The Maudsley Personality Inventory (Eysenck, 1959a) measures the two factors of neuroticism and extraversion, which are considered to be independent and relatively stable aspects of personality in normal subjects. Bartholomew and Marley (1959) tentatively concluded that changes in the mental state did not greatly affect the N and E scores, and Mezey et al. (1963) found that the scores re mained relatively constant during depressive illness, although there was a slight increase in neuroticism. McGuire et al. (1963) noted that the relationship between N and E scores ceased to be orthogonal during illness when the scores became negatively correlated. Knowles (1960) found relatively high test-retest correlations in both a normal group and a neurotic group after a year, although the correlations in the neurotic group were lower than in the normal group; he also found some evidence that fluctuations in clinical state influenced the stability of the N scores. Moreover, on measuring neuroticism and extraversion with the Eysenck Personality Inventory (Eysenck and Eysenck, 1964), Knowles and Kreitman (1965) concluded that N (but not E) scores were influenced to a small but significant degree by changes in the patients' clinical state. Coppen and Metcalfe (1965) found that the mean N score of a group of depressed patients decreased significantly on recovery and that there was an associated significant increase in the mean E score. These changes were most marked in patients with endogenous depression. The scores of the recovered patients were within normal limits. Ingham (1966) demonstrated essentially similar changes over a three year period in a group of neurotic patients.

The relationship between mental illness and physical disease in elderly patients has been the subject of a number of studies, notably those by Kay and Roth (1955) and Roth and Kay (1956). Stenstedt (1952, 1959) reported a high mortality rate among patients with manic-depressive psychosis and involutional melancholia, which he attributed to ‘the high frequency of suicide and to the fact that several patients had died in a mental hospital’. In a survey of elderly people living in the community, Kay and Bergmann (1966) demonstrated a relationship between physical illness and diminished life expectancy on the one hand and functional psychiatric disorders on the other. Shepherd et al. (1964), in a general practice survey in London, found a 'strongly marked association between psychiatric disorder and chronic organic illness'.

That a distinction may be made on clinical grounds between anxiety states and depressive illnesses has been affirmed by some authors (Garmany, 1956, 1958; Stenbäck, 1963), and rejected by others (Mapother, 1926; Conrad, 1958; Ey, 1963; Lewis, 1950–1966). This problem is also of interest from a biological point of view in that anxiety neuroses represent in an exaggerated form an emotion that is ‘directly serviceable’ (Cannon, 1928) and one which has potential survival value for the organism. Moreover, analogous conditions can be reproduced experimentally in animals, while no convincing models have so far been described of states akin to depressive illnesses (McKinney and Bunney, 1969).

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