An investigation was undertaken into the first admissions to (for the years 1963, 1965, 1968, 1972) and the total discharges from (for the years 1963–72) Scottish mental hospitals and psychiatric units of male doctors and other social class I males. The overall rates for both first admission and for all discharges were more than twice as high among male doctors as among other social class I males. First admission and total discharge rates for drug dependence, alcoholism, neurotic and ‘functional’ depression and for affective psychosis were all significantly higher among doctors than non-doctors. Doctors were more likely than non-doctors to have been referred by themselves or by medical sources other than general practitioners, and were as willing as non-doctors to enter hospital voluntarily. Greater access to psychiatrists may have contributed to their higher rates of in-patient care, but it is improbable that such factors accounted for all of the excess in rates of drug dependence, alcoholism and depression.

A quotation from Edward Mapother can serve admirably as text for this address: ‘In practically all properly investigated cases of insanity, it is found that it is the result of a summation of multiple causes, effective in combination, though inadequate singly. It is this that renders all controversy between extremists of the physiogenic and psychogenic schools so futile’ (Lewis, 1969, p 1359). In the same year, 1922, in his Salmon Lecture, Adolf Meyer said: ‘The overmechanization of psychiatry … (has) led to too much reliance on chemistry and physiology as curealls in mental ills, while psychoanalysis, by laying too much emphasis on the subconscious and sex, has lost sight of the … functions of the conscious mind and has … disregarded the fact that man is subject to physical … biological … and social laws' (Meyer, 1922).

Mental retardation may be associated with a number of environmental factors such as undernutrition, lead poisoning or exposure to neuroactive drugs during a critical period of brain development. Possible biochemical mechanisms operating in these various conditions and in animal models are reviewed in relation to the vulnerable period hypothesis. Small brains are common in the mentally retarded, and this may be related to a developmental abnormality particularly at the level of the synapse.

The monthly number of births in Norway fluctuates between a maximum in January–May and a minimum in October–December. This cyclic seasonality is assumed to be of biological origin, but indirectly it is influenced by social factors and consequently tends to vary a great deal. There is a secondary birth maximum in September, corresponding to a peak of conceptions during the traditional festivities around Christmas and New Year. It is shown that this maximum is much less variable within the country studied, though it probably varies from one country to another in relation to the impact of the mid-winter traditions.

The January–May birth maximum is known to be higher in schizophrenia than in the general population, while no such difference is observed in Norway for the September birth peak. It is felt that there is a fundamental difference between the two birth maxima and a corresponding difference between schizophrenic patients and the general population. Minimal paranatal brain damage of seasonal origin is suggested as an explanation.

The responsibilities of a Consultant Psychiatrist are similar to those of other consultants within the National Health Service. The few differences arise from the special circumstances within the specialty, particularly relationships with other disciplines. The ability of Consultants to accept medical responsibility rests on their training, qualifications and statutory responsibility. Medical qualifications carry professional, ethical and legal responsibilities. These responsibilities are exercised towards and given by the public; are aimed at the cure or alleviation of human suffering; are independent of remuneration; and follow the medical practitioner wherever he may be, even within his private life.