Psychoanalytic psychotherapy services in Europe London,

There followed the most searching enquiries, and at the formal inquest the jury blamed the disastrous construction of the temporary buildings equally on the London County Council, the Home Secretary and the Lunacy Commission. The London County Council, however, could plead in mitigation, that so hard pressed were they to meet the ever increasing demands for accommodation for their patients that temporary buildings had to be erected as a matter of expediency. The Home Secretary could have, but for his own reasons, decided not to veto the plans. The Commissioners in Lunacy, in their own defence, made it abundantly clear that "the inflammable

There followed the most searching enquiries, and at the formal inquest the jury blamed the disastrous construction of the temporary buildings equally on the London County Council, the Home Secretary and the Lunacy Commission. The London County Council, however, could plead in mitigation, that so hard pressed were they to meet the ever increasing demands for accommodation for their patients that temporary buildings had to be erected as a matter of expediency. The Home Secretary could have, but for his own reasons, decided not to veto the plans. The Commissioners in Lunacy, in their own defence, made it abundantly clear that "the inflammable character of the buildings in which the disaster oc curred is therefore in direct antagonism to the prin ciples of construction which the Commissioners have habitually demanded". (Journal of Mental Science, 1903).
But, whoever was blameworthy, the repercussions of the tragedy were immediate and included drastic alterations to the plans for the building of mental hospitals. At this precise time the estate of Horton Manor, Epsom, Surrey, was being developed as a This is the first of a new series. 189 complex of psychiatric facilities. Horton Hospital itself was being planned and the appropriate committee had opposed the replication of the plans used for the building of Bexley Hospital in Kent. They favoured the more imaginative design of the Maryland State Asylum in the USA; but to put this into effect would have necessitated the use of tempor ary buildings which, in the light of the Colncy Hatch fire, would have been wholly unacceptable. A compromise was reached: the Bexley design would be used, but with specific modifications. Perhaps the most lunatic of these was to leave the interminable external corridors running round the semi-circular exterior of the hospital unglazed and totally at the mercy of the elements. And in the winter, the winds that blew and the snow that fell could be more unkind than man's ingratitude. I know, because for more than a quarter of a century I suffered them.
The Association for Psychoanalytic Psychotherapy in the British National Health Service* DAVIDTAIT,Physician Superintendent, Murray Royal Hospital, Perth It is often from a conference a little peripheral to one's day-to-day work which we learn most, so it was when I attended this meeting. I was attracted to it partly because it was cosmopolitan and my knowl edge of psychiatric services in Europe was limited. Secondly, although my clinical work is as a general psychiatrist, my orientation is firmly psychodynamic (Tait, 1988). Lastly as Physician Superintendent in Murray Royal (yes we still have them North of the border!) I have on my agenda how best to develop psychotherapy within our own service. The meeting certainly was cosmopolitan, with about 130 delegates from 16 countries. Particularly well represented were the Scandinavians (always of interest to Scots in that these are also small countries where problems can perhaps be grasped more easily), but with delegates from as far apart as Northern Ireland and Hungary, Iceland and Greece, you may imagine just how novel this meeting was for all of us.
It was very clear how important the social and historical context was in different countries. Pro fessor Brocher, from West Germany, spoke mov ingly not only about the Holocaust itself but also about the practical devastation this had wrought in analytic circles in his country, how "de-Nazification" had perhaps left people with a false sense of innocence and that anti-Semitism perhaps still showed itself in disguised ways. Likewise the Finns spoke very clearly of how their unique experience in both World Wars had influenced their society.
With regard to delivery of care, where medical and psychotherapeutic services are involved with Government or private insurance services, one imagines that no blank cheques are written. It was fascinating to hear that a private insurance company in West Germany was convinced on economic grounds by its own research that psychotherapy worked, as was the State social insurance in Finland which had conducted its own eight-year outcome study. Two very opposite ways of trying to develop psychotherapy services were described by Dr Vitger from Denmark and Dr Pylkkamen from Finland. In the former country there had originally been a bias much more towards biological psychiatry; it fell to dynamically orientated psychiatrists themselves to organise further training with the help of colleagues from London, which has been a rolling programme over some eight years and which seems to have turned around the views of the majority of psy chiatrists there. In Finland, by contrast, a Govern ment initiative, a Task Force on Psychotherapy, has been very active in recent years and it was astonishing to hear that in Helsinki there are 200 psycho therapists with a six-year training, 310 with a threeyear training and a further 280 presently being Tait trained -all for a population of 800,000. The model of psychotherapy there would seem to be that the logistics at least bear more similarity to primary care than they do to specialist services.
The two highlights amongst the British contri butions were from Jonathan Pedder and Anton Obholzer. Dr Pedder, as ever, was a joy to listen to, if only for the way he expresses himself, but the theme of his paper 'How can Psychotherapists Influence Psychiatry?' was initially reassuring, as he spoke of how the psychotherapist's stance enriches psychiatry, yet ultimately worrying if psycho therapists were to branch off into further indepen dence from psychiatry which could only lead to its impoverishment.
Dr Obholzer spoke on the theme 'Psychoanalysis and the Political Process'. His challenge was that analysts should leave their introspection behind and become involved in the fight for resources, and that their background, particularly the work of Klein and Bion, armed them with an understanding of organis ations which would be hard to rival. I had just scribbled down "a rallying call to political action" as an aide-memoire for myself when Dr Obholzer used the words "sermon" and "conversion" -his was the perfect inspirational paper with which to close the conference.
What did I get out of it? As a clinician I was fasci nated and reassured to see how neurotic illness and a psychotherapeutic response respect no national or cultural barriers. More importantly I came away armed with ideas and enthusiasm for the further de velopment of psychotherapy both locally and within Scotland.
Reference TAIT,D. (1988) Some aspects of the treatment of the neur oses. Proceedings of the Rovai College of Physicians of Edinburgh, 18,49-58.