A game of chess, a novel and a career all have in common a beginning, a middle and an end. And there is usually a postscript or a post-mortem to round it off: this is, for me at the moment, the first of these.

As announced in 1983, the Department of Transport has issued new procedures for dealing with drinking and driving offenders deemed ‘high risk’, being those disqualified for the second time in 10 years for driving with a blood alcohol concentration over 2 ½ times the legal limit (i.e. 200 mg per cent) or failing to provide a specimen. The Driver and Vehicle Licensing Centre at Swansea will notify such an individual that when he applies for his licence on the expiry of the second period of disqualification (usually three years or more) ‘consideration will be given to whether these convictions indicate a medical disability and, if so, whether he has managed to get his drinking problem under control’. He will be advised to seek help from an alcohol counselling agency and will be given a list of such agencies.

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.

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.