The dilemma of the medical practitioner as to when to break confidence and when to keep silent has again attracted the attention of the courts recently in the case of R v Crozier (The Guardian, 1990).

In mid-1963, Dr Harry Richard Bailey admitted a patient to Chelmsford, a small private hospital in a north-western suburb of Sydney. Between then and April 1979 he, and subsequently a handful of associates, treated a large number of patients with deep sedation, often combined with ECT. The patients' diagnoses included schizophrenia, bipolar disorder, alcoholism, and drug addiction; nothing suggests that the diagnosis and the treatment had any particular connection. Records exist for some 1,100 patients, 24 of whom died as a consequence of the treatment; 16 of them were under the age of 50. Others suffered brain damage, convulsions, delirium, pneumonia, hallucinations, cardiac irregularities, abscesses, urinary tract infections, fractures, and other complications.

Psychiatrists are frequently invited to give expert opinions to Courts about children's emotional welfare, their parents' capacity to care for them and issues of placement and access. Previous child abuse/neglect may have been suspected or confirmed or the parents might suffer from psychiatric symptoms. Assessment may be required of parents' mental state with a guide to prognosis, but, in addition, factors in parent–child relationships will be crucial to overall assessments of parenting.

Current affairs groups are run informally in a number of psychiatric wards, both acute and chronic. They are mostly arranged by the nursing staff and occasionally by an enthusiastic senior house officer or registrar. The goals may be positive such as to stimulate, generate discussion, and encourage understanding and tolerance. Sadly, some groups develop with the negative aim of ‘just having to do it’, as a ‘traditional’ part of the ward programme. We realised from our training years that a current affairs group could be a clinical asset on an acute admission ward if it was run with the following objectives: improved clinical assessment, especially of patients' mental state, and improved understanding and better relationship between patients and doctors.

The Special Hospitals Service Authority (SHSA) has commissed KPMG Peat Marwick McLintock Management Consultants to lead a pilot study to identify how the application of resource management (RM) techniques can best be introduced to the overall benefit of the management of a Special Hospital. The study is to be based at Rampton Hospital. The KPMG staff will work closely with a Project Team comprised of the hospital's staff.

In this personal review we discuss the contemporary issues in Chinese psychiatry, the main themes in recent Chinese literature, and current psychiatric practice in China.

The British Journal of Psychiatry, the title it has enjoyed since 1963, can claim descent in direct line from three earlier journals, entitled in chronological order, The Asylum Journal from 1853; The Asylum Journal of Mental Science from 1855; and The Journal of Mental Science from 1858.

In my medical year there was a student who had been in the RAF in World War II. After the war he worked for Beaverbrook and the Express newspapers and went on to become a publisher. He studied medicine, while a publisher, and then came the crunch. To be a publisher or a doctor? On the first day of house jobs he inadvertently drove his Jaguar into the consultant's reserved parking spot, which caused no amusement. To add to his disquiet he found that his salary of £35 per month, after income tax, and then surtax on top, only paid for his pipe tobacco and refreshments. The rest of us were less egregious and embarked upon life with even less fiscal fun. A bottle of Woodpecker Cider on Saturday night was nirvana. Was this really the reward for all that education? (Most specialists had at least 28 years of formal education: from starting at age four to leaving postgraduate school.) Like many before me, particularly Edinburgh graduates, I crossed the high seas, at the age of 32. My naval forebears would have been surprised that it took so long, especially my father, who went to sea at 14 in World War I. There were many surprises, not least of which was that of money. In a career sojourn, from the UK to Australia and finally Canada, over 18 months, there was a tenfold increase in income.

With a view to stimulating discussion on the subject of trainee's attitudes towards, and experience of teaching, at an informal meeting of members of the Association of University Teachers of Psychiatry held in Leicester last year, a survey of Trent Region Psychiatric Senior Registrars, as well as delegates to the first College Trainees' Conference (held at Warwick University), was undertaken.

The Greek origin of the word psyche (breath) is well-known but psyche also referred to life as action or as soul, some special force or spirit which entered living creatures. It was as soul or spirit that psyche was adopted into the English words psychology and psychiatry but its exact semantic status is a knotty affair.

This Consortium has a distinguished political-legal history. Its predecessor, the Family Court Campaign, was launched in 1985 by Lady Faithfull, then chairman of the all party parliamentary committee for children. Its aims were those of the Finer Committee (1974).

Observers of the American Psychological Association's enthusiastic support for the gathering momentum to accredit psychologists with prescribing privileges will detect professional and economic motives among others: the same can also be said of the AMA's campaign to stop it. Health care in the USA is underpinned by a business culture in which psychologists and psychiatrists operate widely as independent practitioners in the open market place. The prestige value and pecuniary advantages to American psychologists would not be insignificant. Also, since health care insurance companies purchase separate psychological and medical treatment for their customers, it would be to their economic advantage for these treatments to be embodied in one individual. Thankfully, pressures on this scale have yet to reach these shores. Nevertheless, serious consideration should be given to establishing a grade of prescribing psychologist in the NHS if it can be shown to raise the overall quality of care; if prescribing could be done appropriately and safely; and if this did not detract from the quality of psychological intervention.

Although there was some specialist interest in teaching psychological medicine in the 18th century, it was the Asylum Acts of 1808 and 1845 which made the subject a speciality and was responsible for drawing attention to the need for undergraduate and post-graduate training. By 1827 Alexander Morison was giving lectures on insanity in Scotland, to be followed by Dr W. A. F. Browne who, in 1836, was giving a series of lectures at the Montrose Asylum which he repeated at the Crichton Royal Hospital in 1851. Dr D. Skae of Morningside Asylum also gave lectures and clinical demonstrations on insanity from 1846. Edinburgh students benefited from teaching in insanity by Thomas Laycock, professor of medicine following his appointment in 1851 (Crichton Browne, 1851).

In the centre of Norwich stands a red brick building which has a rare place in psychiatry. Its history began on 12 December 1712 when a lease on a small piece of waste ground was granted by the Corporation of the City of Norwich to four men. The men were acting as trustees for an elderly widow, and the deed specified the purpose of the lease: it was to build a house, or houses for “the benefit and use of such as are lunatics.” The term of the lease was 1,000 years at an annual rent of one peppercorn. The widow was one Mary Chapman. Born in 1647, she was the daughter of Thomas Mann, Mayor of the city and one of the richest and most influential men in Norwich. It is thought that she grew up close to the city's Bridewell, where many difficult lunatics would have been housed, and she is known to have had immediate experience of mental illness in her own, and her husband's families. In 1682 she married a widowed cleric, Samuel Chapman, some years her senior and the vicar of a local parish. Together they made plans for the Bethel but in 1700 she was widowed and left childless. Despite this she continued to develop her charitable project. The final choice of name, Bethel, or house of God, was her husband's.