reason for the difficulties raised by incompetent patients is that the connections (ie, the conceptual connections) between psychopathology and rationality are so poorly understood (20,31) (this is especially so for impairment of insight, as in deluded patients). Conceptual analysis may also contribute to improved communication generally, for example by making explicit and clarifying cultural differences in the conceptualisation of health and disease. iv) medico-legal: The problem of the legal ineffectiveness of proxy consent with adult patients has only recently begun to be considered in the United Kingdom in connection with treatment, and in connection with research it has received hardly any attention at all. There is a view that the law in this area should be allowed to develop case-by-case. But the insecurities this will engender have already been outlined. Case law, furthermore, is no guarantee that appropriate legal principles will become established: the emphasis, for example, on the patient's best interests in the judgement in the recent case of 'F' (32), underlines the potential divide in this area between the requirements respectively of research and ordinary clinical care. Research budgets are of course severely limited. With the help of researchers themselves, however, research on research need not be expensive. Thus, while there is a need for direct funding of research on research, much useful work could be piggy-backed on other projects. For example, one or two additional questions could be included in a questionnaire, covering how the patient felt about being asked to participate in the research, whether the experience was as he or she had been led to expect, and so on. 'Market research' of this kind could provide an invaluable guide to the development of future projects. More ambitious work along the same lines could be attempted by including additional disciplines (a philosopher, or a medical anthropologist, say) in a research team. Similarly, with a minimum of additional administration, research ethics committees could monitor the outcome of at least a proportion of their decisions. It is well recognised that there is considerable variation in the way these committees operate (33), and a small additional effort to assess their effectiveness would seem worthwhile. Each of these proposals would involve researchers in a certain amount of additional work. But to balance this, on the profit side as it were, the returns from research on research could be considerable. Such research would address public concerns, reduce rates of refusal and 'drop out', and improve the quality of research itself. As in other areas, then, the ethical requirements of good practice, far from being an impediment, are entirely compatible with and support the proper objectives of research with patients. Conclusions Although sometimes perceived as a barrier to research, a properly functioning ethics of research committee can provide valuable guidance and support in the development of research proposals involving patients. Recently published guidelines should contribute to this process by establishing principles of good practice broadly acceptable to everyone involved in research, not least patients themselves and their relatives. Nonetheless the primary responsibility for good practice in research comes back at a number of points to those actually carrying out the research. Psychiatrists, Royal College of Nursing and British Psychological Society. Ethical guidelines for the conduct of behaviour modification. The Practice of Psychiatric Rehabilitation: Historical, Conceptual, and Research Base by William A. Anthony and Robert Paul Liberman Abstract With the recognition that most psychiatric disorders are associated with severe and persisting disability and the development of effective procedures for improving the longterm outcome of patients, the term "psychiatric rehabilitation" is becoming routinely used in the mental health field. Psychiatric rehabilitation has begun to take its place as a viable, credible intervention approach, even infiltrating professionals' jargon and administrators' program descriptions. The field of psychiatric rehabilitation has progressed to the stage where its history can be traced; its conceptual