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.

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.

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.

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.

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.

There are, in the main, two principal methods of biological research into the problem of causation of schizophrenia. In the first, or direct method, studies are made of the body fluids and of the metabolism of schizophrenics in the hope of turning up some toxic factor or error of metabolism. Such studies are currently under way in a number of centres and, although many claims as to positive findings have been made, none of these has as yet been substantiated and the majority have actually been refuted by subsequent analysis. These studies have been directed by two main hypotheses of the causation of the illness described in a previous communication (14). Now it is clear that one great difficulty entailed in using this approach is that our basic knowledge of neuro-chemistry and neuropharmacology is still extremely limited. The very complexity of the neurochemical processes of the brain would seem to offer a large number of possible loci of metabolic disturbance, any of which might be responsible for the onset of schizophrenia. Thus, we can say that the probable results of all such investigations at present will be purely negative, i.e. we will discover that the given metabolism of injected adrenaline, serotonin, etc., is normal in the illness. Thus, the second, or indirect, method becomes increasingly important. This consists of two parts. The first is implied merely by the general statement that the advance of neurochemistry and neuropharmacology may disclose other areas of function in which specific hypotheses of the causation of the illness may be constructed. The second consists of a detailed study of the precise mode of action of known psychotomimetic agents. Knowledge of the mode of action of mescaline and LSD-25 in detail would pinpoint areas for research in the metabolism of schizophrenics. Unfortunately, however, very little seems to be known at present of the mode of action of these drugs. Most of the work that has been done has been carried out on LSD-25 (see e.g. the annotated bibliography put out by Sandoz Inc., Hanover, New Jersey, 1958). However, the important field of the structure-activity relationships (SAR) of mescaline seems to have been strangely neglected. The research programme here would include the synthesis of a number of analogues of mescaline according to systematic principles to determine the role the details of its molecular structure play in the mode of action. These analogues would be subjected to a number of tests—psychopharmacological, neurophysiological and neurochemical—comparison between the results of which would give important information not only of the SAR of mescaline but also of the details of its mode of action and the interrelationships between behavioural, neurophysiological and neurochemical factors involved that would help us explain the former effects in terms of the latter, which reduction is the main aim of biological science. The present paper reviews the little that is known at present about the SAR of mescaline and then reports some new studies in the psychopharmacology of this field.

In their evidence to the recent Royal Commission on the Law Relating to Mental Illness and Mental Deficiency the R.M.P.A. stated the problem of the psychopath in terms of delinquent or otherwise anti-social behaviour. After eliminating cases where such behaviour resulted from well-recognized forms of mental illness or defect, from psychoneurosis or organic disease or injury, their Memorandum went on to say that there remained a group of patients “whose daily behaviour shows a want of social responsibility and of consideration for others, of prudence and foresight and of ability to act in their own best interests. Their persistent anti-social mode of conduct may include inefficiency and lack of interest in any form of occupation; pathological lying, swindling and slandering; alcoholism and drug addiction, sexual offences, and violent actions with little motivation and an entire absence of self-restraint, which may go as far as homicide. Punishment, or the threat of punishment, influences their behaviour only momentarily and its more lasting effect is to intensify their vindictiveness and anti-social attitude.”

Surgical removal of the temporal lobe is becoming an established therapeutic procedure in the treatment of focal epilepsy arising in one or other of the temporal lobes and good results in the control of otherwise intractable seizures have been widely reported (e.g. Falconer et al., 5; Picaza and Guma, 18). Indeed, with increasing experience of anterior temporal lobectomy and delineation of the indications for operation, even greater success may be anticipated (Hill, 9; Rasmussen and Jasper, 19).

There has recently been a good deal of concern expressed in the Press, both of Nigeria and Ghana, over the high incidence of psychiatric disturbance among West African students in the United Kingdom. Whether the incidence of such disturbances is in fact greater among Africans than among other foreign students in the British Isles is not known; nor has it been determined whether the African student abroad is more prone to illness than his counterpart studying at home. Relevant to the latter question, it is clear that a high proportion of the cases seen in the psychiatric clinics both at Aro Hospital, Abeokuta and at the University College Hospital, Ibadan, are students, teachers and other “brain workers” who have never left Nigeria.

The value of phenothiazine derivatives in psychiatric practice is well established, but in spite of their undoubted usefulness in certain psychiatric disorders none has proved entirely acceptable. The introduction of a new derivative that is reported to be less toxic than earlier phenothiazine derivatives and highly active in small doses merits investigation and trial.

It is well known that psychiatric diagnostic groupings have no claim to represent any fundamental scientific causal principle, but reflect rather the needs of administrative convenience and compromise between different theoretical orientations (Eysenck, 1960). Doubt has in fact been expressed regarding the advisability of retaining categorical divisions in a field where quantitative differences along orthogonal dimensions may be more appropriate than qualitative differences between distinct disease groups (Eysenck, 1947). The appropriate statistical method for dimensional analysis is, of course, multiple factor analysis (Eysenck, 1952) and it is possible to show relationships between factors or dimensions and psychiatric categories by giving factor scores to the subjects of the experiment and to average these scores for groups of subjects sharing a common diagnostic label (Eysenck, 1959). In this way it has been demonstrated that along the dimension of extraversion/introversion, subjects diagnosed as psychopaths tend to have particularly high extraversion scores; hysterics tend to be extraverted but not as highly as psychopaths. Patients suffering from one of the dysthymic conditions (anxiety, reactive depression, obsessional disorders), tend to have high scores on introversion. Mixed neurotics tend to be in between the other groups. All these diagnostic groups have high scores on the factor of neuroticism which is orthogonal to extraversion/introversion (Eysenck, 1957).

Reserpine was first used extensively in mental hospital practice in this country in 1954. Conflicting reports as to its usefulness in psychiatry have appeared and, before a standardized assessment of the drug could be made, investigators examined the combined use of reserpine and chlorpromazine (Barsa and Kline, 3). Hare et al. (10) have pointed out that there is a sequence of events in the investigation of a new drug that is associated with a fluctuating enthusiasm as to its usefulness, and it is our belief that a commentary now on the present use of reserpine would not be out of place. Kline (13) was one of the first to describe the use of reserpine in American psychiatric practice, and his report was shortly followed in this country by those of Foote (8) and Glynn (9). These early studies were essentially preliminary investigations and concerned the use of reserpine in groups of patients, sometimes small, or of one sex. Other more extensive North American investigations by Noce et al. (17) and Azima et al. (2) showed that the beneficial effect of the drug was not as widespread as originally thought, even with adequate dosage, in schizophrenia. Barsa and Kline (4) produced further conflicting evidence that the drug was of value in all kinds of mental illness, although in a later paper in 1956 (3) they outlined the comparative uses of reserpine when contrasted with chlorpromazine.

The terms extrapunitive and intropunitive were introduced by Rosenzweig (1938) to denote two of the possible ways in which an individual might react to frustration or blame. He defined the extrapunitive reaction as: “When the individual tends to blame the external world, reacts with anger and hostility, and psychologically defends himself by what the psycho-analyst describes as the mechanism of projection. An ego which fears blaming itself thus gains security by blaming others instead”.

Few techniques are available which have as their aim the quantitative determination of a physiological function of the human brain. Of these the photomyoclonic threshold has received most attention and numerous reports have appeared concerning findings in epilepsy, schizophrenia, other psychiatric conditions and normal controls (2, 4, 5, 9, 10, 11, 14). The precise neuro-physiological meaning of the “threshold” is unknown but since the first publications of Gastaut (5) it has been widely assumed that the measure is one of diencephalic function and that a change in the latter can be detected by the resulting threshold change.

Attention has been focused on the ecological aspects of mental illness since Faris and Dunham (1939) showed a higher incidence of schizophrenia in the centre of Chicago than in its peripheral parts. Earlier, Ødegaard (1932) had described a disproportionately high rate of psychotic breakdowns in Norwegian immigrants to Minnesota and in those who had returned to their homeland after a period of time in the U.S.A.

At the beginning of this century the high rate of “insanity” among immigrants was a matter of considerable concern in the U.S.A. and it has been used as one of the main arguments for curtailing immigration. The problem has been reviewed, and examined with modern statistical methods, by Ødegaard (1932) and Malzberg (1940).

This investigation was designed to determine whether significant alterations in the metabolism of nitrogen, calcium, and phosphorus occur in psychiatric patients during the therapeutic administration of electric convulsive treatments. Gour and Chaudhry (1) observed transient changes in serum calcium following grand mal convulsions in a series of patients. Jarvie and Mulligan (2), repeating this experiment in patients receiving muscular relaxants during the administration of E.C.T., failed to demonstrate similar calcium changes. More intimate knowledge of electrolyte metabolism can be obtained by means of balance techniques (3), whereby the degree of retention or loss of a particular substance can be ascertained by maintaining each patient on a constant daily intake and regularly determining the urinary and stool excretion of that substance.

Many years ago one of us was introduced by a senior colleague to Thomas Hennell's fine book, The Witnesses (23), and so began in a desultory way to collect accounts of their illnesses written by mentally ill people. We have found that many people know a few books of this genre and speak warmly about their usefulness. One gets the impression that these books are unobtainable. In 1956, after reading Hunter's and MacAlpine's (44) translation of the Schreber Memoirs, and later Schizophrenia, 1677 by the same authors, which consists of Haitzman's account of his illness, we realized that these books had played and could play an important part in the development of psychiatric theory. Indeed, the psychoanalytic theory of schizophrenia derives from the Schreber Memoirs and, although Hunter and MacAlpine rebuke Freud for his extremely selective use of those memoirs, they do not suggest that any systematic study of these writings would be valuable. Psychiatrists of many different persuasions have been given to examining a host of historical, literary, and mythical characters from Moses to Popeye the Sailor; but so far we have been unable to find any systematic study of this uniquely valuable body of information provided by the sick themselves.

The Sentence Completion Test is now a well-established technique. It is more than sixty years since Ebbinghaus (2) published the first completion test, which he used to assess mental abilities of schoolchildren in Breslau. But it was not until 1928 that the completion method was used for “personality” assessment, when a fifty-item test was used by Payne (11) as part of a guidance programme.

The widespread use of barbiturates as hypnotics for insomnia has greatly increased the risk of accidental overdosage and the number of suicidal attempts. The size of the problem concerning barbiturates and suicidal attempts is difficult to estimate as only suicidal deaths are recorded by the Registrar General, and his statistics for 1956 (R.G., 1958) reveal that out of a total of 5,282 suicidal deaths, drugs (mainly barbiturates) were second only to domestic coal gas poisoning as the effective agent. Stengel (1958) calculated that six times the number of suicidal deaths gives an approximate estimate of the number of attempted suicides. Locket and Angus (1952) found that of the patients admitted to their Unit, barbiturates were the drug involved in 80 per cent. of the cases and that in 90 per cent. of the cases it had been prescribed for the treatment of insomnia. Locket (1958) also estimated that some 6,000 patients were admitted annually to hospitals in England and Wales for treatment of barbiturate poisoning.