It is often said that the Disorders of Affect are the most commonly encountered psychoses and it is, of course, depressive illness which accounts for the large majority of such disorders; nevertheless Mania and Hypomania present as great a problem. As great because from the medical point of view treatment is less certain and less satisfactory, and socially because the manic, and even more the hypomanic, patient seems capable of doing more harm to his family and home by his ill-judged actions and schemes than almost any other person. He seems, too, to have a singular affinity and attraction for wasters, ne'er-do-wells and psychopaths who assist all too readily in the disposal of goods and money and encourage him in his grandiose and extravagant schemes.

For depressive illness we have, in Electro-Convulsant Therapy, a ready, useful and comparatively reliable, safe and effective therapeutic measure. The majority of patients accept such treatment quite readily and respond well to it. Where there is a history of chronic or recurrent illness, leucotomy (often in one of its modified forms) seems to offer a good hope with an excellent prognosis. Depressed patients, moreover, from the very nature of their illness, tend to accept treatment, even if they dislike it, often maybe from poorly concealed masochistic urges and as punishment for what they believe to be their guilt and unworthiness.

Manic and hypomanic patients, on the other hand, present a totally different problem. Firstly they rarely, if ever, complain themselves and consequently they resent being referred to the doctor. When they do come it is often unwillingly or merely to demonstrate their well-being; or maybe to show some invention, gadget or discovery they believe they have made. Secondly, such patients, even when they have been seen, are notoriously unreliable over treatment and will rarely accept it. In the majority of patients it is only when under some form of control (which for all practical purposes means certification) that treatment can be carried out satisfactorily.

In Mania (and Hypomania) as in depression, convulsion therapy—usually E.C.T.—proves satisfactory in many instances, but the problem of long-term prognosis is not affected and in the case of recurrent manic attacks leucotomy seems to have no benefits to offer and is in fact often liable to make things worse. Any effective method of treatment is therefore to be welcomed, and more especially so if there is any suggestion that it can be continued after the patient leaves hospital, on a maintenance or prophylactic basis.