In this paper, elaboration of a Realist answer to some of the classical questions of psychology and epistemology will be sought, starting from a knowledge of Soviet and Western findings in psychophysiology (particularly the work of Pavlov, 1932, and Hebb, 1949; see also the summary by Burt, 1968). The point of departure taken in the philosophical literature is the paper by Place (1969). This paper will adopt a reflexological model of brain function—with its implied view that memory is synaptically encoded. While this model has largely fallen into disfavour it is used here paradigmatically—to show that well-developed physiological models in general can provide a satisfactory account of ‘mental’ phenomena.

In the last two years psychiatrists, amongst others, have become aware of the technique of cluster analysis, and having obviously decided that this technique may be useful have applied it to sets of data (e.g. Pilowsky et al., 1969; Paykel, 1970), and in some cases drawn conclusions about the results. This paper will attempt to point out some of the problems of this type of analysis, in the hope that in the future casual users of the technique may be more aware of its possible pitfalls.

The aims of this paper are to report findings from the use of an empirically derived typology to predict response of depressed patients to amitriptyline, and to compare this typological prediction with predictions from two other classifications of depressed patients, one traditional and one newer.

In the development of the MMPI, one of the original purposes of this self-report inventory was to assist the physician in the detection of neuroses in his patients. Dahlstrom and Welsh (i), however, raise the question… ‘can a person who is physically deformed, handicapped, or sick get appreciable score elevations on the profile merely by giving a factual description of his disorder … (p. 274)?’

Thus the mind is not large enough to contain itself: but where can that part of it be which it does not contain?

Cameron (1938, 1939) suggested that schizophrenic thought disorder is largely the result of overinclusive thinking, which he defined as the inability to preserve conceptual boundaries. Payne, Matussek and George (1959) developed a battery of objective measures of overinclusive thinking, which they found differentiated between an acute schizophrenic and a neurotic control group. Payne and Hewlett (1960) found that a battery of tests of overinclusive thinking intercorrelated as expected. They were able to obtain a factor score from their overinclusion test battery which differentiated a group of acute schizophrenic patients from control groups of depressives, neurotics and normal subjects. Payne and Friedlander (1962), on the basis of this factorial study, suggested a short battery of three measures of overinclusive thinking consisting of the number of ‘Non-A’ or unusual responses to the Object Classification Test (Payne, 1962), the average number of words used in explaining the Benjamin Proverbs given under special 'stress free’ instructions, and the average number of objects classified together in the ‘handing over’ section of the Goldstein-Scheerer Object Sorting Test. This standard test battery has been the operational definition of overinclusive thinking in a number of studies. Only one study of the reliability of this test battery appears to have been carried out. Hawks and Payne (1971) report the correlations obtained from a group of 54 psychiatric inpatients who were retested after a 4-day interval. The test-retest correlation coefficient (uncorrected) obtained from the Combined Transformed score (Payne and Friedlander, 1962) was 0 · 87. The reliabilities of the individual tests ranged from 0·77 to 0·86.

Retardation, i.e. abnormal slowness in performing mental and/or motor tasks, is frequently noted as being a prominent feature of schizophrenia. While some writers describe it as being merely one of the several clinical signs and symptoms of schizophrenia, others suggest that retardation has a causative role, and is a basic disorder underlying antisociability and withdrawal from reality (Babcock, 1933), intellectual deficit (Shapiro and Nelson, 1955), affective flattening (Harris and Metcalfe, 1956), thought-process disorder (e.g. Yates, 1966), and other disorders.

The last decade has seen a shift in the emphasis of research into student problems and student performance. On the psychological side there has been a move away from somewhat static concepts of personality measurement and intellectual assessment, and the concomitant preoccupation with prediction and selection, towards a more interactive approach in which individual aspects are related to academic and social processes (e.g. Sanford, 1962; Lavin, 1965; Wankowski, 1969). On the mental health side there has been a shift from 'syndrome identification’ towards a more dynamic appraisal of personal and social forces and their interaction (Grant, 1969; Ryle, 1969; Lucas and Linken, (1970).

The constructs (Kelly, 1955) which individuals use when describing other people may be classified as ‘psychological’, i.e. those referring to the personality and emotional state of the people, or as ‘objective’, i.e. those referring to their physical characteristics, social class, clothing etc.

‘Psychogenic infertility’ refers to the state of childlessness in which psychological factors play an aetiological role. Use of the term ‘psychogenic’ implies that there is a reluctance or an ambivalence on the part of one or both partners towards conception. There is a considerable literature on psychogenic infertility, which has been reviewed elsewhere (Noyes and Chapnick, 1964; Mai, 1969). Although much of this literature is conflicting and inconclusive, it does suggest an association between disturbed sexuality and infertility in the female. Such a causal relationship might be mediated by two types of mechanism.

Hurd in 1888 described cases of mania, melancholia, folie circulaire and attempted suicide in mental defectives. Ireland in 1898 described three ‘imbecile lunatics’ who were ‘clear cases of melancholia’, and quoted an earlier physician, Wells, who in 1845 had seen ‘attacks of mania in cretins, as well as a peculiar suicidal form of this affliction, which prompts the wretched maniac to attempt self-destruction by throwing himself into the fire’. Clouston (1883) considered that ‘congenital imbeciles may have attacks of maniacal excitement or of melancholic depression—in fact are subject to them’. Kraepelin (1896, 1902) took the view that ‘imbecility may form the basis for the development of other psychoses such as manic-depressive insanity, the psychoses of involution and dementia praecox’. Gordon (1918) stated that mental defectives suffering from depression rarely express ideas of guilt or thoughts of suicide; manics lacked ‘quickness of comprehension of wit or humour or sarcasm’. He noted that depression was more common than mania and that recurrences tended to run true to type. Prideaux (1921) accepted that manic-depressive psychosis could occur in high-grade mental defectives, and drew attention to the increased incidence of conversion hysteria in patients of low intelligence. Medow (1925) observed that mental defectives could manifest all the types of mental illness seen in people of normal intelligence but in the defective mental illness had a silly, fantastic, nonsensical colouring. Neustadt (1928) put forward the view that the typical psychoses of the mental defective were acute episodic states of excitement.

Kraepelin (1896, 1902) believed that approximately 7 per cent of cases of dementia praecox arose upon the basis of imbecility. He also suggested that ‘certain forms of idiocy with developed mannerisms and stereotypies might be early cases of dementia praecox’, and proposed the term ‘Pfropfschizophrenie’ to denote ‘eine besonders früh entstandene Schizophrenic’ (a schizophrenic psychosis of particularly early onset). Though he later modified his views and agreed that the rhythmic movements seen in some idiots did not in fact signify dementia praecox, he continued to believe that dementia praecox beginning in the first decade could produce 'states of weakness … regarded as imbecility or idiocy’.

Creatinine has long been used as a basis for urinary excretion studies of drugs and metabolites. Nevertheless, the validity of this has been seriously challenged by Paterson (4), whose findings were confirmed by Scott and Hurley in adults (5) and by Applegarth, Hardwick and Ross in children (1). These authors found that evaluation of urinary creatinine output cannot replace the practice of careful timing of 24-hour specimens as a basis of excretion rate. However, collection of well-timed specimens in ambulant psychiatric patients usually presents a great deal of difficulty.

Urinary retention without apparent organic causation is infrequently commented upon in the psychiatric literature. Cooper (1965) described the use of conditioning therapy in the treatment of a patient with hysterical retention of urine. In our experience urinary retention without organic causation is more frequently seen as a post-operative complication, lengthening considerably the period of stay in hospital. Two such cases were successfully treated by a new psychodynamic technique which we have recently developed. This technique makes use of dream suggestion to the patient in clear consciousness, in that respect differing from other techniques of dream suggestion such as Stoyva's (1965) dream instructions to patients in the hypnotic state.