I hope that there is no need for me to argue the general case for research in psychiatry, or indeed in any branch of medicine where our knowledge is incomplete—which, of course, means every branch. I do not, of course, imply that research is a necessary component of individual careers in psychiatry; but for the health of the discipline as a whole it is quite essential. The greatest enemies of progress in any branch of science are dogmatically held beliefs; and I believe—not I hope too dogmatically—that the best protection from a dogmatic cast of mind comes from some experience or research. Research is sometimes portrayed as something which may inhibit the taking of necessary decisions—but in my experience indecision has not been peculiar to research-workers, who are, however, less likely to take decisions lightly and on insufficient evidence.

In most parts of the country today it is often difficult or impossible to fill consultant vacancies in mental handicap. According to the DHSS there were 146 consultants in mental handicap in post in 1978 compared with 102 in 1968, an overall growth of 43 per cent, compared with 34.7 per cent in general psychiatry. Nevertheless nearly one quarter of posts were vacant on 30 September 1978. The number of new consultants in mental handicap required to replace losses from death and retirement is about 6 to 10 per year. If an expansion of 10 is to be achieved some 16 to 20 fully trained senior registrars will be required each year. For this 60 senior registrar posts will be needed, assuming that senior registrars have three to four years training. At the end of September 1978 there were 34 established senior registrar posts of which 9 were vacant.

Psychiatrists, who in their treatment of mental disorder apply theories, concepts and method drawn from many branches of knowledge, have shown remarkably little interest in the humanities. Distinct from the natural and social sciences, these are concerned with human behaviour and culture. Their neglect contrasts with the keen interest in psychopathology shown in many humanities departments in universities, from which flows a stream of publications on the psychopathology of the famous, writers and artists, and the characters they create. The data on which such studies are based are similar to those making up case-histories, as Jaspers (1913–46; English translation 1963) pointed out, although the selection of the latter tends to be more focussed by a theory.

In case any of you read On Call or Hospital Doctor (I forget which it was before they amalgamated) and believe what you read, I should point out that I did not say what I was recently reported to have said to the House of Commons Select Committee, namely that the secrecy of Distinction Awards should be maintained. It was in fact Mr David Bolt, the Chairman of the Central Committee of Hospital Medical Services (CCHMS) of the BMA, who said this, and I do not agree with him. On the whole, I think more good than harm would come from information being available; but I don't think anyone should ever use his award as part of the subscript to his signature along with his degrees (as a member of our College once did—and probably others equally unwisely).

An element of personal selection is essential in the writing of history. One can do no more than cast an eye over the records of meetings and decisions, achievements and conflicts, struggles and defeats, victories and frustrations. It cannot all be reproduced. And after a mere ten years it is difficult to sift what is ephemeral from that which will prove of lasting and fateful importance.

I esteem it the greatest honour to have been invited to deliver this Inauguration Lecture. It is not only the distinction and importance of this College and its members which make the invitation one to be proud of: I have the additional pleasure of being well acquainted with your new and distinguished President. Having worked with him on tasks closely associated with the welfare of the whole medical profession, I know from personal experience how deep is his learning, how clear his understanding and how abundant his common sense. As an outsider I would respectfully venture to congratulate the College on its choice.

At one time, I knew what psychiatrists should do and it was very satisfying. They should, so far as humanly possible, restore the mad and the distressed to sanity and tranquillity. Now things are less clear, and there are three main reasons for this. First, many of the incurably mad are distressed because they live in conditions of unspeakable social squalor which one does not have the power to relieve. Second, most of the curably distressed are cured by time or their GPs and we see only a small proportion of them. Third, many of the people referred to us have personality or alcohol problems for which, in most cases, no effective treatment can be given.

In giving a brief account of salient events in my professional life I will start in 1937 when I was aged 30 and had just completed my formal training as a child psychiatrist and psychoanalyst. Apart from a medical background and an interest in psychology, my choice of career had been determined by what I had seen and heard during the six months that I had spent in a school for disturbed children between my preclinical training at Cambridge, where I had also read natural sciences and psychology, and completing my medical qualification at University College Hospital. During my time at the school I had worked with children and adolescents whose difficulties I know now to be typical of much personality disorder, and had been exposed to hypotheses, derived from the ‘new psychology’ emanating from Vienna, regarding the role of childhood experience in their origin. Accordingly I had decided to train as a psychoanalyst. This I began before qualifying medically and continued whilst spending eighteen months at the Maudsley, learning the psychiatry of adults as one of Aubrey Lewis's early students. This proved a productive relationship, not least because on many questions we agreed to differ.

A very damning account of the social work profession has been written by Brewer and Lait, a profession which the authors perceive to be a ramshackle collection of idiosyncratic practitioners who clumsily bump and grind their way through the least fortunate sections of our society, doing untold harm. It would be gratifying to dismiss what they say; but social work after just over ten years in its present form is sorely in need of critical examination. We cannot ignore our critics, and it is imperative that we should put our house in order. Should social work survive is the real question being asked here—a political statement of a quite contentious nature.

Our Founders (Hitch, Gaskell, Thurnam and others), who established the Association of Medical Officers of Asylums and Hospitals for the Insane, started an evolutionary process which is continuing to the present day.

For the past 24 years during which time I have been concerned with the management and financing of medical research, either at the MRC headquarters or the Wellcome Trust, I have heard it said that psychiatric research is backward and something ought to be done to improve the situation. My earliest memory of something being done was in 1959 when Professor (now Sir) Denis Hill, as a member of the Medical Research Council, wrote a report making the recommendation that the Council should set up research units, and the universities should establish more academic departments in medical schools. The reasons for these recommendations were fairly obvious. Unless established posts are available one cannot expect to recruit potential research workers to the field. The proposition accepted that even if the perfect head of department was not initially available, the next generation would have the right experience. Professor Hill's recommendations were, I think, very largely implemented. Between 1957 and 1962 the Medical Research Council set up five new units and one new research group. Only two of these units still exist but others have been established since. A number of university departments were also created.

Among reports from committees and working parties, some are crisp and stimulating, while others, the majority unfortunately, are dull and sedative. The Nodder Report falls into the latter category which is a pity because some parts of it are worth reading. It is neither as good nor as useful as it should be because it fails to tackle the problem as fully and as vigorously as required. The working party have avoided difficult but essential problems such as the difficult patient, the patient concerned in criminal proceedings, the role of the consultant psychiatrist, the role of other doctors and the role of the nursing officer. They have grasped the tulips and tiptoed through the nettles.

The reason for admission was early developed as a focus of work in Hill End Adolescent Unit (Bruggen et al, 1973). Boys and girls (they were all under 16) were admitted on the authority of those in parental charge, and the reason usually was that their parents needed a break from the anxiety of having them at home, or that their children's homes could no longer cope with them and that their social workers had nowhere else to place them.