The diagnostic criteria of descriptive psychiatry inevitably vary between the generations and even from decade to decade. New hypotheses imply new selections from the quite illimitable mass of data which may be collected from any patient. Hence new pictures may emerge whose relation to the old may be only partial, and whose inclusion under traditional rubrics may give rise to confusion, or pose problems which are verbal rather than clinical.

Golla, Hutton and Grey Walter (1943) made an attempt to use the EEG as an objective means of assessing imagery. They concluded that there were three types of alpha rhythm which corresponded to three different kinds of imagery processes: M or minus type whose alpha rhythms were almost non-existent and who used mainly visual imagery in thinking; the P or persistent type whose alpha rhythms continue even during mental activity, and who used mainly vocal kinaesthetic imagery; the R or responsive type with a good resting alpha rhythm which blocked readily during mental activity, and whose imagery was mixed. Though they were attempting to find an objective means ofassessing imagery an ultimate appeal is made to introspection as a validating criterion, and the tasks given to the subjects were such as to present difficult problems in the way of introspection. For instance, they were asked to think over to themselves the story of Red Riding Hood, to think over to themselves their plans for some definite day, to think over the argument for and against some abstract proposition such as “honestyis the best policy” or “the existence of free will”. It is felt that if an attempt is to be made to find an objective means of assessing imagery some at tempt should first of all be made to control the kind of imagery that will be used.

Some neurotic patients exhibit such a complex symptomatology that it is often difficult to determine, by present methods, which problems or areas of difficulty are fundamental. Much time may therefore be lost through the treatment of superficial rather than basic sources of difficulty.

A group of adolescent girl thieves have been examined by means of the Object Relations Test, in an attempt to estimate some of the psychodynamic factors determining their thieving. These girls are all at an Approved School where psychiatric treatment is given. They are all of average or superior intelligence and from materially good homes and their delinquency has been considered to be neurotic in origin. The age range is from 15 to 19 years.

A statistical study of large numbers of chronic mental patients may seem to have no direct bearing on the problem of how to treat the individual patient and prevent chronicity. Yet the collection and analysis of mass data form an essential part of epidemiological studies which have made possible many notable advances in preventive medicine. Much of the statistical information at present available in various official documents such as the annual reports of the Ministry of Health and the Board of Control, the Registrar-General's Statistical Review, are so generalized and fragmentary as to be almost meaningless (Lancet, 1955). A few mental hospitals publish annual reports containing broad statistical information; but the detailed facts needed for proper assessment of the size and nature of the problem and for any rational reform are almost invariably lacking. Throughout the field of psychiatry, particularly in connection with the development and effect of chronicity, the existing vital statistics are incomplete and inconclusive.

A paper by Shapiro, Post, Lofving, and Inglis (12) has reported on the relationship of certain aspects of mental functioning to the psychiatric illnesses of old age. This study confirmed that performance on some tasks which appeared to involve “memory function” is relatively more impaired in elderly patients with organic brain pathology than in elderly patients with functional psychiatric disorders. It was also shown, however, that the difference between functional and organic groups on these memory tests was not as great as might be expected on the basis of the commonly held psychiatric hypothesis that memory disorder is one of the leading features of early cerebral involvement in old age. The relatively poorer performance on these memory tests of the organic patients could not be accounted for in terms of, for example, lower intelligence, since the memory tests produced significant differences between the organic and functional groups whereas the intelligence tests did not. A process of correlational analysis (Inglis, Shapiro, and Post (8)) showed that these tests did seem to have some psychological function in common which could usefully be labelled “memory”.

The Malleus Maleficarum, the standard textbook of medieval witch-hunting published in 1484 (2), already mentions that “an illusion of sight and touch can be caused … by the summoning to the fancy or imagination of certain forms and ideas latent in the mind”, and continues by saying that “(the fifth) method of delusion of the devil is by working in the imaginative power, and by a disturbance of the humours effecting a transmutation in the forms perceived by the senses”. This might be the first working hypothesis ascribing certain behavioural changes of an apparently schizophrenic nature to biochemical influences.

In our clinical ward programmes we have utilized music rhythm instruments in rhythm groups to stimulate long-term schizophrenic patients and to induce their participation in social group endeavour. These clinical experiences together with various observations in this same connection, heightened our interest in the actual physiologic and motoric response of the schizophrenic patient to music rhythms. The evidence is strong that mentally “normal” persons do respond behaviourally and physiologically to music and its rhythms. Does the long-term schizophrenic patient manifest an objectively measurable response to such rhythm? If it could be demonstrated that the activity and the physiological functioning of the schizophrenic did respond to musical rhythms, then these stimuli might constitute a valid method for the modification of the behaviour of the schizophrenic patient.

Psychotherapy and what we understand by it today is commonly considered as entirely a product of the last fifty years of psychological and psychiatric development. The psychiatry of the past century is looked upon as a savage and uncultivated field which does not appear to warrant any attention. In a previously published paper I pointed out the strange contradictory development which the field of psychiatry has undergone during the past two hundred years, interchanging material-physicological periods with those primarily psychological. Each period has violently rejected the previous one and with it the total earlier development. This explains why the earlier development seems to be so completely forgotten. Only a few names are known which are pointed upon as forerunners, but no one has seriously attempted to go back over the last contradictory period into the preceding one with a similar basic attitude, for instance the psychologistical period of the first quarter of the past century. This should be of considerable interest to the psychological period we have been experiencing during the past decades.

Perhaps in no other applied discipline are there to be found so many differences of opinion as exist in clinical psychology today. Clinical psychologists in fact even disagree about the fundamental approach to their own subject. Let us examine briefly what appear to be the major approaches.

Nicotinic acid, well known physiologically and chemically as a vitamin if administered in small quantities, has many interesting additional properties when given in relatively large amounts. Altschul (2, 3) found that it markedly decreased the levels of cholesterol in rabbits made hypercholesterolemic by diet, and Altschul, Hoffer and Stephen (4) found that in divided dosages of three grams per day this vitamin produced appreciable decreases in the cholesterol levels of healthy young subjects and in patients from a general hospital. The decrease was related linearly to the initial cholesterol levels while the percentage decrease increased as the initial cholesterol levels were elevated. The incorporation of nicotinic acid into atherogenic diets inhibited the development of arteriosclerosis in rabbits (Altschul (2)). Of seventeen animals tested, two showed intense arteriosclerosis, six showed mild change, and nine showed no arteriosclerosis. Without nicotinic acid, at least thirteen of the rabbits would have had severe arteriosclerosis on the basis of many previous studies by Altschul (2) and by many other investigators.

During recent years various tranquillizing drugs have been used therapeutically, namely, chlorpromazine hydrochloride (Largactil), reserpine (Serpasil), benactyzine hydrochloride (Suavitil) and hydroxyzine (Atarax) in mental disorders. Chlorpromazine and reserpine, though effective to a certain extent in mental disorders of the disturbed type, have the disadvantage of certain side-effects which have necessitated reduction and even cessation of the drugs, even when proving clinically efficacious.

It is now generally conceded that slow wave activity tends to appear in the EEG as age advances. Attempts have been made with varying success to relate these slower rhythms to the presence of organic cerebral deterioration.

In a previous report (Cole and Glees, 1956) on methyl-phenidate (Ritalin) as an antagonist to reserpine (Serpasil) in monkeys we referred to a similar effect produced by amphetamine. Following up this work we have now studied and compared the effects of methyl-phenidate and amphetamine when given separately without reserpine to normal and leucotomized monkeys.

Experimental work on the performance of schizophrenic patients indicated that different patterns of response were to be found among patients who could be considered subjectively as withdrawn and inert on the one hand, and sociable and active on the other. This subjective classification appeared to cut across diagnosis within the schizophrenic group.

Bickford has underlined the need for devoting more attention to the chronic psychotic patient and stressed the possibility of accelerating what he believes to be the inevitable remission of the psychosis. There may be a current tendency to think in terms of the physical or pharmacological treatments in handling psychotic patients and to overlook the value of more conservative measures. Myerson attempted to revive interest in the latter by coining the term “total push” and providing a theoretical basis for the activities organized. Galioni et al. presented the results of a similar programme which showed 18 · 5 per cent. of the experimental group “separated” from the hospital as compared with 5 per cent. of the controls. Kamman et al. show that while the initial improvement certainly takes place, unless careful placement is achieved relapse occurs.

A Multi-Dimensional study of a consecutive series of female patients, aged 40–55,in whom psychiatric illness necessitated first admission to a mental hospital, has already been reported in its general and clinical aspects and in relation to the psychological test findings.