On the Causation of Mental Symptoms: An Inquiry into the Psychiatric Application of Hughlings Jackson's Views on the Causation of Nervous Symptoms, with Particular Reference to Their Application to Delirium and Schizophrenia

Response to Drugs and Psychiatry

Fashion is more deep-rooted than contemporary custom will allow, and the current enthusiasm for drug treatment in psychiatry is no evanescent fad. The Greeks made good use of the pharmacopœia, prescribing borage, buglosse, marigold, polypodie and epithyme for melancholy, more specifically recommending wormwood, centaury and pennyroll for the hypochondriac malady. Burton (a) discussing black hellebor, relates that its virtues were extolled by Galen, Pliny and Coelius Aurelianus, the mentally afflicted being sent to the Anticyrae, or to Phocis in Achaia to be purged, the plant growing there in abundance. Burton (b) describes how the Melangoga, or melancholy purging medicines, were classified as simple or compound, purging upwards or downwards. Asarum, brassivola, laurel, scilla, white hellebor, and antimony purged upwards, whereas polypodie, epithyme, black hellebor, lapis lazuli and aloes purged downwards. Sceptics throve then, no doubt, as they do now. Meryon (1861) mentions Asclepiades—dismissed by Pliny as an impudent quack, who contended that drugs injured the stomach and induced complaints more dangerous than those which they were intended to cure.

Response to Some Stimulant and Depressant Drugs of the Central Nervous System

Nearly one hundred years ago, Anstie (1864) wrote: “Among the too frequent instances which are to be found in medical nomenclature, of confusion and uncertainty in the application of descriptive terms, there is none, perhaps, more striking than is occupied by the words Narcotic and Stimulant.” Both classes of substance embrace drugs of antiquity. Thus of the depressants, alcohol dates from the time of the Thracian god, Dionysus, while the earliest use of stimulants such as caffeine and xanthine is lost in the obscurity of the past (Goodman and Gilman, 1955a). Even today, there exists no systematized codification of response to the two classes of drug, although it is implicitly assumed that stimulants and depressants are invariably and mutually antagonistic in their effect on the central nervous system. Advantage was therefore taken of phenomena arising during drug intoxications to categorize abnormal features in the central nervous system common to each of the two classes of intoxicant and to essay a comparison, the one with the other.

Negative symptoms, defect state and Huber's basic symptoms: a comparison of the concepts

Comparing Crow's schizophrenia model with the defect state and Huber's basic symptoms shows that this model is an oversimplification of the complex reality of schizophrenic outcomes. The concept of negative symptoms is undermined by several factors, such as differing definitions, other confounding cross-sectional variables (e.g., akinesia and depression), short follow-ups and lack of confirmation by factorial analysis. The longitudinal concept of a defect state, which has been used in long-term follow-up studies, includes enduring symptoms currently classified as positive and negative. Huber's conceptualization of basic symptoms describes prodromal and enduring residual symptoms of schizophrenia associated with structural brain abnormalities. The overlap and lack of equivalence of these concepts and the limited empirical evidence does not allow firm conclusions. New longitudinal studies using clinical, psychosocial, and neuropsychological measures are needed to understand the natural history and etiology of the defect state.

Varieties of disorientation

Disorientation is not a uniform phenomenon and does not always follow the same pattern. Its pattern varies with its causes. Three varieties may be recognized. (1) The disorientation of toxic delirium. This is the best known variety. (2) The disorientation seen in some cases of schizophrenia. (3) That seen in some cases of brain tumour and other organic brain disease. The three varieties are all different, and the object of this paper is to consider why.