The use of fibrous wool protein as a model of the structural surface of receptors, possibly involved in the mechanism producing a model psychosis by drugs, was suggested by three lines of evidence.

First, the strong affinity (sorption) of certain basic compounds to keratins of low sulphur content as exemplified by the Gram-positiveness of epidermal (Fischer, 1953c) and nervous (Bailey, 1950) tissue.

Second, the accumulating evidence indicating the similarity in behaviour between keratins of high sulphur content (e.g. wool) and the protein component of certain cell membranes (Fischer, 1951; Fischer and Larose, l952a; idem, 1952b; Larose and Fischer, 1952; idem, l953a and 1953b).

Third, some preliminary experiments confirming the role of wool protein as a useful model to simulate some of those receptors for which certain drugs appear to compete.

I was asked in the early months of 1952 to deliver this lecture towards the end of 1953. Of course I realized that it was a great honour to be asked, for I knew something of the work of the late Dr. Maudsley, and I was aware of the immense contribution he had made in the treatment of the insane.

Psychiatry and psychology.—In his preface to The Pathology of Mind, Henry Maudsley commented on the peculiarly isolated way in which the study of mental illness had developed during the previous fifty years. “Treatises on mental disorders,” he said, “deal with their subject as if it belonged to a science entirely distinct from that which is concerned with the sound mind.” This, he continued, is as though a pathologist were to discuss cardiac and respiratory disease, with little or no knowledge of current work on the physiology of the heart or the lungs. And it was one of his chief aims “to put a happy end to the inauspicious divorce between the two sciences.” Partly in the hope of bringing them into closer touch, his discussion of pathological conditions was prefaced by a systematic account of the normal mind: and in the first edition of his work (1867) the two topics were included in a single volume. Nevertheless, in spite of Maudsley's arguments and his excellent example, few writers on mental pathology have, until quite recently, paid much attention to advances in general psychology. When they describe mental processes or characteristics, they constantly fall back on popular concepts or on out-of-date terms which present an incongruous mixture of an obsolete faculty psychology with an antiquated associationism—doctrines that were already under heavy criticism when Maudsley himself was writing.

I should like to congratulate the Council of the Section on their decision to devote an evening to a historical subject. I cannot, I fear, congratulate them on their choice of a speaker, for I have done no more than scratch the surface of a very obvious period in the history of psychiatry. However, any sort of historical paper must be better than none, for as far as I have been able to ascertain no such paper has ever been read in this Section, with the exception of the Presidential Address delivered by the late Dr. Hubert Norman. Until a few months ago, exactly the same was true of the Section of the History of Medicine, but in recent months we have had two welcome and refreshing papers by Dr. Burns and Dr. Zelmanowits. We have had, too, the brilliant Maudsley Lectures by Prof. Lewis and Dr. Rees Thomas. Perhaps we may take it that these are signs of a renewed interest in the history of our specialty. I am sure that no branch of medicine needs it more.

Depersonalization remains a subject whose fascination for psychiatric investigators shows no sign of waning. That this is so may partly be due to the striking nature of the symptomatology, though for many the philosophical problems it poses cannot fail to exercise much thought (Lewis, 1949). Numerous aetiologies have been advanced, but there exists no common agreement, even amongst those of similar psychiatric discipline, as to the origin of the condition.

Though electro-convulsive therapy (E.C.T.) is one of our most useful treatments, its mode of action is still largely unknown, and this ignorance is preventing us from making it more successful and more widely applicable. Among its possible modes of action is the possibility of its having some “activating” action on the basal, and more particularly on the hypothalamic, structures. Such activation might be expected to show in the psycho-galvanic response (P.G.R.), and we have therefore investigated something of the relationship between them. Many of the facts that would justify this investigation need not be given here as they have been reviewed in previous publications (Ashby and Bassett, 1950; Ashby, 1952(b)).

It is only proper that I should begin this paper with a disclaimer. I am not a psychotherapist, nor am I one who has devoted much of his time to the physical methods of treatment. My only qualification to carry this burden at all is that I believe I am somewhat in a neutral position and have not been fired alone by either set of enthusiasms—neither those which activate the physical treatment experts, nor those which sustain the psychopathologists. Necessarily therefore what I have to say will be from a personal viewpoint, although of course not a detached one and I will apologize once for this and not again. The subject of this talk is obviously an important one and must be the concern of psychiatrists of all persuasions. Those who are psychotherapists cannot ignore the fact that the main mental disorders which constitute the serious core of psychiatric disability in the community are treated first and foremost by physical methods, insulin coma, E.C.T. and surgery, while those who are non-analytical psychiatrists cannot ignore the fact that the less serious but enormously more prevalent conditions are treated in the main by psychological methods. The question might be asked, are there then two types of psychiatric disorder, the one only treatable by a physical method, the other by a psychological method ? But this is a superficial view; with the greater sophistication of physical methods more and more patients who formerly were treated by psychotherapy are now subjected to some physical treatment, and conversely—and this is particularly evident from the American literature—more and more patients, particularly schizophrenics, formerly treated by insulin or surgery are now being subjected to psychoanalysis. Each side is therefore invading the territory of the other, but there is no common language or ground for discussion between them. Now of course there are many different forms of physical treatment, just as there are many different types of psychotherapy. Let me take the physical treatments first. We can I think divide them roughly into two classes. There are those which by their universal use for a special type of mental state or special group of symptoms have come to be regarded, rightly or wrongly, as almost a radical treatment for such conditions. For this group no psychopathological preconception regarding the patient, his problems, his methods of adaptation and defence are necessary. All that is needed is a clear statement of his symptomatology, its duration and course to enable the physician to determine the type of treatment. In this group therefore we can place insulin comas, E.C.T., and cerebral surgery of the leucotomy type. It is only necessary to demonstrate schizophrenic thought disorder and primary delusions of recent onset to arrive at the view that insulin treatment is advisable; on the other hand depressive affect, depressive sleep disorder and loss of weight, continuing beyond the reasonable period following a stress situation or the absence of a stress situation particularly in the involutional period of life will lead many to recommend E.C.T. without more ado. For chronic obsessional tension, rumination or distressing psychotic ideas interfering with adaptation, leucotomy or some modified form of surgery come to mind.

About one year ago, with the encouragement of the Editor-in-Chief, a short paper appeared in this Journal entitled “Schizophrenia; A New Approach” (18). In this paper it was noted that mescaline and adrenaline have a similar biochemical structure. It was suggested that one of the aetiological agents in schizophrenia might be a substance or substances lying between these two; with the psychological properties of mescaline but effective in concentrations nearer those of adrenaline. Dr. Harley Mason elaborated this suggestion from the biochemical standpoint. For convenience these hypothetical substances were called, collectively, M substance. If M substance occurred in the body, it would account for the group of illnesses usually referred to as schizophrenia better than any hypothesis so far advanced. It has been the good fortune of the co-authors of that first paper (J. R. S. and H. O.) to be able to join forces with the third author of this paper (A. H.) to test the hypothsis. It is with the efforts of the last year that this paper is concerned.

Recent interest in the surgical alleviation of mental disorders has centred in the trial of new and different operations. Fairly early in the development of the subject Freeman and Watts (1944) themselves reported the fairly constant observation that under local anaesthesia gross mental change did not occur until certain stab incisions had been made deep in the infero-medial quadrants. Marked mental change, with confusion, unresponsiveness and disorientation, seemed to occur on section of a small bundle of fibres located interiorly close to the midline. Most of the modifications of Moniz's original procedure have, however, been made on an essentially empirical basis.

The “Controlled Projection” Test of Raven is a method of collecting and studying the projection responses of children to a standard series of situations (Raven, 1951). In reports so far published, the technique has provided information on differences in the organizations of thought and conduct characteristic of different national, social and clinical groups, and on individual differences within these groups.