The Canadian Journal of Psychiatry

Although its exact effects are uncertain and the best patterns of dosage and frequency have yet to be ascertained, a combination of scopolamine and methedrine given intramuscularly appears to have some value as a means of rendering young, physically healthy, mentally ill offenders more accessible to treatment when they are participating in an intensive therapeutic community program. It offers a form of control of the psychopathic patient which is superior to heavy doses of tranquillizers or seclusion. In all phases of its employment its effects on the group seem cohesive, providing a focus for concerned and helpful activities.

The psychopathology of organic brain syndromes and functional psychiatric disorders in the aged has been outlined, and the various specific and non-specific physical therapies for psychiatric disorders occurring in this age group have been discussed. The indications for electroconvulsive therapy are restricted to depressions, particularly first and acute depressions in this population. Various drug therapies are successfully employed in numerous geriatric conditions.

Pharmacotherapy is discussed under six headings: Substitution or replacement therapy —whenever there is a break-down of metabolic processes due to deficiency of an important factor in the complex chain of metabolism; Anticoagulants and Vasodilators — when there is sufficient evidence to believe that decreased brain metabolism plays an important role in the causation of impaired behavioural functioning and inertness; Sedatives (minor tranquillizers) — to control restlessness, tension, anxiety and insomnia; Neuroleptics (major tranquillizers) — for the treatment of psychotic symptoms, e.g. hallucinations, delusions and manneristic behaviour; and Anti-depressants — for the treatment of various depressions.

It must be remembered that the general indications for these treatments are the same in geriatric as in younger patients, but the geriatric patient is often more sensitive to drugs and to the side effects they may produce.

This paper is concerned with the interpretation of the informational underload hypothesis of mental illness into the D-state.

Although the uniformity of sensory deprivation experiments has not yet been proven, it is nevertheless assumed that this uniformity exists and that sensory deprivation in the strict sense, perceptual isolation and sensory monotony all lead to a state of informational underload of the central nervous system. A minimum amount of information is needed by the organism and between organism and environment. The consequences of informational underload are assumed to be disequilibria within the organism itself, between the organism and its environment and also a disintegration of previously integrated central nervous system functioning.

The informational underload hypothesis, developed from sensory deprivation experiments, may also be interpreted into a wide variety of mental decompensations by assuming that pathological interference with the gating mechanisms of the nervous system takes place. The D-state is also seen as an example of informational underload in that there is a considerable excitation within the brain with blocking of input at the periphery.

The mechanism of disintegration of holistic nervous functioning under conditions of informational underload is discussed. It is assumed that the integrated cueing function, which unifies the entire nervous system in holistic operations, and the executive of which is thought to be the reticular formation, responds to incoming information. This will fail if insufficient amounts of information enter the nervous system and lead to semi-autonomous functioning of its constituent parts. The central cueing function itself is thought to be discontinuous and operating at a maximum rate of about every 50 milliseconds.

If the interpretation of this model into the D-state is correct, then this state is characterized by disintegration of holistic functioning. Support for this is found in some findings in the field of epilepsy — the lack of complete correlation between the physiological changes of the D-state and dream content and the irregularities in many autonomic parameters.

The possible biological significance of the D-state is discussed. The ‘deprivational' line of argumentation is rejected. It is pointed out that D-deprivation experiments may well be contaminated by a built-in conditioning procedure which does not take place during awakenings from the S-state.

During the ontogenetic development a differentiation between a state of low activity of arousal of the nervous system, the A- state, and one of high activity or arousal, the A+ state, is necessary. There is also a gradual shift from as yet unintegrated functioning to integrated functioning of a holistic nature by cueing on the basis of incoming information during both states. Primitive sleep and primitive waking are both originally unintegrated states, later in the development becoming integrated. It is assumed that the basic metabolic equilibrium is not between behavioural sleep and waking, but between the A+ state, including waking and dreaming, and the A- state, or dreamless S. Thus the D-state is not a particular way of being asleep, but a particular way of being awake. The total amount of A+ time increases from 16 hours at birth to 18 hours in adulthood, which is in line with changing metabolic requirements for A- or S. In order to explain the change in distribution between D and W within A+, it is important to realise that W and D at birth are both unintegrated states and probably represent an oscillation between entero- and distance perception.

A rest-and-activity cycle of 60 minutes at birth is assumed and thought to lengthen to 90 minutes with maturation. As meaning begins to develop in the W-state, parallel with the development of attention or focal awareness and of central integration, the W-state becomes more and more self-perpetuating, overriding the rest-and-activity cycle. Under conditions of prolonged arousal or A+, a metabolic need for A- or S develops. With this physiological pressure a reflex develops consisting of an input shutdown at the peripheral level on moments during behavioural sleep when the 90-minute rest-activity cycle tends to lift the organism from A- to A+. Thus the D-state is brought about and because of its lack of central integration, this variety of the A+ state is not self-perpetuating and a return to S is reassured until the metabolic need for S is fulfilled. Therefore D is there to guarantee a suffirent amount of S. The D-reflex is dependent on the development of the attention function. It is assumed that such a mechanism is only possible in the phylogenetic development if the regulation of informational input has become established.

All the hypotheses concerning the basic problems of schizophrenia have been disproved, challenged or simply never corroborated. We tried to find the reasons.

The first step in any research seems to be the definition of its object, but there is no definition of schizophrenia.

The influence of the organogenesis versus psychogenesis dispute and of the personal convictions of searchers is inevitable and very often unconscious; it is felt at all the levels of research. The interference of other personal factors is also controversial at the research team level and notably regarding the importance of the illness concerned.

Bleuler spoke about “the group of schizophrenias”, but all the studies are carried out as if, behind the diversity of the clinical description there was one single and constant organic substratum. The limitations which this idea engenders are discussed. The emphasis is on the interest in studying acute beginning forms. Various etiopathogenetic hypotheses are taken into consideration when choosing methodology; it is the least limitating hypothesis which must be the deciding factor, namely that there are, in schizophrenia, some social-psychological and some organic factors, but the presence of only one factor of any kind is sufficient. The methodological conclusions are: the value of longitudinal studies compared with sectional studies, the importance of setting up homogeneous sub-groups for at least one additional datum over that of schizophrenia and the interest of repeating the tests recommended by different schools on the same subjects.

For reasons of facility, most studies deal with chronic patients, and various criteria of selection are shown. Consequences of ‘institutionalization' in a mental hospital (secondary alienation) are also looked at from the point of view of the body: it seems to us that chronicity gradually changes a person into ‘another man’, biologically speaking. The peculiarities of diets in mental hospitals were at the beginning of many contradictions and mistakes in those studies; the part of other independent variables is taken into consideration; such as the level of physical activity, stress and chemical treatments. The problem of control groups for the sectional studies is shown.

Throughout the text, examples are given of repercussions on some studies of the methodological problems raised.