Discussion

One of the striking things about Dr. Rubins' paper is the absence of statistical materials. In modern day papers on treatment of medical illnesses, this seems like heresy. But, Lawrence Kubie, in an excellent article in the February 1971 Archives of Psychiatry entitled “The Retreat from Patients” makes two important points, to my mind, that are very germane to tonight's topic. One is that “many older leaders of psychiatry are intimidated by statistics. Unfortunately, few psychiatrists (especially many older ones) understand the pitfalls of statistics. Consequently, if anyone so much as shakes a statistical stick at us, we develop butterflies in our stomachs and run for cover”. Dr. Rubins is not of this ilk and is willing to accept his clinical experience as valid criteria.

Dr. Kubie also points out that it is as difficult to measure results in education, as in psychiatry — as difficult to characterize results qualitatively or even to determine when we should attempt an evaluation — i.e. “whether during the course of the educational process, or immediately at its formal termination, or 5 or 10 years later”. In effect, he says, be well trained, be critical, and trust your observations. I believe that Dr. Rubins subscribes to this, as do I.

On reading and listening to the paper I was struck by my own recurring thought “ah, that's the name for what I was doing” and after a little thought I realized that the ability to conceptualize and to translate those conceptions into words is a special quality. I, as a younger clinican have not that quality, but I do accept my clinical work with schizophrenics as reasonably effective. What effective means has changed with my experience and training — initially it was to return the patient to the community but at present the meaning is more akin to the goal of psychoanalysis — self-realization. Dr. Rubins' ability to conceptualize has permitted him to develop a coherent and consistent theory and treatment of the schizophrenias by using