Since the establishment of the Social and Community Section of the College, it has been apparent that differences exist in the viewpoints of its members on such questions as the role of the psychiatrist in the general community, how services are to be evaluated, what are the functional limits of psychiatry in the population and whether ‘community psychiatry’ is a unitary concept (and if so, whether it implies a generally accepted pattern of services, such as that proposed in 1975 in Better Services for the Mentally Ill).

The Special Hospitals arouse public interest only on occasions of disaster or scandal and there are widespread misconceptions concerning their role. The purpose of this paper is to examine the clinical functions of the Special Hospitals and to critically discuss their medical remit.

The Standing Committee of the Association of University Teachers of Psychiatry (AUTP) have recently prepared guidelines for teachers and students on sciences basic to psychiatry. This followed a request from the College and these guidelines are now being published in the Bulletin. They have been considered by the Education Committee and by Council who commend them to members of the College.

The following is the second part of Sidney Bloch's interview with Sir Denis Hill. Part I appeared in the May Bulletin.

Examinations loom large in the minds of trainees. Rightly, trainees see passing the MRCPsych as official confirmation that they have successfully concluded their period of general professional training and may now advance to higher training and, almost inevitably, to Consultant status. They may assume, and in this the College does nothing to dissuade them, that they have been tested in the skills needed to practise psychiatry. Enumeration of such facts as are to be enumerated and the observation of external behaviour stand high in the lexicon of success. Listening and understanding, tolerance and compassion are also-runs. The examination does not merely reflect the form of the training but dictates the order of priorities. What the exam values, the trainee values. What the exam ignores, the trainee, unless strongly motivated, will be tempted to ignore.

Increasing attention continues to be paid to the discrepancy between the current performance of medical practitioners in dealing with alcohol dependence and the enormous potential which exists for early diagnosis and cost-effective treatment. This discrepancy has been noted in various government reports, in articles in the medical press and in the seminal report of the Royal College of Psychiatrists, Alcohol and Alcoholism. One way of narrowing the gap between performance and potential would be through improvements in medical education. The purpose of this short paper is to review existing evaluated studies of medical education on alcohol dependence in order to discover whether any specific lessons emerge which might be useful in planning curriculum changes either at undergraduate or postgraduate level.

Any service designed to meet the needs of the elderly must necessarily embrace a wide diversity of personnel and facilities. Not only is a multiprofessional team imperative, but such resources as are available—whether in the Health Service or personal Social Services—must be used in the full.

Here surely is the scriptural authority for the existence of forensic psychiatry, even though one interpretation of the text could be that medical care is a fate literally worse than death. In fact, however, forensic psychiatry grew up largely from the efforts of lawyers to use medical expertise to save their clients from the execution of a death sentence, and their efforts antedate the historic trial of Hadfield by many years, indeed centuries.

While sociologists and sociologically-minded historians cast a baleful eye over the global history of mental treatment in the last two centuries, others—consultants, administrators or psychologists, present or past members of psychiatric hospital staffs—prove willing to devote much toil to the writing of detailed, often scholarly and always affectionate accounts of the origins and development of their own respective institutions, produced either spontaneously or on the occasion of some centenary or even bicentenary celebration. For the most part these appear in brochure form, but in a few instances they reach the dimension of full-size hardbacks. An attempt will be made here to review briefly a number of such publications which have appeared in recent years, including one whose authors have chosen to deal with establishments long-since defunct and forgotten, rather than with their own flourishing one.

Despite a good deal of argument to the contrary (Maughs, 1941; Hunter and Macalpine, 1963; Walk, 1954; Walk and Walker, 1961; Craft, 1965; Whitlock, 1967) it is still commonly believed that Prichard's ‘moral insanity’ (1835) was the forerunner of our present-day concept of psychopathic (sociopathic) personality; the most recent example of this appearing in the paper by Davies and Feldman (1981), who write: ‘In 1801 Pinel described a condition termed by him manie sans délire, the notable feature of which was that the sufferer showed bouts of extreme violence but with no signs of psychosis … Prichard confirmed Pinel's observation and coined the term “moral insanity” which led to “a marked perversion of the natural impulses”.’ A number of modern textbooks (Sim, 1974; Friedman et al, 1975; Slater and Roth, 1977; Trethowan, 1979) also appear to regard moral insanity as the precursor of psychopathic disorder, although Trethowan correctly noted how the word ‘moral’ denoted ‘affective’ and was not being used in the usual ethical sense. He went on, however, to write that Prichard described cases showing antisocial or even criminal behaviour.

I have been a member of the Southern Division Approval Panel since its inception in 1972. Thereafter I visited, with other panel members, two or three hospitals per year. I became Convener in 1978 and in my four years in office I visited over 35 hospitals, although these were not all separate visits. I look after a catchment area in South-East London, with all the in-patient services at Bexley Hospital. It is entirely my personal opinion that if I was not involved with a district service I probably would not have accepted the invitation to be a convener. I do not think I would necessarily have been a worse convener, but I might have been rather less credible.

The Montrose Royal Asylum was founded by a remarkable person, Susan Carnegie, who lived at Charleton on the outskirts of Montrose. She had been greatly concerned about the appalling conditions under which many of the mentally ill were kept in the local Tolbooth. She appreciated the suffering experienced by these pauper lunatics, and perhaps also, being married to a Jacobite who had spent 20 years in exile in Sweden after fleeing from Culloden, had brought its own understanding.