Recently several cases have drawn our attention to problems associated with professional driving and mental disorder. All drivers are responsible for informing the licensing authority of any disability likely to cause them to drive hazardously. Medical Aspects of Fitness to Drive (Raffle (ed.), 1985) gives detailed guidelines to help doctors advise their patients. Those relating to ordinary licence holders appear intuitively correct and most psychiatrists would give similar advice without reading them. However, the guidelines for vocational drivers, especially holders of Public Service Vehicle (PSV) and Heavy Goods Vehicle (HGV) licenses, are more stringent because of the serious consequences when accidents occur. The guidelines follow those of the Royal College of Psychiatrists, revised in 1983.

The open psychotherapy clinical seminar at the Maudsley Hospital is a weekly teaching event in which psychiatric trainees can present a case from their general psychiatric work to a forum chaired by a consultant psychotherapist. The seminar has a history stretching back to the 1960s when Heinz Wolff, Henri Rey and Murray Jackson taught in the Maudsley Psychotherapy Unit. The seminar is currently chaired by Nicholas Temple. It draws on a tradition of teaching psychotherapy which owes much to the pioneering work of Michael Balint. The psychotherapy training seminar which he developed is well described in the appendix to The Doctor, his Patient and the Illness (Balint, 1957). A trainee presents a case with particular emphasis on his or her feelings about the patient. The trainee's counter-transference is used as the raw material for the seminar's discussion of the patient. Balint adopted this method for teaching psychotherapy to a variety of professionals including social workers, general practitioners, and medical students. As Pedder (1986) pointed out, it is a model which has been very influential in British psychotherapy training.

A group of interested people met for two days last year in order to attempt to reach a consensus on good practice in the management of patients with generalised anxiety. The result of their efforts is published below.

Most patients presenting with anxiety, whether acute or chronic, mild or severe, were until recently treated with tranquillisers. Recognition that these drugs can cause dependence in some patients has prompted a re-evaluation of the pharmacological management of anxiety and the value of non-pharmacological treatments is now recognised. Uncertainty remains among many doctors about the efficacy of the whole range of current therapies and the place of the new classes of drugs for anxiety. However, research findings are now accruing which indicate the relative merits of these various therapies, and clarify the principles on which they are based.

This paper describes the work of a family therapy team which includes a senior house officer, or registrar, and discusses how such experience is of value to the trainee in general adult psychiatry.

The Psychiatric Unit at Wexham Park Hospital has served a population of 230,000 with no entry to long-stay beds since 1972. There have been between 45 and 60 available beds for all types of mental illness except dementia. Various group homes and unstaffed halfway houses have been started, but the accumulation of more disabled patients showed the need for both a staffed group home, and rehabilitation to fit them for it. There was no separate ward or building in the hospital which could be used, and so rehabilitation had to be arranged on an acute ward. The staffed group home has a lower staff-patient ratio than a hospital hostel.

It is widely acknowledged that the medical profession can be highly stressful. In addition, practitioners in many developing countries face the peculiar problems of poor remuneration, lack of necessary clinical facilities and a heavy clinical case load (due to the lack of qualified manpower). Such a scenario can easily aggravate those medical practitioners with pre-existing deeply rooted emotional conflicts as well as personality vulnerabilities and can result in mental decompensation.

You have all used a database at some time or other, although perhaps not on a computer. For example, every time you look up someone's phone number in your address book, or look up a patient's registration number in the card index file in medical records, you are using a database. Information of any type is easier to sort and find if it is organised into categories.

In his memorial speech given on the 30th anniversary of the Chinese Society of Psychiatry in Taiwan, the founder of the Society, Professor T. Lin, spoke on the evolution of psychiatry in Taiwan. He stressed that the “building up of psychiatry from almost nothing against all odds” just after World War II in an area where “the general attitude of the medical profession as well as the lay public to psychiatry was characterised by indifference and contempt arising from their ignorance and also prejudice against mental illness” (Lin, 1961) is like Robinson Crusoe surviving on his desert island. Today, the Society with its 518 members has had considerable success in the development of psychiatry in Taiwan.

This article attempts to describe a senior manager's search for ‘the medical model’ in psychiatry in two large provincial teaching units. I was brought to a number of realisations and moved to write this article by watching the film ‘Awakenings’∗. This portrays with great sympathy and effectiveness the angst and real pain suffered by a neurologist watching his patients in relapse and being powerless to help them. This was reminiscent of many of my consultants describing their own feelings.

Many psychiatric training schemes hold induction days for their new junior doctors. This practice has now become a College recommendation and has frequently been a mandatory requirement for the approval of training schemes by the Royal College of Psychiatrists (Sims, 1990). Such days often concentrate on orientating the new trainee, looking in particular at facilities rather than the development of skills.