Seven years of ecstasy and agony have been enjoyed and endured in Israel, and from the calm of my sabbatical back in the UK, I welcome this opportunity to look in on Israeli psychiatry. The setting is a dramatic one. Israel's recent history is characterised by a hard-won statehood in 1948, massive waves of immigration, a clash of oriental and occidental cultures, and repeated wars. In the face of this rapid and traumatic change, Israelis have exhibited an exaggerated faith in the powers of the state. By denial of emotional and mental problems, a somewhat brittle stability has been achieved, not enhanced by almost uniformly negative attitudes to mental disorder. Understandably Israeli psychiatry has also been characterised by the fight for survival. The professional scene is made up of fierce, creative, one could almost say “true grit” individualists and powerful professional cliques. Israeli psychiatry was literally forged on the battlefields of the Independence War and has retained an Old Testament character of war-like struggle up until the present day. It is to the credit of Israeli psychiatrists that they have succeeded at the highest level in dealing with routine psychiatric problems alongside the awesome consequences of this continuous stress and trauma.

The issue of sexuality and the mentally ill provokes an uneasy reaction in many people. The lay person possesses inaccurate notions, for instance, about the level of sex drive or the expression thereof. Public interest and anxiety was recently fuelled by the case of Jeanette, the mentally handicapped woman for whom sterilisation was requested. Less understandable is the reaction of the more informed carers of the mentally ill. Being in such a position of responsibility raises a challenge, though the usual attitudes are of either ambivalence or denial. It was not then without some reservations that we organised a group for young people with psychotic conditions, with the aim of tackling sexual issues in relationships.

We were asked to do some research into the needs of people with long-term mental health problems who were living in the community. The main questions which sprang to mind were WHO, WHAT, and HOW to approach this.

The project described in this paper developed from a DHSS funded scheme which was part of the Government's ‘Helping the Community to Care’ initiative. This was aimed at meeting a deficiency in the community — the lack of a coordinated system of after care for people suffering from long-term mental illness. The Mental Health Division of the DHSS described it thus.

Sigmund Freud spent the last year of his life at 20 Maresfield Gardens, an impressive redbrick Hampstead residence. The house was bought by his friends after the penniless psychoanalyst and his family fled from Vienna in 1938. His personal assets had been extorted from him by the authorities following the Anschluss of Austria to the Third Reich. When the family took up residence, Freud's daughter, Anna, organised his new study to resemble his Viennese consulting rooms. Before her own death in 1982, Anna arranged for the house to become a museum in honour of her father. Once again the study was refashioned to Freud's original specifications. This time capsule was opened to the public in July 1986.

The electroencephalogram (EEG) is widely reported to be of limited value in psychiatry. This is particularly so with regard to the neuroses and functional psychoses. The value of the EEG in organic states is not much better, especially since the advent of computerised tomography (CT). However, it should be noted that the former gives a functional and the latter a structural assessment of cerebral disturbance.

Interest in all aspects of NHS management has increased recently, and senior registrar training schemes are becoming widespread.

If you have been referred a sex offender recently, you will probably still be conscious of how difficult it is on an individual basis to provide a comprehensive treatment approach. Indeed, in our area, as in nearly all areas, there has been little therapeutic help available for sex offenders outside the special hospital system, and certainly little for those in the community.

Although the power to defer sentence has been available to the criminal courts in England and Wales since 1973 there has been little discussion of the psychiatric aspects of this disposal. This article considers the legal development of deferment of sentence, the guidelines that have been recommended for its use and the sort of situations in which a deferred sentence might appropriately be considered by psychiatrists preparing a court report.

In October 1987, the new Part I of the MRCPsych examination was introduced. One aim of the College in changing the Preliminary Test, which had been introduced in 1971, was to create a more appropriate screening procedure so that those who are unsuited to psychiatry can receive career advice at an early stage in their career. To this end there has been a shift in emphasis away from the basic sciences towards clinical psychiatry. The major change in format of the examination is the removal of the essay paper and the introduction of a clinical examination. In order to qualify to enter for the new Part I examination, candidates have to submit sponsor forms signed by a consultant for whom they have worked and by their clinical tutor. The sponsors are asked to certify that the candidate has been able to attend an appropriate course of instruction and has received training in interview skills.

The need for such a group as SPRIG was mentioned, although not by name, by Dingwall in his article on psychiatric rehabilitation. SPRIG became operational in 1986 with its inaugural, bi-annual meeting held at Dykebarr Hospital, and consists of personnel working within rehabilitation multidisciplinary teams. Membership is corporate or individual and there are now ten hospitals nationally who have felt sufficiently committed to rehabilitation to invest £50 in acquiring corporate membership.

In his Annual Report on the Health Advisory Service, Dr Peter Horrocks makes a statement that should worry all psychiatrists. He writes, “Participation and leadership in the process of change needs to be re-gained by the respective professional bodies, not least by the Royal College of Psychiatrists”.

We spent part of this morning's ward round making a priority list; which of the five patients in need of admission was most acute, which could wait. There are two elderly ladies, both living alone, both very depressed. Edith is no longer taking care of herself, picking at her skin to the point where nasty sores have formed, and pulling her eyebrows out in her distress. Jonathan should have been admitted last week, we delayed and he took an overdose of Ativan. Alan is an elderly man who gets recurrent depressions. They seem to resolve of their own accord without medication if only he can be admitted for two or three days. Eleanor is a young mother of 28 who has been depressed for three months. Now she is completely preoccupied with ideas of killing both herself and her children.

In July 1986 we went to Moscow and Leningrad to visit refusenik physicians and to learn about the medical and psychiatric problems of this community. Refuseniks, the several thousand Soviet Jews who have applied for—and been refused—permission to go to Israel, suffer considerable official and unofficial punishment. We were interested in the effects of this treatment on physical and mental health as well as in the experiences of Soviet Jewish physicians who apply for emigration. Our information comes from discussions with a number of doctors in both Moscow and Leningrad who gave us examples from their own experiences and those of their patients.