The Presidency of this Association carries with it an opportunity for service commensurate with the challenge of the time, and I am grateful that you should think me worthy of this high honour and fit for such responsibility at a crucial phase in the development of psychiatry. Events will show whether you have been wise in your choice, but however that may be you can be sure of my utmost effort on behalf of the Association.

Have there been changes in the clinical picture of schizophrenic illness over the past hundred years? Or, to put the question more precisely, are the schizophrenic patients of the 1950s any different phenomenologically from their counterparts in the 1850s?

Recent studies (4, 5, 9, 14, 20) have aimed at determining the presence or absence of an increased incidence of psychosis in the nineteenth and twentieth centuries. Opinion is evenly divided as to whether the social changes of the twentieth century have significantly altered the epidemiology of psychotic illness. In spite of an increasing preoccupation with social psychiatry (13), the psychiatric literature is silent on the vital question “Have the changes of the past hundred years altered the clinical picture of schizophrenic illness itself?”

The present study, comparing a selected group of schizophrenics of both sexes from the 1850s and 1950s, begins the search for information on the change or lack of change in this important condition over the past hundred years.

In the psychiatric literature in English there is a tendency today to deprecate speculative neurophysiological theories of the “functional” psychiatric disorders, while little is done to halt the flood of far-fetched and untestable hypotheses of the “dynamic” psychopathologists. The present author believes that it is legitimate to postulate a neurophysiological basis for schizophrenia in the hope that those with a more adequate knowledge of neurophysiology will be obliged to re-examine the problem of schizophrenia more fruitfully. Conrad (1958, and Fish, 1960) has given a very interesting interpretation of acute schizophrenic symptoms, so that his approach to schizophrenia forms a very convenient starting point for further speculation. This worker's views will therefore now be presented in some detail before the present author's theories are discussed.

The early investigators in the field of perceptual isolation were at McGill University, especially Bexton et al. (1954). Since then there have been many subsequent works and papers on the subject. In general, published results of this type of experiment can be divided into two groups. Sometimes marked sequelae to sensory deprivation have been described (Bexton et al., 1954 and Goldberger et al., 1958). Such disturbances included thinking, imagery and time appreciation, together with delusional and hallucinatory phenomena. On the other hand, at Princeton University, Vernon et al. (1956), under very carefully controlled experimental conditions, found virtually no sequelae. A paper published from this hospital (Smith and Lewty, 1959) described a silent room which was designed, constructed and standardized to a mean sound pressure level difference of 80 decibels. (Measurements made at octave intervals from 80-10,000 c./sec.) In this particular room 20 volunteers spent varying periods from 5 hours 50 minutes to 92 hours 20 minutes under conditions of partial and complete sensory deprivation. We used a room so as to mitigate the physical effects of reduced somatic activity and fur gloves were used instead of the more common cardboard cylinders, which after a period of time produce a great deal of skin irritation and indeed abrasions, and introduce a great deal of unnecessary complications into a study of pure sensory deprivation.

Four experiments were carried out on chronic female schizophrenic patients in order to determine the differential effects of colour upon their behaviour. The three primary colours, red, blue and green, were used. The patients, who fell into Arieti's second or third stages of schizophrenia, had a mean age of 45 years (range 38-50), and a mean duration of hospitalization of 19 years (range 9-30). All experiments were carried out in a small side room painted white, the colour of which could be changed by the use of coloured lights hanging centrally from the ceiling. The colours used had a fixed intensity of 2 foot candles at a distance of 2 feet.

One of the fundamental concerns of social psychiatrists is to determine whether social events can influence the onset and the course of a particular mental illness and, if so, in what ways. The problems involved are formidable. In schizophrenia, for example, it is necessary to have reliable means of measuring the manifestations and progress of the disease, as well as adequate methods for assessing social events. However, if these difficulties can be satisfactorily overcome, there is a way in which a preliminary experiment can be made.

No detailed and comprehensive system of subclassification of chronic schizophrenia has been generally adopted in this country. Most psychiatrists are content to use the broad categories of simple, hebephrenic, catatonic, paranoid and undifferentiated schizophrenia. Placing a patient into one of these subgroups entails a judgment which is based upon all the information at the clinician's disposal. Such data are necessarily unstandardized; the method of collection varies from doctor to doctor and from patient to patient, and the criteria of classification are not uniformly agreed upon. No objective tests are available which would serve to check the accuracy of the decisions taken. It is inevitable, in these circumstances, that clinical systems of subclassification should not be much used for scientific purposes. The basic essential of a classifying instrument is that it should produce the same results in the hands of different investigators, and that its standards of measurement should not vary from one occasion to another. No study so far published has attempted to deal with this problem, which becomes more serious as the elaboration (and possibly the clinical usefulness) of the classification increases. Leonhard's system (1, 4, 5) for example, would gain enormously if its reliability could be demonstrated.

No observation can be incorporated satisfactorily in a body of knowledge unless its reliability, however defined, is also known. In psychiatry, the concept of reliability has in great measure been transplanted from clinical psychology, but its optimal application to meet psychiatric needs requires some attention.

For the purposes of psychiatry, reliability can conveniently be measured as the amount of agreement between different observers examining the same subjects (or a comparable series of subjects). The results may be expressed as the percentage of subjects in which agreement on the relevant variables is reached, or, in the case of two or more closely matched series being employed, by comparing the reported incidence of the phenomena under study. In one or other form this simple principle has been applied in a number of reliability studies, of which the majority have been concerned with the vital question of the reliability of nosological diagnosis (Ash, 1949; Mehlman, 1952; Hunt, Wittson and Hunt, 1953; Seeman, 1953; Foulds, 1955; Schmidt and Fonda, 1956; Pasamanick, Dinitz and Lefton, 1959), while Reid and Finnesinger (1952) have contributed an interesting semantic analysis of the concepts involved.

This study arose out of another enquiry currently in progress (Sainsbury and Grad) into the relative merits of community and hospital care of the mentally sick as practised in the Chichester and District Mental Health Service. For this purpose it was clearly important to know how reliable were the psychiatric assessments made on patients referred to the Service. The occasion was seized to carry out a detailed investigation into the reliability of diagnosis and other psychiatric assessments under N.H.S. conditions, with particular reference to why disagreement between psychiatrists sometimes occurs. As described elsewhere (Carse, 1958; Morrissey and Sainsbury, 1959), the Service supplies all the psychiatric requirements of Chichester and district, and thus provides a wide range of patients treated in a variety of settings.

There are some 23,000 long-stay epileptic in-patients in Britain. Most of these patients are in hospitals for the mentally ill or subnormal or in independent colonies. There are, however, only two hospitals within the National Health Service which cater specifically for the long-term treatment of epilepsy, St. Faith's Hospital, Brentwood, for females, and St. David's, Edmonton, for males. This communication is concerned with the incidence of temporal lobe epilepsy among the long-stay female epileptics at St. Faith's.

Roth and his associates (1952, 1955, 1956) making observations on the classification and prognosis of psychotic illness occurring in elderly people found that the majority of patients fell into five main diagnostic categories; about half were cases of affective psychosis, most of which responded to E.C.T., and the rest suffered from arteriosclerotic and senile psychosis, paraphrenia and delirium. All the groups, with the exception of the senile psychotics, showed a considerable proportion of physical illness, particularly the cases of affective psychosis whose first attacks occurred after the age of sixty years. Most of the cases of delirium were physically ill and of the paraphrenics 30 per cent. were either blind or deaf.

In a recent paper by Meehl and Rosen (1955) several important criticisms are made against the majority of diagnostic psychological instruments reported in the literature. Some of these criticisms are well known, for example absence of cross-validation data, not stating the type of population most suited for the particular psychometric device, etc. The main purpose of the present paper is to try to meet, with respect to the M.W.-L.T. (Walton and Black, 1957), one of their other major criticisms namely, that “Base rates are virtually never reported. It is, therefore, difficult to determine whether or not a given device results in a greater number of correct decisions than would be possible solely on the basis of the rates from previous experience. When, however, the base rates can be estimated, the reported claims of efficiency of psychometric instruments are often seen to be without foundation.”

The first clinical histories of this condition were reported in Norway by Stengel (1826). Batten (1903) described changes in the macula in two members of a family who had undergone progressive mental deterioration with loss of visual and motor functions. Vogt (1906) published similar cases and attempted to delimit them as a juvenile form of Tay Sachs disease. It differed from the infantile form in that it occurred in childhood after a period of normal development; the rate of progression was slower; it was not limited to Jewish children and the ophthalmological appearances were those of optic atrophy. The following year Spielmeyer described the pathological changes in juvenile Tay Sachs disease as essentially similar to the infantile form. Further detailed pathological studies were made by Greenfield and Holmes (1925).

The aim of this study was to determine the incidence of selected blood types in a homogeneously diagnosed group of manic-depressive patients as compared to the incidence of these blood types in a control group and in reported figures for the general population. This interest in the blood characteristics of manic-depressive subjects was stimulated by the finding of a relatively high incidence of active duodenal ulcer or medically and roentgenographically confirmed duodenal ulcer histories in manic-depressive patients (16 per cent.) (12) as contrasted with the reported incidence of duodenal ulcer in the general population (5-10 per cent.) (4). The specific association of duodenal ulcer with O-type blood has been reported by several investigators (1, 2). Although the reported relationships between blood type and specific disease entities have been critically questioned in a recent review, the reviewer concluded that the evidence “tends to suggest that a relationship between duodenal ulcer and group O blood actually exists” (10). The known and suspected relationships of blood types with various disease processes have been summarized by established investigators in the field of blood grouping and classification (14).

Shortly after isoniazid (I.N.A.H.) was first used in the treatment of tuberculosis, it became apparent that side-effects were not uncommon. Thompson (1952) lists euphoria, hyperreflexia, vertigo, muscular twitching, insomnia, paraesthesiae and transient loss of memory among the reactions observed. These were noted to be mild and reversible but did suggest involvement of the nervous system.

A large number of papers has been published in the last two or three years on the use of imipramine in depressive states. Much of this literature has been reviewed by Ball and Kiloh (1959) whose investigations on out-patients represents one of the remarkably few controlled trials that have so far appeared. We feel, therefore, that there is room for a report on another controlled study, this time with in-patients, in which the term “controlled” not only involved the usual “blind” procedures of administering tablets, but also included some of those elementary safeguards of reliability and validity of assessments without which uncertainty must remain concerning the meaning of any findings. Foulds (1958), for example, has presented evidence that uncontrolled investigations have a greater tendency to yield results supporting the hypotheses of investigations than experimentally fully controlled trials. In view of the claims that had been made for the efficacy of imipramine in a number of uncontrolled studies, we were primarily concerned to discover whether or not there existed valid scientific evidence of its value and, if so, in what kinds of depressive illness it appeared to be of most benefit.

Antarctica is the southern end of Earth, a continent surrounded by oceans. It is a land of extreme cold and it has been estimated that it contains over 85 per cent. of all the world's ice. It is larger than the United States and Europe combined but contains practically no vegetation or wildlife except along its coasts. The coldest temperature ever recorded anywhere in the world was noted here (minus 109 · 6 degrees Fahrenheit) and temperatures rarely go above freezing. The wind blows almost constantly, including 200 m.p.h. blizzards. In appearance, it is like a great white desert and it includes a cap of ice that in some places is 100,000 feet think.

While abilities and attitudes are frequently subjected to measurement, motivation has largely escaped the attention of experimental psychologists and psycho-metrists. Attempts to use subjective and interpretive techniques have not met with any notable success, and it would seem that this whole area represents one of the most neglected fields of psychology, in spite of its obvious major importance both from the fundamental and from the applied points of view. We would argue that the objective measurement of motivation or drive in human beings is an essential requirement for clinical psychology, and we would further suggest that such objective measurement can only be accomplished in terms of some theoretical system in which drive has a recognized place and mode of interaction with measurable variables. It has been suggested by Eysenck and Maxwell (1961) that only the Hullian system provides such an account, and some evidence is to hand (Kimble, 1950; Wasserman, 1951; Claridge, 1960; Eysenck and Maxwell, 1961) to reinforce the view that deductions can be made from this system which will generate testable hypotheses relating to the measurement of motivation.

The Day Hospital approach in adult psychiatry appears to have begun with the original conception of Cameron in Montreal. He stated (Cameron, 1958) that both the original concept and its further development sprang from growing appreciation of the possibilities of new methods of treatment and diagnosis: at this time the rapid rise of the cost of in-patient treatment took place and there was increasing realization of the importance of the treatment milieu. At the same time as Cameron was setting up his Day Hospital in Montreal, Bierer was setting up the Marlborough Day Hospital in London (Bierer, 1951) and he discussed the theory and practice of Psychiatric Day Hospitals later (Bierer, 1959). Harris (1957) also discussed the implications of Day Hospitals and Night Hospitals in psychiatry with regard to the adult patient.

In psychiatry we often use different kinds of psychology without being aware of doing so. Before we consider existentialist psychiatry in detail we must discuss the three different kinds of psychology, namely, explanatory psychology, understanding psychology and interpretive psychology.