Admission to hospital for psychotherapy facilitates communication with patients and allows more ways of influencing them than do conventional out-patient situations. Small and large groups can be added to individual interviews, and living together allows the development of many potentially therapeutic relationships with other patients and staff. This additional influence can be ignored. If it is assumed to be an integral part of treatment and organised rationally, the whole hospital becomes its instrument; psychotherapists, nurses, patients, domestic staff and administrators can be seen to be subordinate to that whole, and their traditional activities, attitudes to each other, and theories, are inevitably modified. Traditional boundaries between the roles of different workers become blurred, while how they get on with each other has important consequences for patients, so that their separate roles and functions must be clearly defined.

As a junior doctor, I worked on an adolescent unit attached to a large mental hospital. Since it provided a base for a regional service, it struggled to cope with referrals of all kinds. The in-patient population consisted of youngsters of both sexes exhibiting a wide variety of disorders ranging from psychosis, anorexia and brain syndromes to emotional and conduct disorders. The turnover was low: about 18 admissions per year to the 18 beds. This resulted in a lengthy waiting list which afforded the unit some protection: seriously acting out and other very pressing problems that could not wait often had to go elsewhere.

It is now common practice in many hospitals to admit psychiatrically ill mothers along with their babies. Main first admitted a mother with her child in 1948, and started to admit puerperal cases in 1955. Since those days, there has been a piecemeal development of mother and baby facilities throughout the country. Service developments have usually been the result of local interest rather than central planning and motivated by the belief that such a service adds to the quality of care. We were aware that our hospital was not offering such a service and so we decided to look at what occurred elsewhere to help in our planning. We devised a questionnaire and sent this to 42 district medical officers in England and personally visited the mother and baby units at Park Prewett and Fairmile Hospitals. We received 29 replies to our questionnaire, a 69 per cent response rate. Most of these had been completed by an involved clinician or senior nurse and several expressed a wish to be informed of the findings.

It is widely recognised that health professionals whose work involves psychotherapy or counselling need emotional support themselves to sustain them and to avoid the emotional exhaustion known as professional burn-out. In addition most dynamic psychotherapists recognise the need for such professionals to have therapy themselves to reduce the risk of counter-transferential distortions in their work. There appears, therefore, to be a need for counsellors and therapists to engage in therapy themselves, both to achieve fitness to practise and subsequently to maintain that fitness. In both instances it seems legitimate to regard such therapy as necessary training; the need for continuing training to preserve fitness is clear in other fields such as athletics and the performing arts.

I count myself most fortunate to have been living at this time, working in our profession, and to have chosen psychotherapy as a main interest, for it has been a period of quite extraordinary growth and constructive development. Exposed as one has been to such an exciting series of new discoveries, each following so hard on the heels of the last that one scarcely had time to absorb each new understanding and regain some equilibrium before it was upset again by the next wave of new ideas, it seems it would have been far more difficult to narrow down than to stay open.

The debate regarding the scientific status of psychoanalysis is considered by many psychiatrists to be a sterile one; this leads to a polarisation of views in which those in favour of psychoanalysis, feeling themselves to be losing, retreat to the position of stating that meaning is more important than scientific status, while those against argue that because psychoanalysis is unscientific it is meaningless and thus should not remain part of our psychiatric practice; the debate being reformulated as psychoanalysis: sense or nonsense? The consequence of giving up this debate is that it allows us also to give up the struggle to define science adequately to ourselves, and to question the relationship between psychiatry and science. Our understanding of science reflects directly on the quality of our research; this is particularly relevant to research in the practical application of psychoanalysis. Before we consider our understanding of science, however, we should consider our epistemological theories, or how we know things.

The introduction of a systematic approach to their work by nursing colleagues in the last decade provoked a great deal of comment and literature some of it amusing if perhaps slightly dismissive. Not a great deal is known about how widespread is the practice, or how well it is working in places where it has been adopted. Indeed the DHSS has set up a working party within the Nurse Education Research Unit of King's College to obtain enough basic information with a view to developing a research project into the effectiveness of the nursing process.

Even before Erving Goffman's Stigma: Notes on the Management of Spoiled Identity was published in 1963, it had been a commonplace notion that there was a stigma attached to psychiatric illness. King Lear's cry ‘Let me not be mad, not mad, sweet heaven’ echoes down the ages. But in the years since Goffman's book there has been a concerted attempt by psychiatrists, by patients' groups, by the media, to ‘destigmatise’ and ‘demythologise’ psychiatry. This has taken many subtle forms, but several major themes were apparent.

The importance of tracing technique and persistence was stressed by Sims. Long-term follow-up studies help to complete the clinical picture, a phrase used by Morris. They also help to clarify such issues as the effectiveness of treatment methods and changes in the socio-demographic status of patients. Unless a high percentage of the follow-up group is effectively traced, then the results of a long-term follow-up study must be suspect.

The closure of the Camberwell Resettlement Centre, the largest in Europe, in September 1985, followed the closure of an estimated 2,000 common lodging houses and low cost accommodation in London between 1982 and 1984. Over a two year period only 14 out of the 25,000 who passed through the Centre had been rehoused. To aggravate the problem there had been a fall in local authority residential places in the six years up to 1982, accompanied by a decrease in the provision of home helps and meals on wheels, despite an increasing proportion of elderly in the community. of those who had utilised Camberwell Reception Centre 79% had slept rough and 19% had tuberculosis (personal communication of the staff).

Explanations of the over-representation of black psychiatric patients under the Mental Health Act tend to emphasise either the particular psychopathology of black patients or alternatively to locate it within the decisions of individual psychiatrists and police in a racist society. Both contain specific (conspiratorial) and general (cultural) variants. The two models are incomplete in themselves.

On my retirement in the summer of 1984, Professor Gelder, in a generous valedictory speech, drew attention to the entry under my name in Who's Who. ‘You will notice’, he said, ‘that he has described himself as ‘Writer and Psychiatrist’, not ‘Psychiatrist and Writer’ The inference which Michael Gelder intended that his audience should draw is in fact justified. I have not whole-heartedly devoted myself to the practice of psychiatry to the exclusion of other pursuits; certainly not since I was 40, when my first book was published. I have contributed nothing to psychiatric research. If my psychiatric writings contain anything of value, it is because I have interleaved them with the fruits of reading from other disciplines.

In manufacturing industries, measuring productivity is relatively easy. In many service industries where the job is discrete (e.g. mowing a given area of grass or serving a number of cups of tea), work study methods are still easy to apply. In medicine and nursing where both the product and its process of ‘manufacture’ are hard to measure, things become more difficult. Nowhere is this more so than in psychiatry. Perhaps because of this, the standard often applied in the past has been professional judgement, and the Royal College of Psychiatrists, for example, has suggested appropriate levels of nurse staffing in psychiatry of old age. Such standards are now being questioned and an alternative is being propounded, at least in the Yorkshire Region, based loosely on work study methods. Psychiatry and psychiatric nursing have nothing to fear from work study, provided that acceptable standards of service are defined, and work study methods are properly applied. The first of these is partly a political task although it is to be hoped that the politicians would take guidance from patients, their relatives, and the appropriate professionals. Work study can ensure that such standards are achieved in the most economic way. It cannot set the standards. The authors are concerned because an exercise has recently been mounted throughout Yorkshire that purports to be a measure of nursing load, but which neither defines the standards of nursing care to be achieved, nor uses adequate methods to measure the work involved.