Reality ofthe concept of o,.,anic psychitJtry
DEAR SIRSYour correspondent, U. J. Dey (Bulletin, May 1984,8,95), with the suggestion of 'organic psychiatry', has done well to encourage a fundamental review of our thinking, and the issue might be further promoted by embracing the fields of amentia (subnormality) and dementia under the one heading of 'Mentation Psychiatry'. This takes up Sheila Hollins' letter in the same issue (8, 96) pointing up the future trends of bringing the 'Cinderellas' into the rest of the happy family! I speak as one of the new breed of psychiatrists, dealing totally with dementia, and see many parallels between the service run by our small team in putting out bush fires in the community and lowering the general risk of fire-similar, I believe, to the fraught daily life of my colleagues in subnormality. Why can we not, indeed, join forces and seek to change the skills of the multidisciplinary teams and thereby change their attitudes and thereafter the attitudes of those we servethe British public?
TORQUIL MACLEOD
SUllon Hospital SUllon, SurreyAccreditation and registrar training DEAR SIRS I would like to support the views expressed by Dr A. V. P. Mackay in his excellent article on the subject of accreditation and registrar training (Bulletin, April 1984, 8, 62-64).Essentially psychiatric knowledge is not acquired to exist in a vacuum nor indeed in order to pass exams, but in order to be used to help patients. A model of acquiring such knowledge which makes it harder for psychiatric expertise to reach a vast number of patients is defeating its own ends. An accreditation policy which draws trainees away from peripheral units, so that such units become more isolated, is likely to lead to a fall in the standards of such units. This in turn is likely to make psychiatry less attractive to doctors.A disturbing aspect of the College's position is the apparent assumption that if only better academic training were to be provided for psychiatrists the quality of psychiatric services would improve. Academic training is very important, but there are a number of other equally important elements which go to make up a good psychiatric service. A main constellation of these is a service administered so that there is high morale, good multidisciplinary co-operation, efficiency and a caring attitude towards the patient. Future consultants require environments which will help them to learn techniques towards the above ends. This may be better learnt in an apprenticeship model by role modelling on peers than in the academic part of training. The models for these may not necessarily be those of teaching centres. For this reason I would strongly support Dr Mackay's suggestion that 'accreditation' should involve a much wider survey of the functioning of psychiatric services.
180Another concern is the arbitrary, and at times limiting, standards set for accreditation. This seems to be moving towards a too narrowly defined model of the training potential psychiatrists should receive. The assumption seems to be that...
