963 and checking expenditure against the budget used to be considered the special province of the hospital administrator who knew his job. It is encouraging to see them coming once again to the fore ; the Department of Health would find some other well- tried recipes, such as the use of quantity statistics and scrutiny of bed occupancy, in the now almost forgotten files of the 1920s and 30s. But Leviathan is bestirring himself, and if he maintains his energy will soon rediscover most of what can usefully be done by improving the system of hospital accounts. So far so good; but it is no good overlooking the fact that there is still a serious flaw in the financial set-up which has nothing to do with the system of accountancy or techniques of financial control of the kind mentioned above. Why should any hospital unit bother about these refinements if savings are forfeit to the Exchequer ? It would not do, we are told, to make outright allocations to the regional boards and thence to the hospital management committees ; it would be inconsistent with the present system of governmental finance. That, no doubt, is true : but then the administrative frame- work of the hospital system is quite a new thing, and if -we are going to give units at the periphery real administrative responsibility, and if we are going to ask them to sort out, in conjunction with their medical advisory committees, how the money had best be spent, we cannot at the same time say that they are not free to sort it out. We cannot tell them to go shopping and get the best value for money, and add as an afterthought that they must let us know in advance how they are going to spend it ; or add that if they change their minds when they see the prices in the shops they will incur our displeasure and possibly a fine too-unless they have been pretty careless to begin with. Of course nobody at the Treasury or in the health departments sees the matter in this light ; but that is because of the traditional divorce in public affairs between adminis- tration and finance, and the habit of thinking of them in separate compartments. As things stand today, the administrative framework of the hospital part of the Act, and the financial machinery being used to implement it, do not fit together ; and one or the other will ultimately have to give way. So far the crucial nature of the struggle has been obscured by the flow of public money ; and now that this is at an end it is imperative that the financial implica- tions of the new model hospital system should be looked squarely in the face. One last word. In typically British fashion we have indeed admitted a curious non-logical compromise ; for it seems that regional boards have been allowed a power of approving the transfer of a " saving " from a head under-expended to one over-expended. Though this helps-and in some instances " helps " is too Riild a word-to stave off the breakdown of the system, the device is open to serious criticism ; for there is, of course, no true connection between overspending and saving, and the door is left wide open to the unscrupulous : what is easier than to overestimate this and that in the hope of ,pulling off a switch to something else ? . This half-permission to switch from one -head to another is surely a snare, which serves only to obscure the need for clear thinking on the main issue. Annotations THE SPRINGS OF DELINQUENCY EVEN among psychiatrists actually working on adolescent delinquency, the data and conceptions embodied in Sir Cyril Burt’s Young Delinquent still hold the field, with little accession from more recent work ; and it is no reflection on the merit of this pioneer study to wish for fuller confirmatory studies, based on wider data and other personal attitudes. The report on Delinquency and Human Nature,1 compiled by Mr. D. H. Stott, M.A., is thus a particularly useful document. He presents clinical material of first-rate importance in a form which is generally comprehensible. The basis is a detailed survey of 102 youths, between 15 and 18 years of age, in English approved schools. It was impossible to study persistent absconders, but otherwise there was no significant selection. Stott points out that the 15-18 age-group is of particular criminological interest : it is here that the greatest apparent numerical increase of offences has occurred in recent years ; it provides the recruiting-ground for the persistent adult offender ; and the cases in it have reached a stage, both in character-structure and in conflict with society, at which proper investigation is possible with a view to classifying the factors at work. The interview, the technique of which is described, was often supple- mented by fairly extensive social contact and observa- tion. To most readers, perhaps, the investigator’s most notable comments are those on the factors which did not operate to produce delinquency. He points out that in none of the 102 cases studied did simple " wanting and taking " play any identifiable part. The cinema-where its influence was detectable-uniformly determined the type of crime, not its occurrence. Concerning "low moral standards " he aptly comments that since in almost all the boys delinquency constituted an outlet from an intolerable inner or outer environment, precisely because it was a disapproved and exceptional activity, low moral standards cannot be considered a primary factor : the child whose father is a burglar does not choose burglary as his own form of protest. " Lack of home discipline," which Stott investigated in some detail, he finds inseparable from a general inadequacy in the personality of the parent, and to this extent spoiling and harshness are opposite sides of the same coin. He extracts five main motives behind delinquent action : avoidance-excitement (the excitement being a symptom of the unconscious avoidance-sometimes to the extent of complete amnesia or blackout-of a painful or distressing thought or memory), inferiority- compensation, delinquent-attention-seeking, resentment against parents, and desire for removal from home. Of these the first was by far the most conspicuous (53 cases) and desire for removal from home the most prevalent (58 cases). The cases are further cross-divided into categories of parental background. In all these groups, Stott repeatedly stresses the explosive nature of crime, its function in relieving tensions in the criminal which are entirely unrelated to obvious motive and purposive wickedness, and the clear-cut distinction between the " once-er " who may benefit by reproof, and the persistent offender for whom reproof, punish- ment, and the reaction of society are part and parcel of the pattern which he deliberately courts when he adopts delinquency as an escape mechanism from inner forces. This is- fully in line with widely diverse psychiatric experience, and is true of all persistent offences, from sadistic assault to pilfering. The offence is a breakdown, or more correctly a breaking out. In a few cases physical factors such as fright or illness 1. Carnegie United Kingdom Trust, Comely Park House, Dunfermline. 1950. Pp. 460.
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and checking expenditure against the budget usedto be considered the special province of the hospitaladministrator who knew his job. It is encouragingto see them coming once again to the fore ; the
Department of Health would find some other well-tried recipes, such as the use of quantity statisticsand scrutiny of bed occupancy, in the now almostforgotten files of the 1920s and 30s. But Leviathanis bestirring himself, and if he maintains his energywill soon rediscover most of what can usefully be doneby improving the system of hospital accounts.So far so good; but it is no good overlooking the
fact that there is still a serious flaw in the financialset-up which has nothing to do with the system ofaccountancy or techniques of financial control ofthe kind mentioned above. Why should any hospitalunit bother about these refinements if savings are
forfeit to the Exchequer ? It would not do, we aretold, to make outright allocations to the regionalboards and thence to the hospital managementcommittees ; it would be inconsistent with the
present system of governmental finance. That,no doubt, is true : but then the administrative frame-work of the hospital system is quite a new thing, andif -we are going to give units at the periphery realadministrative responsibility, and if we are going toask them to sort out, in conjunction with their medicaladvisory committees, how the money had best bespent, we cannot at the same time say that they arenot free to sort it out. We cannot tell them to goshopping and get the best value for money, and addas an afterthought that they must let us know inadvance how they are going to spend it ; or add thatif they change their minds when they see the pricesin the shops they will incur our displeasure andpossibly a fine too-unless they have been prettycareless to begin with. Of course nobody at the
Treasury or in the health departments sees
the matter in this light ; but that is because of thetraditional divorce in public affairs between adminis-tration and finance, and the habit of thinkingof them in separate compartments. As things standtoday, the administrative framework of the hospitalpart of the Act, and the financial machinery beingused to implement it, do not fit together ; and oneor the other will ultimately have to give way. Sofar the crucial nature of the struggle has been obscuredby the flow of public money ; and now that this isat an end it is imperative that the financial implica-tions of the new model hospital system should belooked squarely in the face.One last word. In typically British fashion we have
indeed admitted a curious non-logical compromise ;for it seems that regional boards have been allowed apower of approving the transfer of a
"
saving " froma head under-expended to one over-expended. Thoughthis helps-and in some instances " helps " is tooRiild a word-to stave off the breakdown of thesystem, the device is open to serious criticism ;for there is, of course, no true connection betweenoverspending and saving, and the door is left wideopen to the unscrupulous : what is easier than tooverestimate this and that in the hope of ,pullingoff a switch to something else ? . This half-permissionto switch from one -head to another is surely a snare,which serves only to obscure the need for clear
thinking on the main issue.
Annotations
THE SPRINGS OF DELINQUENCYEVEN among psychiatrists actually working on
adolescent delinquency, the data and conceptionsembodied in Sir Cyril Burt’s Young Delinquent stillhold the field, with little accession from more recentwork ; and it is no reflection on the merit of this pioneerstudy to wish for fuller confirmatory studies, based onwider data and other personal attitudes. The reporton Delinquency and Human Nature,1 compiled byMr. D. H. Stott, M.A., is thus a particularly usefuldocument. He presents clinical material of first-rate
importance in a form which is generally comprehensible.The basis is a detailed survey of 102 youths, between
15 and 18 years of age, in English approved schools.It was impossible to study persistent absconders, butotherwise there was no significant selection. Stott
points out that the 15-18 age-group is of particularcriminological interest : it is here that the greatestapparent numerical increase of offences has occurredin recent years ; it provides the recruiting-ground for thepersistent adult offender ; and the cases in it have reacheda stage, both in character-structure and in conflict withsociety, at which proper investigation is possible with aview to classifying the factors at work. The interview,the technique of which is described, was often supple-mented by fairly extensive social contact and observa-tion. To most readers, perhaps, the investigator’smost notable comments are those on the factors whichdid not operate to produce delinquency. He pointsout that in none of the 102 cases studied did simple"
wanting and taking " play any identifiable part. Thecinema-where its influence was detectable-uniformlydetermined the type of crime, not its occurrence.
Concerning "low moral standards " he aptly commentsthat since in almost all the boys delinquency constitutedan outlet from an intolerable inner or outer environment,precisely because it was a disapproved and exceptionalactivity, low moral standards cannot be considered aprimary factor : the child whose father is a burglar doesnot choose burglary as his own form of protest. " Lackof home discipline," which Stott investigated in somedetail, he finds inseparable from a general inadequacy inthe personality of the parent, and to this extent spoilingand harshness are opposite sides of the same coin.He extracts five main motives behind delinquent
action : avoidance-excitement (the excitement being asymptom of the unconscious avoidance-sometimesto the extent of complete amnesia or blackout-of apainful or distressing thought or memory), inferiority-compensation, delinquent-attention-seeking, resentmentagainst parents, and desire for removal from home.Of these the first was by far the most conspicuous (53cases) and desire for removal from home the most
prevalent (58 cases). The cases are further cross-dividedinto categories of parental background. In all these
groups, Stott repeatedly stresses the explosive natureof crime, its function in relieving tensions in the criminalwhich are entirely unrelated to obvious motive and
purposive wickedness, and the clear-cut distinctionbetween the " once-er " who may benefit by reproof,and the persistent offender for whom reproof, punish-ment, and the reaction of society are part and parcelof the pattern which he deliberately courts when headopts delinquency as an escape mechanism from innerforces. This is- fully in line with widely diverse
psychiatric experience, and is true of all persistentoffences, from sadistic assault to pilfering. The offenceis a breakdown, or more correctly a breaking out. Ina few cases physical factors such as fright or illness
1. Carnegie United Kingdom Trust, Comely Park House,Dunfermline. 1950. Pp. 460.
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determined the timing of a-breakdown. With regardto war, Stott predicts from his data a fairly rapiddecline in cases attributable to the actual events andconditions of war-time, though this forecast could notbe taken to include cases due to the social and emotionalfactors on which war was engrafted, and which have inpart persisted in the " cold " war. The average Raventest score for the group was 40, corresponding to the36th percentile. Frank psychosis was not widespread,though some of the recorded cases show a curious
pseudoschizophrenic reaction which is more familiarin older delinquents.The most urgent problem in modern criminology is that
of identifying the offender whose delinquency is com-
pulsive at his- first offence-that is, to pick out the recurr-’ ing decimal. The anger of judges and moralists whenthe term " neurotic " is used in connection with
delinquency cannot withstand the enormous body ofevidence, both in this report and in general experience,which shows that while some crimes result from impulseor greed, the entire body of repeated and persistentcrime arises as an inappropriate form of behaviourwhich gratifies an unconscious and irrational need in thecriminal. This observation fits exactly into Horney’sdefinition of a neurosis ; over the wider issue, Stottremarks that " the moralist and the psychologist caneat grass together. In our present society we cannotafford the luxury of endlessly tolerating neurotic ways oflife, delinquent or otherwise.... [But] the undiscrimina-ting philosophy of a self determination has outgrown itsusefulness when it insists on the ability of the psycho-path to adjust himself unaided to life, and inflicts onhim term after term of imprisonment in the vain hopethat this will prove a deterrent."
At the present time a remarkable amount of ill-informed and ignorant comment on juvenile crime is
being made by prominent people. It is important,-there-fore, that studies such as this-presented with humourand insight, from a wide general culture, and wholly freefrom emotional bias-should reach the general public.The Carnegie Foundation would do well to issue thisreport far outside its present envisaged circulation tolibraries and interested individuals. It is a cheeringdocument, and its title is well chosen, for it strengthensthe humanist conviction that conduct is comprehensibleeven when it is not understood, and that we are withinsight of an extension to human misconduct of the sameepistemological and systematic method which hasenabled us to control infectious disease. Mr. Stott is
fully aware of these implications, and treats them at alevel which will satisfy the philosopher as well as thepsychiatrist. He deserves the support of all those, insideand outside psychiatry, who share his awareness.
PSI PHENOMENA AND PSYCHIATRY
Prof. J. B. Rhine, of Duke University, South Carolina,had a crowded audience of psychiatrists and psychologistswhen he lectured on parapsychology in the RoyalSociety of Medicine. Parapsychology, according to
Rhine,! is the science of those mental manifestationsthat appear to transcend recognised principles. " It
attempts to deal scientifically with the problem of man’splace in nature and the relationship of the personalityto the physical world." Professor Rhine credits Mesmerwith having encountered and described both thoughttransference and clairvoyance. He referred to famous
psychiatrists (Ribot, Janet, Freud, and others) who hadreported examples of extrasensory perception. Interestin these phenomena has been growing among psychiatristsand psychologists of late, partly no doubt as the resultof the work carried out in Professor Rhine’s laboratory
1. Rhine, J. B. The Reach of the Mind. London, 1948.
over the last twenty years. A recent inquiry amongAmerican psychiatrists revealed that, of 725 who replied,a quarter believed themselves to have encountered suchphenomena, while 68% thought them worthy of investiga-tion. The term " psi phenomena " was suggestedby Thoulless and Wiesner,2 of Cambridge University.It is applied to both extrasensory perception, or E.S.P.,(the extrasensory influence of mind on mind), andpsychokinesis, or P.K. (the influence of mind on matter).Professor Rhine and others regard both as experi-mentally established beyond doubt, E.s.p. with the helpof card tests, P.K. with dice tests. The technique ofthese methods and the application of the laws of chancein the interpretations of test results are described inProfessor Rhine’s books.
Their methods established, the investigators began tostudy the types of subjects and states of consciousnesslikely to produce demonstrable psi phenomena. Contraryto popular belief, they found no basic connection betweenmental abnormality, in the psychiatric sense, and psiphenomena ; nor was there any indication that emotionalmaladjustment favoured their occurrence. They rathergained the impression that a high degree of emotionaladjustment made for success in their tests, though afew of their media had been of an " excitable tempera-ment." Hypnosis has been found to affect both P.K. andE.s.p., but controlled experiments have so far beeninconclusive as to the kind of changes which thesephenomena undergo in the hypnotic state. Psi phenomenaare functions of the unconscious mind, and failure inexperiments may be due to unconscious
"
negativism,"resulting in large deviations which cannot be explainedmathematically as chance effects. Rhine and his co-
workers confirmed the observations made by Soal andGoldney 3 of the " displacement effect "-the extra-
sensory perception of objects near the target. Therelation of psi phenomena to the functions of the nervoussystem is still unexplored, though a promising start hasbeen made with tests in states following concussion.Urban,4 of Innsbruck, using E.s.p. card tests before andafter electroconvulsant treatment and narco-analysis,found a rise of the scores during a certain phase of
clouding of consciousness ; but his report is based on100 tests only, and his experiments still require confirma-tion. Urban suggested that the emergence of psi pheno-mena was due to the removal of inhibiting mechanisms.Professor Rhine posed the question whether " there maynot have been something in the mind that has beensmothered in the history of evolution." He is inclinedto regard the homing phenomena in animals as basedon E.s.p., and referred to experiments which to him madethis assumption almost inescapable. The. " vestigialtheory " of the psi phenomena has many adherents
among parapyschologists. Professor Rhine regards thesephenomena as a challenge to our psychological andphilosophical concepts : do they not force us back fromour unitary concept of the mind-body relationship, heasks, to a dualistic conception of man ? We must choosebetween a mind-centred (psychocentric) and a brain-centred (cerebrocentric) conception. Although heowned to being cautious and open to correction, he leftno doubt where his sympathies lay, and he was supportedby Mr. Thoulless who also felt that parapyschologyseemed to be pointing to the old idea that soul ruledthe body. According to present-day psychologicaltheory, psi phenomena should not take place ; but theydo. Psychological theories, Mr. Thoulless said, musttake account of parapsychological facts.5 Other speakersreported on psi phenomena from their own experience.2. Thoulless, R. H., Wiesner, B. P. Proc. Soc. psych. Res.
1947, 58.3. Soal, S. G., Goldney, K. M, Ibid, 1943, 47.4. Urban, H. Festschrift für Pötzl. Innsbruck, 1949.5. Thoulless, R. H. Brit. J. Psychol. 1949, 39, 97.
