The word “personality” is being used in psychological medicine with increasing frequency. Personality tests are now to a large extent replacing pure intelligence tests, the term is frequently encountered in psychological papers, monographs and text-books, and one modern journal is even entitled Character and Personality.

The interrelationship between neurotic manifestations and psychotic reaction types represents one of the major problems of psychiatry. Psychotic reactions sometimes develop in patients with old-standing neuroses. It is also well known that neurotic symptoms are not uncommon in the preliminary stages and during the course of psychoses. However, the knowledge of the interaction between neurotic and psychotic manifestations is still incomplete. In this study an attempt is made to elucidate some of the clinical aspects of this problem. It is not intended to discuss here such basic issues as the definition of neurosis and psychosis and their interrelationship in general. Those questions have been widely debated, and it seems doubtful whether much can be gained from a continuation of this discussion at the present stage of psychiatric knowledge. In a clinical study the question whether or not there is a fundamental difference between neurotic and psychotic symptoms and behaviour is better left open. An investigation into the interplay between various phenomena of mental illness occurring in individual patients is justified, even if one looks at them as manifestations of a single and continuous development.

Those who read the Police Court reports in the newspapers—and every psychiatrist should!—will have read, since the war, of persons guilty of unlawfully wearing military uniform or medals. Often the crime appears to be due, not to ordinary motives of gain, but to motives of personal prestige. Seven cases of this disorder of behaviour have been observed at the Royal Edinburgh Hospital for Mental and Nervous Disorders, and in these cases at least the problem has been one of gravely disordered personalities. It seems worth while reporting the cases, as so far little psychiatric interest has been taken in them. Petrie (1942) and Rossiter Lewis (1942) have each referred briefly to one case. Three of the cases were included in the figures in a previous paper on psychiatric states in ex-service patients (Stalker, 1944), but in one of these the masquerading was not known at the time. Their case-records were not reported in that paper.

It is felt that the following case and post-mortem report is of such clinical and pathological interest that it is worth while recording it in its present form. Under existing conditions of service we have been unable to go deeply into the literature concerning such conditions.

Whatever the ultimate decision on the permanence of the results of electric convulsive therapy, there can be no doubt as to the present widespread popularity of this treatment in psychiatry. To meet the big demand there have become available in the last few years a number of different convulsant machines, most of which are fairly efficient, but not one being free from defects when exposed to the test of practical application. Some are too heavy and cumbersome, most are liable to minor technical breakdowns, which are the source of much annoyance because they disrupt the hospital routine, one has a faulty time switch which has caused the writer a considerable amount of anxiety when it jammed and allowed the current to flow for about 5 seconds—the patient developed a prolonged period of post-convulsive apnoea, but fortunately came round eventually and suffered no lasting ill-effects. Most machines incorporate one or more instruments to measure the current or the patient's resistance. Neymann et al. have shown the inaccuracy of such simple instruments, and it is doubtful whether they serve any useful purpose. The ammeters are relics of the early days of this treatment, when we were not sure about the safety range of the current, and they were included in the circuit as an extra safeguard. Our experience over the last five years has taught us what currents can be safely used, and an efficient convulsant machine can now be designed whose maximum voltage and maximum time give an output which is well within the limits of safety. A knowledge of the current used is of interest while the machine is undergoing the initial tests, but once this period is over its evaluation, even by an accurate method, is of little academic interest, and a waste of time from the point of view of the practical psychiatrist. The resistance measurements, too, are unnecessary in practice. They were originally made in the hope that they would enable the dosage to be correctly adjusted so as always to ensure a convulsion. But we now know, as Grey Walter has recently pointed out, that the convulsive threshold varies from individual to individual by as much as 1,000 per cent., and since it is a value which can only be found by a method of trial and error, the resistance instruments are of little use. Moreover, no great harm is done if an underdose actually is given—all that happens is that the patient has a temporary period of unconsciousness, and after a short interval a higher dose can be given, which will produce the desired convulsion. It is true, of course, as Kalinowsky (1939) said, that resistance measurements enable one to ensure that the electrodes are making good contact with the patient's skin, but one feels that this is an elaborate and costly method of doing something which could be more easily and quickly accomplished by training the nursing staff always to clean the patient's skin thoroughly before applying the dampened electrodes.

I once knew a child psychiatrist who had two treatments: Boy Scouts for all symptoms except enuresis, for which he prescribed Sea Scouts; but that was before the war, when we had a seaboard.

There is great satisfaction to the human mind in reducing multiplicity to unity, diversity to simplicity, but this exercise can be carried too far, especially in dealing with such a complex creature as the child. In contrast there is the school of thought which believes in intensive analytic treatment, four to five sessions a week, for every child. How can one steer a middle course in a modern Child Guidance Clinic where numbers must be dealt with, without the sacrifice of the deeper approach, where short and long treatments must be fitted in, where diagnosis and consultations are essential, yet treatment must always be one of the fundamental aims?

Von Storch has induced headache by the sudden intravenous injection of minute amounts of histamine phosphate in three groups of persons—the first group consisting of those subject to migraine, the second group composed of those suffering from chronic recurrent non-migraine headache, and the third group consisting of those not subject to headache. He has found that in persons subject to migraine the headache produced by histamine is frequently similar in character to their habitual headache (though bilateral), while in those subject to chronic recurrent non-migraine headache the experimental headache is only occasionally similar to their usual headache. From the evidence presented by him, linking migraine and histamine, the latter would appear to be a useful drug for distinguishing migraine from other forms of recurrent headache. Using a technique similar to his, experiments were performed at this centre to determine the relation of histamine headache to post-contusional and psychogenic headaches, and the results are worth recording.