In Scotland's National Portrait Gallery, there hangs the only portrait of a 20th century Scottish psychiatrist to have been commissioned by this pantheon to the country's great and good. The subject of the painting is, of course, R. D. Laing, who was not only Scotland's most famous psychiatrist, but, for a brief period in the 1960s and early 1970s, the most famous psychiatrist in the world. He was the world's first media psychiatrist, and his books sold in millions and were translated into more than 20 languages.

In recent years, psychiatrists have become much more aware of the sexual abuse of adults with a learning disability. Having struggled with such a case, which raised challenging problems of law, ethics and management (Crichton, 1997), I turned to the literature to help inform me about the subject. There I found helpful statistics from recent surveys, but sometimes such material fails to convey the true nature of what is a distressing and painful subject. To my astonishment I discovered that at a local theatre there was to be a performance on this very theme: An Error of Judgement I had heard of the Strathcona Theatre Company, a touring company of eight learning disabled professional actors who, with the assistance of two directors, devise the original plays they perform, but I had no idea of what the evening was going to be like.

Drug development in psychiatry has famously been something of a stop–start process. First, there were no truly effective psychotherapeutic agents, then, in the 1950s, phenothiazines, monoamine oxidase inhibitors and tricyclics all appeared in the space of a few years. Then, virtually nothing: no substantial developments for 25 years. In the mid–1980s the first selective serotonin reuptake inhibitors appeared, heralding a new era in psychopharmacology. Then, in 1990 clozapine was re-introduced, to be followed by other atypical antipsychotics and by drugs such as donepezil and acamprosate for entirely new indications. In addition, research into antidepressant therapy has produced new agents with varied modes of action and new strategies for the treatment of refractory depression.

The compulsory detention and treatment of patients against their will is unique to psychiatry. It is arguably the most stressful event in psychiatric practice, both for the doctor and for the patient, and yet, although much has been written about the details of mental health legislation (Clare, 1980; Fennell, 1995), very little has been said about the psychological impact that this procedure has on either the doctor or the patient (exceptions are Mills, 1962; Rogers et al, 1993). This paper will examine the emotional factors involved when a patient is deprived of his or her liberty, and will take as its point of reference the Scottish Mental Health Act.

It was in early 1984 when, after receiving my basic postgraduate training in the UK, I returned to my home country, Pakistan. As I began to settle down in my professional work I soon realised that I was facing problems on more than one front. Whereas some of these I have been able to overcome with time, others remain largely unresolved. Psychiatrists from the developing world who receive their training in the West and subsequently return to their home countries may be facing similar dilemmas. Here I would like to share some of my own.

In 1979, I wrote a personal paper on psychiatry viewed from retirement (Jones, 1979). Six years later Wounded Healers included a chapter by me (Phoenix, 1985). In the first I was coy about the nature of my ‘personal crisis’; in the second, I could pseudonymously be frank. Now, at 76, my further account appears above my own name.

The Internet provides information on virtually any subject. This is readily accessible to the public, although of variable quality. The Internet also plays an important role in contemporary psychiatry with the dissemination of information on disorders, research and clinical practice. Our patients may have access to mental health web-sites, consulting electronic sources when making decisions that affect their health. The implications of patient power on the Internet are discussed.