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CORRESPONDENCE
and explanatory theories of generalisable validity
of mental phenomena (Frommer & Frommer,
1990).
A discussion between philosophy and psy
chiatry may stimulate not only the topic of
nosology and categorisation, but also basic
epistemological efforts, integrative work at the
interface of different language games within
psychiatry (Langenbach, 1993), and the link
between psychopathological phenomena and
everyday life. After all, psychiatric patients are
members of the shared social world. Accordingly,
philosophy can sharpen concepts of the mental,
e.g. by introducing qualitative methods of under
standing and researching.
One of the most useful contributions of phil
osophy to psychiatry, especially in times of pre
vailing and virtually exclusive methodological
interest in operationalisation, is the facilitation
of fluid thinking. According to Novalis, a
philosopher-poet two centuries ago, philosophy
"frees everything and relativises the universe. It
neutralises the fixed points, as does the system
of Copernicus, and makes the resting a floating".
FROMMER.J. & FROMMER.S. (1990) Max Webers Beduetung
fürden VerstenhensbegrllT in der Psychiatrie. Der Nerve
narzt, 61, 397^101.
LANGENBACH,M. (1993) Conceptual analyses of psychiatric
languages: reductlonlsm and Integration of different dis
courses. Current Opinion in Psychiatry, 6, 698-703.
SCHWARTZ.M.A. & WIGGINS.O.P. (1986) Logical empiricism
and psychiatric classification. Comprehensive Psychiatry.
27, 101-114.
MICHAELLANGENBACHand JÖRGFROMMER,De
partment of Psychosomatic Medicine and Psycho
therapy, Hienrich Heine University, Düsseldorf,
Germany
Sir: I agree with much of what Drs Langenbach
and Frommer say, and am rather surprised that
they found my article hostile to their approach to
philosophy.
The Philosophy Special Interest Group, while
encouraging high standards of philosophical
thinking, does not require adherence to any
philosophical school. Indeed, many of our mem
bers, especially those with psychotherapeutic in
terests, share Drs Langenbach and Frommer's
distaste for logical empiricism. I feel sure the
Group would give their views a warm welcome.
I would like to correct one misconception they
have: they have implied I believe that Carl
Hempel's concepts of classification underpin
what psychiatrists actually do. As they so rightly
point out, this is not so. However, his work did
allow psychiatrists to come to agreements with
each other about what would be called schizo
phrenia, for example. Without such agreement,
meaningful debate is of course impossible. Even
Martin Buber considered meaning had to be
shared before one could relate to the Other
(Buber, 1984). So, Hempel's work is a good ex
ample of the utility of philosophy for psychiatry,
which was why I chose it. Psychiatrists are prac
titioners, and rightly require demonstrations of
utility as well as truth.
It is, of course, important to debate which
philosophical methods are best for addressing
which psychiatric problems. I look forward to Drs
Frommer and Langenbach developing their argu
ments in more detail.
BUBER. M. (1984) / and Thou. (Translation) Edinburgh:
T «iT Clark.
D. M. FOREMAN, University of Keele, North
Staffordshire Hospital Centre, Stoke-on-T rent
ST4 7QB
GPs' attitudes towards sectorisation
Sir: I read with interest Eluned Dorkins article
Towards sectorised psychiatric care - what do
GPs think?' (Psychiatric Bulletin, 1993, 17, 594-
596).
Our Community Health Care NHS Trust has a
population of 198,000 of which 60% are regis
tered with GP fund-holders. Having three general
psychiatrists, we thought it opportune to
'sectorise' our service for general psychiatry and
wrote to all general practitioners with the pro
posal. The response as a whole was unequivocal
and sharp, objecting to not having been con
sulted, lack of choice of consultant psychiatrist
and the difficulties GPs had been experienc
ing post sectorisation in neighbouring health
districts.
Although we felt that sectorisation would have
led to a better service, we succumbed to the
pressure.
This case illustrates the strength of the
market-orientated customer given service and
the compromises one has to make within it.
A. K. CHAUDHARY,Scunthorpe Community Care
NHS Trust, Scunthorpe General Hospital,
Scunthorpe, South Humberside DN15 7BH
The Caiman Report on specialist
training
Sir: I would like to respond to the articles by the
President and Dr Kisely on the Chief Medical
Officer's (Caiman) Report on specialist training
(Psychiatric Bulletin, 1993, 17, 577-579 and
610-612) on behalf of the CTC.
The CTC welcomes the general recommen
dations and principles of the Caiman Report. We
support the President's view that minor changes,
building on our current achievements, are
needed to meet these recommendations in psy
chiatry. Policies regarding the structure, content
308 Correspondence
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and standards of postgraduate training and
methods of accrediting schemes are already well
developed in the College. We need to concentrate
on improving the translation of these policies
into high quality psychiatric training throughout
the country. The other vitally important factor in
ensuring the College's compliance with the re
quirements of the CMO's Report, particularly
with regard to the length of training, is the fund
ing of the latest allocation of senior registrar
posts. This will allow us to address our own
bottleneck which occurs between registrar and
senior registrar grades and fill the large numbers
of vacant consultant posts in some areas. This is
in contrast to the excess of senior registrars to
consultants in many other specialities.
On behalf of the CTC I would also like to correct
the impression which may have been gained from
Dr Kisely's article that we have not been active or
responsive to the issues raised by Caiman. The
statement that the CTC recommends only mini
mal changes to the present system is true in as
much as we only see a need for continuing the
progress made in psychiatry over recent years.
This view is not intended to apply to the other
Royal colleges where more radical changes may
be needed. The CTC is an integral part of the
Royal College of Psychiatrists and as such has
been working to ensure that the standards of
psychiatric training are high and continue to
improve, since our foundation in 1979. We do not
feel that radical change is necessary and are
proud of the College's record of setting standards
for training and involvement of trainees at all
levels. As far as comments about reducing the
length of postgraduate training to five or six
years, we do not find a great deal of support for
this among trainees themselves, as long as the
time is spent in useful postgraduate training and
not repeating previous experience while waiting
for an SR (or to a lesser extent registrar) post.
There is so much material in the psychiatric
curriculum that trainees feel the need to expand
the length of time spent in educational activities
during the current training period.
The future for psychiatric training is to build
on the progress made and to address the short
age of posts at SR level to allow a smoother
transition through the training grades. We do not
need radical changes, designed to address the
problems of other specialities, imposed on us
again. Trainees can be assured that the CTC will
continue to be vociferous in its support of train
ees and training standards within the College.
STEFFANDAVIES,Chair. Collegiate Trainees Com
mittee (CTC), The Royal College of Psychiatrists
Sir: I am sorry that Dr Steffan Davies, Chairman
of the Collegiate Training Committee (CTC),
should take such exception to the suggestion
that his committee should carefully consider
whether psychiatric training could be further
improved in the light of the Caiman Report
(Kisely, 1993).
I am well aware of the views of the CTC, given
that I was one of the representatives on the
committee for North Western Region until six
months ago. Unless the committee has changed
radically since, I found that many representa
tives were more open-minded about possible
changes to training following Caiman. In my
experience, trainees in general certainly are.
While training in psychiatry has many advan
tages over many other specialties, this does not
mean that there is no room for improvement.
Psychiatric trainees may wonder why training
to be a psychiatrist in the UK should take so
long; the Colleges of other medical specialities in
Britain may soon require only five to six years of
training, while the Royal Australian and New
Zealand College of Psychiatrists stipulate only
five years. Is the answer to an expanding psy
chiatric curriculum simply to increase the time
spent in education activities within the current
framework, or to critically examine the relevance
of some of the training?
KISELY.S.R. (1993) The future of psychiatric training after
the Caiman report: a trainee's perspective. Psychiatric
Bulletin. 17, 610-612.
STEVE KISELY, Northampton Health Authority,
Department of Public Health Medicine, District
Headquarters, Cltftonville Road, Northampton
NN1 5DN
CT scans in the elderly
Sir: We read with interest the article by Jon Spear
(Psychiatric Bulletin, 1993, 17, 536-537) which
compares the quality of the use of computerised
tomography (CT) scans in two psychogeriatric
services. The author does not define the term
'quality' and it is assumed that this is measured
in terms of identifying potentially treatable
structural lesions (PTLs).
If diagnosing these PTLs is the only aim, as
seems implied, then there is evidence supporting
the finding that the most useful predictor is the
presence on examination of focal neurological
signs although further clinical prediction rules
for the use of CT scans in the elderly are required
(Martin et al, 1987; Wasson et al, 1985; Deitch,
1983).
In Spears study, patients of Service X, which
only had access to CT scans through neuro-
surgical referral, suffered proportionately more
'risk factors' and had a greater rate of PTLs
diagnosed. This implies that the application of
neurosurgical criteria leads to more efficient
use of CT scans. Discovering PTLs is obviously
important but psychogeriatricians need to adopt
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