The following paper describes the psychological part of a psychiatric and EEG study of psychiatric illness occurring for the first time in women of the involutional age range. The origins of the investigation and the clinical results are fully discussed elsewhere (Tait et al., 1957). They include such matters as the psychiatric observation that classical forms of melancholia seem to have become relatively infrequent. One possible explanation for this may be thought to be in the earlier recognition, hospitalization and treatment of psychiatric illness. It was decided that an appropriate study would pay attention only to women who are admitted to a mental hospital for the first time. In practice this has included all such women admitted to amenity beds in the hospital over a given period of time. This modified selection of admissions was made in order to ensure as wide a range of illness as possible, giving a higher proportion of neurotic illness without excluding psychotic material. The age range studied was that usually considered to encompass the normal range of the biological involution, 40–55. Such a study thus avoids the bias (apart from age) of any preconceived mode of selection. By including only first admissions, some assurance was given that up till then, the patients had been reasonably free from psychiatric illness.

The safety of electro-convulsive therapy (E.C.T.) has been greatly increased since muscle relaxants were first introduced for this purpose. Short-acting relaxants such as suxamethonium and suxethonium reduce the usual strong tonic and clonic contractions to faint muscle twitchings, and fractures do not occur. Respiration can be maintained throughout by positive pressure inflation so that cyanosis and stertorous breathing are avoided. This may ensure that material from small pulmonary lesions is not disseminated to other areas. It is disappointing that the cardiovascular commotion is only slightly reduced, and deaths still occur, albeit rarely.

In attacking the problem of the relationship of endocrine function to the schizophrenias and other mental diseases, we have avoided the elementary conception that certain hormones are responsible for special psychological traits and have reached the following conclusions. First, the quality of the mental disturbance depends mainly on a genetically conditioned personality pattern, various individuals reacting in different ways to the precipitating causes. Second, the hormones come into the whole picture only in so far as the hormone equilibrium of the body determines how far the individual can adjust himself to the increased demands arising out of the occurrence of various precipitating causes (Reiss, 1955). It is therefore understandable that very many, or even the majority of people suffering from severe endocrine disturbance, need not necessarily show any psychopathological changes, since their personality pattern is not so conditioned and no increased demands for adjustment are made by the occurrence of precipitating causes. On the other hand, it is equally understandable that certain disturbances in hormone production and equilibrium, even when clinically obscure, can be decisive for mental breakdown in individuals with the appropriate personality pattern, at the occurrence of precipitating causes.

For this purpose average normal values were studied in 40 normal cases, and 40 mental cases were selected from amongst those who were suffering from various mental disorders who were given electric convulsive therapy.

In recent years a number of new drugs have appeared, grouped together as so-called tranquillizing agents. The publication of three very encouraging papers describing the use of meprobamate prompted the present trial. Selling (1955) prescribed one 400 mg. tablet daily after each meal and one at bedtime in 187 cases, combined with psychotherapy, and found its use in anxiety and tension states was of considerable value (90 per cent and 95 per cent respectively improved or recovered). Borrus (1955) used one to six 400 mg. tablets daily in 104 cases. In 68 per cent of all cases, and 78 per cent of the anxiety states, there were favourable results. Lemere (1955) contrasting chlorpromazine and reserpine, found meprobamate (used in over 250 patients with at least 70 per cent good results) to be relatively uniform in its action, remarkably free from side reaction and more effective in the relief of insomnia. All three authors stressed the absence of toxicity.

In a previous paper one of us (4) has elaborated a theory relating drug action to personality. According to this theory, depressant drugs increase cortical inhibition (Pavlov) or reactive inhibition (Hull), thus producing an extraverting effect on personality, while stimulant drugs decrease inhibition and produce an introverting effect in behaviour. It was also suggested in this paper that a direct proof of the hypothesis might be obtained by making predictions regard ing the effects of stimulant and depressant drugs on a variety of experimental laboratory situations connected with the general theory of inhibition and excitation.

It is a well-known principle in psychology that the effects of sensory stimulation do not cease when the stimulus itself ceases. The so-called visual after-images are probably the best known of these after-effects, but almost equally well known are those induced by a rotating spiral. If a normal person fixates the centre of the rotating spiral for a period of time, and if then the motion of this spiral is suddenly stopped, an after-sensation of movement is well nigh universal. This after-sensation is opposite to the original motion in direction, just as the after-image produced by the fixation of a colour is usually the complementary colour to that which caused the original perception. There is little doubt that while peripheral factors play some part in these after-effects, central features also play a part, and it becomes tempting, therefore, to use phenomena of this type in attempts to verify or disprove the drug action hypotheses advanced by one of us in a previous paper. This hypothesis stated that stimulant drugs increased excitatory potential and decreased inhibitory potential, while depressant drugs decreased excitatory potential and increased inhibitory potential. The question now arises as to how this general postulate can be applied to the phenomena under discussion.

During the last few years the use of electroconvulsive therapy in the treatment of out-patients has greatly increased. For example, in 1951, one hundred and forty-one treatments were given in the out-patient department of Freedom Fields Hospital, Plymouth, while in 1955, four hundred and sixty-four were given. There is no doubt that the number of treatments given to out-patients has increased even more in the country as a whole, as many hospitals did not start giving E.C.T. on an out-patient basis until well after 1951.

For this study, calcium level in the blood was studied in 20 normal individuals between the ages of 20 and 25 years to find out the normal serum-calcium level in them in order that this finding might serve as a control. It was found to vary from 8·9 to 11·0 mg. per cent. (see Table I).

In the first paper of this series, it was pointed out that one of the reasons why McDougall's theory of drug action and personality was not accepted at all widely was connected with the fact that he failed to provide an objective, experimental test which could be used to diagnose extraversion-introversion, and to assess drug effects. This argument is not entirely correct; McDougall did in fact suggest one such test, namely the rate of fluctuation of so-called reversible perspective figures. Many varieties of these are known, and have been used experimentally; the Necker cube, the staircase, the vase-face, and the windmill patterns being probably the best known. In all of these, there is an ambiguity in the drawing which makes it possible to perceive two distinct patterns in the stimulus; on prolonged inspection these patterns alternate, and it is the rate of alternation, signalled verbally or by suitable mechanical arrangement, which constitutes the score on this test. It is known that different types of pattern give reasonably reliable scores, and also that rates of alternation on different patterns correlate quite highly together, thus demonstrating that one and the same tendency is being measured. That this tendency is of central rather than peripheral character is indicated by the fact that changes in the rate of reversal due to fatigue and other causes can be transferred from one eye to the other.

In a previous paper in this series, a brief discussion has been given of the theoretical reasons for anticipating that depressant drugs would shorten the perceptual after-effects of visual stimuli, and stimulant drugs would lengthen these effects. The present paper is concerned with a related type of prediction, also concerned with certain visual after-effects. The phenomenon in question was first observed by Bidwell; it has not received much study, unfortunately, in spite of its great theoretical interest. The phenomenon is simply this. If a beam of red light (the primary stimulus, or Sp) is thrown into the eye of a person having normal colour vision, that person will report a red sensation, followed after the extinction of the light source by a series of after-images, usually in the complementary colour. The theory governing the appearance of the after-image is conventionally a photochemical one; the Sp produces certain effects in the retina which are opposite in direction for complementary colours and which are reversed when the Sp ceases to act on the retina. This reversal is perceived as the complementary after-image. Bidwell discovered that when the Sp is shown only for a relatively short period of time, say 20 milliseconds, and is immediately followed by a neutral stimulus, such as a beam of white light, then the S is not perceived at all, but only the complementary after-image. In other words, a red stimulus is perceived as green, a green stimulus as red. It is this perception of a non-existent stimulus which caused the phenomenon to be of such interest to psychologists.

This paper sets out to demonstrate similarities of behaviour between obsessionals and hysterics in responses to perceptual conflict, which might be expected on the basis of psycho-analytical theories, but which could not be predicted from the dimensional framework of personality favoured by Eysenck in which obsessionals and hysterics are found at opposite poles of an introversion-extroversion continuum, and in which anxiety states, depressives and obsessionals are grouped together in one indistinguishable category of dysthymia.

Chemically hydroxyzine is one of a series of p-chlorobenzhydryl piperazine derivatives. It has a formula as follows: