The Neurology of Schizophrenia

Abstract

During the two and a half years from May, 1953, sixty-one cases of schizophrenia, none of whom had been leucotomized, were studied by me at St. Ann's, a 69-bedded subsidiary hospital of Holloway Sanatorium, Virginia Water, which has been available for the treatment of psychoneuroses since the end of 1946 and where at any one time a large majority of the patients are psychoneurotic. Except that patients are normally expected to be in by 10 p.m. it is as open as any hotel, there is no sex distinction in any of the sitting and games rooms, the dining room, the occupational therapy department and so on and where the ‘male side’ and the ‘female side’ meet the rooms may be occupied by men or women, so that men may have to pass women's rooms on the way to the toilets and vice versa. The hospital is mainly an ‘amenity bed’ one with charges of 2 to 4 guineas a week and although no policy of exclusion exists the bulk of patients are from ‘lower middle’ or ‘upper lower’ backgrounds. Treatment is based on careful history-taking and investigations of various kinds, with explanatory and supportive psychotherapy, but E.C.T. always with pentothal and scoline, modified insulin, modified narcosis and other physical treatments are available although they are strictly limited by the small nursing staff. Remembering that there are only three doctors, one of whom is partly taken up with administrative duties, both for in-patients and for a reasonably active out-patient service which includes the use of all the daytime hospital facilities, an exercise in simple arithmetic will make it clear that the forms of psychotherapy used are also strictly limited.