In 1953, in an article intended for the general practitioner, Denis Hill made a brief reference to the chronic paranoid psychoses which may develop in association with temporal lobe epilepsy. He described the condition as likely to come on when the seizures were diminishing in frequency, as appearing gradually with onset in middle age, and as resembling a paranoid schizophrenic state. In 1957, D. A. Pond, from the same department of applied electro-physiology at the Maudsley Hospital, gave a more detailed account of the clinical features. He described the psychotic states as closely resembling schizophrenia, with paranoid ideas which might become systematized, ideas of influence, auditory hallucinations often of a menacing quality; and occasional frank thought disorder with neologisms, condensed words and inconsequential sentences. There were, however, also some points of difference, of a quantitative rather than qualitative kind: a religious colouring of the paranoid ideas was common; the affect tended to remain warm and appropriate; and there was no typical deterioration to the hebephrenic state. All the patients had epilepsy arising from the temporal lobe region with complex auras; occasional major seizures occurred in sleep only. EEG foci, always present, were sometimes only to be demonstrated in sleep-sphenoidal records. The epilepsy began some years before the psychotic symptoms, usually in the late teens or the twenties; and the latter often seemed to begin as the epileptic attacks were diminishing in frequency, either spontaneously or with drug treatment.

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The ability to distinguish separate types of disorder among patients who seem at first sight to have similar symptoms has been a powerful factor in the progress of medicine. It is for this reason that the attempt to distinguish different varieties of depressive illness is important. In Britain recent studies have been concerned with the presence (as rated by the examining physician) of various symptoms and signs which from clinical experience have been thought likely to distinguish a neurotic from a psychotic type of depression. The investigators agree on the presence of these two types but disagree on the nature of the distinction, one school holding that there are two largely distinct types of illness and the other that the types merely represent the opposite ends of a continuum. The holders of the latter view accept that there may well be distinct types of depressive illness, but maintain that, if so, they cannot be distinguished by present methods of clinical examination. The divergence of view has been attributed by Kendell (1968) to sampling differences and to the subjective bias of raters, and by Eysenck (1970) to disagreement on whether the two types of depressive illness are of a categorical nature (i.e. specific disease entities) or of a dimensional nature (i.e. each has a graded distribution in a population of depressed patients).