Oral history and biographical research gathering previously unpublished material directly from Altschul and Peplau, and new commentaries on Eileen Skellern from colleagues, are triangulated to form a collective biography that accesses historical consciousness of times of great change in psychiatry. We can see core ideas about psychiatric nursing aggregated around the idea active therapeutic engagement. Peplau and Altschul were simultaneously working with innovative methods of community-based therapy during the Second World War in England with shell-shocked soldiers. Both developed founding ideologies in psychoanalysis and therapeutic community practice. A similar trajectory is apparent in the work of Eileen Skellern. User involvement and social inclusion, the corner stones of therapeutic community practice, remain intrinsic to the aspirations of psychiatry today.

Medication continues to be the most widely prescribed treatment in the NHS for mental health problems. It has been known for many years that individuals differ in the way they respond to a given pharmaceutical therapy, and one reason for this lies in the genetic variation between individuals. This paper recognizes the impact that pharmacogenomics and pharmacogenetics are having in the field of mental health. Variants in genes that code for the drug metabolizing enzymes in the liver have been found to influence the way in which these enzymes handle psychotropic medication. Individuals can be classified as poor, moderate or extensive metabolizers when standard regimes are used, and this can lead to huge differences in therapeutic effect and toxicity. There are now genotyping tests available which provide information on the individual's ability to metabolize psychotropic medication. One author provides an account of the effects of medication on her son's physical and psychological well-being. Genotyping provided evidence for his poor metabolism of psychotropic medication, and his life is now changing as he is being very gradually weaned off this medication. This emerging field of work has implications for the way in which practitioners consider medication adherence.

flict and potential personal and social change' (Burr 1995, p. 44). Berger & Luckmann (1966) argue that the mechanism governing the genesis and maintenance of the successful social construction of reality is the process of externalization, objectification and internalization; to quote from Burr (1995, p. 10):'People "externalise" when they act on their world, creating some artefact or practice . . . [for example] . . . by telling a story or writing a book . . . this then enters into the social realm, and once in this . . . begins to take on a life of its own. The idea that it expresses has become an 'object' of consciousness for the people in that society . . . and has developed a kind of factual existence or truth . . . which appears . . . "natural", issuing from the nature of the world itself rather than dependent upon the constructive work and interactions of human beings . . . they "internalise" it as part of their consciousness . . .'

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