Throughout medical history we find evidence that hysteria has predominated over all other psychological disorders in attracting the attention of philosophers and physicians, yet despite the leading part which the study of hysteria has played in building up our present-day knowledge of psychopathology, it is remarkable how little we have advanced in acquiring an understanding of the cause of the hysterical syndrome itself. Even the wisdom of Freud has failed to offer us a readily acceptable explanation of hysteria, and to this day medical literature contains many theses suggesting that hysteria is related to disorders of the diencephalon, or to glandular dysfunction, and other such organic approaches to the problem. Seemingly we have no yardstick by which we can measure to what extent the hysteric is born, predestined by some elusive factor to develop the malady, and to what extent hysteria is imposed on persons by environmental circumstances. Much significant information on hysteria may be neglected by those who study it as an isolated phenomenon or disease entity, whereas it may well be that the truth of the matter is that at least a little bit of the hysterical reaction goes to form most of the neurotic syndromes met with in practice, and that the pure hysterical reaction is only an academic concept.

I propose to explain the application to play therapy of a theory of family sexuality (Turner, 1947), upon which I have been working for some time.

When children are referred to me I see them individually and ask them to tell me, usually by their play (Lowenfeld, 1935), what real or imaginary thing could have caused their symptoms. I then follow the technique of Melanie Klein (1932) in that I straightway give an interpretation.

Tridione (Abbott) is 3.5.5-Trimethyloxazolidine-2, 4-dione, and has been demonstrated clinically to have an inhibitory effect on petit mal, myoclonic and psychomotor seizures in epilepsy. Gibbs, Gibbs and Lennox first demonstrated a similarity between the cortical dysrhythmias in certain cases of schizophrenia and those of psychomotor epilepsy, whilst Kalinowsky and Putnam, as a result of these findings, gave the anti-convulsant dilantin as a successful sedative to 60 cases showing mental symptoms. Since tridione has a specific action against psychic equivalents in epilepsy, it was thought that its administration to patients showing chronic mental disturbances might result in at least a similar improvement.

Pythagoras appears to have been the first to recognize “the profound effect of music upon the senses and emotions.” He tried to influence the mind and body with what he termed “musical medicine” (1).

He declared that the soul could be purified from its irrational influences, and he made detailed investigations into the therapeutic value of the seven different Greek keys. Pythagoras is said to have cured many mental illnesses “by having certain specially prepared musical compositions played in the presence of the sufferer.” For example, Iamblichus, in his life of Pythagoras, relates how he devised certain melodies against despondency, others against anger and still others against desires.

Ever since Group Therapy became established as a scientific method for the furtherance of mental health, therapists have looked for ways of measuring the behaviour of the Group. It is clear, for example, that there are important differences in structure between a group of people newly assembled in a railway carriage and those who share the same dining table at the end of a long sea voyage. Interpersonal relations have been established in the latter company, and each member has himself achieved some kind of relationship to the group as a whole. It cannot be conceded that any purpose would be served in quantitatively measuring these relationships in the two kinds of groups which have been mentioned. This is because they are accidentally formed groups, lacking a basic purpose and without a pre-appointed leader. Membership of such a group may be interesting, boring or entertaining, but it cannot be said to play any great part in the life-plan of the individual.

We are met to consider the application of psychoanalytical principles to hospital in-patients. Before we consider the applications it would be well to consider briefly, and have some agreement on, what those principles are.

This paper has been written with the intention of illustrating the application of psychoanalytic principles to the treatment of in-patient psychotics by reporting the treatment of a female manic-depressive patient by psychoanalysis at the Cassel Hospital during 1936–38. Unfortunately no reports of intensive in-patient psychotherapy of psychoses in this country have been published. Little prolonged intensive psychotherapy of psychoses has been carried out in hospitals, apart from the Cassel Hospital, where for many years the staff was sufficiently numerous to allow most patients to have daily interviews of significant length. In the United States experimentation has been much more active. Recently Fromm-Reichmann (1947) has reviewed many of the problems encountered in the several Mental Hospitals where psychoanalytic methods of treatment are actively pursued. Rosen has reported daring and courageous experiments. He has reported (1946) the treatment of acute catatonic excitements by psychoanalysis—his chief innovation being the long interview. With one patient the first interview was 16 hours with a break of half an hour. He has reported (1947) favourable results from treating 38 male and female schizophrenic patients, the ages of the patients ranging from 15–49, the duration of illness before treatment ranging from 1 month to 27 years, and the duration of hospital residence ranging up to 11 years. The average daily hours of treatment ranged from 1 to 12, and the duration of treatment ranged from 3 days to 11 months. In my opinion the New York Psychiatric Institute which encouraged Rosen's experiments has fostered a technique about which much more will be heard.

There is no need for re-stating, in general terms, the importance of the psychoanalytical contribution to psychiatry. This has been discussed here on several occasions, and possibly more seriously than in any other society of psychiatrists. I am referring to the papers read to this section by Bernard Hart (1), David Forsyth (2) and Edward Glover (3). They form a most interesting introduction into the problem of the relationship between psychiatry and psychoanalysis. Psychoanalysis has not been the main topic of discussion in this section since Edward Glover's address on the application of psychoanalytical principles in psychiatry thirteen years ago. Since then the psychiatric scene has changed out of recognition. We have entered an era of great therapeutic activity. The hospital in-patient with whom we are concerned to-day has been subjected to a variety of physical methods, and the campaign has still not reached its peak of intensity. It is too early, at this stage, finally to assess the therapeutic value of those treatments, but we can say this much already: it is most unlikely that they will save us the trouble of studying mental illness the hard way. Psychiatry cannot afford to neglect any approach that promises to contribute to the understanding of mental phenomena. It is against this background of psychiatric developments that psychoanalysis has again been chosen for discussion here.

Although homicidal tendencies are well recognized in the depressive psychoses, this medico-legal aspect of the illness receives only cursory mention in text-books, e.g. Henderson and Gillespie and Noyes, if it is referred to at all. Inasmuch as it is on this most serious complication that the psychiatrist is most liable to be asked to give evidence in court, there would seem to be good reason for examining the factors leading to such behaviour, and comparing them with similar data from non-depressive homicides. It is hoped that these notes will show a behaviour complex peculiar to the melancholic subjects.

Electronarcosis is a state of coma, or anaesthesia, induced and maintained by the continuous passage of electricity through the brain. Although described in animals and man many years previously, it was not introduced into psychiatry until 1944, when a group of Californian workers (Frostig et al.) experimented with its use as an alternative to insulin coma treatment in schizophrenia.

In this discussion of psychiatry outside mental hospitals, it is proposed to deal mainly with the field of psychiatry inside general hospitals. The idea of in-patient psychiatric beds in the general hospitals is certainly not new, and was tried out between the last two wars. One of the factors responsible for failure was a lack of effective therapeutics. Thus the comparatively small number of beds available were occupied for periods too long for ordinary general hospital practice, and facilities to ease long-term admission in occupational and social directions were usually lacking. The situation has not substantially changed from that described by Weir Mitchell, who caustically remarked that psychiatrists pleaded for opportunity to treat the early case, but when the plea was granted there was little that could be done. In the last few years advances in both psychological and physical methods have reached a point where certain categories at least of mental illness can be considerably helped by admission to a general hospital psychiatric unit, and be discharged in a period comparable to that usual in general medical wards. A report made in 1943 by the author at Sutton Emergency Hospital, and later, social studies by Brown and Carling, 1945, at the Radcliff Infirmary, Oxford, showed that the six weeks' average stay of the psychiatric in-patients was less than the average for medical patients of a general ward. It was not just a matter of performing a little diagnostic investigation and then transferring the patient elsewhere. In fact less than 8 per cent. of these psychiatric patients were sent to other hospitals. The full figures for a year's admissions are available in the 1943 report.

There are three particular pupillary movements in the course of the electrically-produced epileptic fit: dilatation during the convulsion, constriction in the post-convulsive stage, and spasmodic dilatation towards the final stages of the post-convulsive stage. The pupillary dilatation in the convulsive phase is identical with that found in the spontaneous epileptic fit, where it is generally considered as an expression of sympathetic activity, either the consequence of a general (Bumke, 1914) or of a focal cortical excitation (Foerster, 1936; Penfield and Erickson, 1941), or, an opinion held more recently, due to a hypothalamic mechanism (Delay, 1946).

This paper attempts to describe in detail the results of an educational programme aiming at the improvement of reading (accuracy, comprehension and speed) in a class of high grade educationally subnormal boys who were all in one or the other respect unsuccessful readers. For the purpose of this paper an unsuccessful reader is defined as a reader whose power of word recognition, of fluency of reading or of understanding is below the level expected from him. It has been assumed that this level is indicated by the mental age, though it has been kept in mind that the result of a verbal intelligence test need not be the final decision as to the intellectual capacity of a child.

The results of leucotomy in mental hospital practice are already well known and are familiar from the Board of Control's review of 1,000 cases published in 1947.

I am not aware that in mental deficiency institutions the operation has become a practice in application to cases presenting gross abnormality of conduct having its origin in mental disorder which, though not amounting to one of the insanities, has the characteristics of a psychopathic state.

Since the introduction of prefrontal leucotomy by Moniz in 1936, an ever-increasing number of psychotics have been subjected to this operation. Results have been very satisfactory in certain types of psychosis and psychoneurosis, especially in obsessional tension states, in agitated depression, and in patients with considerable apprehension and anxiety, while less favourable results have been reported in many cases of schizophrenia, hebephrenia, and others. Naturally, with the number of cases operated on, experience has grown, and psychiatrists, neurologists as well as psychologists are nowadays, to some extent, in a position to determine which case is likely to benefit from the operation, and where leucotomy should rather not be resorted to.