When medical school educators – polished veteran doctors – review data on their students’ attitudes towards residencies, they remember their own long days in the anatomy dissection room. They recall treating their first teenage patient and comforting a patient seeking solace while succumbing to a fatal illness. They think about why they made their important career choice. Thus the glory days of medical school become a defining and shaping experience for physicians, similar to boot camp for veteran paratroopers.

This note is written for two reasons: the first is to thank Drs Ndetei, Karim and Mubbashar for their fine article (Ndetei et al, 2004) and for reminding the readers of International Psychiatry of the problems arising from the ‘brain drain’; and the second is to comment on the astonishing argument presented in the paper written in reply by Catherine Jenkins, of the UK Department of Health (Jenkins, 2004).

Many leaders in Africa bemoan the disappearance of African culture, including the use of traditional medicines, and there have been numerous calls for recognition of their value and for the integration of these treatments into orthodox medicine. This is especially so with regard to psychiatric disorders. The literature on psychiatric practice in Africa contains very few references to herbal treatments, however, and more is to be learnt about the use of herbs as adjuvants in the solution of psychosocial problems from the anthropological literature. At a conference held in the University of Ife in 1974, psychiatric disorders were not included in a list of nine conditions (e.g. cancer) in which it was recommended that herbal treatments be further investigated.

Violence towards an intimate partner, substance misuse and other mental health disorders are problems that tend to cluster together and result in multiple burdens for afflicted individuals (Desjarlais et al, 1995; Wyshak & Modest, 1996; Wyshak, 2000). They are prevalent not only in high-risk groups but also among members of the general public seeking primary healthcare (Bauer et al, 2000; World Health Organization, 2001), where their afflictions often go undiagnosed and untreated (Edlund et al, 2004; Kramer et al, 2004). Furthermore, violence towards an intimate partner, substance misuse and other mental health disorders involve common symptom pathways, such as psychiatric distress, headache, abdominal pain, gastrointestinal problems and multiple somatic complaints (Berwick et al, 1991), which suggests that the use of an integrated set of screening instruments may lead to early detection and treatment for patients who are suffering from one or more of these problems.

Human resources for mental health are a challenge in all countries. In countries rich and poor, there is a big gap between the need for mental health services and the availability of those services. In an unusual way, the barriers to mental healthcare appear to be universal, which is not true of non-psychiatric healthcare. Nonetheless, the World Health Report 2001 and the World Health Organization's Atlas project have recorded extremely low levels of service in most developing countries (World Health Organization, 2001a,b). The recruitment of consultant psychiatrists from low- and middle-income countries, discussed in the October 2004 issue of International Psychiatry (Ndetei et al, 2004; Jenkins, 2004), raises a number of challenges for both developing and developed countries.

When the world of public health considers the health of women, one tendency is first and foremost to link the well-being of women to that of children and the family, and, legitimately, to the health of society overall. Epidemiological data point to sex differences in the patterns and clusters of psychiatric disorders and psychological distress. The origins of much of the pain and suffering particular to women can be traced to their social circumstances. Depression, hopelessness, exhaustion, anger and fear grow out of hunger, overwork, domestic and civil violence, entrapment and economic dependence. Understanding the sources of women's ill health demands awareness of how cultural and economic forces interact to undermine their social status. This article highlights aspects of social suffering among women in Iran. Self-inflicted burns, a significant indicator of mental health among Iranian women, are discussed in order to increase awareness of the phenomenon among the international community, as a first step towards initiating an improvement in the health of women in Iran.

There is a growing concern in many countries over the low recruitment into psychiatry among medical graduates. This has led to studies that aim: (1) to study the attitudes of medical students towards psychiatry, (2) to determine factors that influence such attitudes, (3) to assess the possible causes of this low recruitment and (4) to try to change students’ views of psychiatry during their medical education to improve recruitment.

The mission to find ‘the secret of the village’ is one attraction of engaging in mental health services in Bangladesh. Over the last 15 years much attention in world psychiatry has been given to the fairly robust finding that the prognosis of people with established and severe mental illness is better in ‘developing countries’ than in ‘developed’ ones (e.g. World Health Organization, 1979; Leff et al, 1990; Jablensky et al, 1992). Earlier assumptions that ‘developing’ is a simple variable were almost certainly a result of racist ignorance (Kulhara, 1994). Developing countries are not homogeneous. The variation in mental health outcomes seems to be clearer in more remote villages and tribal areas (Chatterjee et al, 2003), especially those that have less contact with Western (colonial) models of psychiatry and ways of life. More studies on this topic across a wider range of rural and urban settings would have much to offer. Is there something poisonous that comes with lots of expensive services? Or is there something missing?

The International Fellowship Programme (IFP) was launched in 2003 under the name of the International Fellowship Scheme, its title being changed in 2004 because it was causing confusion to US doctors, who interpreted the word ‘scheme’ as having Machiavellian implications.

In Mexico, there are two females with depression for each male (Medina-Mora et al, 2003) and the rate among poor females is three times higher than that among those with the highest income (Berenzon et al, 1998). Most research findings suggest that depression cannot solely be explained by a simple biological theory but that sociocultural variables also play a major role. These include the different degree of control and power that women and men have over socio-economic determinants and the differences in social position, status and gender role expectations. Traditional gender roles are expressed in prescriptions such as ‘women should be passive and submissive in relation to men’, while the lower value attributed to them, their higher rates of exposure to violence and other stressful risk factors and their scarce opportunities for development affect women's susceptibility to specific mental health problems. The present paper describes Mexican attitudes towards women and women's exposure to stressful life experiences that may contribute to their increased psychiatric morbidity, and shows what it means to be female in different Mexican contexts.

Psychiatry has probably always been the least attractive of the medical specialties. The choice of psychiatry as a career has been consistently low in the English-speaking world over the past 50 years (British Medical Journal, 1973; Feifel et al, 1999; Brockington & Mumford, 2002). Over the past decade there has probably been a further decline in the proportion of medical graduates choosing to train in psychiatry (Sierles & Taylor, 1995; Feifel et al, 1999).

Around three-quarters of the Singaporean population are of Chinese ethnic origin, and so traditional Chinese medicine is the most widely practised non-Western system of healthcare on the island.