The invitation to give a commemorative lecture of such importance evokes feelings of gratitude and pleasure that a body as distinguished as your own should show interest in the work of one's collaborators. This is especially so for us because the field in which we work might seem, to superficial observation, to be remote from practical interests. It has long been our hope that by study of a relatively simple animal we might be able to discover some of the fundamental features of living memory systems, which have not yielded to investigation in mammals or man. Your interest encourages us to think that we may be on the right lines and I hope that in return it may be possible to tell you at least something of the principles that underlie the coding and storing of information in the nervous system. But the brain is a very complicated instrument and the problem is far from solution. The account that I shall give will be grossly over-simplified and will probably seem to present an absurdly static picture of what we all know to be a continually active and dynamic system.

Following the socio-psychiatric surveys on the Chinese population in three communities from 1946 to 1948 (Lin, 1953), similar studies were carried out in Taiwan (Formosa) from 1949 to 1953 on four aboriginal tribes. The purpose of these studies was to investigate the characteristic features of mental disorders among the aborigines and the relationship of the occurrence of mental illness to their differential levels of social development. The present paper reports the main results of the comparative psychiatric surveys on 11,442 aborigines distributed among tribal groups of different levels of acculturation.

Social medicine seeks to discover and tries to remedy pathogenic influences arising from poor housing, poverty, and occupational hazards. Similarly, social psychiatry has shown much concern with the prevalence and incidence of mental disorders in different socio-economic classes, in urban as against rural surroundings, and especially in conditions of relative social isolation or integration, which have often been found to be linked with certain areas of towns and cities. The limitations of this ecological approach have been summarized by Clausen and Kohn (1954). They were highly critical of many of the assumptions made by ecological workers, and they felt that their approach was too coarsegrained. The units studied were too big, and they suggested that a study of family relations and of more intimate interpersonal interactions would be more rewarding and more likely to shed some light on the social aspects of mental ill-health. They might have added that it would also be much more difficult.

Although there is general agreement that the neuroses constitute a major public health problem there is little reliable information about their distribution. The difficulty is largely one of definition. As most people experience emotional conflict of some sort, the concept of neurosis can be widened so readily as to rob it of much value for medical purposes. Epidemiological enquiries have been hampered by disagreement about the nature of neurosis and by the lack of screening techniques (Shepherd, 1960). In consequence formal morbidity surveys have proved difficult to conduct and their results still harder to interpret.

Patients are occasionally encountered who spend much of their lives gaining admission to hospitals apparently suffering from acute surgical and medical conditions. They elaborate long and complicated histories which are full of falsifications, and may submit to operations which they do not require. Consequently an extensively scarred abdomen is characteristically seen in those who undergo repeated laparotomies, but seldom is anything found at operation to account for their symptoms, although adhesions from former operations are occasionally noticed. Usually they leave hospital against medical advice, or discharge themselves while investigations are still in progress or before their operation wounds have fully healed.

The practice of psychiatry in general hospitals is increasing and some of the problems it raises have been widely discussed. Many administrative questions have received close attention (Bennett et al., 1956; Smith, 1961) and the advantage to psychiatric patients of having readily available medical, surgical and laboratory facilities has been clearly seen (Gillies, 1959). It has been shown, too, that patients with mental illness can be admitted to beds in medical wards and be treated there successfully (Brook and Stafford-Clark, 1961). On the other hand, much less attention has been given to the psychiatric requirements of the general hospital itself, and there is very little information about the use that physicians, surgeons and specialists are likely to make of a psychiatric service for their own in-patients. Studies of psychiatric morbidity among general ward patients (Mittelmann et al., 1945; Zwerling et al., 1955) are of great interest, but they tend to shed an artificial light on the problems of practical needs and probable demands. Shepherd, Davies and Culpan (1960) have provided the most useful report so far, on the incidence of psychiatric referrals by physicians and surgeons and the clinical conditions encountered. This was the result of a one-year work-study specially set up for the purpose of investigating these questions at a general hospital in London. However, there appears to have been no account of findings based on the routine work of a hospital where a psychiatric unit has been well established.

Some of the earliest objective approaches to the removal of specific anxieties and fears in children were based on the fact that neurotic (learned, unadaptive) responses can be eliminated by the repeated and simultaneous evocation of stronger incompatible responses. An early and well-known example of this approach was the experiment of Jones (1) in which a child's fear of rabbits was gradually eliminated by introducing a “pleasant stimulus” i.e., food (thus evoking the anxiety-inhibiting response of eating) in the presence of the rabbit. The general method of “gradual habituation” was advocated by Jersild and Holmes (2) as being superior to all others in the elimination of children's fears. This rationale was crystallized in Wolpe's (3) formulation of the Reciprocal inhibition Principle, which deserves the closest possible study:

In recent years interest has attached to the fact that experiences allied to those described by patients during acute schizophrenic illnesses can be induced in normal people by the use of certain drugs, sometimes called “hallucinogens”. In so far as these drugs have caused hallucinations, however, they have induced predominantly visual hallucinations, whereas in schizophrenia the outstanding hallucinations are auditory ones, of voices—often making remarks in the third person singular, sometimes making apparently senseless or absurd remarks. In this paper, attention is drawn to means whereby non-schizophrenic persons can be caused to experience hallucinatory and illusory voices by primarily psychological and not pharmacological techniques. These techniques are also applicable to normal volunteers, but this paper will deal with first experiences of them during the treatment of some sexual deviants and alcohol addicts.

Recent time estimation studies (e.g. Loehlin 1959, Frankenhaeuser 1959, Wallace and Rabin, 1960) although carrying on studies dating back to the time of Vierodt and Wundt, suggest that time experiments merit more attention in modern psychology and psychiatry. Two omissions are (a) the time estimation of periods longer than one or two minutes and (b) the possible relation of individual variations of these estimates with individual personalty variations of a normal and abnormal kind. Everyday anecdote and observation in fact, do suggest a relationship in stressing how the passage of time varies with differing emotional states, even in normal people. In clinical groups striking variations of time experience have been recorded (see e.g. Dubois, 1954).

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 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.

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 order to explore the possibility of there occurring, in accordance with the Law of Mass Action, a reversal of the deposition of the cholesterol-lipoid-lipoprotein complex (Bevans et al., 1951), in the walls of cerebral arteries of atherosclerotic dements following a reduction in serum cholesterol, a study was made in March 1959 of changes that were shown in the behaviour of six such patients compared with six senile dements and four schizophrenics following the intake of large quantities of corn oil (Keys, 1956; Anderson et al., 1957).