It is a great privilege to be asked to give this memorial lecture. There must be few in this audience who do not know the name of Jack Kahn, if only from his classic writings on school refusal. To many of us, however, he was a dear friend as well as a rather special colleague. I seem always to have known Jack, although in fact I probably first met him in the middle ‘60s at just such a residential conference as we are having now, on that occasion in Harrogate. This was in the days of the RMPA. Jack was chairman of the Child Psychiatry Section and the guiding spirit behind the organisation of that particular conference. I recall particularly the concluding session on the Saturday morning when to our surprise (although we would be less surprised to-day) the presentation was not by one of our members or distinguished guests but by a local dramatic society who presented us with one scene from a play which Jack, as master of ceremonies with his customary skill and flair, used as the catalyst for an exciting large group discussion.

In 1990 I saw every member of the Child and Family Guidance Service within the Swindon Health Authority to discuss children from their last (unselected) six or 12 families in relation to child protection issues. All 19 professionals were part-time workers, some only doing three, two, or one sessions per week of child and family guidance work. They were seven psychiatrists (consultants and a senior registrar), two psychologists, six psychiatric social workers (including family therapists), and four specialised therapists (family, child psychotherapy, nurture-group and art). There were 14 female and five male professionals.

Discussion of psychiatric casualty figures in military personnel tends not to distinguish between acute and chronic conditions. Combat-related stress (CRS) responds well to immediate, short-term intervention. Overall psychiatric casualties are approximately 30%. Contemplating the future in 1982, Romo & Schneider suggested casualty figures might be higher. This article considers factors contributing to the incidence of psychiatric casualties.

Despite the brevity of the Gulf war, there is still the strong possibility that it will leave long-term problems for psychiatric services within the NHS. The low incidence of acute psychiatric problems in the Falklands conflict does not obviate long-term problems. Surgeon-Commander O'Connell of the Royal Navy, reported informally in the newspapers (Guardian, 7 May 1990) that up to 30% of the 28,000 Falklands veterans are still suffering from post-traumatic stress disorder (PTSD). Hughes (1990), medical officer with 2nd Paratroop Regiment at Goose Green, described his realisation that he had PTSD, his subsequent treatment by the NHS and transfer to a military hospital. The Royal Navy still has a counselling service, set up in 1987, but it is clear that military services cannot deal with all the current problems, let alone those to come. The advice of the Ministry of Defence is that the initial onus to recognise a problem lies with the family and that sufferers should seek treatment through their GP.

The year 1991 will be emblazoned on our minds as the year of the Middle East War. Saddam Hussein gave more than a clue to his own psychopathology when he named this conflict “The Mother of All Wars”. All nations which actively participate in battle will lose troops and civilians. Physical damage, terror and distress are the immediate accompaniments of battle. Starvation, sub-standard living conditions and infectious disease often follow. Modern weapons and terrorism are capable of inflicting major damage on populations which are far away from the centre of the war.

High attrition rates in psychiatric out-patient departments are well documented in the literature (Baekeland & Lundwall, 1975; Gillis & Egert, 1973). Non-attenders' attitudes and beliefs about their illness and treatment may provide valuable insight into reasons for not attending. This consumer orientated approach could enable clinicians not only to improve clinic attendance but to assess their treatment efficacy.

The UK, in common with all other countries party to the Vienna Convention on Diplomatic Relations, affords foreign diplomats a special status in law. Under the Diplomatic Privileges Act (1964) (DPA), accredited diplomats are accorded inviolability and cannot be detained compulsorily under any Act of Parliament, including the Mental Health Act 1983 (MHA).

The volume of literature on medical audit and the broader field of quality assurance is expanding rapidly. Medical audit is now a requirement for all medical practitioners; therefore, to perform it, they need to know something about it. There is a multitude of articles written in the journals, especially the British Medical Journal and the Journal of the Royal Society of Medicine. However, in this paper I intend concentrating on some of the many books pertaining to this field which have been published recently.

This paper draws the attention of psychiatrists to the developing field of neural networking in the belief that the models created in this discipline demonstrate several functions central to cerebral performance.

There is an increasing interest in the role of audit in medical practice. Less emphasis has been placed on audit by trainees and it has traditionally involved the use of log books or case books for examination purposes. One type of log book simply lists the diagnoses of consecutive cases seen. Such a record is used in the Viva part of the Examination for Membership of the Royal College of General Practitioners. Another form of log book, often referred to as a case book, usually involves a more detailed account of the cases seen by the trainee. Case books form part of the Examination for Membership of the Royal College of Obstetrics and Gynaecology as well as the MRANZCP and Canadian Psychiatric Examination.

Among other things, good medical practice demands continuation of training at every level of professional life. Post-membership psychiatrists who have started their senior registrar (SR) jobs may face a lack of formal training. In many subspecialities of psychiatry this has been extensively remedied by various training courses and programmes.

This speciality is predominantly concerned with the psychiatry of patients in the general hospital setting. It involves the psychiatric management of patients who present with physical symptoms, and the treatment of psychiatric illness in physically ill patients. In addition, it also includes the management of patients who deliberately self-harm.

The Marcé Society, a multidisciplinary group set up in 1980 to advance the understanding, prevention and treatment of post-partum mental illness, met in York for its biennial meeting last September to celebrate its tenth birthday. In the middle of the 19th century, Louis Marcé first drew attention to the special nature of psychiatric illness in the puerperium. Since then, as opening speaker, Dr Channi Kumar pointed out, although maternal morbidity has dropped dramatically, in particular over the last 40 years with improvements in obstetric care together with social, cultural and educational changes, psychiatric morbidity in the puerperium remains as prevalent as it was 100 years ago.

Apart from the degree of mental handicap, the traditional description of a genetic syndrome is limited to somatic characteristics, although occasionally noting some quirk of personality or behaviour. However, these subjective stereotypes become a memorable part of our concept of the syndrome. Although at times startlingly perceptive, more often they are misleading, particularly where there has been only a superficial contact. Latterly more systematic scrutiny, albeit using idiosyncratic rating scales, selected populations, and differing diagnostic standards, has highlighted earlier inadequacies. Consequently the last three years have seen the formation of an informal, multidisciplinary group interested in behavioural phenotypes: an initiative greatly helped by contact with parent groups. Their intention is to develop research and, by introducing some consistency to the observations, to allow comparisons across studies. From this has grown the more public and formal Society for the Study of Behavioural Phenotypes† which was launched at this symposium.