May I, in the first place, thank you most sincerely for the honour you have done me by electing me as your President during the coming year. Whilst the names of my distinguished predecessors enhance this honour in my eyes, at the same time I cannot help a feeling of humility and inadequacy at the thought of attempting to follow in the footsteps of those illustrious members of our profession whose names shine ever more brightly as the march of time reveals more clearly their contribution to our specialty and to the welfare of the mentally ill.

When the Council greatly honoured me by their invitation to be the Maudsley Lecturer for 1956, my first concern was as to what subject I could choose for my remarks.

The nomenclature of neurology is already so extensive and so chaotic that every proposed new term requires its apology and precise definition before being accepted—just as every term, new or old, should be weeded out, if it cannot be given a satisfactory definition.

This paper follows a preliminary communication to this Journal two years ago (Sandison, Spencer and Whitelaw, 1954) and gives an account of the fuller experience gained up to the present time with lysergic acid diethylamide in the treatment of mental illness.

Although numerous instances of the surprising efficacy of placebos in a wide variety of conditions have been reported lately, little has yet been done towards providing an explanation of the occurrence of placebo reactions in terms of psychology. In what follows, the main findings concerning placebos will first be described, and then an attempt made to relate them to psychological theory. Even if this attempt is premature, it may succeed in showing the need for further work and in suggesting what directions this might take.

The following case of Folie à Trois, in which a married couple and the husband's brother shared a system of paranoid delusions, is being reported firstly because of the rarity of the condition, and secondly because it presents several unique features which it is hoped will shed further light on the nature of induced psychosis.

In a previous study, Shapiro, Post, Lofving and Inglis (10) found that a modified version of the Bender Visual-Motor Gestalt Test differentiated, at a high level of confidence, three groups of elderly psychiatric patients: brain-damaged patients, functionals and a group of doubtful diagnosis. This level of confidence was far higher than that of any of the other 24 tests used. Furthermore, a number of recent studies have shown that the Bender test differentiated Organic from non-Organic subjects (2, 4, 6, 7, 8). In our own Department Yates (13) found significant differences on measures of the reproductions of other designs between Organics and Functionals. In view of these findings we decided to investigate our own results further. Our general purpose was to measure and control some of the variables appearing relevant in the performance of the task and in this way make possible testable explanations for the results.

Recently D. S. Trouton and A. E. Maxwell (7) reported the results of a factorial analysis of 45 variables derived from an Item Sheet used at the Bethlem Royal and Maudsley Hospitals. Their sample consisted of 819 male hospitalized patients aged 16-59 having non-organic psychiatric disorders. The variables included the major symptoms and past history notations of psychotic and neurotic patients. Their analysis yielded six factors, the first two of which were identified as “psychoticism” and “neuroticism”. The authors conclude that their findings support the view that the varied symptom patterns of mental illness can be accounted for by these independent components.

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.

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.

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.

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.