During the last two years, the medical profession in Britain has been participating in a public debate – perhaps in a more exposed way than for some time. Eminent Presidents have been writing letters to The Times, and less eminent ones demonstrating in Downing Street. This can all be seen as contributions to the discussion on the state of the National Health Service. But there is, I believe, a wider and in my view a more long-lasting change going on, namely the relationship between the medical profession and the public – the citizens of this country. You may feel that the basic premise is based on a false dichotomy, rather like the sterile debates on community care. Hospitals are part of the community. Doctors are citizens. Yet there is an implicit or explicit contract, social if not financial, between a country's medical profession and its citizens. As we are in the era of negotiating or inventing or specifying contracts, I wanted to consider this.

The study of infancy can provide us with new models for the genesis and treatment of psychiatric disorders. It allows us to observe development and can elucidate the contribution the internal and external world make to mental health and disorder. It can also help to define and describe developmental pathways which may be instrumental in creating a resilient or vulnerable adult.

Personality disorders have for many years been on the fringe of psychiatry, with considerable doubts expressed about the usefulness, implications and validity of the concept. It is argued here that developments in the past few years have brought personality disorders into the mainstream of psychiatric practice. In particular, the recognition that personality function can be separated usefully from clinical symptoms, and that both mental state and personality can be disordered simultaneously, has led to better assessment and understanding. Advances in the classification, epidemiology, treatment and prognosis of personality disorders show that these conditions are common, extensive in their pathology, and cause much suffering. They cannot be ignored or dismissed as peripheral to psychiatry for they are an essential part of good psychiatric practice.

Witchcraft and Hysteria in Elizabethan London (£45, 149 pp., 1991) is edited with an introduction by Michael MacDonald, Professor of History at the University of Michigan. George Cheyne: The English Malady (1733) (£40, 370 pp., 1991) is edited with an introduction by Roy Porter, Senior Lecturer in the social history of medicine at the Wellcome institute for the History of Medicine, London. The Asylum as Utopia (£40, 240 pp., 1991) is edited with an introduction by Andrew Scull, Professor of Sociology and Science Studies at the University of California, San Diego, Clinical Lectures on Diseases of the Nervous System by J. M. Charcot (£45, 438 pp., 1991) is edited with an introduction by Ruth Harris, Fellow of Modern History at New College, Oxford. All four titles are published by Tavistock/Routledge, London, in a series of facsimile editions.

Good scientific hypotheses rarely succumb to a lack of confirmatory evidence; they may sometimes even be resistant to apparent outright refutation (Kuhn, 1970; Lakatos, 1970). Considering this, Kuhn (1970) suggested that the dominant hypotheses in a field are often replaced not on grounds of greater theoretical coherence but rather on grounds of strategic necessity.

One hundred and thirty-eight patients satisfying NINCDS/ADRDA criteria for Alzheimer's disease (AD) and 36 normal controls underwent cranial CT. A comparison of methods of scan analysis showed good agreement between computer-assisted methods and visual ratings and planimetry. The CT scans of controls differed significantly from patients and a discriminant analysis, based on all CT measures, predicted group membership (control or patient) in 81% of cases. Within the AD group, cortical atrophy correlated with age and duration of illness. Global tests of cognitive function correlated significantly with both cortical atrophy and ventricular size. Subjects who died in a three-year follow-up had more atrophy and larger third ventricles than survivors, but this effect was due entirely to increased age.

Three distinct trends in modern psychiatry distract from a proper concern with the phenomena of mental disorders. Pressures of time and heavy case loads may stand in the way of detailed exploration of mental states. A quick scan for a few critical markers — mood disturbance, thought disorder, delusions, hallucinations, cognitive dysfunction — often seems to suffice for currently accepted diagnostic classifications and treatment decisions. And thirdly, clinical science in psychiatry is dominated by neurological, epidemiological, and psychosocial themes which commonly disregard the intricate realities of abnormal psychic phenomena.

Issues concerning the use of predictive and screening instruments include the difficulties posed by temporal changes in the base rates for the behaviour of interest, the possible advantages of using three rather than the customary two risk categories, and the desirability of specifying in advance the proportional sizes of the risk subgroups. A method is proposed for constructing and assessing tripartite risk scales, and a new scale for predicting the repetition of parasuicide, with the results of a prospective validation study, is reported.

Ninety patients with severe anorexia nervosa fulfilling DSM–III–R criteria were assessed in depth in terms of their family developmental psychopathology and then randomly allocated to either one of three treatment groups or to no treatment. In three treatment regimes, a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems. All three treatment regimes were highly significantly effective at one year in terms of weight gain, return of menstruation, and aspects of social and sexual adjustment. Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group.

Delusional memories have an established place in psychiatric phenomenology and use of the term extends to its inclusion in the Present State Examination (Wing et al, 1974). Not all writers have used the term, however, and present definitions are inconsistent. This paper attempts to clarify the significance of delusional memories for a diagnosis of schizophrenia according to Schneiderian criteria.

Andre Koppers is a historian, now working as a research assistant attached to the International Association on the Political Use of Psychiatry. His A Biographical Dictionary on the Political Abuse of Psychiatry in the USSR is published by the IAPUP, Amsterdam (£5, 180 pp., 1990) Lone Jacobsen is head nurse and Peter Vesti a psychiatrist at the Danish Rehabilitation and Research Centre for Torture Victims. Torture Survivors–A New Group of Patients is published by the Danish Nurses1 Organization, Amsterdam (£12, 80 pp., 1990, in an English translation by Bente Bach) and is intended primarily for nurses. Finally, Eric Stover, a staff officer with the American Association for the Advancement of Science (AAAS), and Elena Nightingale, lecturer in health policy at Harvard and chair of the AAAS Committee on Scientific Freedom and Responsibility, edited The Breaking of Bodies and Minds, published by W. H. Freeman, New York (£16.95 (pb), 335 pp., 1985).

The literature is reviewed on children variously described as having ‘schizoid’ personality disorders, Asperger's syndrome, and schizotypal personality disorders, with the aim of clarifying the nature of these clinical syndromes, and in particular the features of those children whose follow-up characteristics are described in the following two papers.

The Holocaust under the Nazi regime is probably the most traumatic catastrophe of our century and even of history in the civilised world. Its deepest abyss consumed the lives of one-third of the world's Jewish population, who were selected and murdered in a cold-blooded industrialised machinery of death in this their ‘Shoa’. The Jewish people represent the victims of the Holocaust more than any other group of human beings who suffered this iniquity. The Holocaust has left in its wake few survivors, and many invalids in body and in mind, who remain compelled to live with a trauma that surpasses any other deliberately caused by fellow humans: and it has left in its wake an entire nation in shame and bewilderment, stigmatised and traumatised by the horrifying crimes that were committed in its name, faced with the task of analysing what happened, so that it may never be repeated, forbidden by the enormity of the horrors from repressing the past, and obliged to integrate deeds that cannot be undone.