The experience of working with disturbed adolescents—many of whom manifest conduct disorders—in a therapeutic community is in many respects contrasting and different from the more conventional psychiatric setting. Studies have shown that doctors' attitudes to the therapeutic community approach are very polarized, as are attitudes to psychological and organic methods. When faced with a choice of using psychotherapy, behaviour therapy, social psychiatry, or biological methods, doctors again exhibit strong preferences. The opportunity to experience therapeutic community methods is not usually available in teaching hospitals, and is not uncommonly a source of friction when sited in a hospital. Relationships between psychotherapists and other psychiatrists in teaching hospitals are not always harmonious.

It was bold, as well as shrewd, to have held the 4th Conference of the African Psychiatry Association in London (Institute of Psychiatry) rather than Lagos or Lusaka. Yet Dr A. C. Raman (Consultant, St Augustine's Hospital and Secretary General of the Association) should be well satisfied with the rewards for his hard work. There were about 100 participants (the majority from Africa) who debated with vigour and courtesy the diverse facets of the conference theme. To have discussed these controversial training matters at the institution which, together with the department of psychiatry in Edinburgh, had influenced considerably the development of psychiatry in Nigeria, as well as in other Anglophone African countries, could have misfired. However, for most participants the conference presented a rare opportunity for legitimate nostalgia, as well as the chance to contribute to discussion on the present training of psychiatrists in Africa.