Stress, like depression, is a universal experience. Both are generally self-limiting and may even prove to be beneficial in terms of personal growth. In some circumstances, however, stress and depression may become excessive or morbid, and lead to considerable disability.

This document, originally published in the Bulletin, September 1977, is now reprinted on the instructions of Council. The reasons for this decision are incorporated in the fourth section of the paper by me, ‘The Future of the Consultant in Psychiatry’, which appears in this issue.

The Mental Health Act 1983 stimulated discussion on all aspects of compulsion in psychiatry. It has been the practice at St. Mary Abbots Hospital to use the powers granted by Section 39 of the 1959 Act and Section 17 of the 1983 Act as a means of compelling a small number of seriously ill patients to take medicines in the community, and I described this practice briefly in a recent article.

In 1975, seven years after registration, I had two small children and a part-time post as Staff Medical Officer with an Area Health Authority in London. For various personal and medical reasons I had decided to have a family early in my marriage. I felt it right that their upbringing should be largely done by me, and the alternative, if I worked full time, would be to hand over their care to someone else. I knew, however, that I should not be satisfied with a purely domestic role and part-time work in occupational health provided a compromise at the time. But I was uneasily aware of the lack of a definite goal and of my own doubts about continuing long term in this type of work.

The Irish Division, through its Executive Committee, is pursuing a policy of pressing for early consultation with the Department of Health on Irish national issues bearing directly on the welfare of the mentally ill. Part of this policy is to publish from time to time selected position papers of significance which have been submitted to the Department. The following paper advocates the monitoring of psychiatric services in the Republic of Ireland by peer review with tentative suggestions as to how this might be achieved. In a slightly different form this paper was submitted to the Department of Health in March 1983 without, to date, formal response.

The experience of working with disturbed adolescents—many of whom manifest conduct disorders—in a therapeutic community is in many respects contrasting and different from the more conventional psychiatric setting. Studies have shown that doctors' attitudes to the therapeutic community approach are very polarized, as are attitudes to psychological and organic methods. When faced with a choice of using psychotherapy, behaviour therapy, social psychiatry, or biological methods, doctors again exhibit strong preferences. The opportunity to experience therapeutic community methods is not usually available in teaching hospitals, and is not uncommonly a source of friction when sited in a hospital. Relationships between psychotherapists and other psychiatrists in teaching hospitals are not always harmonious.

A meeting of psychiatrists with an interest in rehabilitation was held in Oxford in April 1983 just prior to the College Quarterly meeting. The meeting was convened by Dr Brenda Morris and chaired by Professor John Wing; its purpose was to discuss the scope and future direction of rehabilitation in mental illness.

A survey of the views of consultant psychiatrists concerning possible difficulties for the practising clinician in the early aftermath of the Mental Health Act 1983 is presented. The number of consultant psychiatrists written to was 118 and the breakdown of responses was as follows: 37 of 79 general psychiatrists replied; 4 of 8 psychogeriatricians replied; 2 of 9 consultant adolescent psychiatrists replied; 2 of 4 forensic psychiatrists replied; and 5 of 18 consultants in mental handicap replied. The letter asked eight questions concerning specific aspects of the Act and invited any comment.

Birley (1981) has quoted Whitehead as saying ‘a science which hesitates to forget its founders is lost’. On the other hand, however, Hunter and MacAlpine (1963) noted that ‘the historical study of psychiatry, unlike that of medicine, is inseparable from the appreciation of its current problems', and that ‘just as it is the historical and biographical method which the psychiatrist adopts when faced with the problem of the individual patient, so the historical approach may be expected to throw light on the wider problems of psychiatry by laying bare their roots'. Certainly, since taking up appointment as librarian of the Institute of Psychiatry I have been surprised at the awareness of professional history shown by senior staff who I would have expected to be totally absorbed in day-to-day minutiae. A brief note in a specialized journal (Guha, 1983) elicited a considerable correspondence from psychiatric librarians who had noticed the same interest. It is, perhaps, unfortunate that historical resources in psychiatry are somewhat scattered, so that there is no one central archive or library to act as a focus for research in this area.

Developments in preventive psychiatry should occur as a result of new knowledge of the psychiatry of infancy as presented at recent conferences: the International Conference of Child and Adolescent Psychiatry, Dublin 1982; the World Infant Psychiatry Congress at Cannes, March 1983; and the Child and Adolescent Psychiatry Congress in July 1983 at Lausanne.

The North West Doctors and Dentists Group is part of the wider British Doctors Group. In Britain Doctors' groups began when the London Group was formed in 1973. Since then new groups have been established in Birmingham, Bristol, Durham, Glasgow, Manchester, Northampton, Petersfield and Portadown.

The importance of the adolescent life period, from 10 to 19 years, is evident increasingly in all cultures of the world. The short, ritualized transition from childhood to adulthood, which has been characteristic of some cultures, is giving way to more prolonged periods as the pattern of Western industrialized society spreads to other parts of the world. The mental health problems of adolescents are attracting increasing attention since they have long-term social and economic implications. In Europe and the United States, epidemiological surveys indicate a high prevalence of psychiatric disorders in teenagers. At all times in the community there is a large group of adolescents who are a source of concern because of their misbehaviour and apparent unhappiness. Nevertheless, adolescents world-wide have received relatively less medical and psychiatric attention than other age groups and specialized services, professional training and research are poorly developed. This is the state of affairs in many European countries and there are grounds for concern about the present state of adolescent psychiatry in Britain, in terms of both its clinical services and its professional development and status.

During the third quarter of the 19th century it became clear that the problem of pauper lunacy was not being contained by the county asylums. Despite much new building, accommodation in asylums was over-crowded; the patient population had become increasingly heterogeneous and therapeutic optimism was waning. The proportion of curable patients in county asylums declined steadily—for example, from 1844 to 1870 the proportion fell from 15 per cent to 7 per cent. The prospect of large-scale institutional confinement, however, did not go unnoticed and alarm was expressed by many contemporary writers. J. T. Arlidge, formerly of St Luke's Hospital, for example, observed that: ‘Many asylums have grown to such a magnitude, that their general management is unwieldy, and their due medical and moral care and supervision an impossibility … in a colossal refuge for the insane, a patient may be said to lose his individuality, and to become a member of a machine … In all cases admitting of recovery, or a material amelioration, a gigantic asylum is a gigantic evil, and, figuratively speaking, a manufactory of chronic insanity.’