To describe the role of the consultant psychotherapist in the mental health services, we must start from the situation in regard to psychotherapeutic needs in the community and the kinds of resources that can be mobilized to meet them. I should make it clear that when referring to consultant psychotherapists in the psychotherapeutic clinic I assume that optimally these specialists would be part of a comprehensive psychiatric service. For convenience I shall use the term “psychotherapeutic centre” to allow for the location of the psychotherapeutic services to vary according to circumstances in any one area. Also, although I shall speak often of the psychotherapist as though his was a rather separate contribution, I want to stress that this is partly a reflection of the present situation. Much of what I have to say about his role must become increasingly a part of the work of all psychiatrists.

In psychiatry, lithium has been used mainly in the treatment of manic states and other forms of affective psychoses (Cade, 1949; Schou, 1956; Maggs, 1963; Baastrup, 1964). Strömgren (1965) puts forward the view that the usefulness of lithium is very questionable in the treatment of other psychiatric disturbances than affective disorders. Even earlier, Teulie et al. (1955) had found lithium to have a relatively weak therapeutic effect in schizophrenic, hallucinatory and epileptic psychoses. The Russian investigators, Mosketi et al. (1963), treated different kinds of psychotic disturbances by administering lithium iodide (0·5–1·0 g/die) intravenously. They found the effect of the drug to be highly favourable within 7 to 15 days, in some cases in 30 to 60 minutes. They obtained the best results in cases of paranoid-hallucinatory, confusional and depressive-paranoid psychoses. Compared with earlier observations, these results indicate a surprisingly favourable effect of lithium in non-affective psychoses.

While there are reports from the United Kingdom of the use of closed-circuit TV in medical education, most of those relating specifically to psychiatry appear to have come from North America. There is also one from the U.K. (Stafford-Clark, 1964) and a few others from elsewhere. But even in the U.S.A. there has been no rush to use television. According to Ramey, by 1964 only 179 of 1,500 departments of various kinds in U.S. medical schools were using closed-circuit TV, and only 141 to any substantial extent. Departments of physiology and pharmacology were found to be the prime users, with psychiatry coming a close third.

The role of the doctor in society has changed rapidly over the past 20 years consequent upon great developments in the biological sciences and equally great changes in the society in which we live. In particular we would stress the following factors which would influence the medical curriculum.