As with most issues in medicine, the prevention and management of a problem is best understood when the origins are known. The term ‘false memory syndrome’ (FMS) came into use in March 1992 with the foundation of the False Memory Syndrome Foundation (FMSF), a non-profit-making organisation established in the USA by a group of families in which one or more of the parents was accused. The parents in these families were reacting to a phenomenon which developed in a characteristic form in the preceding decade and had become common enough by 1991 for a number of them to realise that they were not alone, and to join in setting up the Foundation with a professional and scientific advisory board.

The study of trauma is inherently political. It is hard for psychiatrists to maintain an open mind, to respect and tolerate uncertainty and to maintain standards of scrutiny of scientific data when there are powerful political and emotional pressures to take up a polarised view of recovered memories of child sexual abuse. The two polarisations that have arisen are of recovered memories as invariably historically accurate versus recovered memories as invariably false and created by suggestion by clinicians. Current evidence suggests the psychiatrist should take up a cautious position somewhere between these two poles.

Whenever colleagues meet it seems there is discussion about the latest inquiry into suicides or homicides. One cannot turn on the television without the news or a documentary referring to the latest tragedy. Risk assessment and defensible documentation are commonly the subjects of lectures and symposia. Lessons are learned, or not, from published inquiries and associated media attention. The attribution of blame is always high on the agenda. Yet when visiting psychiatric services and talking to staff I am usually impressed by their professionalism and staggered by their workload.

Despite the frequency with which psychiatric emergencies are encountered in medical and other services, the literature, at least in the UK, is relatively sparse, with little systematic research on either service provision or areas of clinical interest. Services have often evolved in an ad hoc way and psychiatric emergencies are often seen by very junior trainees early in their psychiatric careers, with little relevant training. Although the vigilance of the Royal College of Psychiatrists on its approval visits has ensured that most trainees are given advice on the recognition and management of violence (at induction courses at the start of their training), it is not uncommon to find that wider areas of training in emergency psychiatry are neglected. It is still the case, for example, that some postgraduate programmes in psychiatry provide little or no formal training on emergency psychiatry.

Family therapy for schizophrenia began in the early 1950s, inspired by theories that located the cause of the illness in family dysfunction. The family pathology was seen as stemming from disturbed relationships (Fromm-Reichmann, 1948; Lidz et al, 1956; Laing & Esterson, 1964) and / or distorted communication (Bateson et al, 1956; Wynne & Singer, 1963).

The term hypochondriasis was first coined over 2000 years ago to describe a physical illness afflicting the hypochondrium. Subsequently the term was used for a variety of physical illnesses, until the 17th century when forms of melancholia were labelled as hypochondriasis. Since then a very large number of psychiatric disorders have been given the term hypochondriasis, for example, a form of schizophrenia, anxiety neurosis and malingering (Kellner, 1986).

Warwick's paper shows how recent advances have completely altered the previous therapeutic nihilism expressed in the above quotation. Physicians and surgeons have long been aware that medical and surgical problems turn out to have no organic cause. Joyce et al (1986) from New Zealand examined 105 people with abdominal pain who had been admitted to a surgical ward. They found that the most common surgical diagnosis was non-specific abdominal pain, closely followed by appendicitis. Those with non-specific abdominal pain contained a very interesting group of patients: they were predominantly female, did not have any physical findings, and were more anxious and conformed to the pattern of patients showing fear of illness. This group presented, in the words of the New Zealand team:

Beck's cognitive therapy originally developed as a short-term treatment for depression (Beck et al, 1979). It has been shown to be effective with a range of other disorders including panic disorder, generalised anxiety disorder, social phobia, eating disorders and sexual dysfunction (Roth et al, 1996). It is promising in the treatment of yet more disorders, many of which have traditionally been thought relatively impervious to psychotherapy, for example, bipolar disorder, chronic fatigue and psychosis (Clark & Fairburn, 1997). However, not everyone responds well to short-term cognitive therapy. In particular, it has been proposed that people with multiple, chronic problems that are apparently expressions of personality, rather than temporary responses to adverse life experiences, require more extended therapy (Beck et al, 1990).

Diabetes mellitus in childhood is almost always insulin-dependent diabetes mellitus (IDDM). The UK prevalence is 1 in 600 children under 16 years of age (Metcalfe & Baum, 1991) and the incidence is 13.5 new cases per 100 000 children per year aged 15 years and under. One quarter of newly diagnosed cases in the UK are under the age of five years, half are aged between 10 and 14 years.