This paper describes a basic training course in cognitive therapy for trainee psychiatrists on the Sheffield rotational scheme. Cognitive therapy, as represented by the work of Beck and Ellis, has emerged over the past decade as a potent therapeutic tool, particularly in the treatment of depression. It is a structured, directive, short-term therapy aimed at eliciting and modifying the dysfunctional cognitions which are hypothesised to play a central role in initiating and maintaining emotional disorders.

For the past twenty years or more it has been suggested that all our large psychiatric hospitals should be closed and psychiatry transferred to the community. This idea has generated a large amount of discussion, innumerable papers and much anxiety. More recently it has become the stated objective of the Department of Health, and now every region in the country is making concrete plans to transfer psychiatry from the mental hospital to facilities in the community with the definite objective of closing down psychiatric hospitals within a measurable time. Naturally this has generated even more discussion—and even more anxiety.

Judge Schreber published Memoirs of My Nervous Illness in 1903 in which he described an illness since quoted as an outstanding example of paranoid schizophrenia and one which supports psychoanalytical explanations of the development of paranoia (first published in English in 1955 by MacAlpine & Hunter). The Schreber case became famous when Freud published his Psychoanalytical Notes Upon An Autobiographical Account of a Case of Paranoia (Dementia Paranoides) in 1911.

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.

It is often felt that group meetings with long term chronically psychotic patients have little therapeutic value and become weekly ‘complaints’ sessions. In this paper I would like to indicate that group work with such a population can be both a therapeutic and valuable training experience. I shall describe a group which I took over a six month period in one of the wards at the State Hospital, Carstairs Junction, Lanark.

The DHSS/College recommended establishment for consultant posts in the psychiatry of mental handicap is one whole-time equivalent per 200,000 population.1 In 1982 the theoretical average in the English∗ regions was 1:321,000, varying between 1:153,000 (South West Thames) and 1:620,000 (North West). There were, however, 41 vacant posts, 19 of which were occupied by locums,2 so the actual substantive average was 1:612,000. By 1983 the number of vacant posts had risen to 49 and the substantive consultant/population ratios varied between 1:202,000 (South Western) and 1:2,170,000 (North Western).3

Microcomputers are increasingly being used in psychiatry for a variety of purposes. When used in computer-patient ‘interviews’ they have generally proved acceptable—indeed popular—with psychiatric patients. Automated psychological assessment is one form of computer-patient interview that is attracting much interest. Some of the early applications were with elderly patients. Kendrick has expressed doubts regarding this application with the current generation of elderly people, suggesting that their relative unfamiliarity with computers and video games might cause difficulties.

A general practitioner needs to be kept well-informed when a patient with a psychiatric disorder is admitted to hospital. This can be difficult because a number of professional workers, not all of whom are hospital based, become involved in management, and confusion over clinical responsibility may develop. In these circumstances communication usually depends upon the hospital discharge summary which should contain information that is relevant to the GP's requirements.

A day workshop on the subject of psychosynthesis was held in June 1985 by the Action Therapies Group. The group consists of health professionals working in psychiatry and related fields, who meet regularly to educate themselves about the ‘new’ therapies, including gestalt, transactional analysis, psychosynthesis. Teaching is carried out by group members, the emphasis being on experiential rather than theoretical learning, though time is given to theoretical issues.

The climate in 1969, in which the HAS was created, was one of increasing anxiety and embarrassment about the quality of long term care being offered to elderly, mentally ill and mentally handicapped patients in England and Wales. The need for a body to advise the Secretary of State, independently of the Department of Health and Social Security, was recognised and, with the wise guidance of Dr Alex Baker, the concept of multidisciplinary review by professional colleagues was established. Both these important principles have been maintained and stoutly defended by subsequent Directors, including myself.

The very mention of Albania conjures up the wildest fantasies. For years we have been hearing about this ‘most closed society in the world’ where ‘people are locked up for watching football on television’, the roads of which are lined up with horse-carts, the only place in the world where no cars are seen and where dissent from the state is dealt with by Stalinistic means.

A recent edition of the Bulletin contained a letter which was originally published in La Révolution Surréaliste 60 years ago. The letter was probably written by André Breton and was basically an attack on psychiatry as then practised in France and in particular on the process of involuntary admission. The letter appeared in the Bulletin under the title ‘An Historical Vignette: Surrealism and Anti-Psychiatry’. While there can be little doubt that the surrealists were antagonistic to psychiatry I would like to argue that a great deal of their work is of potential interest to psychiatrists. The surrealist movement was opposed to any form of rationalism. It was opposed to anything which could possibly limit the imagination and this was the source of its conflict with psychiatry. But surrealist art and literature was essentially an exploration of the bizarre, the irrational and the unconscious and these are subjects which are, of necessity, of importance to the psychiatrist and the psychotherapist.

Liaison psychiatry has been an influential element in hospital psychiatric practice for over a decade now. It is concerned with the ‘diagnosis, treatment, study, and prevention of psychiatric disorders among patients in non-psychiatric health care institutions, especially in general hospitals’. This paper describes and evaluates a project in which the principles of liaison psychiatry were incorporated into a psychogeriatric service.

Since taking the decision to pursue a career in mental handicap, I have been increasingly aware of the debate surrounding the role of the consultant psychiatrist in this field. Nowhere else in medicine does there seem to be such uncertainty about the continued need for an already established specialty. I believe that one of the major reasons for the continued difficulty in attracting trainees into mental handicap is precisely this uncertainty about its future, which is in no way ameliorated by the College's view that a full time specialist appointment in the psychiatry of mental handicap is not superior to a joint appointment either with adult or child psychiatry.1