It is certainly noteworthy that, during the last few decades, whatever the contributory forces, more and more emphasis is being placed on the contention that man is a social being and that his individuality as a person is meaningful only in terms of his relations with others. Mead (1947) has shown that man as a social being is subjected “throughout his entire individual existence to systematic cultural pressures” which reinforce or intensify, elaborate or suppress his psycho-biological potentialities in a way which not only refutes the false belief in the uniformity of human behaviour but reveals also its most extreme types.

The aim of this paper is threefold:

1. (i) To review critically the literature on the Ganser State and clarify its meaning.

2. (ii) To provide a case illustration with some hitherto unreported features.

3. (iii) To present psychological test results, which has not previously been done in a case of this kind.

Our classification of the mental disorders of later life, which are becoming a social and medical problem of increasing magnitude, is still based upon the views of the great descriptive psychiatrists of half a century ago. Most of the classical accounts of mental disorder of old age (Kraepelin, 1909; Bleuler, 1916) confine themselves to the pre-senile, senile and arteriosclerotic psychoses. Their writers evidently regarded other illnesses as numerically insignificant in relation to these degenerative disorders peculiar to old age. Cases with a predominantly depressive or paranoid picture or with clouding of consciousness alone were described in these old accounts, but were attributed to an underlying cerebral illness, either of senile or arteriosclerotic type. It is consequently a long-established practice when such symptoms appear for the first time in old age, or occur in senescence after prolonged remission, to search for neurological signs, or for some evidence of a decline in intellectual efficiency which might account for the illness in terms of organic disease of the brain. Weight is thus often given to clinical findings of a quite subtle character, or the results of “deterioration tests” whose value in the early diagnosis of degenerative processes in the brain is unproven, form the basis of conclusions of doubtful validity.

The importance of the psychoses of later life has been demonstrated by Cook, Dax and Maclay (1952), who found that 15 per cent. of patients admitted to mental hospitals in this country were aged 65 or over. Our own corresponding figure (derived from a Mental Hospital serving a county with a mixed rural and residential area) is 20 per cent. for the year 1953. Furthermore, it has been shown by Roth (1955) that about one-half of all admissions aged 60 and over are suffering from affective disturbances, and that of these over one-half have had no psychiatric illness before that age. Robertson and Brown (1953) report a similar proportion with late onset in their material.

3,4,5-Trimethoxyphenyl-β-aminopropane (TMA) is structurally related to both amphetamine and mescaline, as is shown in Figure 1.

Because of this structural relationship of TMA and amphetamine, methedrine, and mescaline, one could anticipate a clinical response to the compound which would represent certain phenomena characteristic of each of these drugs. This presented an intriguing problem as to whether or not, in actuality, this would be the case.

Psychiatry is handicapped in the task of evaluating new methods of treatment because it has had to tackle the problems presented by early and mild cases without modern psychometric methods. There is clearly something wrong when the spontaneous remission rate in schizophrenia can be reported by the New York State Hospitals as 59 per cent. (1944) at a time when the equivalent figure in Kent (Monro, 1950) was 24 per cent. The practical impact of this failure to define terms is that the majority of articles describing the results of new treatments lose most of their force. This happens most obviously when the cases considered are presented simply in diagnostic categories, for example, as x schizophrenics or y hysterics. The trouble can be lessened by giving more clinical detail, but seldom can enough diagnostic and prognostic information be given to enable the reader to arrive at a proper evaluation of the issues presented. New descriptive techniques are therefore an urgent practical necessity, as well as being theoretically desirable.

One of the important schizophrenic symptoms listed by Bleuler (1950) is a disturbance in attention. Bleuler viewed the attention disturbance as a complex phenomenon which was also related to disturbances in thinking and affect, and possibly to individual emotional complexes.

The use of chlorpromazine is now firmly established in psychiatry (Delay et al., 1952; Arnold et al., 1953; Staehelin and Kielholtz, 1953; Anton-Stephens, 1954; Elkes and Elkes, 1954; Charatan, 1954). A hyperglycaemic effect in man has already been reported (Dobkin et al., 1954), and might be of importance if, for example, in schizophrenia, chlorpromazine was combined with insulin coma treatment. The following investigation was carried out to study the effect of chlorpromazine on glucose tolerance.

Several studies have been undertaken in which the “dark vision” of normal and neurotic groups has been compared (see (5) for references). As a result of these researches it appears that neurotic patients tend to have inferior performances to normal subjects on tests of “dark vision”. The term “dark vision” is, however, a very general one, covering all aspects of visual functioning at brightness levels below about 0 · 01 candle per square foot (13). Clearly we need to know more precisely which aspects of dark vision are impaired in neurotics, the extent of the impairment, the conditions under which it occurs, etc., if we are to go beyond fairly crude descriptive statements about differences between normal and neurotic groups to an understanding of the processes involved.

Experiments with animals have shown that electrostimulation of brain tissue is followed by a number of biochemical changes in the brain. The information obtainable is limited since there are only comparitively few reports about investigations in this field (4).

Earlier investigations (3, 4) have shown an abnormal glutamic acid metabolism in schizophrenic patients.

These changes are, briefly, low glutamic acid level (and high glutamine level) especially in acute cases. Glutamic acid concentrations below 1.2 milli grams per 100 ml. venous blood were ascertained in most of these patients.

Introduction Since the publication of Rorschach's Form Interpretation Test in 1921, its applications have been extended to cover an increasing number of clinico-psychological problems. Of these, one of the most important and difficult is the diagnosis of organic brain damage and pathology.

It is established that healthy individuals and schizophrenics respond in different ways if subjected to stressors (“alarming stimuli”) under seemingly identical conditions. It is also common knowledge that healthy individuals react differently under the impact of “alarming stimuli” than individuals already under stress, i.e. for instance, suffering from certain psychosomatic manifestations.

Maladjustment at work is not synonymous with sickness, but when a middle-aged man becomes grossly inefficient in a job at which he has previously excelled, the chances are that he is ill. This paper describes such a case, and the investigations that led to the diagnosis by cortical biopsy of Alzheimer's Disease. So far as is known, this is the first recorded instance in this country of Alzheimer's Disease being diagnosed histologically during life. Apart from its interest as a clinical curiosity, however, this case illustrates some practical problems often arising in the assessment of this type of patient, which can be as difficult and responsible a task as any that the psychiatrist has to undertake.

Mephenesin is a muscle relaxant which acts mainly on the spinal cord but which also has a definite effect on the thalamus, the basal ganglia and the brain stem. It relaxes hypertonic muscles, without appreciably reducing motor power, and allays fear and tension.

One and a half years after she had been excluded from school a little girl of six and a half years was being watched by me as she took her part in the school assembly and entered into the normal activities of the A stream of her class. Some two months later the head teacher telephoned us excitedly to say that this same child had put up her hand in the full school assembly and answered the question correctly. There is perhaps little remarkable in this until I add that this child, Gwen, in October, 1952, was diagnosed as a schizophrenic and has, with two others, been treated along the lines indicated in a previous paper.∗

During recent years a number of Local Education Authorities have opened Hostels for Maladjusted Children but few have been open long enough for any adequate review of their work to be undertaken, or for principles of working to be clearly formulated. Winnicott and Britton (1944, 1947) have discussed their work in Hostels for evacuated children during the War, and the Ministry of Health (1944) also reviewed their war-time experience in similar Hostels. Little however has been written on the work of Hostels for Maladjusted Children as part of the ordinary peace-time work of a Child Guidance Service. This paper reviews the work done during the five years 1946 to 1951 in two Hostels in a Midland City and comments on the experience gained. It is felt this may be of general clinical interest, and of value for comparison with observations being made in other areas. As part of the review a study has been made of 50 unselected children who, having been in the hostels, had been discharged during that period, and whose subsequent progress it has been possible to follow.