During my psychiatric training to date I have been observed at work by medical students, psychiatric nurses and social workers, by video cameras and the members of family therapy teams, by consultant psychiatrists and others. All these experiences of being observed have been challenging and educative; probably I share them with most psychiatric trainees.

The Whitechapel murders of 1888 attributed to Jack the Ripper were, like many of the crimes of multiple-victim killers, well-publicised, bizarre and dramatic (Lunde & Sigal, 1990). Although in the public mind at the time the murders of at least seven women in and around the Whitechapel district of London's East End were believed to have been carried out by Jack the Ripper. However, according to police and forensic evidence his victims, all prostitutes, numbered only five, beginning with Mary Ann Nichols, found murdered on 31 August 1888, and ending with Mary Jane Kelly, whose mutilated body was discovered on 9 November 1888.

I have been asked to explain the structural changes that are taking place in UKSCP and to describe how these will lead to the formation of a register of psychotherapists early in 1993. I shall briefly survey the present balanced structure, describe the most recent changes and show how they will work in practice.

The history of Horton Hospital is best seen in the context of the socio-economic history of the late 19th century. London, as a result of the Industrial Revolution, had grown enormously so that the existing metropolitan mental hospitals could no longer cope with sheer numbers of mentally disordered arising within its boundaries. The Metropolitan Asylums Board, whose responsibility it then was, looked for suitable land within easy – but not too easy – reach of London. Epsom at the turn of the century was an exceedingly fashionable area boasting a number of large and elegant “Derby Houses” (some of which still exist, although now put to rather more plebeian use) to which the aristocratic racing fraternity transferred themselves for the races. It was known that this wealthy and influential body would oppose the sale of the private estate of Sir Thomas Powell Buxton in the parish of Horton, roughly one square mile in size, for the purpose of building mental hospitals. What added even more bitterness to the pill was that the hospitals were to house “pauper lunatics”, a sobriquet with obviously undesirable social connotations. The negotiations for the sale were carried out in secrecy and the fait accompli, when it was announced, created an outcry. But it was too late. In retaliation the “toffs of the turf” including, ironically perhaps, the Royal Family, transferred their establishments and training facilities mainly to Newmarket which grew in importance as Epsom declined.

You might regard words as dependable things, that never do anything more tricksy than linger overly long on the tip of your tongue. But beware – don't let them gang up on you, or you'll be left with phrases.

George Orwell (1946) wrote in ‘Politics and the English language’ that:

“prose consists less and less of words chosen for the sake of their meaning, and more and more of phrases tacked together … the ready-made phrases come crowding in. They will construct your sentences for you – even think your thoughts for you, to a certain extent – and at need they will perform the important service of partially concealing your meaning even from yourself.”(pp. 145, 152, italics in original)