I have had a very busy professional career and have not been much concerned with its formative influences. I was born in Edinburgh on 2 October 1915 into an orthodox Jewish family which migrated to Scotland from Lithuania at the turn of the century. As my father was serving in the army during World War One I did not see him till he was ‘demobbed’ and as my mother had the responsibility of bringing up a family and running a small business on her own I did not see very much of her either. Yet, I consider that I was brought up in a very caring home. I attended Boroughmuir Secondary School where the standard was first-class and I concentrated on modern languages (French, German and English) and mathematics and was offered a place at Edinburgh University when I was 16 years old. I had also acquired a better than average knowledge of Hebrew as well as of Holy Writ and a smattering of Talmud. I then decided to study medicine so I spent an extra year at school to get the necessary grades in physics and chemistry and enrolled in the Faculty of Medicine at 17 years and qualified in July 1938 at 22 years.

Although several studies have found the frequency of postnatal depression to range from 9 to 13%, optimal services for the recognition and management of this disorder are not fully established. There is a lacuna in the provision and costing of comprehensive services for women with postnatal mental illness, although it is recommended that each large district requires a consultant led team (three to five sessions per week) and a district or supra-district mother and baby unit (Oates 1988; Royal College of Psychiatrists 1992).

Over the last four decades there has been a substantial reduction in the number of psychiatric hospital beds. Alternative residential facilities in the community have been developed. These include staffed hostels, group homes and supportive lodgings providing bed and breakfast. While hostels and group homes are often integrated with psychiatric services and run by experienced staff, this may not be the case with the small privately run homes. Anstee (1978, 1985) described two supportive lodging schemes and suggested that such facilities were particularly helpful for people with schizophrenia. However, there has been little further research in this area even though supportive lodgings may constitute a significant proportion of long-stay residential facilities. We know little about the landladies, their background, training, experience and particularly the rewards and frustrations of their work. The extent of psychiatric morbidity and the overall burden of care for these landladies is also unknown.

The aim of the present study was to gather information about the carers, the residents and the level of care provided in these facilities.

In 1992, Pippard reported a comprehensive audit of electroconvulsive treatment, (ECT), in two NHS regions. He found deficiencies in most aspects of ECT administration (Pippard, 1992), particularly the training and supervision of the administering doctor, usually an SHO or registrar. Regrettably, the competence of a trainee to administer ECT appeared to have improved but little in the 11 years since the same author first reported on the subject (Pippard & Ellam, 1981). In particular, it failed to meet the guidelines issued by the Royal College of Psychiatrists in 1989. This was reflected in inadequate administration of ECT as assessed by direct observation and by determining the provision made for teaching and supervision of ECT by senior staff. Pippard concluded that the overall standard of training was inadequate and that “The responsibility for this mediocrity rests squarely on the consultants as a whole and not just on those whose nomination to be in charge appears to absolve the rest…”.

Background of the study

Rationale for monitoring carbamazepine levels

Carbamazepine fulfils some of the criteria required in order to render a drug suitable for serum level monitoring in that there is poor inter-individual reproducibility of the serum levels achieved with fixed dosage regimes, interbrand differences in bioavailability are known to occur and serum levels can be raised significantly by several commonly prescribed drugs; dextropropoxyphene (a constituent of coprozamol), erythromycin, isoniazid and cimetidine.

Psychotherapy is recognised as an integral part of general psychiatric education at the level of preparation for the membership exam. Guidelines were first published over 20 years ago by the Royal Medico-Psychological Association (RMPA, 1971). In 1986 these guidelines were reviewed and clarified amid some pessimism about how widely the previous recommendations were being met (Royal College of Psychiatrists, 1986). The shortage of consultant psychotherapists and the competing demands of other service and training commitments were suggested as explanations for this.

While working as a registrar on a Regional Alcoholism Treatment Unit (ATU), I took part in a weekly support group for women. This afforded a valuable insight into the way in which alcoholism affects women, and showed how a group could be used by its members in a variety of ways. It was an important and valuable learning experience which is not commonly available to trainees in psychiatry.

The misuse of alcohol causes a range of health, legal, social and employment problems for the individual and the rest of society. Many agencies are involved in dealing with the consequences of alcohol misuse and providing services to those with problems. Sources of funds to finance interventions for drinkers whether from health authorities, social services, probation or other sources are very limited. Without some coordination there will be a tendency for each funder to shift responsibility and costs. These difficulties have been recognised and in 1989 a government health circular was issued emphasising the need for the development of local multi-agency alcohol misuse prevention strategies. Implementing policies such as community care and Health of the Nation also require multi-agency co-operation if they are to fulfil their aims. The survey of the development of local alcohol strategies reported in this paper (Wallace et al, 1993) is therefore of great interest.

Otto Dix (1891–1969) was a leading German Impressionist painter whose major work was associated with the Weimar Republic period, although his art extended from before to after both world wars.

Early in 1992, two articles were published on the subject of multidisciplinary teams in child and adolescent psychiatry. In the first, Mathai (1992) challenges the “accepted multidisciplinary model” as being “unworkable”. He comments that in many teams an appearance of multidisciplinary working can hide covert conflicts and goes on to propose that all referrals should be made to the consultant psychiatrist who will then decide to whom these referrals should be allocated within the team.

The author J. R. Hartley and his book on fly fishing do not exist in external reality. They are instead a product of the advertising fantasy world, dreamt up to promote the Yellow Pages. This advertisement was at its prime when I was trying to develop a suitable analogy for teaching medical students and junior doctors about psychotherapy and some of its techniques. When taking a short break in front of the television set, it suddenly struck me just how appropriate this advertisement was. J. R. Hartley himself lends credence to the analogy, while fly fishing as a sport provides an excellent comparison for the art of psychotherapy. Like the fictitious publication in the advert, psychotherapy and its techniques can prove exasperatingly elusive, as they constitute a series of shared internal beliefs and representations which exist largely within the collective mind. I therefore felt that this ambiguous character who is not part of the external real world, yet has a special inner meaning for a wide number of people, seemed like the ideal analogy for describing psychotherapeutic processes.

Charles Darwin (1809–1882) enjoys an uneasy position in the history of psychiatry. In general terms, he showed a personal interest in the plight of the mentally ill and an astute empathy for psychiatric patients. On the other hand, he has generated derogatory views of insanity, especially through the writings of English social philosophers like Herbert Spencer and Samuel Butler, the Italian School of “criminal anthropology” and French alienists including Victor Magnan and Benedict Morel.

Over recent years the National Health Service has undergone many changes, one of the most important being the development of purchaser/provider roles. From April 1993 district health authorities (DHAs) and general practitioner fund holders (GPFHs) have been able to choose from which provider to purchase their adult psychiatric out-patient services. While discussions on how to attract and keep the contracts from DHAs and GPFHs have been underway at a managerial and consultant level, we believe that the potential role of a key player for hospitals, the psychiatric medical secretary, has been overlooked. This paper examines the secretarial role in the context of the ‘new’ health service.

As part of winding-down from the Society for Psychotherapy Research's conference in Ravenscar and the Royal College of Psychiatrist's meeting in Cambridge on destruction, I went to see the award winning film Scent of a Woman∗. There was a synchronicity to this choice since in retrospect it seemed to me to reflect much of what was to be gained from the two conferences.