Dysplastic growth differentials in patients with psychiatric disorders studies on the morphology of maturity.

This paper is concerned with some aspects of the morphology of man, as they present in relationship to the occurrence of psychiatric disorder. Kallmann in the U.S.A. and Slater in England, among others, have initiated fundamental work, summarized recently by Slater (1950), dealing with the genetic linkages involved in the causation of mental illness, while the sociological, clinical, psychiatric, and especially psycho-analytic literature provides an overwhelming if diffuse body of evidence pointing to the importance of environmental factors. It is not a function of this paper to review this literature; it is necessary only to mention its existence for orientation purposes since the studies which follow will necessarily have to be interpreted in terms of the relative importance of these two fundamental aetiological influences. The present investigation resulted from two assumptions based on the clinical observation of mentally ill patients in a psychiatric hospital. These were firstly, that there is something about the physical appearance of such patients which reflects their relative incapacity to remain emotionally stable under stress, and secondly, that, if this clinical impression be true, then over the length of the patient's life the separate features of his physical appearance on which the impression is based must have resulted from dysplastic or imperfect develop ment at some definite phase of his growth, since such features cannot be assumed to appear sud denly out of the blue. Some of the differentials contributing to the clinical "hunch" have been measured and analysed by Draper and his co-workers (1944) at Columbia University with respect to physical illnesses such as cholecystitis, peptic ulceration, rheumatoid arthritis, rheumatic fever, and migraine. Features of significance in Draper's data are convincing, not only because of the com prehensive nature of his morphological observations, but also because of their ontogenetic basis. This point will be referred to later, but it is worth remark ing here that, in the field of psychiatry, the scientific strictures of the developmental hypothesis in biology ave been largely neglected. Somatotypology has been widely employed by Kretschmer (1936) a d authors to reveal constitutional dysplasias in psychiatric patients but these studies remain largely descriptive, and therefore sterile, in so far as they do hot lead to an increase in understanding of causation and later of rational therapy in mental disor ers. The studies of Sheldon and others (1941, 1942) suffer from the same purely descriptive faults but do at least add one set of useful data to those of Kretschmer, i.e., an analysis of the predominating germ-layer involved in the resulting dysplasia. Both workers, moreover, have pointed to the concordance of emotional, temperamental, and other psychological features of the personality with the constitutional somatotype of the individual examined, each agreeing that the extreme dysplasias in any orientation of their classifications tend to be ass ciated with overt mental illness of a particular type (Kline and Tenney, 1950).