My first duty is to thank you for the very great honour you have done me in electing me to the office of President of the Royal Medico-Psychological Association, an office which in the past has been held by so many distinguished men in comparison with whom I feel very unworthy. I am greatly touched by this evidence of your goodwill.

The purpose of psychotherapy does not differ essentially from that of the treatment of sickness generally. It is to relieve distress and promote efficiency of mind while improving the patient's adaptation to the group in which he lives, to their mutual benefit. Before psychotherapy can be prescribed or undertaken, a diagnostic review is necessary of the relationship between the patient's psychophysical constitution and the stresses to which he has been and is being exposed. This relationship is a complex one which involves the effects of previous stresses and the way in which they have been surmounted or have left their mark. The introduction of a third complex entity, the method and personality of the therapist, renders the total situation too involved for detailed comprehension and logical analysis, especially if the therapy is to be of the causal-anamnestic or comprehensive kind which is not content simply to deal with symptoms and their immediate causes. In the presence of this degree of complexity—well beyond the range of mental encompassment by one mind at one time—the psychotherapist must walk in humility, for he can rarely feel justified in thinking that he knows exactly what is going on.

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.

I should like to express my deep gratitude to you, Mr. President, to the immediate Past President, Dr. L. C. Cook and to the Association for the great honour that has been bestowed upon me by your invitation to deliver a lecture in this august series. It is a custom that the lecturer should pay homage to Henry Maudsley to whose memory these lectures are dedicated: may I reserve my homage until we come to the active part Maudsley played in the course of events with which this lecture will be concerned.

In previous studies of patients on whom an anterior temporal lobectomy has been performed for the relief of temporal lobe epilepsy, it has been shown that, following removal of the dominant temporal lobe, certain specific defects of cognitive functions arise which are not present after removal of the non-dominant temporal lobe (Meyer and Yates, 1955; Meyer, 1957; Meyer and Jones, 1957; Meyer, 1959). The present study has been undertaken to find out whether destruction or damage to the same region by massive lesions such as tumours and large scars would produce comparable findings.

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.

Disturbances of ego, self-concept and body-image have always been regarded as central in the psychopathology of schizophrenia. The passivity phenomena, automatisme superieur of the French authors, are indeed very common in this disease. There is a disturbance of the self which is shown in depersonalization and in feelings of influence and passivity. The boundaries of the self become loose or blurred and the patient may feel, for example, that parts of his body do not belong to him or that he is part of the plants, animals, clouds, other people or of the whole world and that they are part of him. He may feel at one with the whole of mankind. Self-concept is closely related to what has been termed “body image” or “perceived body”. Head (29, 30) has shown that what he called “body schema” is very important for motor co-ordination and performance of purposeful movements and also for orientation in space. Schilder (53) in his monograph has analysed the problem of body-image in great detail. He has found in the idea of the body image the basis for the body or physical ego. He follows Head in stating that the body image consists of the proprioceptions of the whole body and that it changes with the body's varying postures. Yet neither Head's body schema nor Schilder's body image are identical with the body ego. The body schema represents the constant mental knowledge of one's body; the body image is the changing presentation of the body in one's mind. Throughout the changes of the body image there is an awareness of continuity of one's body, a sense of basic identity and oneness. This constitutes the bodily or physical ego. The body ego in its turn is the basis of a wider “self” which can be called self-concept or selfhood. This self-concept or selfhood contains, in addition to the awareness of the continuity and the identity of one's own body in spite of its constant change, the awareness of the continuity of one's self as a person in spite of constantly changing relationship with the external world, and in spite of the playing and taking different “roles” in social interactions. According to Mead (38) and Coutu (16), selfhood is a social phenomenon and emerges only through interaction with other people, through “taking their roles” and viewing oneself from their point of view.

I am deeply appreciative of the great honour you have done me in electing me as your President for the coming session. Although very sensible of this honour I am also much aware of my own shortcomings when I remember the distinguished men who have preceded me in this office. The following contribution, I am afraid, contains very little that is original. The purpose of this paper is rather to emphasize a point of view in the study of psychotic illness, which does not always seem to receive adequate attention.

Since the introduction of chlorpromazine for the treatment of mental illnesses a number of other tranquillizing drugs, belonging to the phenothiazine group, have come into use. Experience has shown that the first of a new kind of drug is not necessarily the best and it is important that “variations on a theme” should be properly tested.

For the Chairman's Address to the Child Psychiatry Section in 1955, Cameron (5) decided to survey the scene of Child Psychiatry. His survey was historical and he described the various influences that have in turn borne on and helped to shape the practice of Child Psychiatry as it is today. Kanner (9), in the Maudsley Lecture of 1958, took the same theme and elaborated on it further. It is significant that they both felt that the time had come to do this for a young speciality and, indeed, their lectures were of considerable interest and use to those of us who have not lived through—in Child Psychiatry—the times described. However, Child Psychiatry has not become static; the scene will continue to change and to enlarge as more new influences come to bear. It seems that we who are engaged in its active practice now, and in the future, have need to watch where we are going; especially, as comparative success has brought some rewards and we foresee the likelihood of further rapid expansion in the speciality, with the need, to recruit more child psychiatrists. Again, the joint or liaison committees that have sprung up with other medical professional bodies are in a sense a recognition of our significance; they are also a responsi bility and may be a test of our loyalty to psychiatry as a whole.

This paper is offered as a contribution to the better understanding of depersonalization. It is divided into two sections. In the first section an account is given of the occurrence of brief episodes of depersonalization in young normal adults. In the second section a consistent interpretation of the symptoms of the syndrome itself is attempted. The two sections are loosely connected; the conclusion drawn from the study of the material in the first section—that it is the persistence, and not the nature of depersonalization which is abnormal—needs to be applied to the considerations advanced in the second. The interpretation will do as well for the brief experiences as for the established syndrome. The writer hopes that—if the interpretation is acceptable—the way will be cleared for attention to the remaining problem posed by this perplexing condition; why, in some cases, it endures. The following abbreviations are used throughout: For the depersonalization syndrome DP; for the depersonalization symptom, dp; for derealization, dr; for desomatization, ds; for the loss of feeling which frequently accompanies the other symptoms, dE; for visualization, vs, and for loss of visualization, dv; for the slowing-up of subjective time, dT.

“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).

The need to clarify the “confusion in neurology and allied disciplines between the body image, the body schema, the body concept and the perceived body” was emphasized by Smythies (1953). For the neuropsychiatrist it is perhaps the disorders of the body schema and perceived body which are of the greatest interest and importance, but the confusion which still exists between the body concept and the body percept make it probable that a definition and examination of the body concept would clarify thinking about all Body Image problems.

An investigation into the factors concerned in the etiology and pathogenesis of childhood schizophrenia is fraught with difficulties in numerous areas. Encountered are such problems as the diagnosis itself; doubt that psychoses exist in childhood; the existence of the duality organic or functional schools of thought, and of frequent contradictory findings reported by various groups of investigators in the field.

In these days we expect a good deal of a painter with claims to originality—a good deal more than most of them can give. We are habituated to pictorial representation as a major means of communication of ideas and we are surrounded by technically proficient work in the competitive field of advertising. Work of this kind is evocative too—at least to the variety of emotions which may determine the act of buying—and the poster that does not come off soon comes down. Except in the esoteric field of prestige-advertising, the sales-curve is the sole judge of the efficacy of this kind of appeal and the consumer—the indirect and unwilling patron—is rarely himself able to judge the effects of such hidden persuaders as the artist has built into his work.

Nearly one hundred years ago, Anstie (1864) wrote: “Among the too frequent instances which are to be found in medical nomenclature, of confusion and uncertainty in the application of descriptive terms, there is none, perhaps, more striking than is occupied by the words Narcotic and Stimulant.” Both classes of substance embrace drugs of antiquity. Thus of the depressants, alcohol dates from the time of the Thracian god, Dionysus, while the earliest use of stimulants such as caffeine and xanthine is lost in the obscurity of the past (Goodman and Gilman, 1955a). Even today, there exists no systematized codification of response to the two classes of drug, although it is implicitly assumed that stimulants and depressants are invariably and mutually antagonistic in their effect on the central nervous system. Advantage was therefore taken of phenomena arising during drug intoxications to categorize abnormal features in the central nervous system common to each of the two classes of intoxicant and to essay a comparison, the one with the other.

In a previous study H. Holland (3) had found an increase of static ataxia under a depressant drug, as compared with a “no drug” condition, and in view of the close relation between static ataxia and the body sway test of suggestibility (1), which in turn is a frequently used measure of personality, it appeared desirable to investigate the general problem of the relation between drugs and behaviour on the ataxia test.

The authors wish to describe and discuss a patient suffering from a sub-acute organic psychiatric syndrome, who appeared to have visual hallucinations. One of us (F.F.) had been interested in the attempt of K. Conrad (1953a, b) to apply Gestalt Theory to the psychiatric syndromes due to coarse brain disease. When he heard of this case, he felt that the psychological approach of Conrad would explain the patient's unusual symptoms. The case was under the immediate care of Dr. A. Forrest and psychological testing had been carried out by Mr. E. Macpherson. The three authors decided that the case merited publication in view of its considerable clinical and theoretical interest.

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.