I am writing this just after returning from India and Sri Lanka and, after being exposed to a welter of cultures and religions in the past few days, I have had cause to reflect on the Journal's aspirations to be international. I think I can detect a touch of sophistry here. Professor Navendra Wig, one of the most distinguished of Indian psychiatrists, puts it better. He describes how the government excise records in India refer to locally produced spirits such as brandy and whisky as IMFL – ‘Indian Made Foreign Liquor’1 – and this made him realise that, at heart, he was an IMFD, an ‘Indian Made Foreign Doctor’, as he could never escape his cultural heritage however much he tried. Similarly, I cannot escape the conclusion that we are seen by all non-UK-born readers as a British Made Foreign Journal, with a style and substance that cannot genuinely resonate with all our readers. But we can learn much from each other, as this issue shows. Manoranjitham et al (pp. 26–30) show that even if we were successful in both identifying and treating depressive illness over in the West, it might have little impact on suicide in south India as there overt depression appears to be rare prior to suicide, and what matters much more is simple stress and isolation following loss. Why south India is different from the UK, and even Pakistan2 here, is a puzzle, but such research shows that we cannot export or import evidence derived from only one country if it is at least partly dependent on culture and setting. Fottrell et al (pp. 18–25) similarly demonstrate the tremendous value of one of the most joyous of events, childbirth, in Benin where perinatal mortality is high, so that even the trauma of a baby almost dying can be overcome triumphantly by the exuberance of successful motherhood. But it is equally important to report results that are entirely consistent with those in countries of different cultures, and Chen et al (pp. 31–35) find that recurrence of self-harm in Taiwan follows a pattern that is virtually identical to that in Western countries.3–5 Large international studies can allow for cultural and national variations and Bottomley et al (pp. 13–17) illustrate this in comparing risk factors for both onset of depression and recovery. Bisson et al (pp. 69–74) do likewise and in their guidelines for psychosocial care after disasters involved experts from 25 nations across the world – quite a feat.

Practitioners in all branches of mental health quickly become aware of the importance of time and place as they develop their craft. The value of guidelines for good practice can be considerable, but if they become echoing mantras that are applied indiscriminately, they can impair good care. Psychiatry does not lend itself easily to sound-bites because so much of what we say and do has to be put into a context that is more complex than most other parts of clinical medicine. When giving a talk about the fundamentals of community psychiatry recently in a country with limited resources I was simply told after I had finished with a flourish, ‘this wouldn't work here’, and, after first feeling affronted, had to acknowledge in discussion that what I took for granted as universal, was clearly wrong.