You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
In his paper on “training,” Dr. Kubie presents his ideas with freshness and vigor, which should not surprise anyone who knows him. It is evident his ideas have come out of long experience and formulated after much thought and consideration.
The first proposal, that “… the sequence of steps in training for psychiatry should be reversed and much of the content changed” has much merit. To add to Dr. Kubie's arguments for his proposal, I would emphasize the element of anxiety which affects most first-year residents when they are faced with the task of attempting to look at the psychopathology in floridly psychotic patients; in my opinion this often results in the erection of defensive barriers which may, in some, never be overcome. It is easy for administrators and other staff members to forget how frightening it can be for someone who has had little or no experience with psychotic patients, to be confronted with the massive irrationality found in such patients. This is particularly important in programs where the staff is permanently established; it is necessary and important to remind ourselves that we start each year with untrained residents and, in many instances, with the fiction that the first-year resident is “responsible” for a group of patients and is expected to “treat” them—an obvious impossibility.
Dr. Kubie believes it would be better to introduce the students to, “… the complex processes of growth, observing the subtle early neurotic deviations from normal psychological development.”
Again, I agree, because I have seen such a program work, not for residents but for medical students. In this program which extends over four years, the student, in the first and second years sees some psychotic patients in a carefully protected setting. In the third year he begins work with the less ill individual patient in the out-patient department. In the fourth year the students see the more severely disturbed psychotic patients in the hospital. There is considerable evidenc