As students at the Durham medical school in Newcastle during the early thirties, we were taught that illness could be due to certain factors and these were listed. The malady could be caused by infection, acute or chronic, trauma, neoplasia. … there were many possibilities but at the very end was a sort of garbage bin for all the diseases which did not fit neatly into the organic syndromes; these were called hysteria or psychoneurosis. These functional cases were diagnosed in a purely negative way, by a process of exclusion. No attempt was made to explain possible reasons for these troubles and there were no suggestions as to how to treat them. We were led to believe that such people were no more than time-wasters, suffering from unworthy maladies. If neurosis in all its forms gave rise to disdain, psychosis produced overt panic, as exemplified in the following case history. A young woman of 20 was admitted to a medical ward in the late stages of pregnancy because she was suffering from severe Sydenham's chorea. She was so bad, she was constantly in danger of falling out of bed and she was quite unable to speak coherently. It must have been because of this she was deemed mad, and a respectable medical ward was certainly no place for a lunatic. Fear in both the medical and nursing staff had completely obliterated all feelings of compassion. She was certified and transferred to the asylum where she died the next day. It was well known that chorea gravis carried with it a bad prognosis and, after all, there were side wards. The poor lass should have been allowed to die in dignity in one of them.

The clinical management of a mother who has a severe puerperal mental disorder is complicated by the fact that her baby is not ill and does not need to be in hospital—especially a psychiatric one. On the other hand, separating babies from their mothers can have adverse effects upon their relationship and upon the psychological development of the infant, although much depends upon the timing, nature and duration of the separation as well as on the quality and stability of the family background.

Psychological knowledge is important to psychiatrists, both because of the psychological concepts central to some fields, such as normal human development, and because of the psychological procedures widely used in both the assessment and treatment of patients. Psychology is taught to trainee psychiatrists as part of their preparation for the MRCPsych examination, mainly through the teaching for the Preliminary Test of the examination which covers the ‘sciences basic to psychiatry’. In practice, the content of the test covers basic psychopathology and the neurosciences, as well as the behavioural and social sciences. While the Royal College of Psychiatrists does not itself produce a detailed syllabus for the examination, the Association of University Teachers of Psychiatry (AUTP) has prepared guidelines for students and teachers for these subjects. Since the Royal College has ‘commended’ these guidelines and published them (Bulletin, April 1982, 6, 54–56) they have a semi-official status.

The Bahamas is a group of islands, just off the coast of Florida, extending southwards to near the island of Hispaniola. There are approximately 25 inhabited islands and numerous small islands and cays that are uninhabited. The population of the Bahamas is approximately 230–240,000. A census taken in 1980 showed that approximately 65% of the population is aged between 15–45 years. The major industries lie in tourism and off-shore banking. The Bahamas has not always had a drug problem; the diagnostic records at the mental hospital, Sandilands Rehabilitation Centre, reveal that in the sixties drug-related admissions were negligible. In the early seventies, however, there was a rapid increase in cannabis use and at the same time the number of drug-related admissions increased. The patients were mainly admitted in acutely disturbed states which were thought to be drug psychoses caused by cannabis inhalation. There do not seem to have been many patients requesting help to stop using cannabis, and generally there has been no significant change in this pattern. The major difference is the vast increase in the quantities smoked by an individual user. In the mid-seventies, the pattern of drug use began to change in that more patients were using a number of drugs at the same time. Methaqualone enjoyed a period of popularity and was known on the street as Quaaludes, Mx or Disco Biscuit. The drug's ability to potentiate the action of alcohol made it both dangerous and alluring, as it was possible to get ‘stoned’ almost immediately for the price of only one drink and one pill. It was about the same time in the mid-seventies that cocaine hydrochloride began to arrive on the market in increasing quantities and start gaining in popularity. The major problems at that time were associated with drug-induced psychoses, acute intoxications and occasions of violent bizarre behaviour due to the disinhibition and release of aggression caused by these drugs. One drug addict from this era, interviewed in the prison, said that a good night out was to smoke some grass, drink a Guinness stout, take a quaalude and then snort some cocaine. There is really no literature as to what effect these combinations may have on the brain. It is of interest however that very few patients were presenting for treatment of addiction, though by the late seventies a trickle had begun to come forward. Cocaine was not that plentiful and was being used by snorting, i.e. the inhalation of the finely ground white powder into the nostrils. A less popular method of use of cocaine at that time was smoking the finely ground powder as a constituent of a tobacco cigarette or mixed into the contents of a marijuana cigarette. The quantities of cocaine available on the Bahamian street market at that time were small.

A liaison is a union or effective conjunction with another unit or force. A liaison officer is seen as one who forms links or integrates such units or forces. This is a simple definition obtained from a standard dictionary but a further attempt at defining what is meant by liaison psychiatry is not so easy. This problem of definition and the lack of uniformity in such services in different settings may partly result in the marked under-utilisation of psychiatric expertise in dealing with the large number of medical patients who have a psychiatric disorder regardless of the presence or absence of a physical illness.

In the Mersey Regional Health Authority it has been decided that closure of at least one large mental illness hospital will take place within some 10 years and may be complete by 1992. To facilitate this the region has provided funding for every long-stay patient who might be discharged to the care of voluntary organisations or Social Services Departments and joint assessments of patients have been undertaken by the Health Service and Social Services staff.