Audit in general practice.

actionbut the debate will then have moved away from fundamental scientific issues concerning the genesis of mental states.This view, which is close to what is often termed the social concept of disease, brings its own difficulties, and until these are resolved no one is in a strong position to pronounce on the definition of mental health.The approach nevertheless has certain advantages, including its recognition of the arbitrary way in which conditions are designated as requiring to be prevented or treated.There is a large measure of agreement about these, as reflected in standard taxonomies such as the International Classification of Diseases.Yet even that distinguished publication includes some rule of thumb decisions.Few would doubt that patients with schizophrenia or Alzheimer's disease fall outside the rubric of the healthy, but with the common neuroses or personality disorders we are dealing with extremes of distributions rather than categorical distinctions.In such cases-as with, say, hypertension-the dividing line must be based on informed judgment rather than logic.A solution of this kind may be untidy, yet it may serve us best for practical purposes.Assuming, then, that we have provisionally identified the condition we wish to tackle and are fortified by some extensive epidemiological knowledge of psychiatric disorder, the next