This paper summarizes the main findings of two years' ethno-psychiatric field-work carried out in N.W. Ashanti throughout 1956 and 1957, and later to be published in full detail.

The picture surrounding the rural field-worker is essentially different from that seen by psychiatrists in mental hospitals. In rural districts only homicidal patients are ever referred to a mental hospital, and then only from the police-magistrate's court. All other mental illness is regarded as super-naturally determined and hence outside the province of European medicine.

Psychotic patients with periodically changing symptoms offer particular opportunities for psychosomatic and metabolic studies. Following the classical work of Gjessing (1932, 1935, 1939, 1953) other authors (Ashby, 1952; Rowntree and Kay, 1952; Smith, 1954; Gunne and Gemzell, 1956; Crammer, 1957) have studied metabolic changes in periodic catatonia. Cycles of behaviour and metabolism in psychiatric patients and in patients with “periodic disease” have been reviewed by Richter (1957) who also reported on interesting experiments aimed at the induction of periodic cycles of behaviour in rats.

During recent years members of the Medical Research Council Pneumoconiosis Research Unit have carried out a number of studies of the prevalence and incidence of common diseases in two populations in South Wales and attempted to relate differences in morbidity to known differences in social and environmental factors (Cochrane and Miall, 1956). The communities studied are the Rhondda Fach, a mining valley with a population in 1951 of 19,722 (aged over 15 years) living in a contiguous series of eight small towns, and a number of parishes in the Vale of Glamorgan, approximately ten miles from the Rhondda Fach, in which the population of 4,621 (aged over 15 years) is spread over a relatively large agricultural area. These will be referred to as the Rhondda and the Vale. They were originally chosen to provide a complete mining community (in which the prevalence of diseases of the lungs in miners and ex-miners could be estimated) and a contrasting, predominantly rural, population respectively.

Few problems in the whole field of psychopathology are more important than that of aetiology. While it is generally accepted that heredity and environment must interact in some fashion in the causation of most mental disorders, the nature of the roles played by the two classes of determinant is not known. Consequently, any study shedding light on this problem is of primary importance.

Pavlov's theory of hypnosis is, perhaps, the first theory of hypnosis to be essentially derived from physiological experiments. Arising out of his experiments with dogs, the theory hopes to explain the hypnotic phenomena in human beings.

The increasing importance of properly controlled drug trials in modern medicine has shown the need for further study of the “placebo response” and the effects of “suggestion”, particularly in the evaluation of the results of treatment of the psychoneuroses. Much of the work on the response to placebos has been done on their deleterious side-effects, i.e., the production of symptoms of various kinds, but some recent investigations have clearly demonstrated the amelioration of symptoms by the administration of placebo.

Despite the widespread use of chlorpromazine in psychiatric treatment during recent years and the voluminous literature on its use, there is still considerable difficulty in forecasting which patients are likely to benefit.

Some time ago the Department of National Health and Welfare of the Government of Canada became interested in the therapeutic effects of a preparation of nucleotides in the treatment of mental illness. It was decided that the research group from the Saskatchewan Hospital, Weyburn, should assess the usefulness of the preparation in the treatment of chronic schizophrenia.

The customary classification of the amaurotic family idiocies according to the time of life at which neurological signs first appear has obvious limitations when consideration is given to cases occupying an intermediate position between the well-established infantile form of Tay-Sachs' and the juvenile form first described by Batten (1903). It was to this group of atypical cases that Bielschowsky (1913–14, 1920) gave the name “late infantile”. This term is convenient clinically but when more examples of the variant had been reported it became evident that the group of cases so designated was not homogeneous. Wyburn-Mason (1943) was able to show in a large clinical material that many of these intermediate forms belonged either to families affected by Tay-Sachs' or by Batten's disease and that in an individual case the ophthalmological findings were usually of decisive importance in classification. The existence of a precocious variant of the classical “juvenile” type of amaurotic idiocy was thus clearly established. Klenk's (1939) discovery that the nerve cells in Tay-Sachs' disease contain large amounts of a glycolipid subsequently called “ganglioside” has provided a further valuable criterion in distinguishing this form of lipidosis from other members of the group. The present case, an example of the precocious juvenile type of amaurotic idiocy or, as we prefer to name it, the subacute form of Batten's disease, is presented as a further contribution to this subject.

It is clearly advantageous to the personality theorist to know which of his measures covary and to what extent. The results of factor analyses can be useful in summarizing some of the patterns of covariation and classifying response measures. An indefinitely large number of sets of factors may equally well describe the same set of data, however, and, before any choice of one particular set of factors, dimensions, principal components, etc., can be considered as revealing basic intervening variables or constructs in a personality theory, independent evidence must be provided. It is the purpose of this paper to reveal some of the pitfalls in making such a choice by showing how concentration on one set of factors obtained by analysing a multivariate scatter can lead to a serious loss of information when applied to the analysis of group differences in the same set of data and can suggest interpretations which are at odds with the full evidence.

Of all the tranquillizers, it may well be said that benactyzine has had the most chequered history. After its synthesis, a series of most careful experiments on animals demonstrated its ability to reduce or modify behaviour induced by stress. The first clinical trial gave rise to high hopes of its value in treatment but as further trials, more carefully designed, were made the results became increasingly inconclusive.

Evidence is accumulating that schizophrenia is a disease involving “immunoallergic” sensitization of the tissues of the central nervous system. Variations in its symptomatology may in part depend upon the altered ability of the sensitized nervous tissue to bind or release serotonin, and perhaps other endogenous catechol amines. Accumulation of these products; their rates of turnover; the presence of endogenous enzyme enhancers or inhibitors; specific endocrine dyscrasias; blood-brain barrier conditioners; as well as cellular changes in electrolytes, may all play a part in the process. Genetic defects; lags in maturation; autonomic imbalance and pre-psychotic personality structure may lurk in the background.

The assessment of the results of a treatment in any particular disorder is generally a very complicated one, by reason of the fact that the treatment does not usually improve all the manifestations of the disorder, and even when it does so, it does not affect them equally. The case of thyroid medication, which completely eliminates all the manifestations of thyroid deficiency, is an unusual one in medicine. Even where the pathological process may be completely stopped, as in general paresis and pulmonary tuberculosis, the patient may be left with residual loss of function due to irrevocable loss of normal tissue. In some cases the treatment itself may be of such a nature that the patient merely exchanges one disability for another. For example, the treatment of mild diabetes mellitus by a reducing diet may indeed eliminate the diabetes, but only at the cost of replacing it by chronic hunger and social restrictions, which many patients feel are worse than the original disease. In the end, they may give up their treatment. In some cases, the treatment has “complications”, which means to the patient that he merely exchanges one set of symptoms for another. For example, he may exchange the symptoms of duodenal ulcer for those of dumping syndrome.

Psychiatrists and clinical psychologists can be classified into the Big-Endians who believe in classification and the Little-Endians who do not. Each side has its derogatory stereotype of the other. According to the Little-Endians, Big-Endians are tough-minded, cold, impersonal monsters who think about the human personality in terms which are static and rigidly structural rather than fluid and dynamic. Contrary to Swift, they love people in general and hate Tom, Dick and Harry. In the field of mental health, they believe in illnesses rather than in people and believe that these illnesses all have an as yet unknown physical cause. They are reactionaries.

There has grown up in the past 30 years in East Africa a school of medical psychologists which sets out to interpret African thought processes, personality traits and mental disorders in terms of a racially genetic and cultural disposition. A correlation is assumed or suggested between a specific brain structure, social behaviour, psychology and psycho-pathology. Explanations are couched in terms of a racial determinism, and involve an assertion of inferiority as compared with the White race.

When the diagnosis of epilepsy is made, the patient must first of all be investigated to make sure that the epilepsy is not symptomatic of a disease that will need some special line of treatment. For example, epilepsy starting at any age may be the first indication of a cerebral tumour, although this will obviously be more likely among the older patients. The nature and extent of these investigations will depend on such factors as the age of onset, the type of seizure and the associated positive physical signs. However, even in the cases where there is no evidence whatsoever that the epilepsy is symptomatic, an electroencephalogram may help in differentiating the type of epilepsy from which any particular patient is suffering, and so aid in deciding on the form of treatment most likely to be beneficial. When any necessary investigations have been carried out and the form that treatment is to take has been settled, the social implication of this diagnosis has then to be faced. This often resolves itself into a discussion of the patient's employment.

Tumours of the corpus callosum (C.c.) are known to be a difficult diagnostic problem. Intellectual and mental disturbances and rapid deterioration in the course of the illness have been observed in most of these cases and are considered by many authors to indicate an involvement of this body (Lévy-Valensi, 1910; Mingazzini, 1922; Ironside and Guttmacher, 1929; Alpers and Grant, 1931; Voris and Adson, 1935; Schlesinger, 1951, Bremer et al., 1956). However, a similar picture may also occur in tumours of other sites; moreover, tumours of the C.c. tend to infiltrate the hemispheres, particularly the cingulum and the frontal lobes, and this might well account for the mental picture. A sign which seems to be more specific for damage of the C.c. is dyspraxia restricted to the left limbs in right-handed persons. Although this dyspraxia has been reported only in a small minority of cases concerned, it has not been observed in lesions other than those of the C.c.

At a recent court case (40), the plaintiff, who sustained bilateral acetabular fractures following unmodified electroplexy, maintained that the defendants were guilty of negligence by failing to use relaxant drugs to prevent the risks of injury.

The term “post-operative psychosis” refers to mental illnesses which follow in the wake of surgical operations. These conditions have received relatively little attention from psychiatrists. The text-books either do not mention them or, if they do so, consider them with the delirious or toxic-exhaustive states.

Between 1 January, 1948 and 1 July, 1956, forty-one children in the Fountain Group Hospital were accepted as educable by ten Education Authorities and they were transferred to appropriate schools. In addition three children under 5 years were found on admission to be of average intelligence. All forty-four children had been admitted to this hospital of approximately 700 beds for low-grade mentally defective children.