I should like to express my deep gratitude to you, Mr. President, to the immediate Past President, Dr. L. C. Cook and to the Association for the great honour that has been bestowed upon me by your invitation to deliver a lecture in this august series. It is a custom that the lecturer should pay homage to Henry Maudsley to whose memory these lectures are dedicated: may I reserve my homage until we come to the active part Maudsley played in the course of events with which this lecture will be concerned.

I am deeply appreciative of the great honour you have done me in electing me as your President for the coming session. Although very sensible of this honour I am also much aware of my own shortcomings when I remember the distinguished men who have preceded me in this office. The following contribution, I am afraid, contains very little that is original. The purpose of this paper is rather to emphasize a point of view in the study of psychotic illness, which does not always seem to receive adequate attention.

For the Chairman's Address to the Child Psychiatry Section in 1955, Cameron (5) decided to survey the scene of Child Psychiatry. His survey was historical and he described the various influences that have in turn borne on and helped to shape the practice of Child Psychiatry as it is today. Kanner (9), in the Maudsley Lecture of 1958, took the same theme and elaborated on it further. It is significant that they both felt that the time had come to do this for a young speciality and, indeed, their lectures were of considerable interest and use to those of us who have not lived through—in Child Psychiatry—the times described. However, Child Psychiatry has not become static; the scene will continue to change and to enlarge as more new influences come to bear. It seems that we who are engaged in its active practice now, and in the future, have need to watch where we are going; especially, as comparative success has brought some rewards and we foresee the likelihood of further rapid expansion in the speciality, with the need, to recruit more child psychiatrists. Again, the joint or liaison committees that have sprung up with other medical professional bodies are in a sense a recognition of our significance; they are also a responsi bility and may be a test of our loyalty to psychiatry as a whole.

In these days we expect a good deal of a painter with claims to originality—a good deal more than most of them can give. We are habituated to pictorial representation as a major means of communication of ideas and we are surrounded by technically proficient work in the competitive field of advertising. Work of this kind is evocative too—at least to the variety of emotions which may determine the act of buying—and the poster that does not come off soon comes down. Except in the esoteric field of prestige-advertising, the sales-curve is the sole judge of the efficacy of this kind of appeal and the consumer—the indirect and unwilling patron—is rarely himself able to judge the effects of such hidden persuaders as the artist has built into his work.

In a previous study H. Holland (3) had found an increase of static ataxia under a depressant drug, as compared with a “no drug” condition, and in view of the close relation between static ataxia and the body sway test of suggestibility (1), which in turn is a frequently used measure of personality, it appeared desirable to investigate the general problem of the relation between drugs and behaviour on the ataxia test.

There has been relatively little work in psychology and psychiatry in which use has been made of the pupillary reaction to light and darkness; most of the work that has been done has been connected with the relatively slow reactions found in schizophrenia. This neglect is difficult to understand in view of the fact that this reaction and the autonomic innervation determining it are relatively well understood and do not present the same experimental and theoretical difficulties as the psychogalvanic reflex which is very much more widely used (Martin, 1960). In the present study, which forms part of a larger series, an attempt was made to investigate the influence of drugs on the reactivity of the pupil to changes in light stimulation.

In a previous paper in this series Eysenck, Holland and Trouton (1957) showed that the seen after-effects resulting from stimulation by means of a rotating spiral were increased very little by a stimulant drug and decreased significantly by a depressant drug. At that time there was little evidence that these aftereffects were in fact correlated, as the theory demanded, with extraversion and introversion. Since then two separate experiments dealing with normal and neurotic subjects respectively produced very strong evidence in favour of this hypothesis (Eysenck, 1960), and it seemed desirable to repeat the experiment in order to discover whether the failure of the stimulant drug in the first experiment to produce very positive results was merely a chance effect or was in fact a genuine failure of the theory.

Figural after-effects are the observable results of a hypothetical process of satiation or inhibition which accompanies and follows the passage of neural currents consequent upon stimulation. Most of the work in this field has been on figural after-effects affecting contours. In this work an inspection figure is fixated for a fairly lengthy period of time; this is then withdrawn and two test figures are substituted. One of these test figures falls within the same area as the inspection figure while the other is well removed from this area. Differences in size between the two figures which are objectively equal are usually observed and are supposed to be a consequence of satiation set up by the inspection figure (McEwen, 1958).

In the previous paper we have given a brief discussion of the reasons why figural after-effects are of interest in the study of personality and why stimulant and depressant drugs would be expected to have certain effects upon them (Eysenck and Easterbrook, 1960a). In this paper we describe an experiment using kinaesthetic figural after-effects rather than visual ones. By and large results with kinaesthetic figural after-effects have been more clear-cut and definite in relating these after-effects to personality; several studies have shown extraverts to have greater figural after-effects than introverts (Eysenck, 1957). Furthermore there is at least one study demonstrating that stimulant and depressant drugs have the predicted results upon kinaesthetic figural aftereffects (Poser, 1958). The reasons for this may be that whereas for visual experiments it is difficult to check on the subject's ability to maintain fixation, nothing comparable is required in experiments on kinaesthetic figural aftereffects. Furthermore any departure from instruction on the part of the subject can easily be checked by the experimenter. For these reasons kinaesthetic tests have very definite advantages over visual ones.

Several workers have demonstrated a relationship between anxiety and critical flicker frequency (CFF); among these are Krugman (1947), Goldstone (1955) and Friedl (1954). Unfortunately the trait of anxiety is not unidimensional, being a compound of neuroticism and introversion, so that these data might indicate a lower threshold of CFF for neurotics, or for introverts, or for both. The second of these interpretations has been tentatively adopted (Eysenck, 1957), in spite of some questionnaire evidence to the effect that thresholds are lower for extraverts (Washburn et al., 1930; Madlung, 1935; Simonson and Brozek, 1952). The main reason for not considering this additional evidence too convincing lies in the curious nature of the measures used to determine extraversion-introversion; these seem to compound introversion and neuroticism, as pointed out elsewhere (Eysenck, 1960). However, when we take into account the rather strong evidence regarding drug effects (Simonson and Brozek, 1952; Landis, 1954), which tends to show that stimulant drugs raise the threshold, while depressant drugs lower it, as well as the fact that brain injury tends to lower the threshold (Enzer et al., 1944; Halstead, 1947; Landis, 1949; Werner and Thuma, 1942), then the case against this tentative hypothesis becomes rather strong. It may be that the attempt to relate CFF to only one dimension of personality was mistaken, and that CFF is related to both neuroticism and extraversion, in the sense that low thresholds characterize the more neurotic and the more extraverted person. This hypothesis would certainly account for all the available facts better than the original hypothesis.

The phenomenon of flicker fusion requires no elaboration to the modern reader. Its psychological, physiological, physical determinants have been outlined by an immense literature (1). Even the limited field of the effects of chemical agents on flicker and fusion is great. In a recent review Landis (2) went so far as to suggest that CFF might be employed as a method of standardizing the depressant effects of somnifacient drugs (Landis (2)). Despite contradictions, which may occur due to the biphasic characters of certain drug effects, the barbiturates and similar depressant compounds tend to depress CFF whereas the stimulants tend to raise it. The effects of alcohol and caffeine are still unclear (Simonson and Brozeck (3)). Whether the drugs affect the organism towards greater or lesser total sensitivity or whether the changes are due to some complex function of, say, the light/dark ratio is also unclear.

Phenylketonuria is an inborn error of metabolism characterized by excretion of phenylpyruvic acid in the urine and usually by severe mental defect and certain bodily features of which dilution of pigment is the most noticeable.

The interest of 5-hydroxytryptamine (5HT) for psychiatry arose originally from Gaddum's (8, 9) observation that its peripheral pharmacological actions were antagonized in a highly specific manner by a low concentration of lysergic acid diethylamide (LSD). This led to the hypothesis that the hallucinogenic action of LSD was due to its antagonism to 5HT in the central nervous system (Woolley and Shaw, 21; Gaddum, 7). However, Cerletti and Rothlin (5) subsequently found that brom-LSD, which is not a hallucinogen, was an equally potent antagonist of the peripheral actions of 5HT.

The depressive syndrome is very distressing and incapacitating for any patient who suffers from it, and wherever it occurs psychiatrists are faced with a serious problem more particularly because of the consequent risk of suicide. The incidence of depressive illnesses has in my experience certainly not decreased during recent years, on the contrary it has probably increased and there is still an urgent need for more effective therapy to counteract the dire suffering and suicidal rate involved.

The concept of psychopathic personality in this presentation stresses a disorder of personality development. In these patients one finds a poorly organized personality with contradictory strivings, lacking consistency and unity in experiencing and acting. Disturbances of organization may be noticed in any phase of personality development but for various reasons they are most noticeable in adolescence and adult life. In this concept of personality organization and its disorders, psychologic, physiologic, and social aspects are considered but none of them is made the basic issue. The organization of the personality may be too loose or too rigid. In the too rigid organization, we find unbending persons with, or without, projection. In these persons certain personality features may be exaggerated and adaptation to the demands of life might be difficult. This discussion will be limited to the loosely organized personality with its features of immaturity, dependency and inadequacy, impulsiveness, aggressiveness, and inappropriate control of drives and desires.

The production of “model psychoses” in animals and man by a variety of chemical substances is of great interest. While the relationship between disturbances so produced and schizophrenia are problematical, these investigations may eventually throw light upon the causes of this condition. More important, at present, is the fact that the investigation of the way these drugs modify various aspects of normal psychological functioning is of great value in suggesting the physiological and biochemical processes that underlie these functions.

In this paper it is my intention to review some of the central aspects of the psychopathology of schizophrenia. At the outset it would be appropriate to establish the role which psychopathology must play in our efforts to arrive at a fuller understanding of the schizophrenic psychosis. Psychopathology is, as the term itself reveals, a psychological study of abnormal mental functions. It is not primarily concerned with the organic bases for the disturbance of mental activity, but such a study does not imply that the roots of abnormal psychological processes do not in fact lie in somatic pathology. To my mind psychopathology and studies of disturbed brain function in mental disease are complementary to one another. Many distinguished workers in the field of the psychoses have referred to the disappointing results of biochemical and electro-physiological research in schizophrenia. They have suggested that the failure of such research has arisen in part from the absence of correlation between clinical studies on the one hand and physiological studies on the other. Tait (1958) has remarked that although physiological research can provide us with a wealth of data this data will only become meaningful whenever clinicians are in a position to provide biochemists and electrophysiologists with sets of specific questions. The formulation of such questions must depend upon a refinement of our diagnostic categories. Similar criticisms have been levelled against psychological research. In a recent review of contemporary psychological research Rabin and King (1958) have pointed out that the lack of criteria necessary for the selection of a homogeneous group of patients leads to the vitiation of much current psychological research. It is possible that psychopathology may be able in the future to contribute something to the solution of these methodological difficulties which so beset and hamper contemporary research in schizophrenia.

The author has already briefly reported on his investigation of senile paranoid states to the First Meeting of the European Clinical Section of the International Association of Gerontology (Fish, 1959a). He would now like to present his findings in more detail and discuss the relevant psychiatric literature.

In an earlier investigation the author (1959) raised the question regarding whether a higher incidence of psychiatric disorders could be observed among refugees who remained in, or came to Norway after World War II. Through a personal investigation of all the (sixty) refugees who were admitted to Norwegian mental hospitals and psychiatric departments during the period 1 January, 1946–31 December, 1955, it has been possible to answer this question in the affirmative and without any shadow of doubt. The author could also show that the incidence of psychoses among refugees in Norway is, for all diagnoses, five times higher than could be expected when compared with a matched Norwegian population. For schizophrenia alone the incidence is less than five times higher, while for reactive psychoses it lies far above this number.

The voluminous literature reporting the effects of cortical lesions has shown contradictory and diverse findings from the earliest studies to the present (Franz, 1907; Klebanoff, 1945; Klebanoff, Singer and Wilensky, 1954; Meyer, 1957). Some investigators found no losses in intellectual function regardless of the locus of the lesion; others, a temporary loss followed by recovery of original capacity. Still others have reported significant losses following brain damage in the forebrain or other portions of the central nervous system. But for investigators in all three categories, what did “brain damage” consist of? The neurologists Brain and Strauss have observed “The study of psychological problems without an adequate knowledge of the physiology and pathology of the central nervous system can be likened to the exploration of the uncharted seas without the aid of a compass; and yet there are many psychologists who undertake the rash venture” (1955, p. vi). And what of the criteria on which the conclusions were based? An additional source of ambiguity is indicated by the fact that the overwhelming majority of conclusions on “mental” changes by psychiatrists and neurologists have generally been based on clinical or subjective estimates. Measurement, a crucial factor in any study, is of special importance in studies of brain damage and brain function, although despite a multiplicity of tests, there are few measures designed with attention to their unique problems. Tests employed in many psychological studies of brain damage were originally oriented toward quite different problems and had been carefully developed and standardized on non-brain damaged populations.