The 100th Annual Dinner of the Gaskell Club for Winners of the Gold Medal was held at the Royal College of Psychiatrists on 30 October 1987.

Looking round the tables I was struck by the number of people who had worked at the Maudsley, a tangible reminder of the contribution of that centre of excellence to psychiatry.

I do not doubt that the standard of psychiatry at the Maudsley remains as high as it ever has been, but inevitably my thoughts ran to the post-war period when, as a 21 year old, it seemed one was surrounded by giants.

As a specialist in child abuse for the past five years, I have been presented with various technical difficulties in trying to convey important, but often emotive, material to medical students and, for that matter, to groups of professional colleagues from other disciplines. It is hoped that the following reflections may be useful to colleagues who teach medical students about child abuse.

The incidence of child sexual abuse varies according to definitions and methods used. The MORI Poll 1984 found it to be 12% for girls and 8% for boys and to occur across all the social classes using this definition: “A child (anyone under 16 years) is sexually abused when another person, who is sexually mature, involves the child in any activity which the other person expects to lead to their own sexual arousal. This might involve intercourse, touching, exposure of the sexual organs, showing pornographic material or talking about sexual things in an erotic way”. The majority of studies have shown that these experiences can have adverse psychological effects, but the effect on the clinical practice of general psychiatrists seems to be too small if one considers the estimated 4.5 million adults in Great Britain who have been sexually abused as children. We thought that this could be related to attitudes rather than knowledge of the subject.

Seven years of ecstasy and agony have been enjoyed and endured in Israel, and from the calm of my sabbatical back in the UK, I welcome this opportunity to look in on Israeli psychiatry. The setting is a dramatic one. Israel's recent history is characterised by a hard-won statehood in 1948, massive waves of immigration, a clash of oriental and occidental cultures, and repeated wars. In the face of this rapid and traumatic change, Israelis have exhibited an exaggerated faith in the powers of the state. By denial of emotional and mental problems, a somewhat brittle stability has been achieved, not enhanced by almost uniformly negative attitudes to mental disorder. Understandably Israeli psychiatry has also been characterised by the fight for survival. The professional scene is made up of fierce, creative, one could almost say “true grit” individualists and powerful professional cliques. Israeli psychiatry was literally forged on the battlefields of the Independence War and has retained an Old Testament character of war-like struggle up until the present day. It is to the credit of Israeli psychiatrists that they have succeeded at the highest level in dealing with routine psychiatric problems alongside the awesome consequences of this continuous stress and trauma.

Although the power to defer sentence has been available to the criminal courts in England and Wales since 1973 there has been little discussion of the psychiatric aspects of this disposal. This article considers the legal development of deferment of sentence, the guidelines that have been recommended for its use and the sort of situations in which a deferred sentence might appropriately be considered by psychiatrists preparing a court report.

“That is unusual.” “What?” “That young men like you take up consultant posts in mental handicap. I thought it was a job retired psychiatrists returned to, to avoid the boredom of inactivity.”

The first British day hospital was established by Bierer in 1946; by the end of the 1950s there were 45 and during the next few years the number trebled. With the trend towards community care, day hospitals and centres have continued to increase in number.

Many junior doctors, some with only undergraduate training, will this August feel at the pointed end of psychiatry when they are asked to see an ‘overdose’. The referral letter is unlikely to be more specific concerning what service they are to render to the patient or the referring physician. In the psychiatric textbooks the tyro will find a wealth of actuarial data but little clinical advice. After four years as a junior psychiatrist I present a personal philosophy of what one is doing when one assesses the survivor of a (para) suicidal act.

With the process of closing psychiatric hospitals and establishing community-based alternatives more than 20 years old in the United States, psychiatric practice there is in the post-deinstitutionalisation age. In Britain we are now starting on this same path. Against this background, I attended the annual conference convened by the journal Hospital and Community Psychiatry in October 1987. Held in Boston, in the same week that Major Koch of New York sanctioned the compulsory reinstitutionalisation of homeless mentally ill people from the streets of Manhattan, the conference emphasised four themes: homelessness, outreach programmes, systems of case management, and compulsory out-patient treatment.