Psychiatry might be seen as a three dimensional space, with two of its dimensions caricatured in the title. Of the first, ‘phenomenology’ stands for scientific rigour, the medical view favouring diagnosis based on analytical activity, followed by construction of syndromes from individual symptoms/measures. The ‘price of beans’ stands for materials; the economics of care in the post Griffiths era, value for money, hospital closures, massive reorganisation and the negative implications for service users.

Child psychiatrists-in-training must become conversant with a range of inter-personal skills—psychotherapy, family therapy, management, consultation—in addition to their traditional expertise of assessment, differential diagnosis and psychiatric treatments in different settings. In the Riverside training scheme we have introduced a Consultation Workshop to help trainees learn this essential art, for although it is said to be practised widely it has seldom been taught systematically. This is a report from the first 18 months of the Workshop's studies.

That a hospital in an African country has just celebrated 25 years of its existence may not seem a particularly newsworthy event but I hope that the story I have to tell will prove to be interesting and maybe even instructive for many more colleagues than those having a special interest in Africa. My own qualification for recounting the story is that I have worked at Chainama Hills Hospital since September 1964, just 15 months after it was opened.

The Marlborough Family Day Unit has been in existence for 10 years. It is part of the Marlborough Family Service, a community-based psychiatric service for patients of all ages. Its location is the site of the former Marlborough Day Hospital in London NW8. The Day Unit was created in 1977 by Dr Alan Cooklin who is still the consultant in charge of the whole service. The reason for setting up such a unit was to experiment with new ways of dealing with what is now so fashionably termed ‘multi-problem families’. These are families where one or more members have been in extensive contact with psychiatric and social services. Multiple hospitalisations, removal of children into care, and general chaotic behaviour are the presenting ‘symptoms’. Such families have unrivalled skills in collecting agencies and professionals like flypaper and making it very difficult for anyone to leave the field given the enormous anxiety created all round.

This paper aims to compare two SHO/registrar training schemes, both of which have grade ‘A’ approval from the Royal College of Psychiatrists but have differences in character and content. We intend to present an overview of current general training in psychiatry by focusing on these rotations. We would like to point out that these are personal views based on our own experiences, but hope that this paper will stimulate discussion.

At a time of increasing emphasis on community care for the mentally ill and of mounting concern about its adequacy, questions arise about the necessity for asylum and its optional provision. The term ‘asylum’ was first used in relation to institutions for the insane in the late 18th century and it became the ‘in’ word in 19th century lunacy terminology. It took over from ‘madhouse’, which a contemporary observer called “an opprobious epithet, only suited to the horrible ideas formerly deservedly associated with such places”. In turn, it was superseded officially by ‘mental hospital’ under the 1930 Mental Treatment Act, in an attempt to jettison the negative connotations of ‘lunatic asylum’, and to suggest a parallel curative function with general hospitals.

There is a trend for new consultant posts in child psychiatry to be linked to Social Services Departments. I recently took up such a post, with four of my sessions funded by the local Social Services Department. Training of child psychiatrists for such consultative posts is variable, but I was fortunate to have trained as a senior registrar at the Tavistock Clinic, where one of the training options was a link with Camden Social Services through a placement at Camden Assessment Centre.

As a specialist in child abuse for the past five years, I have been presented with various technical difficulties in trying to convey important, but often emotive, material to medical students and, for that matter, to groups of professional colleagues from other disciplines. It is hoped that the following reflections may be useful to colleagues who teach medical students about child abuse.

Over the past 20 years the Department of Psychological Medicine at King's College Hospital has gradually taken responsibility for the provision of psychiatric services to the East Lambeth sector of the Camberwell Health District. A small District General Hospital (DGH) in-patient unit was opened in 1972, and since then it has been the aim of the Department to provide a comprehensive locally based psychiatric service. Slow progress has been made compared with the developments that have taken place in the South Southwark sector of the District, which have been fostered by the Maudsley Hospital. With the impending closure of Cane Hill Hospital, on which the District has historically relied, the object of a completely local service is rapidly becoming a reality. Releasing the resources hitherto tied to the large institution presents an unparallelled opportunity for change.

Last summer I spent two weeks as visiting psychiatrist at Chestnut Lodge Hospital, one of the pioneering institutions in the psychoanalytically oriented treatment of psychotic disorders. This approach has been modified over the years until the present time having been complemented by new developments in the social, psychological and biological fields of psychiatry.

The major novelists of the Victorian era enjoyed a large readership amongst the general public. They dealt with the pressing social issues of the day and their work both reflected and shaped society's attitudes to contemporary problems. The 19th century saw fundamental changes in society's response to the mentally ill with the creation of purpose-built asylums throughout the country. The Victorians were ambivalent in their reaction to the mentally disturbed. Whilst they sought to segregate the insane from the rest of the population, they were also terrified by the prospect of the wrongful confinement of sane people. The trial of Daniel McNaughton in 1843 for the assassination of Sir Robert Peel's Private Secretary, and the subsequent legislation, provoked general public debate about the nature of madness.

During my training I have had the relatively unusual experience of two placements in community psychiatry—one at registrar, the other at senior registrar level. These placements were in many respects quite different. One was in an Emergency Psychiatric Service based in a London teaching hospital and the other was in a domiciliary-based Crisis Intervention Service in a district general hospital. A feature shared by both services was a multi-disciplinary team. The move towards community psychiatry is going hand in hand with the multi-disciplinary approach, and this leads inevitably to some re-evaluation of the role of the psychiatrist as other disciplines contribute more to clinical assessment and management. From my own experience as a member of these teams I have noted the relevance of two overlapping issues; these concern attitudes to the practice of psychiatry and the distribution of responsibility within the team.

An enquiry concerning the difficulties faced by doctors with domestic responsibilities was undertaken as a response to a letter by a part-time senior registrar who was facing problems in her training.

The incidence of child sexual abuse varies according to definitions and methods used. The MORI Poll 1984 found it to be 12% for girls and 8% for boys and to occur across all the social classes using this definition: “A child (anyone under 16 years) is sexually abused when another person, who is sexually mature, involves the child in any activity which the other person expects to lead to their own sexual arousal. This might involve intercourse, touching, exposure of the sexual organs, showing pornographic material or talking about sexual things in an erotic way”. The majority of studies have shown that these experiences can have adverse psychological effects, but the effect on the clinical practice of general psychiatrists seems to be too small if one considers the estimated 4.5 million adults in Great Britain who have been sexually abused as children. We thought that this could be related to attitudes rather than knowledge of the subject.