The guidelines on criteria necessary for promotion to senior registrar grade in psychiatry may be found in The Handbook for Inceptors and Trainees 1987. The criteria are essentially those in the 1980 edition, namely the need for possession of MRCPsych status and completion of at least three years general professional training approved by the College. Yet it is undeniable that in recent years eligible candidates have experienced much more difficulty in achieving appointment as a senior registrar. Indeed Holden (1988) comments that “dedicated clinical service and the qualification of MRCPsych is insufficient to guarantee a registrar success in his or her application for a senior registrar post”. In the increasingly competitive job market research experience, possession of publications, and management training have become valuable assets for prospective candidates. Our concern at the lack of pertinent career guidance for trainee psychiatrists prompted us to look at trainees' perceptions of requirements and at the provisions which exist in their training to enhance their career prospects.

The 1980s have been a productive decade for the aptly re-named MHS (Managerial Health Services) nationally and locally. And here at District X, 1989 saw us exceed national norms for most of the usual indices of managerial activity, including bulletins and minutes at a staggering 6.2 metric equivalents per person per year of service.

Improving discharge procedures is a topical subject and audit of discharge summaries is an important part of this procedure. In many hospitals the summary compiled following a patient's discharge is used for two purposes: a copy is sent to the general practitioner to provide details of the patient's illness and management, and a copy is filed in the hospital notes as a record of the admission. Discharge summaries often fail to meet the needs of either psychiatrist or GP. Using a questionnaire study, we have recently demonstrated that GPs and psychiatrists have different requirements from discharge summaries (Craddock & Craddock, 1989). The present study, which examines the content of a sample of discharge summaries from a large psychiatric hospital, was conducted to identify potentially important items of information which are consistently poorly covered in psychiatric summaries.

I was appointed clinical tutor at Knowle Hospital seven years ago with little idea of what my responsibilities would be. From the College literature (which I have not found very helpful) it seemed I was responsible in a more or less indirect way for the psychiatric education of most of those working in the hospital as well as of those local general practitioners who might refer patients here. In addition, all medical students in the place are my responsibility – a considerable number of young people. To complicate this task, our academic unit had moved out of Knowle two years before my arrival and new trainees were advised that Knowle Hospital (usually described as a ‘traditional Victorian mental hospital’) would be closing in the near future as modern community services were provided. Finally, the advent of proper management, welcomed by me, was spoiled by an indifference to psychiatric education which bordered on absurdity.

A majority of psychiatrists embark on their careers by entering an SHO/registrar rotation where they can expect to receive a broad based training in the principles and practice of their chosen specialty. These posts should provide the trainee with an opportunity to observe and emulate high standards of clinical care as well as fostering academic interests and research skills. The Royal College of Psychiatrists recognises the importance of these years by monitoring the standard of posts and by examining trainees at the end of this period.

Depressed patients and their families can benefit enormously from being given appropriate information about their illness, their treatment and the steps that they and their families can take to cope with and overcome the problem. All too frequently, the doctor or psychiatrist, through lack of time, may pay too little attention to this aspect of treatment. Self-help books provide a useful solution to the problem, and not surprisingly the market has been flooded with books which cover, with varying degrees of success, the many facets of depression and its treatment.

Some 40 years had passed since the death of Mozart, and Donizetti had made a name for himself with Anna Bolena and L'Elisir d'Amore. His music is certainly more fragile than Mozart's and his originality lies in his use of melody which is masterfully constructed to evoke humour, sentimentality and tragedy. In Lucia his musical canvass is, perhaps, the greatest he ever painted. Based on a story by Sir Walter Scott, it tells of the love of Lucia for Edgar of Ravenswood, who is the last of a rival household. In order that the Lammermoors' fortunes can be retrieved, Lucia's brother, Lord Henry Ashton, arranges for her to marry a politically influential figure, Lord Arturo Bucklaw. Ashton arranges that a forged paper indicating the infidelity of Lucia's lover is passed to her. She believes herself deserted and unwillingly consents to marriage with Bucklaw. On sealing the contract with her signature at the wedding, Edgar appears, having returned from France to claim his Lucia. Convinced that she has betrayed his love he damns her and throws the ring she gave him at her feet. The effect of this is to drive Lucia insane, she slays her husband and dies of her sorrows. Edgar waits to duel with Lord Ashton outside the castle. But Ashton flees, leaving Edgar in solitude. Edgar is then told by a procession of Lucia's death. He kills himself in sorrow.

James Tilly Matthews, a paranoid schizophrenic admitted to Bethlem on 28 January 1797, was to become the most colourful and controversial inmate of the hospital in the years up to his death in 1815. Influential relatives and friends campaigned for his release and attempted to demonstrate his sanity, on two occasions, in 1797 and 1809, having him examined before high court judges. The hospital medical staff, in particular John Haslam, the apothecary (in post 1795–1816), were obliged to demonstrate repeatedly Matthews' continued insanity, and to this end his case was published (Haslam, 1810). Bethlem was under political pressure to continue Matthews' detention. His admission followed an attempt to disrupt a sitting of the House of Commons in December 1796, which occurred as the climax of a campaign of deluded lobbying during which he had made threats against the safety of senior politicians, including Lord Liverpool, the Home Secretary (Matthews, 1796). Under in-patient care, Matthews continued to express threats against the lives of the Royal Family, politicians, and the staff of Bethlem (Matthews, 1804). Transferred to the incurable ward in 1798, his continued detention was at the specific request of the Home Secretary, a fact revealed by Haslam at the 1809 hearing (Haslam, 1809). In May 1813, Matthews, having developed a spinal abscess, was transferred to a private madhouse in Hoxton, where it was felt country air might improve his medical condition. He died there in January 1815.

The process of psychiatric research, as distinct from its content, has been the subject of little comment. Central to present-day techniques are the use of questionnaires and more or less structured interviews. Pre-coded data are preferred, and even if there are few cases in any one study, the quantity of data collected for each usually compensates for this and justifies computer analysis, using statistical packages such as SPSS∗. The days of punched cards have passed (only in the last eight years in one centre of excellence), so at least one of the error-prone steps (transfer of data from paper schedules by card-puncher) has been abolished, but the major chore is still this process, albeit direct to magnetic media (floppy or hard disk).

Your two correspondents are psychiatrists in their mid-30s working at two publicly-funded mental health centres in Navarra. We share the responsibility for co-ordinating the eight mental health centres, two day hospitals and two psychiatric units in general hospitals in the province. Each of us takes care of half these resources, grouped in a ‘mental health area’.

Horton Hospital, Epsom, has many claims to fame; but none so worthy of communication than the unique contribution towards the relief of suffering made by the Horton Laboratory, the name by which it became universally known.