There has recently been an emphasis on creating a therapeutic milieu in mental hospitals. Numerous publications reflect this trend (1, 2, 5, 6, 7, 8, 9, 11, 14, 15). In addition, studies on attitudes of nurses and patients and on some of the factors which seem important in creating a favourable ward atmosphere have become commonplace (3, 4, 10, 12, 13, 16, 17).

In the course of studying the clinical effects of LSD-25 various workers have commented upon its possible use as an aid to psychiatric diagnosis. Stoll (1947) and Becker (1949) considered it to be of limited value in this respect. Condrau (1949) pointed out that it tended to exaggerate catatonic and hebephrenic features in schizophrenics and to produce a caricature of the personality in normal subjects; the latter point also being made by Anderson and Rawnsley (1954). Von Felsinger et al. (1956) considered the primary psychological effect of the drug to be an exacerbation of existing symptomatology, through a weakening of central functions and defence systems.

One of the most interesting parallels between the functioning of brain and mind is provided by Hughlings Jackson's Doctrine of Dissolution and Freud's theory of psychological regression. Basically, they each imply that under certain circumstances the organism partially or wholly reverts to an earlier stage of functional organization, the one in the bodily and the other in the mental sphere. At first sight the parallel would seem to end here, for neurological dissolution is usually regarded as a passive process, an unmasking of lower levels of functioning by organic disease, while regresson consists of an active withdrawal to an earlier stage of mental development, usually, but not always, brought about by difficulties in external adjustment. Nevertheless, we can attempt a reconciliation between the two if we regard the ‘positive” symptoms of nervous dissolution as representing attempts on the part of a crippled nervous system to adjust to a normal environment. Viewed from this angle both neurological dissolution and psychological regression present themselves as dynamic reactions to stress, promoted in the one instance by internal and in the other by external difficulties. That the two mechanisms are in fact related is suggested by two facts: first, that the symptoms of nervous dissolution can be made worse by environmental difficulties (Cf. Goldstein's “catastrophic reaction”), and second, that regression occurs regularly in sleep, which is surely organically determined.

Rating scales are used a great deal, particularly in psychiatric medicine, for the assessment of severity of a patient's condition, to assist with diagnosis and classification, and for the comparison of results of treatments. Much time and effort is expended in the construction of such scales, in analysis of their meaning and in verification of their reliability. However, even the best scale gives unreliable results if it is not used correctly.

In 1963 there fell to be celebrated the 150th anniversary of a modest book giving an account of the new mild or “moral” treatment of the insane at the Asylum opened by the Quakers in 1796, Samuel Tuke's Description of The Retreat, an institution near York for insane persons of the Society of Friends. Containing an account of its origin and progress, the modes of treatment, and a statement of cases, York, 1813. Tuke achieved in England and America what Philippe Pinel did in France, and their names remain coupled in history as they were by contemporaries. “To those two great and good men, society is indebted for nearly all the improvements which followed their essays” said John Conolly, the third of the triumvirate who inaugurated the modern mental hospital era (1). In the course of preparing a reprint of Tuke's book recently we were privileged to have access to the privately printed Memoirs of Samuel Tuke, London, 1860, 26 copies “for the use of the family only”, edited in two volumes of together more than 1,000 pages. (A selection from these volumes emphasizing the religious aspects of Tuke's philanthropic works formed the basis of Charles Tylor's biography of Samuel Tuke (2), published for general circulation.)