A symposium on Expatriate Stress and Breakdown was held on 27 October 1983 in London under the auspices of Guy's Hospital and Charter Medical to bring together psychiatrists, psychologists, sociologists and physicians with an interest in occupational health. Since the 1920s, when one-fifth of the British employees of the Anglo-Persian Oil Company suffered from ‘tropical neurasthenia’, little has been published on this topic.

The role played by the House of Commons in the legislative process has been steadily changing since the Reform Acts of the nineteenth century. Previously, most of the Commons' legislative work consisted in passing private measures initiated and introduced by individual Members of Parliament concerned with, and knowledgeable about, local issues which required change. The growth of an increasingly vocal and educated mass electorate, the pressures of mass-membership political parties, and the increasing specialization of an industrial society, all increased the need for wider legislation, particularly for public social measures, and its initiation passed from the hands of individual members to the Government Parliament as a law-making body moved towards a more formal constitutional and legal role. Its twentieth century task is more often the legitimation of legislative changes originating elsewhere.

A group of child and adolescent psychiatrists working in or near London has been meeting regularly for a number of years. There are places for about 20, and the composition of the group changes as old members leave and are replaced by new ones. In 1974 a pilot study was published on how members divided up their professional time.1 Seven years later the present group decided to examine this topic again,2 and also to explore other issues concerning their working arrangements.

Child psychiatry is a relative newcomer to the area of medical training. In the past teaching has focused more on the education of psychiatrists and paediatricians than on the contribution of child psychiatry to the education of medical students.

It was bold, as well as shrewd, to have held the 4th Conference of the African Psychiatry Association in London (Institute of Psychiatry) rather than Lagos or Lusaka. Yet Dr A. C. Raman (Consultant, St Augustine's Hospital and Secretary General of the Association) should be well satisfied with the rewards for his hard work. There were about 100 participants (the majority from Africa) who debated with vigour and courtesy the diverse facets of the conference theme. To have discussed these controversial training matters at the institution which, together with the department of psychiatry in Edinburgh, had influenced considerably the development of psychiatry in Nigeria, as well as in other Anglophone African countries, could have misfired. However, for most participants the conference presented a rare opportunity for legitimate nostalgia, as well as the chance to contribute to discussion on the present training of psychiatrists in Africa.

Travel has always been a part of medical education. Many of the great figures of British psychiatry seemed to have derived some of their inspiration from periods spent in European clinics, and more recently no c.v. seemed truly complete without the all important ‘Been to America’. Unfortunately, as the Atlantic has become cheaper to cross, the professional welcome at the other end has become increasingly lukewarm and the VQE and FLEX have proved substantial deterrents. There are, however, several alternatives which are worth considering. From 1980 to 1983 I worked as a psychiatrist in Africa, in the Republic of Botswana, and I thought a description of some of the practical aspects involved in making such a step might be of interest.

The introduction of the College's Membership Examination in 1971 created a dilemma for the university departments which had previously provided postgraduate teaching for a Diploma in Psychological Medicine. For it was clear that the MRCPsych would soon become a mandatory qualification for anyone wishing to pursue a psychiatric career, at least in this country, and that consequently there would no longer be a useful role for these diplomas. The universities concerned therefore had to choose between letting their diplomas die, or converting them into something other than a basic clinical qualification. The University of Edinburgh, like the Institute of Psychiatry and one or two other departments, decided to replace its DPM with a master's degree (M.Phil) in psychiatry which would be primarily an academic and research qualification, complementing rather than rivalling the College Membership.

There are now six psychiatric case-registers covering areas in England, two in Scotland and one in Wales. All record the contacts made by patients or clients from a defined geographical area with specified medical and social services. This information is stored in a linked and cumulative file so that the care of any individual or group can be followed over time and the patterns of care established. The geographical base allows rates to be calculated and epidemiological research to be conducted.

Occupational therapy is rarely featured in psychiatric journals and little discussion takes place between our two professions. Now, however, we have a chance to consider a paper, issued by the Education Board of the College of Occupational Therapy, stating their case for a professional degree.

In spite of the vast strides forward made by the brain sciences this century, the gap between our understanding of the brain and our understanding of the mind remains uncomfortably wide. At one end of the scale, physical scientists scratch patiently away at the chemistry of receptor sites on cell membranes, at the other, clinicians make brilliant deductions by sheer intuition, and in between is a hazy land. As the pendulum now swings back towards a biological approach to psychiatry, we hear again the old assertion that the only true knowledge can be obtained by objective observation; subjective intuition must therefore be suspect, an unreliable and intangible entity. What validity is there in this argument?

Teaching and research and Membership Examination orientation, this is the new religion and the major preoccupation now of every ‘good’ psychiatrist. There is a growing attitude that day-to-day patient care, unless there is a new experiment or innovation, is too familiar and therefore contemptible, and consultants have better things to do. Is it not time to reserve some credit to old-fashioned good patient care, to which all medical people, even the most academic, pay lip service. After all, to win resources doctors have usually to prove to the public the benefits to patient care and not to teaching and research.