For many involved in the management of people with personality disorders the title of this article may appear to be a contradiction; drugs may alter mental state but intrinsically seem unlikely to alter personality. Nevertheless, drugs are available for treating personality disorders (even though none of them are licensed for these conditions). So it is hardly surprising that there is now a considerable body of literature on the subject which has recently been extensively reviewed (Stein, 1992) but which has attracted more attention since personality disorders have achieved greater prominence in all parts of psychiatric practice.

An audit of case notes and a survey of in-patients was carried out to evaluate risk assessment on an in-patient ward. We found considerable inconsistencies between the risk assessment records in medical and nursing notes. A systematic survey found higher levels of risk than either set of notes, but combining the notes improved the quality of risk assessment compared to the survey. We suggest three key areas for action to improve risk assessment.

On the opening page of Daniel Hack Tuke's 1892 Dictionary of Psychological Medicine, is a statement which reads:

Since 1978, Members and Fellows of the College have met once or twice annually at meetings of the American and Canadian Psychiatric Association. Although small in numbers, the meetings off the North American Group have served to maintain contact with the College. The College President, Immediate Past President and Registrar have attended recent meetings. There are over 500 Fellows and Members in the USA and Canada, and with increased awareness off the existence of the North American Group, which was officially recognised by the College in 1996, expansion of activities to include educational programmes is expected. For this to occur, the membership would need to respond in greater numbers than heretofore.

Regional Public Education Officers of the Royal College of Psychiatrists are strategically placed to influence and improve the coverage of mental health issues in the media. Their role needs to be enhanced and clarified, and a proposal is being put forward in the College to achieve this. One possible way of working locally is illustrated through the work of West Midlands Insight, which demonstrates the value of working with a wide group of people, including those who have experienced mental ill health.

The Glasgow Media Group, through a combination of media watching and group interviews, has confirmed the importance of media representations of mental illness, with its finding that negative images can outweigh even an individual's direct experiences in this area (Philo, 1996). In one recent summary, Philo concludes: “the results show clearly that ill-informed beliefs on, for example, the association of schizophrenia with violence can be traced directly to media accounts” (Philo, 1997). The origins and strength of this association can be traced to cinema, where powerful images of violent ‘insanity’ endure today. In a questionnaire of 487 people who had a family member with severe mental illness, 85.6% identified “popular movies about mentally ill killers” as the largest single contributor to the stigma of that illness (Wahl & Harman, 1989).

Some names appear to stick to syndromes or diseases like a proverbial glue, regardless of their total inappropriateness. Gross self-neglect in old age characterised by domestic squalor, social withdrawal, apathy, tendency to hoard rubbish (syllogomania) and a lack of shame was originally reported by Macmillan & Shaw in 1966 and subsequently ‘christened’ by Clark et al as Diogenes∗ syndrome in 1975. Post (1982) preferred the term ‘senile recluse’ and argued that this is not a syndrome but merely an end stage of personality disorder. It was usually extremely difficult to help these patients, as one's care and goodwill often met with hostility and blunt refusal to cooperate (Cybulska & Rucinski, 1986). More recent studies, however, have shown a strong association of this condition with frontal lobe dysfunction (Orrell & Sahakian, 1991), thus giving a psychiatrist of old age a somewhat firmer basis for action.

The Royal Society is the oldest scientific society in Great Britain and one of the earliest in Europe. It is usually considered to have been founded in 1660, though a nucleus had been in existence for several years before that date. From Charles II's reign onwards, British Governments have constantly appealed to the Royal Society for advice in connection with scientific undertakings. The Society elects some 32 Fellows annually, who have been proposed by six or more existing Fellows. Foreign Members, not exceeding 50 in all, may be selected by the Council from among “men of the greatest scientific eminence” abroad. From this it can be seen that Fellows of the Royal Society are among the most distinguished scientists in the country. It is not widely known that several psychiatrists have been Fellows of the Royal Society.

Over a decade has now elapsed since the last national guidelines from Government health departments about the management of deliberate self-harm, although the scale of the problem has remained unchanged. Three years ago the Royal College of Psychiatrists issued a consensus statement which set standards for suitability of staff, particularly with regard to training, experience and supervision, the available facilities for assessment, the range of appropriate management options, communication of these and management of services. This postal questionnaire study in one health region of England of all senior house officers and registrars working in psychiatry found that levels of training and supervision varied widely and often fell below those suggested.

The similarity between the work of the fictional detective and that of the psychiatrist has often been remarked. Both Marcus (1984) and Shepherd (1985) have compared the technique of the archetypal sleuth, Sherlock Holmes, with that of Sigmund Freud. The sage of Baker Street attempted to solve criminal cases by finding links between items in the external world, such as footprints, bloodstains or broken locks, while Freud tried to make sense of the mysteries of the mind by making connections between events in the inner world, such as dreams, thoughts and desires. Both attempted to provide an all-encompassing explanation of seemingly disparate phenomena. Over the years, the literary descendants of Holmes have become increasingly similar to psychiatrists, because, as well as attending to the external events, they also take account of the individual psychology of the criminal and the social context of the crime.

Edgar Degas (1834–1917) is perhaps best remembered for his pictures of women bathing and of ballet dancers. The awkward posing, the physical unattractiveness and the voyeuristic viewpoints that are characteristics of many of his later works have given him a reputation for misogyny. A lesser known aspect of Degas' work concerns portraiture. In the earlier part of his career he painted many portraits of his family and friends which are remarkable for their psychological insights as well as their technical and compositional mastery. One of the finest is the portrait of the Bellelli family which he started in Florence in 1858 and appears to have worked on intermittently until 1867. Its large size (200 x 250 cm), the length of time in execution and the number of preparatory studies all point to its significance in the artist's eyes. Despite this, scholars doubt that it was ever exhibited during Degas∗ lifetime and was discovered with considerable surprise in his studio following his death (Boggs, 1994).

Throughout the 19th century some 20–25% of all known pauper lunatics in England and Wales were accommodated in workhouses. Early on, the lunacy commissioners considered that all pauper lunatics should be admitted to asylums and were highly critical of the conditions under which they were kept in workhouses. As the century progressed the lunacy commissioners were forced to compromise because of the lack of space in asylums and diminishing confidence in the results of asylum treatment. By the end of the century the lunacy commissioners were reconciled to the accommodation of feeble-minded, imbecile, idiot, chronic psychotic and demented paupers in workhouses, but held to the view that the acute pauper insane should be admitted to asylums.

Apparently more than 15 books have already been written about the death of Diana and the associated phenomena, and as many again are shortly to be published. You will be glad to know that I am not writing one of them. Nor am I going to add to the numerous research papers, since I cannot write phrases like “Diana functions as a radical fetish of virtual reality, a move beyond alienation to a principle of otherness raised to perfection” (Diane Rubinstein in That's the Way the Mercedes Benz: Di, Wound Culture and Fatal Fetishism’; The Sunday Times, 5 April 1998). The humorist, Alan Coren writes that soon we will all have to undergo official tests on our attitude to Di before we will be allowed a mortgage, a credit card, or a subscription to Reader's Digest the catch being we will never know if we should be for or against her.

When invited to give the Maxwell Jones lecture as part of the Fiftieth Anniversary Celebrations of the Henderson Hospital I was pleased and honoured, as well as somewhat surprised. I welcomed the opportunity to pay tribute to an outstanding social psychiatrist and to reflect on a decade of turbulent change within mental health services.