Nearly everyone here, I imagine, has either been present at or has read the splendid Maudsley Lecture delivered in 1958 by Professor Leo Kanner (1). In this Lecture Kanner reviewed the various interests, or, as he called them, the loosely scattered segments which by their eventual convergence and fusion resulted in the emergence, between thirty and forty years ago, of child psychiatry. He caused them to pass before our eyes in a vivid and colourful procession—psychiatry, mental deficiency, education, criminology, psychology, psycho-analysis, the child guidance clinics, with paediatrics given a place of its own, though not allowed to march in the procession itself. Now, I have been asked to take up one or two of these segments for closer examination, and give some account of their contents and development during the pre-historic period before they began to converge towards their final synthesis. In so far as I am able to do this, my account will be merely factual; I must leave it to you who are engaged in this field of work to assess the relevance of the material which I am presenting.

Speech has been called a socio-economic device for saving effort in the attainment of objectives (Whitehorn and Zipf, 1943). One of its earliest and most fundamental purposes is to orientate the individual within the community. This socializing effect operates early in childhood, and in a phylogenetic sense it was perhaps one of the greatest factors in the origin of speech in primitive man. As maturity is slowly achieved in the individual as in the genus, the use of language becomes inextricably interwoven within the warp and woof of the organism, as exemplified not only by thinking processes, but also by the complicated structure of personality. The development of speech during the pre-hominoid stage synchronizes with the gradual elaboration of communal life: with cries and calls serving as a “sound-tool”: and with the beginnings of delegation of labour. Thus language is primarily a vocal actualization of the tendency to see reality symbolically (Sapir). The same is true ontogenetically. As the child gradually acquires speech, the organization of his thinking slowly changes; it evolves by intricate steps from ego-centric to socialized activity; and as he begins more and more to employ pronouns of the second and third person, he also utters fewer “action words”. We readily agree with Fillmore Sanford (1942) that “there are many indications that language is a vehicle of personality as well as of thought, for when a person speaks, he tells us not only about the world, but also, through both form and content, about himself”. The same author quoted Ben Jonson: “Language most showeth a man; speak that I may see thee.”

Over the last few decades, social psychiatry has demonstrated correlations between mental illness and certain broad social categories. At the same time clinical, genetic and psychological studies have continued their traditional interest in the illness of the individual. The divergence of these two approaches has left relatively unmapped a large area which is of considerable psychiatric interest; despite much descriptive work, very little has been clearly established (outside genetics) concerning mental illness in the small, closely-integrated group, of which the prime example in our culture is the family. Out understanding of how personal and social factors jointly contribute to mental ill-health might well be furthered by studies in this field.

Roth and Rosie (1953) discussed the beneficial effect of E.C.T. in a wide range of psychoses complicated by clouding of consciousness, including syndromes of frankly organic origin. The treatment has been used effectively for psychotic symptoms in G.P.I. (Ewald and Haddenbrock, 1942; Bini, 1947; Solomon et al., 1948; Yaskin, 1948; Kalinowsky, 1949; Lopez Ibor, 1950), pellagra and pernicious anaemia (Fernandes and Polonio, 1946). It is perhaps not surprising that a search through the literature has failed to bring to light a case of stupor subsequent to a head injury being treated with E.C.T.

From a review of the literature Carstairs (1959) demonstrated that the sharp rise in admissions to mental hospitals since the Second World War has been due to the changing pattern of use of these hospitals, and not to any significant change in the prevalence of major mental disorder. The present paper examines statistics relating to admissions to Scottish mental hospitals in general, and to Dingleton Hospital in particular, in the 15 post-war years 1945–1959, with the object of showing some of the ways in which the character of admissions to mental hospitals has changed over that period.

The passage of small direct currents through nerve cells gives rise to changes in their excitability. For example an outward current flow through the membrane of the soma gives rise to depolarization and a consequent fall in the threshold for excitation of the neurone. When a cell lies in an applied external electrical field a potential gradient exists between the cell body and its distant processes. If this gradient is such that the cell body is negative relative to its processes, the cell becomes more excitable; it becomes less excitable when the cell body is relatively positive.

A previous paper (Lippold and Redfearn, 1964) described the mental changes that can be produced by the passage of small polarizing currents through the brain in human subjects. It became apparent during the course of these experiments that some of the effects persisted for hours or days after the current had been turned off. A persistent excitatory after-effect of surface-positive cortical polarization has recently been demonstrated in the rat (Bindman, Lippold and Redfearn, 1962). It is possible that a similar phenomenon, at the cellular level, is responsible for the long-lasting psychological effects of polarization.

In a series of neurotic twins who are being systematically studied by the Genetics Unit at the Maudsley Hospital, two pairs have been of particular interest.† Both had identified with each other to an extreme degree, yet only one of each pair had a psychiatric illness requiring extensive in-patient treatment. They illustrate the fact that identification can be a feature in monozygotic twins, yet does not necessarily lead to concordance for emotional disturbance.

The term echopraxia refers to the automatic repetition by an individual of visually perceived actions of others. It has been reported to occur in a variety of pathological mental states (Stengel, 1947). Descriptions of the phenomenon as it occurs in schizophrenia tend to be limited to a brief reference to its presence in catatonic patients, and it is not generally recognized to be a feature of the early stages of the illness. The purpose of this paper is to make an attempt to analyse the phenomenon, in discussing the subjective reports of a number of young schizophrenic patients who were interviewed in the early stages of their illness. Before proceeding to these reports it may be useful to examine briefly echopractic behaviour first as it is reported in normal development and then in clinical conditions, particularly chronic schizophrenia.

Retrospective and prospective studies of personality development each have their own strength and weaknesses (1, 3). However, as parental recall of the characteristics of their children when younger is so inaccurate (10), certain developmental questions require longitudinal study in order to avoid the biases inherent in the retrospective method (6).

In Scotland the central collection of forms bearing details of admissions to all psychiatric hospitals was begun in January, 1962. These forms are intended to provide knowledge about the incidence of psychiatric disorders and the result of treatment. The details of this scheme and the nature of the information required were presented at a meeting of the Scottish Division of the Royal Medico-Psychological Association in 1961, and in the discussion which followed the reliability of data which depended on clinical diagnosis was questioned.