of these side-effects became available, we felt that a clinical evaluation should be undertaken.

In recent years there has been increasing experimental evidence that specific disturbances of perception occur in schizophrenia. Reduced size constancy in schizophrenic patients has been reported in studies by Raush (13), Crookes (6), and Weckowicz (16). Further investigations by Weckowicz and his colleagues (17), have also demonstrated reduced distance constancy in schizophrenia. (The retinal image of an object alters proportionately with the distance at which it is perceived. Size and distance constancy refer to our normal ability to compensate for changes in the stimulus and thereby to retain a stable perception of the object.) Brengelmann (3) and Angyal (1) have shown that schizophrenic patients have difficulty in reproducing briefly exposed visual stimuli. Penrose (12) has shown that schizophrenics perform poorly in a variety of tests involving visual discrimination.

While anomalies of sensory and perceptual responses characterize many mental disorders it is only recently that any serious attempt has been made to investigate them experimentally.

The work to be reported is a replication and refinement of a previous study (Bannister, 1960). As preface to the previous study, four traditional approaches to the problem of schizophrenic thought disorder were briefly reviewed, namely “dissociation” (Kretschmer 1936), “deterioration in mental efficiency” (Babcock, 1933), “concretism” (Kasanin 1946) and “overinclusion” (Payne, Matussek and George, 1959). These explanations and the experimental work arising from them were not utilized in the current research since it is argued that they suffer from three major defects.