This chapter introduces the role of The Teacher within medical education and considers how this has changed in recent years. There is reflection on what it means ‘to teach’, as well as the importance of attitudes and role-modelling. The Hidden Curriculum is considered, with discussion of why it is important and how it can be influenced by the medical educator. This chapter also acknowledges the peculiarities of teaching psychiatry, and how this can be a rich vehicle for teaching values and attitudes – directly through the content, and indirectly through the hidden curriculum.

Why do people leave home and seek asylum? Conflict, war, and persecution, living in fragile states, being trafficked, and climate change may all play a part.Global statistics of forced displacement are reviewed.

Types of journeys and attendant experiences are considered, and reasons for how and why people may come to the United Kingdom.

We then review developments in international refugee policy and law, and problems with the current approach, including the role of socioeconomic status, the difficulties in how initiatives are funded, and the lack of long-term perspectives.There are barriers to resettlement in wealthier third countries.Restrictive and punitive asylum policies have a high human cost.There are limits to international cooperation.

This all matters to health professionals because understanding someone’s context explains much about individual behaviour.It enables relevant enquiries to be made, and appropriate help offered. Some possible misapprehensions are considered.

If you are reading this book, the chances are that you or someone you know has a gambling disorder or is affected by harms related to gambling. In this chapter, we will look at what a gambling disorder looks like and what you can do about identifying it. Finding out whether gambling is in fact problematic is the first stage before action to overcome it.

This chapter will examine a brief overview of obsessive compulsive disorder (OCD) and its defining features. Public perception of OCD over time will then be appraised, from the low awareness that existed throughout much of the early twentieth century to the present, when it is almost fashionable to claim that an individual is ‘a little bit OCD’.

The chapter will then examine what distinguishes ‘normal’ obsessions and compulsions from those that are detrimental to the individual and their functioning. Finally, the chapter explores how obsessions and compulsions may have evolved and how they may give the individual a biological advantage.

The law, like medicine, is full of ‘ifs’ and ‘buts’, with ‘not yet determined’ in place of the medical ‘not yet known’. In that it is ‘man-made’ it is simpler than medicine, but it has the added complication that it does not remain static, being amended by Parliament and the courts as the attitudes of society change. Although some questions have a clear answer, a ‘right’ or ‘wrong’ or ‘lawful’ or ‘unlawful’, most do not. Rarely, this is because there is no law. More commonly, it is because the law could be interpreted in several ways and, as yet, there hasn’t been a relevant court case or, as will be seen, there have been many cases with different judges interpreting the law in different ways.

Attendance at school can contribute substantially to young people’s optimal development and long-term outcomes. School absenteeism and mental health problems, which are often intertwined, present a major obstacle to optimal development. This chapter introduces research on the relationship between school absenteeism and young people’s mental health problems, including internalising and externalising problems. Attention is also given to the relationship between school attendance and mental health. The authors then present three lenses through which the reader may assimilate the wealth of data and ideas in this book: the multiple needs of young people displaying absenteeism and mental health problems; a multiple disciplinary approach to responding to these needs; and a multi-tiered system of supports for conceptualising, providing, and researching interventions to prevent and address school absenteeism and mental health problems.

Historical chapters in scientific books are generally dull even though they do not intend to be. There is an understandable need to record what happened in the past even though it may be quite irrelevant to what is going on today. We are frequently asked to remember George Santayana’s comment, made by many others, that ‘those who cannot remember the past are condemned to repeat it’ (Santayana, 1905). But this is hardly relevant for a textbook on The Wheel. Those who concentrate on wheel technology are not going to be particularly interested, except in a voyeuristic sense, in how Neolithic people might have been able to move large blocks of stone to Stonehenge for hundreds of miles using primitive garden rollers. But with personality disorder it is different. Without some knowledge of the history of personality disorder current descriptions cannot be placed in any sort of context.

The nosological background is outlined, with particular reference to the fifth edition of the American Psychological Association's Diagnostic and Statistical Manual and the International Classification of Disease's eleventh iteration. Categorical diagnoses of antisocial personality disorder are critiqued. The question of what motivates people to engage with others, and how this may be lacking in antisocial individuals, is addressed. It is emphasised that to understand what people are like and why they behave the way they do, we need to look at both traits and values – the latter being goals that people find desirable and use as guides for their behaviour across different situations. The importance of motivation for an understanding of personality pathology is outlined in the context of a schema that re-describes PD in terms of an ‘approach vs withdrawal’ dimension that is fundamental to human motivation. Finally, the question ‘How does personality become pathological?’ is raised.

This chapter traces the evolution of the term ‘addiction’ over time, demonstrating how its meaning has altered in the face of social and political changes in society. The second half explores the story behind the diagnostic terminology used in clinical practice today, and describes the recent changes to the addiction section of the major classificatory systems. Addiction is conceptualised as a disorder involving a loss of the normal flexibility of human behaviour, leaving a dehumanised state of compulsive behaviour (‘overwhelming involvement’). It has acquired a variety of terminology over time, much of it inferring moral weakness. Addiction may be associated with psychoactive substances or other pleasurable behaviours and occurs on a spectrum of use and harms, which vary in severity. The term ‘dependence’ may refer to physiological aspects of addiction (tolerance or withdrawal), but is also used to define the severe end of the spectrum. Confusion around this terminology has led to it being removed from the latest version of the Diagnostic and Statistical Manual (DSM-5).

Modern developments in research and in the development of services have demonstrated the need for the better integration of mental and physical healthcare in various areas of medicine, including endocrinology. Years of research into the aetiology of depression and other mental disorders have demonstrated the importance of the stress response and the hypothalamic–pituitary axis in the aetiology of many common mental disorders. Where collaborative care or integrated care systems or interventions have been implemented, they have shown improved outcomes across the domains. There is a need for more naturalistic research in the management of complex comorbidities.