Stupor revisited

Stupor is a neglected syndrome. This may be due to its low incidence, intrinsic complexity and good response to ECT. Paucity of clinical material has not allowed for adequate statistical and scientific analysis and therefore its phenomenology and neurophysiology remain unclear. Important questions are whether: (1) stupor constitutes a stable form of behavior amounting to a “symptom complex”; (2) it represents a preprogramed or vestigial behavior which may be triggered off by severe noxae, whether psychogenic or organic; (3) personality and underlying cause play a modulating role and; (4) organic and functional stupors share similar underlying mechanisms or, alternatively, refer to unrelated clinical states.An evolutionary view should integrate neurological and organic stupors and justify the use of the “freezing” or cataleptic response to stress in animals as a research model. This should in turn suggest pharmacological predictions of interest for the management of human stupor.     

Institutionalism revisited

The sociological background to clinical studies of the effects of large single-specialty psychiatric hospitals on their long-term residents is briefly discussed. The review emphasises the continuities in structure and function between complex organisations of many kinds irrespective of their geographical situation. The aims, methods and results of a study of three mental hospitals during an 8-year period in the 1960s are reviewed with a view to their relevance for the institutions of the 1990s. It is concluded that the concept of institutionalism, in both its narrow and its broader sense, remains highly relevant to present day problems and that lessons learned 30 years ago have yet to be fully applied.     

Neurotropism revisited

The purpose of this study is to re-examine the probable directive effect of the distal stump of a severed peripheral nerve on regenerating axons. Forssman postulated the existence of such a directive influence and Cajal interpreted it as chemotactic in nature. This view was subsequently refuted by Weiss and Taylor. In our study the proximal stumps of transected rodent sciatic nerve were inserted into the single inlet end of a Y-shaped autogenous inferior vena cava graft. Into one limb of the double outlet end, namely the common iliac nerve bifurcation, the distal stump of the same sciatic nerve was inserted, while the counter limb was ligated in one group, left open in the second group, inserted with a segment of autogenous tendon in the third, and grafted with a segment of autogenous nerve in the fourth group. Both outlets were left unoccupied in yet another group as the control. The vena cava conduit was prepared so that a 1.5 cm gap existed between the proximal stumps of the sciatic nerve and the distal sciatic nerve stumps and the tendon grafts respectively. The grafted sciatic nerves were explored and biopsied after 12 weeks. The direction of nerve tissue regeneration in each group was analyzed histologically. Predilection of the regenerating nerve fibers toward the distal stumps was observed in each of the test groups. These results indicate the existence of a guiding influence at the distal stump toward the regeneration nerve fibers.     

Schizotaxia revisited

A conjectured neural integrative defect (schizotaxia), due to a dominant schizogene completely penetrant for a parametric aberration in synaptic signal selectivity (hypokrisia), gives rise under ordinary social learning regimens to schizotypy, a personality showing ambivalence, aversive drift, dereism, autism, and cognitive slippage. Given unfavorable polygenic potentiators (eg, introversion, hypohedonia, and anxiety) and adverse life experiences (eg, childhood trauma or adult misfortune), around 10% develop schizophrenia. That schizophrenia is basically a neurologic disorder does not contradict whatever is known about its psychodynamics, nor preclude efficacy for psychotherapy or other psychosocial interventions. Research should concentrate on soft neurology and psychophysiology as indicators, being closer in the causal chain to the schizogene than psychometric, social, or high-level cognitive processes. Taxometric statistics are appropriate to testing a major locus model not simplistically formulated.     

Inscape revisited

Abstract

This article is concerned with the way in which things come to me sometimes, the way in which images arise. In particular it is concerned with imaginal perspectives on image-making processes and, in seeking such perspectives, draws on the literature of poetry and psychology. This includes a discussion of the work and ideas of Gerard Manley Hopkins, who is generally credited with inventing the word inscape, a word which may be understood to describe an approach to process. Consideration is given to Jungs ideas about active imagination and to writing by Yeats from the same era. The final part of the article presents recent explorations into art-making processes involving frequent photography of emerging images, and concludes that such exercises designed to attune us to the close observation of emerging images may help to inform our practice.     

Asperger syndrome revisited

Asperger syndrome (AS) is a disorder on the continuum of autistic spectrum disorders characterized by a lack of social reciprocity and empathy, and severe difficulties in social integration. Controversy remains as to what constitutes AS and whether it should be declared a separate disease or higher-functioning autism. This review discusses the contributions made by Hans Asperger and Leo Kanner in first delineating the condition, and examines the syndrome's incidence, prevalence, and etiologies. Recent studies using neuroimaging are described, along with current diagnostic and treatment options.