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

Dr. Kubie is to be commended for directing his talents and interest to matters concerning the proper training of the psychiatrist; important changes are undoubtedly indicated. For instance, it has long been remarked that the psychiatric resident finds himself treating psychotic patients before he has had an opportunity to know what he is doing or what he is trying to do. One finds oneself saying that he should start with neurotic patients and “work up” to treating psychotics almost as though it were a question of starting with easy problems and progressing to those which are more difficult.

I will comment on two of Dr. Kubie's themes, themes which are among those from which he appears to derive his sweeping recommendations in regard to the training of the young psychiatrist or psychotherapist. It should be pointed out in the connection that my comments are actually directed toward only a part of his argument and are not to be construed as opposition to his main thesis—the need for radical reexamination and change of our present methods of training psychotherapists. I do not feel sufficiently informed to discuss this main theme here.

First, a word about Dr. Kubie's statements, some of which are made almost as pronouncements, and some of which, if taken literally, do not meet the facts as I see them. Surely Dr. Kubie's return to the study of psychoses has not shaken him out of his ideas “about almost everything.” Surely his comments have to be understood to some degree as reflections of his mood of enthusiasm as arising from his examination of the psychopathology of the psychoses (and it is an exciting experience) and from his natural desire to improve the training of young psychiatrists. For instance, his statement that “Letting a young physician, just out of his medical internship, examine and treat psychotic patients … is roughly equivalent to putting a scalpel in the hands of a young resident in surgery and asking him to take out a brain tumor” is somewhat inaccurat