Gelineau (1880) introduced the term “narcolepsy” and suggested that it constituted a disease sui generis. A careful perusal of the literature, however, shows that the condition had been described previously. Precedence has been claimed for Bright, Thomas Willis and even for Galen! At any rate, Notkin and Jelliffe (1934) were able to unearth 270 cases of narcolepsy and allied conditions in a literature survey covering the years 1813–1931.

It was in my early youth that I first read Bergson's Creative Evolution. At that time, as I recollect, it particularly captured my interest and attention because it seemed to embody certain essential principles which I had not found to be expressed quite so forcibly elsewhere. It is true that the validity of many of Bergson's speculations and ideas have since been seriously controverted and so find little or no support today, but his philosophy also propounds certain conceptions which are perhaps worthy of renewed attention. I refer more especially to Bergson's contrast of those two aspects of conscious experience which he terms intellect and intuition. Intellect, he argues, is the product of a gradual evolutionary process which enables the individual with increasing efficiency to select and abstract just those several features of surrounding objects which are directly relevant to the problem of evolutionary survival. In so far as it selects and abstracts, the intellect by itself can provide only a partial view of external reality. “To conquer matter,” Bergson says, “consciousness has had to exhaust the best part of its power”—it has had to “adapt itself to the habits of matter and concentrate all its attention on them, in fact, determine itself more especially as intellect.” But there remains “around our conceptual and logical thought a vague nebulosity, made of the very substance out of which has been formed the luminous nucleus which we call the intellect”. Therein reside certain powers that are complementary to the understanding—powers of intuitive recognition. Intellect is essentially based on a sort of derived symbolism gradually elaborated in the course of evolution, which serves its immediate purpose as a convenient, useful, and indeed essential device for gaining control over the material world; on the other hand intuition, according to Bergson, is capable of giving scintillating flashes of insight “into the very inwardness of life”.

Since the author has been working for some fourteen years alongside psychiatric colleagues his slender assets are as heavily and inextricably invested in the future of Psychiatry as those of any psychiatrist. Such criticisms as are offered must, therefore, from this point of view be regarded as within rather than between group criticisms.

Alcoholism is a grave social, economic and psychiatric problem which has attracted the attention of countless research workers and theorists. From a survey of the recent literature two conclusions emerge. Firstly, that there is at present no general agreement as to the aetiology, dynamics and treatment of alcoholism (1). Secondly, that the inadequacies of the majority of the experiments reported are such that the findings are often difficult to interpret and highly limited in their value (2, 3). In many cases the conclusions do not follow from the data; in others they are impossible to evaluate because insufficient procedural details are given; other studies attempt to answer a large number of questions and answer none adequately; some findings are based upon extremely small or atypical samples while others are based upon experiments open to such obvious criticisms that serious consideration is unwarranted. Many of these studies are apparently the by-product of the busy clinician's experiences and consequently lacking in rigour of any description. Remarkably few are predictive in their techniques or based upon any clearly formulated and testable theory. It is hardly surprising that so many fail to satisfy the usual criteria of acceptable scientific research (4).

Jaspers (1946) has pointed out that in the history of psychiatry one can distinguish two main types of psychiatrist. On the one hand there is the describer who depicts a lively clear clinical picture and communicates it to the reader in everyday speech. On the other hand there is the analyst who dissects the clinical picture and tries to obtain clear concepts about the abnormal phenomena. The describer is always popular because little effort is required to understand his views and appreciate his clinical descriptions. However it is much more difficult to understand the analyst as this requires time-consuming preparatory work and an attempt to apply the analyst's views in practice. Thus anyone who wishes to understand the views of Kleist and Leonhard, who are the modern representatives of the great clinical analyst Carl Wernicke, has a difficult task. If therefore this present communication appears to disagree with other work recently published by the author (Fish, 1957b, 1958) then all that can be said in extenuation is that the analysis of clinical pictures is difficult and one can only achieve accuracy in this field by learning from mistakes.

Cattell's basic strategy in personality research has been first to establish personality factors for each of three major types of measurement, rating (Life-Record), questionnaire (Self-Rating), and objective tests, then to compare factors from one realm with factors from another (7). A factor in any one realm is established in the first place by being replicated. As Cattell says (4, p. 291): “… a functionally unitary trait or process should nevertheless not be considered established by a pattern in a single factor analytic research, but must reappear consistently and persistently in independently rotated studies.”

Enquiry into the occurrence and the pattern of S.† in different cultures promises to reveal information of importance, but there is as yet inadequate material from which definite conclusions can be drawn. Cavan (1928) and Dublin and Bunzel (1933) devoted chapters of their works on S. to this aspect of the subject. These, however, were but poorly assorted collections of descriptive items from various ethnologists, orientalists, and historians, and from them few significant relationships between S. and culture could have been deduced. Zilboorg (1936, 1937) tried to build a concept of S. as a preformed, archaic behavioural reaction on ethnological data, but it must be admitted that valuable though this formulation is he has made somewhat tendentious use of his material in weaving them into the fabric of psycho-analytic theory. His arguments have been subjected to criticism by Wile (1937). Ellenberger (1953) cited examples of S. from various cultures that could be classified under the three components of the S. impulse described by Menninger (1938), viz., the wish to die, the wish to be killed, and the wish to kill. Such a classification, however, cannot cover all the facts. The social sanctioning of S. for different motives in different cultures would seem to argue against the notion that S. everywhere involves the same “components”. The view that S. is rare in elementary and compactly organized societies has long been held, and has recently been confirmed as far as the Yorubas of West Africa are concerned by Lambo (1956).

This paper describes an inquiry into the effects of giving oral doses of the narcotic drug variously known as hashish, marihuana and, in South Africa, dagga. The drug is a preparation from the plant Cannabis sativa whose narcotic effect has been known for centuries. The writer's interest in it was inspired by the work in recent years on the mental disturbances produced by the active principles of other plants, e.g. mescaline and lysergic acid. Because of the similarity of these changes to those occurring in conditions such as schizophrenia, some workers have suggested that these “model psychoses” could be used as a research tool in attempts to elucidate the mechanisms and causes of the naturally occurring psychoses. Although there has been a great deal of work on mescaline and lysergic acid, cannabis has not received much attention. This may be because its chemistry is still not fully worked out and preparations of the plant are difficult to standardize and vary in their potency.

It was Bleuler (1917) who introduced the conception of “schizophrenia” as a mental illness and described its characteristics. Since 1957 was the centenary of Bleuler's birth the attention of psychiatrists has been focused on the various problems and difficulties still confronting us today regarding the diagnostic, aetiological and therapeutic aspects of this disease.

Nowadays when clinicians feel happier guided by methodologists and statisticians, only the brash or the sophisticated care to report single cases in detail. Yet medicine has in the past profited greatly by careful observations of this sort, and so good is this precedent that we have decided to defy fashion and report the affair of Mr. Kovish, one of those curious happenings which, we think, deserves a permanent record.

A detailed scheme of classification of schizophrenia has been produced by Professor K. Kleist and elaborated by Professor K. Leonhard (Kleist, 1943, 1949; Kleist et al., 1950, 1951; Kleist and Schwab, 1951; Leonhard, 1936, 1957; Schwab, 1949). The validity of this scheme has been established by other investigators (Schneider, 1955; Schulte-von der Stein, 1955). An English summary of the Kleist-Leonhard scheme has recently been published (Fish, 1957). In 1955 an attempt to classify the chronic schizophrenics in the Female Division of St. Nicholas Hospital, Gosforth, according to the Kleist-Leonhard scheme was begun. By means of reading the case notes, enquiring from the medical and nursing staff and short clinical interviews it was provisionally concluded that there were 243 chronic schizophrenics in the female division with an illness of more than 10 years' duration. These patients were investigated clinically, but by the time the author took up his present appointment only 107 cases had been seen. An attempt was made, however, to investigate approximately the same proportion of patients from each ward of the female division with the exception of the geriatric ward. This series seemed to be a fairly representative sample of the chronic female schizophrenics.

The aim of this paper is to show how, in our view, the diagnosis of Pick's pre-senile dementia can be made in some cases during life on clinical grounds alone.

The problem of differentiating impending hepatic coma from delirium tremens is one which arises less commonly in Great Britain than in the United States. It is a problem which occurs, of course, chiefly in connection with alcoholic patients and while alcoholism has declined in Great Britain it is becoming an increasing medical and social problem in certain sections of the United States (1). Thus, at the Boston City Hospital alcoholism was a factor in over 45 per cent. of patients with cirrhosis of the liver at post-mortem (2). At the Hammersmith Hospital in London alcoholism was an aetiological factor in 5 per cent. of patients with the clinical diagnosis of cirrhosis (3). There is no doubt that the problem of differentiating impending hepatic coma from delirium tremens is a common and relatively easy one in Boston, whereas in London it is a rare and therefore more difficult one.

Genetic factors have been shown to play an important role in the development of neurosis. These factors, however, determine the vulnerability of an individual, the degree of his predisposition for neurotic breakdown, while the available evidence indicates that the actual behavioural disturbance results from the imposition of some form of environmental stress on the individual concerned. The probability that any particular individual will develop a neurosis is partly determined by his genetic constitution and partly by the degree of stress to which he is subjected.

The present investigation deals with the effects of two lengths of exposure time in neurotic and schizophrenic subjects, and with the relations between these effects and measures of extraversion, neuroticism and rigidity. A consideration of previous work, discussed in the following paragraphs, led to three main predictions concerning varying exposure times.

The investigation described in this paper had two aims. The first of these was to determine the effects of E.C.T. on psychomotor slowness. As has been reported elsewhere (Shapiro and Nelson, 1955), psychiatric patients of the major diagnostic categories have been found to be slower than normal subjects on psychomotor tests. In addition it has been found that such slowness is correlated with subjective estimates by psychiatrists of degree of illness. As E.C.T. is given in order to improve the clinical condition of depressed patients, it was of interest to ascertain the effect of E.C.T. upon slowness.

The task of preventive psychiatry—if there is such a thing—can be expressed in a positive form as the promotion of mental health; but mental health can be defined in two ways: as the absence of recognizable mental illness or, in more grandiose terms, as the realization to the fullest possible extent of one's personal potentialities. The latter concept has been denounced by some authorities as representing much too wide an extension of psychiatry: that it continues to be prominent in discussions of mental health programmes and the like is due to the insistence of laymen perhaps even more than of psychiatrists. It appears that in the Western World people are increasingly turning to psychiatrists for the answer to problems which once would have been the concern of priests or politicians. That they do so is a psychiatric problem in itself; that they will continue to do so in increasing numbers seems very likely—so we had better have our answers ready, even if they are only disclaimers of problems which do not concern us.

The controlled study of the major physical treatments in schizophrenia (and other psychiatric conditions) has been retarded by the view that it is unethical to withhold treatment from the patient. Although this argument is clearly dubious until a treatment is proved, the number of forward-looking controlled studies of E.C.T., insulin coma therapy and leucotomy may nevertheless be counted on the fingers of two hands. Not all schizophrenics have, however, received every possible treatment, and if it were possible to make comparisons of treated and untreated cases retrospectively, there would be no ethical objection to overcome.

Since the original article by Elkes and Elkes (1954) numerous reports have been published in the world literature on the use of chlorpromazine in chronic psychotic in-patients. The majority of these studies indicate that the drug is indeed effective in improving the behaviour of these patients; a small minority of authors is more sceptical including Mitchell (1956) using doses up to 300 mg. daily, Sarwer-Foner and Ogle (1956) with doses of 150–400 mg. daily, and Trelles and Saavedra (1954) using sleep treatment. The literature contains numerous reports of controlled and uncontrolled studies on chlorpromazine and comparisons of its effects with those of a placebo, Reserpine, Azacyclonal, etc.; attention is now turning to the effects of such drugs in various combinations.