In times of pessimism when psychiatry is described as in decline, subject to public scepticism with the psychiatrist's role threatened by social workers, psychologists and community nurses, one's immediate reaction is to adopt a historical perspective. The advances achieved during the last 50 years which I recall are so impressive that it seems reasonable to see current legal and bureaucratic problems as resembling a ditch rather than a precipice! These advances have occurred in spite of adverse administrative situations. It is important to remember that in spite of its merits the National Health Service was not conceived with Mental Health Services in mind—nor were Social Work Services.

As a junior doctor, I worked on an adolescent unit attached to a large mental hospital. Since it provided a base for a regional service, it struggled to cope with referrals of all kinds. The in-patient population consisted of youngsters of both sexes exhibiting a wide variety of disorders ranging from psychosis, anorexia and brain syndromes to emotional and conduct disorders. The turnover was low: about 18 admissions per year to the 18 beds. This resulted in a lengthy waiting list which afforded the unit some protection: seriously acting out and other very pressing problems that could not wait often had to go elsewhere.

The closure of the Camberwell Resettlement Centre, the largest in Europe, in September 1985, followed the closure of an estimated 2,000 common lodging houses and low cost accommodation in London between 1982 and 1984. Over a two year period only 14 out of the 25,000 who passed through the Centre had been rehoused. To aggravate the problem there had been a fall in local authority residential places in the six years up to 1982, accompanied by a decrease in the provision of home helps and meals on wheels, despite an increasing proportion of elderly in the community. of those who had utilised Camberwell Reception Centre 79% had slept rough and 19% had tuberculosis (personal communication of the staff).

Judge Schreber published Memoirs of My Nervous Illness in 1903 in which he described an illness since quoted as an outstanding example of paranoid schizophrenia and one which supports psychoanalytical explanations of the development of paranoia (first published in English in 1955 by MacAlpine & Hunter). The Schreber case became famous when Freud published his Psychoanalytical Notes Upon An Autobiographical Account of a Case of Paranoia (Dementia Paranoides) in 1911.

The very mention of Albania conjures up the wildest fantasies. For years we have been hearing about this ‘most closed society in the world’ where ‘people are locked up for watching football on television’, the roads of which are lined up with horse-carts, the only place in the world where no cars are seen and where dissent from the state is dealt with by Stalinistic means.

As is often the case, Oxford was damp and cold, but this did not deter the more athletic of us from trotting round lovely Christchurch meadows, or the more aesthetic from visiting an exhibition of Impressionist drawings in the Bodleian. The unpretentious, even homely, character of University College helped to draw a quite disparate group of psychotherapists together. This in turn was reinforced by the personal quality of all the formal presentations, and by the repeated experiences of small groups whose composition is stable. They allow the development of some degree of relationship both personal and intellectual in the course of two days.