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which defines each symptom precisely. Psychiatrists trained to use this instrument achieve high reliability when rating patients' answers to the questions. The present state examination has been translated from English into languages as diverse as Russian, Chinese, and Yoruba (a Nigerian tongue). Translated versions were used in the International Pilot Study of Schizophrenia,2 which showed that schizophrenia is an international concept used to categorise similar illnesses throughout the world and which transcends differences in language, economic development, and family structure. Unfortunately the same cannot be said of the neuroses. Five of the papers at the Bradford congress dealt with differences between western and non-western patients in the presentation of neurotic illness. In particular, non-western patients tend to express emotional distress in somatic terms. Hysteria (virtually a historical curiosity in Britain) is still the most common form of neurosis seen in psychiatric hospitals in India. To a great extent the presentation depends on the patient's knowledge of biology and medicine and his interpretation of the symptoms. Asian immigrants to Britain have usually come from places where psychiatrists are few and as a consequence western psychiatry has made few inroads into folk beliefs about sickness. As a result their presentation of distress is predominantly in terms of somatic symptoms, and this is likely to mislead the general practitioner and to result in unnecessary pathological investigations and delay in reaching the correct diagnosis. Guidelines to help doctors deal with immigrant patients have been given in a recent publication by the Community Relations Commission.3 One of the papers presented at the congress was a study by Cochrane of admission rates to mental hospitals. He analysed these by country of birth for England and Wales in 1971, taking care to standardise the data by age and sex (necessary since immigrant populations usually show a predominance of males and ofthe age groups between 20 and 50), and found that Asian immigrants had low rates in comparison with the British population. This might indicate less psychiatric illness among Asian immigrants than among their white neighbours or alternatively that the Asians were underusing the psychiatric services. Again, while the way to resolve this issue is to conduct a psychiatric survey of an Asian immigrant group, the problem is the same: the need for an appropriate survey instrument. It would have to be translatable between English and several Asian languages (Hindi, Urdu, Punjabi) and to be flexible enough to pick up the somatic presentation of neurosis. Several rating scales in use cover the major neurotic syndromes, but all have been developed from experience with western patients, and Professor Giel from Groningen showed how inappropriate such a scale may be when translated and tested on Ethiopian students. One answer might be the development by psychiatrists in non-western cultures of independent instruments based on experience with their own people. Though it is not easy for such psychiatrists to free themselves from the bias implicit in western training, only when such an instrument is available will it be possible to assess the extent of untreated psychiatric morbidity among immigrants and determine whether the stress of living among the British outweighs the relief from poverty, malnutrition, and physical disease.