Discussion of Lawrence S. Cubie's Article, Reflections on Training

To meet the problems presented by the ever-widening demand for psychiatric services, Kubie has proposed the creation of a new sub-discipline of medical psychology.

I have serious reservations about this proposal. By asking the medical profession to endorse and help implement such a system of training of non-medical personnel, Kubie is requesting the relinquishment of the principle that the treatment of illness, whether bodily or mental, is the sole responsibility of the physician. Lay therapy would thus be sanctioned as a permanent institution.

It is highly questionable that the average graduate of a school of medical psychology would be as well trained to handle all psychiatric problems as the average psychiatrist. The fact that he will be practicing under certain indispensable safeguards will make the medical psychologist dependent on the psychiatrist and the problem of first and second class citizenship in the psychiatric field will continue to exist.

There is no denying the desirability of upgrading the training of the clinical psychologist by incorporating into it some exposure to clinical medicine and medical ethics so long as the clinical psychologist is going to attempt to

treat patients. However, I have not been aware of any ground swell of support for the plan on the part of the psychologists. Perhaps they see no pressing need to graft the medical disciplines to their training.

Kubie's proposal is predicated on the assumption that the existing system of medical education is unequal to the task of training a sufficient body of psychiatrists in the foreseeable future to meet the community's needs. I do not share this pessimism. What is needed is the creation of a greater awareness on the part of medical educators, and of the educated public generally, of the overriding importance of greatly expanding the training of psychiatrists. Once this problem is fully recognized, the means for meeting this challenge will be generated. If the energy and money required to