As Bleuler (1925) pointed out, all our relationships with our human environment are regulated through language. For this, auditory perception is essential, this can only take place if the peripheral auditory mechanism (viz., the tympanic membrane, ossicles, spiral ganglion of Corti and VIIIth nerve) is not diseased. When a person becomes deaf through disease of any of the latter, it does not matter which one of the peripheral mechanisms is involved, the result is always the same. Often not knowing what his fellow men are saying he becomes doubtful about them : losing auditory contact with them he has to rely on an inner world of auditory memories and images ; he misinterprets auditory sense impressions which have been distorted by disease, and incorporates tinnitus caused by such disease into his world ofinner phantasy. He projects his inner feelings of inferior ity caused by his deafness on to his environment and develops ideas of refer ence. Systematization soon follows, with active delusions of persecution. If the personality is sufficiently unstable a psychotic illness results.I have endeavoured to show the existence of a higher proportion of paranoid patients (i.e., having delusions of persecution) among deaf psychotics than non-deaf psychotics, in order to verify this hypothesis.The investigation was carried out in a mental hospital containing 1,lOO patients. I investigated those patients in the hospital reported as being deaf, testing their hearing by means of the spoken word, a watch, tuning fork, and in those caseswhich appeared by all tests to be stone deaf, dropping a bunch of keys heavily on the floor behind their backs to exclude hysterical deafness. I used written messagesto communicate with them. I also examined them with the auriscope. Audiometry was not practicable, for many were too paranoid and unco-operative.A number of supposedly deaf patients turned out to be schizophrenics who were withdrawn and were able to answer questions spoken to them after gaining their confidence. Some schizophrenics denied vehemently being deaf, though they obviously were, as one of them put it â€oe¿ Why, doctor I can hear the spirit of Billy Brooks (a fictitious person) tormenting me―â€"in other words his inner world of auditory phantasy was the only reality to him.The method of investigation was as follows: This deaf group was compared with a control group of non-deaf psychotics, selected at random, and matched for age and sex. Owing to the fact that the eldest deaf female aged 94 was the only one of her age in the hospital, and 990

In Canada and the U.S. the percentage of elderly people is increasing and more funds are being spent on institutional programs. Yet many are not so impaired that they cannot be looked after by relatives. A number of community outreach programs are available. From an inpatient psychogeriatric unit in Hamilton Provincial Hospital an outreach program is described. A follow-up study was done during a 2 year period by contacting the referral sources. The 24% who had been admitted were compared with the 75.9% who remained in the community. While patients' relatives and referring sources were mostly pleased with the assessments, and those patients not admitted were less institutionalized, those admitted with affective disorder showed a higher recovery rate than those remaining in the community. The total number admitted to hospital showed a lower mortality rate than those not admitted, even though the latter three considered less mentally ill because of the criteria for admission to the hospital.

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