We conceive that the ideal position of a pathologist is that in which his laboratory stands in direct communication with the wards of an institution—whether hospital or asylum—rendering intercourse with those engaged in clinical research easy, whilst he himself is absolutely free to prosecute his special studies. To expect the laboratory worker to undertake clinical, a fortiori, administrative duties appears unphilosophical, an incongruity, an indication of imperfect appreciation of the value of time and specialised energy. Those who have experience of the exacting nature of research work will, we believe, at once concede that nothing can be more irritating nor more detrimental to good work than to have to relinquish temporarily some absorbing laboratory pursuit in order to engage in the work of the office or the wards. In medical circles in this country we are unfortunately only too familiar with this mélange of occupations, this professional polymorphism, in consequence of which our leading men are compelled to appear in various characters during the course of a day, exchanging frock-coat for laboratory blouse, and this again for lecturer's gown, throughout manifesting an adaptability truly astonishing. But such versatility, admirable in itself, is necessarily inconsistent with steady progress in special directions. It is therefore no wonder that in research work there is danger of lagging behind our continental confrères, labouring consistently in special departments of science, and less concerned with the commercial potentialities of professional life, as we know it.

In 1881 J. M. Machado de Assis published a short novel entitled The Psychiatrist. The main character, Simao Bacamarte, “a physician of noble birth”, devoted himself to “the health of the soul” (as he defined psychopathology) and conceived a new, revolutionary (for the times) hypothesis: “The number of persons suffering from insanity, he believed, was far greater than commonly supposed”. Dr Bacamarte explains: “Till now, madness has been thought a small island in an ocean of sanity. I am beginning to suspect that it is not an island at all but a continent”.

Personalised prediction of functional outcomes is a promising approach for targeted early intervention in psychiatry. However, generalisability and resource efficiency of such prognostic models represent challenges. In the PRONIA study (German Clinical Trials Register: DRKS00005042), we demonstrate excellent generalisability of prognostic models in individuals at clinical high-risk for psychosis or with recent-onset depression, and substantial contributions of detailed clinical phenotyping, particularly to the prediction of role functioning. These results indicate that it is possible that functioning prediction models based only on clinical data could be effectively applied in diverse healthcare settings, so that neuroimaging data may not be needed at early assessment stages.

Felt presence is a widely occurring experience, but remains under-recognised in clinical and research practice. To contribute to a wider recognition of the phenomenon, we aimed to assess the presentation of felt presence in a large population sample (n = 10 447) and explore its relation to key risk factors for psychosis. In our sample 1.6% reported experiencing felt presence in the past month. Felt presence was associated with visual and tactile hallucinations and delusion-like thinking; it was also associated with past occurrence of adverse events, loneliness and poor sleep. The occurrence of felt presence may function as a marker for general hallucination proneness.