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Postgraduate training in psychiatry: A model theoretical course
Postgraduate Training in. Psychiatry: A Model Theoretical Course B y Z. J. Ln,owsKr
CREASING SCOPE AND I Nnecessitate constant revision
C O M P L E X I T Y of t h e field of p s y c h i a t r y of p o s t g r a d u a t e t r a i n i n g p r o g r a m s in this specialty. A climate of d y n a m i c c h a n g e , c o n c e p t u a l confusion, a n d d i s c o n t e n t w i t h the c u r r e n t state of the field, so well d e s c r i b e d b y G r i n k e r , s c a n be fe]t. This intellectual f e r m e n t i n e v i t a b l y affects those c o n c e r n e d w i t h t h e p l a n n i n g a n d i m p l e m e n t a t i o n of p o s t g r a d u a t e t r a i n i n g . It faces e a c h i n d i v i d u a l t e a c h e r with the d i l e m m a of e i t h e r f o l l o w i n g t h e safe grooves of the status q u o in his te:aching activity or of e x p e r i m e n t i n g with n e w a p p r o a c h e s a n d a t t e m p t s a t a synthesis of d i s p a r a t e k n o w l e d g e . This p a p e r is a n o u t g r o w t h of one t e a c h e r ' s e x p e r i e n c e a n d his reflections. It deals with only one f a c e t of p o s t g r a d u a t e training: the aims, str3mture, a n d contents of a theoretical course consisting of lectures a n d seminars. T h e w r i t e r leaves u n t o u c h e d t h e r e l a t e d b u t m o r e often discussed a r e a of clinical t e a c h i n g a n d experience. A n u m b e r of p u b l i s h e d c o n t r i b u t i o n s d e v o t e d to t h e p o s t g r a d u a t e t r a i n i n g of psychiatrists h a v e a p p e a r e d lateh,. 2.a.,'.r,'~'~t.la'la.l; T h e most thought-prov o k i n g a n d c o m p r e h e n s i v e s t a t e m e n t of the goals of s u c h t r a i n i n g can b e f o u n d in the R e p o r t of the Cofiference on G r a d u a t e P s y c h i a t r i c E d u c a t i o n , p u b l i s h e d u n d e r the Significant title, T r a i n i n g t h e P s y c h i a t r i s t to M e e t the C h a n g i n g Necd.s'. ~: It is t h e c h a n g i n g needs vchich a r e Significant. T h e g r o w i n g e m p h a s i s on p r e v e n t i v e a n d c o m m u n i t y p s y c h i a t r y , on t h e biological a n d social determigrants of b e h a v i o r , on p s y c h o p h a r m a c o l o g y , a n d on closer Cooperation w i t h the rest of m e d i c i n e ~ t o intuition just a f e w c u r r e n t d e v e l o p m e n [ s ~ p r e s e n t s psy-ehiatrie t e a c h e r s v¢ith a f o r m i d a b l e c h a l l e n g e . W e are f a c e d w i t h tim task of s t r u c t u r i n g the t r a i n i n g of a n e w g e n e r a t i o n of p s y c h i a t r i s t s in such a w a y as to m a k e t h e m c a p a b l e of g r a s p i n g the e x p a n d i n g scope of p s y d a i a t r y a n d of a s s i m i l a t i n g n e w a d v a n c e s . T h e concepts a n d criteria of m e n t a l illness are e h a n g i n g u n d e r the social pressures. T h e s e p r e s s u r e s force u s to a s s u m e the role of experts in the p r o b l e m s of m a n ' s p s y c h o l o g i c a l a d a p t a t i o n to his h u m a n a n d n o n h u m a n environmen{; yet this e n v i r o n m e n t is itself in a dyn a m i c state of c h a n g e . Psychiatrists a r e i n c r e a s i n g l y e x p e c t e d to offer remedies for a l e n g t h e n i n g list of m o d e s of h u m a n discontent, v a l u e a n d identity crises, a n d simple u n h a p p i n e s s . T h e s e are the " c h a n g i n g n e e d s " on "o,-hidl w e m u s t "'cast a cool eye" a n d steer a b a l a n c e d course b e t w e e n r u s h i n g to m e e t society's d e m a n d s a n d p r e s e r v i n g o u r i d e n t i t y as m e d i c a l p r a c t i t i o n e r s a n d scientists. This is a c h a l l e n g e w h i c h calls for a p u b l i e discussion a n d e x c h a n g e of views a m o n g us. T h e p r e s e n t p a p e r is a t e a c h e r ' s c o n t r i b u t i o n to such a dialogue. Z. J. L]powsgt, M.B., B.CiI., D.PsYcH.: Assistant Pro[essor o[ Ps!/chiatrff, ~fcOill Universtt!!, and Associate Psychiatrist, Allan 3fcmorial Irt~'titute o[ Psychiatry~, Alontreal, ()uebcc, Canada. 183 C.().XII'I~EHI'~NSIVi~ P.~IYO|IATHY, '~'O|.. 8, NO. 3 (JUNE), 19~7
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The Report referred to earlier states the goals of training unequivocally: "')ks t h e s u b j e c t m a t t e r r e l e v a n t f o r p s y c h i a t r y becomes more abundant and more complex, training programs should strive to keep the resident's mind open to new advauces from whatever disciplines they may come. To this end, programs n e e d t o b e f l e x i b l e in s c o p e , a n d t o b e p e r m e a t e d by a holistie att i t u d e a b o u t m e n t a l h e a l t h a n d i l l n e s s . " ,7 A S a l u t a r y g o a l i 1 1 d e e d , b u t h o w c a n it b e a c h i e v e d i n p r a c t i c e ? F r e y h a n , ~ i n a r e v i e w o f t h e l { e p o r t , e x p r e s s e s disappointment t h a t it f a i l e d t o o f f e r a c u r r i c u l u m m o d e l w h i c h would reflect t h e c h a n g i n g t r e n d s . I t is s u r e l y e a s i e r t o o f f e r w e l l - s o u n d i n g generalities than to translate them into practice, and this must be the teacher's job. T H E P~E.~]SES B e f o r e d i s c u s s i n g d e t a i l s of" a m o d e l a few premises or postulates on which
c o u r s e , it m a y b e f i t t i i l g t o the, w r i t e r b a s e s it.
torn'uOate
1. Psychiatry is a clinical discipline and art to b e distinguished from the empirical sciences on w h i c h it is based. T h e c h i e f amo~l.,.,' tllese are p s y c h o p a t h o l o g y 1"_' and normal p s y c h o l o g y , including p s y c h o d y n a m i c s , ~. T h e shifting, relative, a n d c~Iturally d e t e r m i n e d conct,pts of mental health and illness refer to an individual's, as well as a group's, current state of psychological a d a p t a t i o n to the h u m a n a n d n o n h u m a n cnx'ironmt:l~t. Both health and illnt,ss arc m~dtidetormiz~ed and d e p e n d on social, biological, and experit'ntial factors. :3. Psychiatry is b y the v e r y nature ~f its activities aml sc'ientiflc basis au t't'lectic discipline. It d e p e n d s on a n d strives to int¢',~ratt" in theory at~d action t w o n l m u , l l y irr e d u c i b l e m o d e s of abstraction~i.e-., t h e personal and st,cial on the oi~e h a n d vmd. on the other, the biophysical. 4. Eclecticism implies a sc'ientific a t t i t u d e b a s e d on the follo~vin~ beliefs: that systc, matic o b s e r v a t i o n a n d its publicly: av~tilable records are the fiTial c'riteriotl of truth; tlmt tLvpoiheses a n d theories are necessary co~niti','e tools for e x p a n d i n ~ and or,2anizin~ ~,mpirical k u o w l e d g e ; that intuition and l m n c h e s are i n d i s p e n s a b l e .~tddes to d i s c o v e r y b u t not cxiteria of its validity: that no one o w e s aile,~iance to a t h e o ~ ' a n d fanaticism is i~c'ompatible with the .~pirit of free i n q u i o ' ; a n d that k n o w l e d g e at a n y point in time is o p e n - e n d e d and no s t a t e m e n t s need be a c c e p t e d w h i c h are "'dispr~tff-proof.'" 5. O u r teachin.~ p r o g r a m s have to m a k e allow-race for the expantliIIg k n o w l e d g e a n d the i m m e d i a t e social needs. At the s a m e time, w e should insist ¢m the preserxation of the a c a d e m i c s t a n d a r d s a n d goals w h i c h cannot rellect each passing fashion. T h e r e is no d o u b t that psyehiato" as a discipline has to discharge its p u b l i c responsibility a c c o r d i n g to the c u r r e n t d e m a n d s of society. But e q u a l l y i m p o r t a n t is our role as scie~tists striving, to exp a n d the k n o w l e d g e almut m a n w h i c h can h a v e both practical usefulness a n d offer the esthetic satisfaction of a clearer t m d e r s t a n d i n ~ of h u m a n e x p e r i e n c e a n d behavior. T h o s e of us c o n c e r n e d with teaehin~ should b e the last m e m b e r s of the psyciaiatrie c o m m u n i t y to j u m p on e v e r y n e w b a n d w a g o n plastered with lofty slogans a b o u t mental health. 6. T h e trainin.e, must b e formally s t r u c t u r e d a n d include a theoretical course the ,~oals of w h i c h are to integrate k n o w l e d g e , inspire intellectual curiosity, a n d offer a c h e c k on the intuitive aspects of clinical work. 7. Interest in the m i n d is the eore of p s y c h i a t r i c e d u c a t i o n , as H e n d r i c k ~ poit~ts out, b u t the teaching m u s t go b e y o n d t h e psyeholot~ical f o u n d a t i o n of o u r k n o w l e d g e a n d strive for a ~:nit'ersalis't v i e w of m a n in health a n d disease. P s y c h o d y n a m i c s is an i n d i s p e n s a b l e part of such e d u c a t i o n , b u t it m u s t not displace o t h e r e n d e a v o r s to explain h u m a n behavior. 8. T h e basic issues in t h e r a p y revolve a r o u n d three c o n c e p t s : reversibility, modifiability, and c o m p e n s a b i l i t y of the p a t i e n t ' s p a t h o l o g y mid his e n v i r o n m e n t b y a n y m e a n s at our disposal.
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"file m o s t crucial issues ill p l a n n i n g a" t h e o r e t i c a l p o s t g r a d u a t e course in p s y c h i a t r y a r e those of releoance, selection, a n d integration of t h e t e a e h h a g material. I t is a s s u m e d t h a t the c u r r i c u l u m s h o u l d r e f l e c t a d e q u a t e l y t h e contributions of the psychological, social, a n d biological sciences to t h e traders t a n d i n g , t r e a t m e n t , a n d p r e v e n t i o n of m e n t a l illness, b u t t o p r e s e n t all the r e l e v a n t facts a n d theories w o u l d b e impossible in the t i m e available. B u t w h a t are t h e critelSa of r e l e v a n c e ? O n e c o u l d say t h a t r e l e v a n t to flae course are those facts, m e t h o d s , concepts, a n d theories w h i c h a r e necessaD', or at least t e m p o r a r i l y useful, for the e x p l a n a t i o n of h u m a n e x p e r i e n c e a n d behavior, b o t h n o r m a l a n d a b n o r m a l . Yet r e l e v a n c e is not an all-or-none concept. T h e r e are d e g r e e s of it d e p e n d e n t on the c u r r e n t k n o w l e d g e , trends, a n d i n d i v i d u a l choice. Tht~s the p r o b l e m of selection of m a t e r i a l to be t a u g h t i n e v i t a b l y reflects a p a r t l y subjective j u d g m e n t . T h e p r o b l e m of m e a n i n g f u l integn'ation of t h e diverse r e l e v a n t facts a n d theories is the m o s t difficult one to solve. Yet w i t h o u t an a t t e m p t at such integration t h e course m a y leave the s t u d e n t x~dth an impression of d i s c o u r a g ing chaos a n d p o s s i b l y p u s h him into a s e c u r e n i c h e of this o r o t h e r t h e o l y that gives v e r b a l illusion of e s t a b l i s h e d k n o w l e d g e a n d a s a t i s f y i n g closure as a d e f e n s e a g a i n s t intolerable u n c e r t a i n t y . T h u s the intellectual q u e s t c o m e s to an end. T h e theoretical course s h o u l d c o u n t e r a c t this tende2~e), a n d foster the n e v e r - e n d i n g sense of w o n d e r m e n t a n d a n e e d f o r c o n t i n u e d i n d i v i d u a l leanling. TH~ MOt)EL COURSE It is p r o p o s e d that the contents of a formal c u r r i c u l u m should b e o r g a n ~ e d a r o u n d a tripartite core consisting of courses on g e n e r a l p s y c h o p a t h o l o g y , n o r m a l h u m a n d e v e l o p m e n t a n d clinical p s y c h i a t r y . T h e courses s h o u l d continue t h r o u g h o u t the t h r e e - y e a r t r a i n i n g period. T h e last of t h e s e subjects is: sufficiently well e s t a b l i s h e d n o t to n e e d f u r t h e r discussion. T h e course on d e v e l o p m e n t is en~Ssaged a,s a p r e s e n t a t i o n of p s y c h o d y n a m i c , psychological, a n d biological pa-Jnciples a n d facts of the m a j o r p h a s e s of h u m a n life as it evoh,es in the given society. It should s p a n t h e h u m a n life-cycle f r o m birth to old a g e a n d deal w i t h the m o r e c o m m o n l e a r n i n g p a t t e r n s , d e v e l o p m e n t a l sequences, existential crises, a n d h e a l t h - p r o m o t i n g m o d e s of coping. GENEIL4,L ~SYCtlOPAT/IOLOGY
T h e course in g e n e r a l p s y c h o p a t h o l o g y n e e d s m o r e d e t a i l e d c o n s i d e r a t i o n since this subject is at p r e s e n t n e g l e c t e d a n d u n d e f i n e d . T h i s w r i t e r a r g u e s for its revival a n d discusses its tasks elsewhere, a= P s y c h o p a t h o l o g y s h o u l d p l a y the k e y role in integrati1~g the scientific basis of clinical p s y c h i a t r y , i t ix seen as an e m p i r i c a l science of a b n o r m a l b e h a v i o r a n d e x p e r i e n c e of persons. I t consists of o b s e r v a t i o n , desc.ription, methotLs of d a t a g a t h e r i n g , a linguistic a p p a r a t u s , a n d a b o d y of e x p l a n a t o r y hy'potheses of v a r y i n g d e g r e e s of g e n e r a l i z a t i o n . Its h y p o t h e s e s a r e d e r i v e d froo~ t h e psychological, sociological a n d b i o p h y s i c a l m o d e s of a b s t r a c t i o n . This c o n c e p t i o n of p s y c h o p a t h o l o g y as a unified a n d d y n a m i c science is a c o n t i n u a t i o n of a tradition in A m e r i c a n p s y c h i a t r y g o i n g
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b a c k to a p i o n e e r i n g p a p e r b y V a n C,ieson '; p u b l i s h e d in 1898. Its revival a n d return to a central position in p s y c h i a t r i c e d u c a t i o n m a y give s u b s t a n c e to tile prediction of the late F r a n z A l e x a n d e r ~: " I - s e e t h e d e v e l o p m e n t s of the next ten years: in a g r o w i n g integration of the biologic, p s y c h o d y n a m i c a n d sociologic a p p r o a c h e s , a n d the e m e r g e n c e of c.omprehensive p s y c h i a t r y w h i c h no longer a t t e m p t s to solve the g r e a t m y s t e r y of h u m a n b e h a v i o r from one single r e s t r i c t e d p o i n t of view." It is useful, for heuristic reasons, to m a k e a distinction b e t w e e n g e n e r a l a n d special p s y c h o p a t h o l o g y . T h e f o r m e r deals w i t h basic principles, relationships, conceptions, methods, a n d theories; the latter constitutes pathology" of the specific s y n d r o m e s a n d is m o r e c o n v e n i e n t l y dealt w i t h in the context of clinical psychiatry. The p r o p o s e d contents of the courses of lecture.s a n d seminars on g e n e r a l p s y c h o p a t h o l o g y can n o w be s u m m a r i z e d . First Year: ( 1 ) I n t r o d u c t i o n : clefir~ition a n d scope of p s y c h o p a t h o l o g y . (:2) T h e role a n d m e t h o d s of observation, description a n d classification; the conc e p t of n a t u r a l history of disease. ( 3 ) G e n e r a l survey of a|)nornmlities of cognition, perception, p s y c h o m o t o r behavior, emotions, a n d conammaication ill the light of clinical observation a n d c u r r e n t psychological conceptions. ( 4 ) Critical r e v i e w of the key concepts in p s y e h o p a t h o l o g 3, such as a b n o r m a l i t y , reality testing, conflict, anxiet3~, defenses, disorganization, psychological stress, b o d y i m a g e a n d its disorders, c l o u d i n g of consciousness, etc. ( 5 ) Illustrations of p a t h o l o g i c a l states o b t a i n e d from a u t o b i o g r a p h i c a l aceolmts a n d literar.~" \vorks. S e c o n d }'ear: ( 1 ) T h e c o n c e p t of etiology a n d a review of the multifactorial d e t e r m i n a n t s of a h n o r m a l b e h a v i o r a n d experience. E m p h a s i s on the d y n a m i c interplay of the etiological factors in p r o d u c i n g various forms of psychological m a l a d j u s t m e n t . (2.) G e n e r a l principles of p s y c h o s o m a t i c interrelationships a n d conceptions of the b o d y - m i n d p r o b l e m . (:3) E x p e r i m e n t a l p s y c h o p a thology. A s u r v e y of the current r e s e a r c h m e t h o d s in tlm field with special emphasis on recent techniques such as variation of sensory inpnt, d e p r i v a t i o n of sleep a n d d r e a m s , m o d e l psychoses, hypnosis, stressfld interviews a n d films, animal research, etc. T h i r d Year: (1) Critical survey of psychological, biological, p s y c h o d y n a m i c , a n d sociological e x p l a n a t o r y h y p o t h e s e s a n d theories. ( 2 ) P s y c h o p a t h o l o g i c a l m e t h o d o l o g y ~ i . e . , application of the conceptions of t h e philosophy of science to the m e t h o d s , language; a n d t h e o r y formation. (.3) ]-]istory of p s y c h o p a tholog3~. T h e p r e c e d i n g outline is not, of course, m e a n t to b e either c o m p l e t e or final, h u t is offered h e r e as a basis for discussion. Psychiatric literature is replete with generalizations a b o u t an ideal c u r r i c u l u m , but concrete proposals are g e n e r a l l y lacking a n d a p r o p o s e d scheme, such as the one given here, m a y at last lead the discussion from the g e n e r a l to the particular. T h e writer also believes t h a t in v i e w of the c u r r e n t u n c e r t a i n t y r e g a r d i n g the subject m a t t e r of p s y c h o p a t h o l o g y a m o r e d e t a i l e d consideration of its t e a c h i n g was in order. To this tripartite core should b e a d d e d brief courses on biological a n d social sciences, d e p e n d i n g on the availability of t i m e a n d teachers.
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I~OSTCIIADUATE TI:~A1NIN(; IN I'SYCII1ATt~'~" ] ' I t E TEACt~IEllS
W h o s h o u l d teach these courses a n d h m v ? A discussion of t e a c h i n g In¢,tnotas w o u l d fall o u t s i d e t h e scope of this p a p e r . O n t h e q u a l i t y of t h e t e a c h e r s such a m o d e l c u r r i c u l u m s t a n d s or falls. T h e r e m u s t be a d e l i b e r a t e a n d o r g a n i z e d a t t e m p t to train p s y c h i a t r i c t e a c h e r s w h o s h o u l d f i r s t a t t e m p t i n t e g r a t i o n of t h e m a t e r i a l in their o w n m i n d s b e f o r e t r y i n g to t e a c h it. T h e w r i t e r p r o p o s e s the f o r m a t i o n of an advanced i~stitute a t t a c h e d to a w e l l ' d i v e r s i f i e d p s y c h i atric c e n t e r w h e r e m e n w i l l i n g to d e d i c a t e t h e m s e l v e s to t e a c h i n g a s a c a r e e r could s p e n d some m o n t h s or even y e a r s of t r a i n i n g in t e a c h i n g t e c h n i q u e s . T h e t e a c h i n g of p s y c h o p a t h o l o g y s h o u l d not b e left to w e l l - m e a n i n g a m a t e u r s . A t r a i n i n g i n s t i t u t e s h o u l d p r o v i d e t]m i n t e l l e c t u a l c l i m a t e o f free d i s c u s s i o n a n d a l l o w for d e m o n s t r a t i o n lectures a n d s e m i n a r s before; Critical a u d i e n c e s . A similar p r o p o s a l h a s b e e n m a d e b y /~ueseh, ~4 a n d its i m p l e m e n t a t i o n is an u r g e n t m a t t e r . T r a i n i n g t h e t e a c h e r s is not t h e c o m p l e t e a n s w e r : h o w e v e r . T h e r e a r e also p e r s o n a l q u a l i t i e s whiela d i s t i n g u i s h good from b a d teat:hers. 3qae m o s t i m p o r t a n t is p e r h a p s tim a p p r o a c h to t e a c h i n g not u n l i k e that of a c r e a t i v e c r a f t s m a n to his c h o s e n craft. I can d o n o b e t t e r t h a n q u o t e an o]d professor in one of C h e k h o v ' s g r e a t s h o r t stories: "No k i n d of sport, no kind of g a m e or diversion, h a s ever g i v e n m e such e n j o y m e n t as l e c t u r i n g . O n l y at lectures h a v e I b e e n able to a b a n d o n m y s e l f e n t i r e l y to p a s s i o n , a n d h a v e u n d e r s t o o d t h a t i n s p i r a t i o n is n o t an i n v e n t i o n of t h e poets, b u t exists i n real life... "" ~'~ Is it n o t h i g h t i m e to s t a r t a s e a r c h for a n d offer t h e besi t r a i n i n g to p s y c h i a t r i s t s m o v e d - b y this i d e a l a n d b o l d e n o u g h n o t to be d e t e r r e d b y the diflqculties i n h e r e n t in t h e task of i n t e g r a t i n g our k n o w l e d g e ? SU,X t ~AY/Y
T h e e x p a n d i n g scope of the scientific basis of p s y c h i a t r y as well as t h e m o u n t i n g social p r e s s u r e for p s y c h i a t r i c services call f o r a r e e v a h m t i o n of t h e c u r r e n t p o s t g r a d u a t e t r a i n i n g curricula. T h e r e is a n e e d for an o p e n discussion of b o t h t h e g e n e r a l goals a n d the p a a ~ c u ] a r c o n t e n t s of t h e p o s t g r a d u a t e courses. T h e clinical t e a c h i n g is of crucial i m p o r t a n c e for t h e i m p a r t i n g of d i a g n o s t i c a n d t h e r a p e u t i c skills. It m u s t b e s u p p l e m e n t e d b y formal theoretical courses c o n s i s t i n g of lectures a n d s e m i n a r s e x t e n d i n g over at le.ast t h r e e years. T h i s p a p e r p r e s e n t s a t e n t a t i v e m o d e l of such a d i d a c t i c course to be b u i l t a r o u n d t h r e e core s u b j e c t s : g e n e r a l p s y c h o p a t h o l o g y , n o r m a l h u m a n d e v e l o p m e n t , a n d clinical p s y e h i a t ~ , . It is felt t h a t such a c u r r i c u l u m could a d a i e v e t h e i n t e g r a t i o n of t h e b a s i c sciences of p s y c h i a t r y a n d p r e p a r e t h e s t u d e n t p l w s i c i a n s #or a n y t y p e of clinical, r e s e a r d a , or t e a c h i n g c a r e e r in t h e field. It is p r o p o s e d t h a t £onaaation of an a d v a n e e d i n s t i t u t e for the t r a i n i n g of t e a d a e r s in p s y e h i a t ~ , is u r g e n t l y n e e d e d . REFERENCES l.
2.
A l e x a n d e r , F. : T h e next ten year~ in psychiatry'. A m e r . J. P s y c h o t h e r . 12: 4 3 8 - 442, 1958. Cameron, D. E. : T i l e psye]fiatric t r a i n i n g networi~ of ~lcGiil U n i v e r sity. A m e r . J. p s y d a i a t . 1 2 0 : 1 0 3 9 ,
1044, 1964. :3. C a m e r o n , D. E . : T r a i n i n g of p s y d l i a trists. ComDr. Psychi nt , 6 : 2 2 7 - 2 3 5 , 1965. 4. F r e y h a n , /:. A.: A r e v i e w of Traini~g
the Psychiatrist to Meet
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5.
6.
7.
8.
9.
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Needs. Amer. J. Psychiat. 122: 718719, 1965. Freyhan, F. A.: On the psychopathology of psychiatric education. Compr. Psychiat. 6:221-:2926, 1965.. Gieson, I. Van: Correlation of the sciences in the investigation of nervous and mental disease. Arch. Neurol. Psychopathol. 1 ::295-262, 1898. Grinker, R. R., Sr.: A struggle for eclecticism. Amer. J. Psychiat. 121: 451-457, 1964. C;rinker, 11. R., St.: Psychiatry rides madly in all directions. Arch. Gen. Psychiat. 10:228-237; i964~ Hendrick, I.: Psydfiatry Education Today. New York, International Universities Press, Inc., 1965. Hoch, P. 1t.: Comments on graduate psychiatric education. Compr. Psychiat. 5:133-136, 1964.
11. Kubie, L. S.: A school of psychological medicine within tile framework of a medical school and university. J. Med. Educ. 39:,17%480, 1964. 12. Lipowski, Z. J.: Psychopathoh)gy as a science. Compr. Psyehiat. 7:175-182, 1966. 13. Rado, S.: Fundamental seientillc goals of psychiairie education: Compr. psychiat. 6:3-5, 1965. 14. Ruesch, J.: Adwmced training for psychiatric teaching and research. J. Ncrv. Ment. Dis. 128:115-124, 1959. 15. Sheptlerd, M.: Psychiatric education in the United States and United Kingdom: similarities and contrasts. Compr. psychiat. 6:246-254, 1965. 16. Tchehov, A.: Select Tales. London, Chatto and Windus, 1954, p. 482. 17. Training the Psychiatrist to Meet Changing Needs. Washington, American Psychiatric Association, 1963.
CREASING SCOPE AND I Nnecessitate constant revision
C O M P L E X I T Y of t h e field of p s y c h i a t r y of p o s t g r a d u a t e t r a i n i n g p r o g r a m s in this specialty. A climate of d y n a m i c c h a n g e , c o n c e p t u a l confusion, a n d d i s c o n t e n t w i t h the c u r r e n t state of the field, so well d e s c r i b e d b y G r i n k e r , s c a n be fe]t. This intellectual f e r m e n t i n e v i t a b l y affects those c o n c e r n e d w i t h t h e p l a n n i n g a n d i m p l e m e n t a t i o n of p o s t g r a d u a t e t r a i n i n g . It faces e a c h i n d i v i d u a l t e a c h e r with the d i l e m m a of e i t h e r f o l l o w i n g t h e safe grooves of the status q u o in his te:aching activity or of e x p e r i m e n t i n g with n e w a p p r o a c h e s a n d a t t e m p t s a t a synthesis of d i s p a r a t e k n o w l e d g e . This p a p e r is a n o u t g r o w t h of one t e a c h e r ' s e x p e r i e n c e a n d his reflections. It deals with only one f a c e t of p o s t g r a d u a t e training: the aims, str3mture, a n d contents of a theoretical course consisting of lectures a n d seminars. T h e w r i t e r leaves u n t o u c h e d t h e r e l a t e d b u t m o r e often discussed a r e a of clinical t e a c h i n g a n d experience. A n u m b e r of p u b l i s h e d c o n t r i b u t i o n s d e v o t e d to t h e p o s t g r a d u a t e t r a i n i n g of psychiatrists h a v e a p p e a r e d lateh,. 2.a.,'.r,'~'~t.la'la.l; T h e most thought-prov o k i n g a n d c o m p r e h e n s i v e s t a t e m e n t of the goals of s u c h t r a i n i n g can b e f o u n d in the R e p o r t of the Cofiference on G r a d u a t e P s y c h i a t r i c E d u c a t i o n , p u b l i s h e d u n d e r the Significant title, T r a i n i n g t h e P s y c h i a t r i s t to M e e t the C h a n g i n g Necd.s'. ~: It is t h e c h a n g i n g needs vchich a r e Significant. T h e g r o w i n g e m p h a s i s on p r e v e n t i v e a n d c o m m u n i t y p s y c h i a t r y , on t h e biological a n d social determigrants of b e h a v i o r , on p s y c h o p h a r m a c o l o g y , a n d on closer Cooperation w i t h the rest of m e d i c i n e ~ t o intuition just a f e w c u r r e n t d e v e l o p m e n [ s ~ p r e s e n t s psy-ehiatrie t e a c h e r s v¢ith a f o r m i d a b l e c h a l l e n g e . W e are f a c e d w i t h tim task of s t r u c t u r i n g the t r a i n i n g of a n e w g e n e r a t i o n of p s y c h i a t r i s t s in such a w a y as to m a k e t h e m c a p a b l e of g r a s p i n g the e x p a n d i n g scope of p s y d a i a t r y a n d of a s s i m i l a t i n g n e w a d v a n c e s . T h e concepts a n d criteria of m e n t a l illness are e h a n g i n g u n d e r the social pressures. T h e s e p r e s s u r e s force u s to a s s u m e the role of experts in the p r o b l e m s of m a n ' s p s y c h o l o g i c a l a d a p t a t i o n to his h u m a n a n d n o n h u m a n environmen{; yet this e n v i r o n m e n t is itself in a dyn a m i c state of c h a n g e . Psychiatrists a r e i n c r e a s i n g l y e x p e c t e d to offer remedies for a l e n g t h e n i n g list of m o d e s of h u m a n discontent, v a l u e a n d identity crises, a n d simple u n h a p p i n e s s . T h e s e are the " c h a n g i n g n e e d s " on "o,-hidl w e m u s t "'cast a cool eye" a n d steer a b a l a n c e d course b e t w e e n r u s h i n g to m e e t society's d e m a n d s a n d p r e s e r v i n g o u r i d e n t i t y as m e d i c a l p r a c t i t i o n e r s a n d scientists. This is a c h a l l e n g e w h i c h calls for a p u b l i e discussion a n d e x c h a n g e of views a m o n g us. T h e p r e s e n t p a p e r is a t e a c h e r ' s c o n t r i b u t i o n to such a dialogue. Z. J. L]powsgt, M.B., B.CiI., D.PsYcH.: Assistant Pro[essor o[ Ps!/chiatrff, ~fcOill Universtt!!, and Associate Psychiatrist, Allan 3fcmorial Irt~'titute o[ Psychiatry~, Alontreal, ()uebcc, Canada. 183 C.().XII'I~EHI'~NSIVi~ P.~IYO|IATHY, '~'O|.. 8, NO. 3 (JUNE), 19~7
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The Report referred to earlier states the goals of training unequivocally: "')ks t h e s u b j e c t m a t t e r r e l e v a n t f o r p s y c h i a t r y becomes more abundant and more complex, training programs should strive to keep the resident's mind open to new advauces from whatever disciplines they may come. To this end, programs n e e d t o b e f l e x i b l e in s c o p e , a n d t o b e p e r m e a t e d by a holistie att i t u d e a b o u t m e n t a l h e a l t h a n d i l l n e s s . " ,7 A S a l u t a r y g o a l i 1 1 d e e d , b u t h o w c a n it b e a c h i e v e d i n p r a c t i c e ? F r e y h a n , ~ i n a r e v i e w o f t h e l { e p o r t , e x p r e s s e s disappointment t h a t it f a i l e d t o o f f e r a c u r r i c u l u m m o d e l w h i c h would reflect t h e c h a n g i n g t r e n d s . I t is s u r e l y e a s i e r t o o f f e r w e l l - s o u n d i n g generalities than to translate them into practice, and this must be the teacher's job. T H E P~E.~]SES B e f o r e d i s c u s s i n g d e t a i l s of" a m o d e l a few premises or postulates on which
c o u r s e , it m a y b e f i t t i i l g t o the, w r i t e r b a s e s it.
torn'uOate
1. Psychiatry is a clinical discipline and art to b e distinguished from the empirical sciences on w h i c h it is based. T h e c h i e f amo~l.,.,' tllese are p s y c h o p a t h o l o g y 1"_' and normal p s y c h o l o g y , including p s y c h o d y n a m i c s , ~. T h e shifting, relative, a n d c~Iturally d e t e r m i n e d conct,pts of mental health and illness refer to an individual's, as well as a group's, current state of psychological a d a p t a t i o n to the h u m a n a n d n o n h u m a n cnx'ironmt:l~t. Both health and illnt,ss arc m~dtidetormiz~ed and d e p e n d on social, biological, and experit'ntial factors. :3. Psychiatry is b y the v e r y nature ~f its activities aml sc'ientiflc basis au t't'lectic discipline. It d e p e n d s on a n d strives to int¢',~ratt" in theory at~d action t w o n l m u , l l y irr e d u c i b l e m o d e s of abstraction~i.e-., t h e personal and st,cial on the oi~e h a n d vmd. on the other, the biophysical. 4. Eclecticism implies a sc'ientific a t t i t u d e b a s e d on the follo~vin~ beliefs: that systc, matic o b s e r v a t i o n a n d its publicly: av~tilable records are the fiTial c'riteriotl of truth; tlmt tLvpoiheses a n d theories are necessary co~niti','e tools for e x p a n d i n ~ and or,2anizin~ ~,mpirical k u o w l e d g e ; that intuition and l m n c h e s are i n d i s p e n s a b l e .~tddes to d i s c o v e r y b u t not cxiteria of its validity: that no one o w e s aile,~iance to a t h e o ~ ' a n d fanaticism is i~c'ompatible with the .~pirit of free i n q u i o ' ; a n d that k n o w l e d g e at a n y point in time is o p e n - e n d e d and no s t a t e m e n t s need be a c c e p t e d w h i c h are "'dispr~tff-proof.'" 5. O u r teachin.~ p r o g r a m s have to m a k e allow-race for the expantliIIg k n o w l e d g e a n d the i m m e d i a t e social needs. At the s a m e time, w e should insist ¢m the preserxation of the a c a d e m i c s t a n d a r d s a n d goals w h i c h cannot rellect each passing fashion. T h e r e is no d o u b t that psyehiato" as a discipline has to discharge its p u b l i c responsibility a c c o r d i n g to the c u r r e n t d e m a n d s of society. But e q u a l l y i m p o r t a n t is our role as scie~tists striving, to exp a n d the k n o w l e d g e almut m a n w h i c h can h a v e both practical usefulness a n d offer the esthetic satisfaction of a clearer t m d e r s t a n d i n ~ of h u m a n e x p e r i e n c e a n d behavior. T h o s e of us c o n c e r n e d with teaehin~ should b e the last m e m b e r s of the psyciaiatrie c o m m u n i t y to j u m p on e v e r y n e w b a n d w a g o n plastered with lofty slogans a b o u t mental health. 6. T h e trainin.e, must b e formally s t r u c t u r e d a n d include a theoretical course the ,~oals of w h i c h are to integrate k n o w l e d g e , inspire intellectual curiosity, a n d offer a c h e c k on the intuitive aspects of clinical work. 7. Interest in the m i n d is the eore of p s y c h i a t r i c e d u c a t i o n , as H e n d r i c k ~ poit~ts out, b u t the teaching m u s t go b e y o n d t h e psyeholot~ical f o u n d a t i o n of o u r k n o w l e d g e a n d strive for a ~:nit'ersalis't v i e w of m a n in health a n d disease. P s y c h o d y n a m i c s is an i n d i s p e n s a b l e part of such e d u c a t i o n , b u t it m u s t not displace o t h e r e n d e a v o r s to explain h u m a n behavior. 8. T h e basic issues in t h e r a p y revolve a r o u n d three c o n c e p t s : reversibility, modifiability, and c o m p e n s a b i l i t y of the p a t i e n t ' s p a t h o l o g y mid his e n v i r o n m e n t b y a n y m e a n s at our disposal.
]~OS'FGIIADUATE T R : I I N I N ( ;
IN
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"file m o s t crucial issues ill p l a n n i n g a" t h e o r e t i c a l p o s t g r a d u a t e course in p s y c h i a t r y a r e those of releoance, selection, a n d integration of t h e t e a e h h a g material. I t is a s s u m e d t h a t the c u r r i c u l u m s h o u l d r e f l e c t a d e q u a t e l y t h e contributions of the psychological, social, a n d biological sciences to t h e traders t a n d i n g , t r e a t m e n t , a n d p r e v e n t i o n of m e n t a l illness, b u t t o p r e s e n t all the r e l e v a n t facts a n d theories w o u l d b e impossible in the t i m e available. B u t w h a t are t h e critelSa of r e l e v a n c e ? O n e c o u l d say t h a t r e l e v a n t to flae course are those facts, m e t h o d s , concepts, a n d theories w h i c h a r e necessaD', or at least t e m p o r a r i l y useful, for the e x p l a n a t i o n of h u m a n e x p e r i e n c e a n d behavior, b o t h n o r m a l a n d a b n o r m a l . Yet r e l e v a n c e is not an all-or-none concept. T h e r e are d e g r e e s of it d e p e n d e n t on the c u r r e n t k n o w l e d g e , trends, a n d i n d i v i d u a l choice. Tht~s the p r o b l e m of selection of m a t e r i a l to be t a u g h t i n e v i t a b l y reflects a p a r t l y subjective j u d g m e n t . T h e p r o b l e m of m e a n i n g f u l integn'ation of t h e diverse r e l e v a n t facts a n d theories is the m o s t difficult one to solve. Yet w i t h o u t an a t t e m p t at such integration t h e course m a y leave the s t u d e n t x~dth an impression of d i s c o u r a g ing chaos a n d p o s s i b l y p u s h him into a s e c u r e n i c h e of this o r o t h e r t h e o l y that gives v e r b a l illusion of e s t a b l i s h e d k n o w l e d g e a n d a s a t i s f y i n g closure as a d e f e n s e a g a i n s t intolerable u n c e r t a i n t y . T h u s the intellectual q u e s t c o m e s to an end. T h e theoretical course s h o u l d c o u n t e r a c t this tende2~e), a n d foster the n e v e r - e n d i n g sense of w o n d e r m e n t a n d a n e e d f o r c o n t i n u e d i n d i v i d u a l leanling. TH~ MOt)EL COURSE It is p r o p o s e d that the contents of a formal c u r r i c u l u m should b e o r g a n ~ e d a r o u n d a tripartite core consisting of courses on g e n e r a l p s y c h o p a t h o l o g y , n o r m a l h u m a n d e v e l o p m e n t a n d clinical p s y c h i a t r y . T h e courses s h o u l d continue t h r o u g h o u t the t h r e e - y e a r t r a i n i n g period. T h e last of t h e s e subjects is: sufficiently well e s t a b l i s h e d n o t to n e e d f u r t h e r discussion. T h e course on d e v e l o p m e n t is en~Ssaged a,s a p r e s e n t a t i o n of p s y c h o d y n a m i c , psychological, a n d biological pa-Jnciples a n d facts of the m a j o r p h a s e s of h u m a n life as it evoh,es in the given society. It should s p a n t h e h u m a n life-cycle f r o m birth to old a g e a n d deal w i t h the m o r e c o m m o n l e a r n i n g p a t t e r n s , d e v e l o p m e n t a l sequences, existential crises, a n d h e a l t h - p r o m o t i n g m o d e s of coping. GENEIL4,L ~SYCtlOPAT/IOLOGY
T h e course in g e n e r a l p s y c h o p a t h o l o g y n e e d s m o r e d e t a i l e d c o n s i d e r a t i o n since this subject is at p r e s e n t n e g l e c t e d a n d u n d e f i n e d . T h i s w r i t e r a r g u e s for its revival a n d discusses its tasks elsewhere, a= P s y c h o p a t h o l o g y s h o u l d p l a y the k e y role in integrati1~g the scientific basis of clinical p s y c h i a t r y , i t ix seen as an e m p i r i c a l science of a b n o r m a l b e h a v i o r a n d e x p e r i e n c e of persons. I t consists of o b s e r v a t i o n , desc.ription, methotLs of d a t a g a t h e r i n g , a linguistic a p p a r a t u s , a n d a b o d y of e x p l a n a t o r y hy'potheses of v a r y i n g d e g r e e s of g e n e r a l i z a t i o n . Its h y p o t h e s e s a r e d e r i v e d froo~ t h e psychological, sociological a n d b i o p h y s i c a l m o d e s of a b s t r a c t i o n . This c o n c e p t i o n of p s y c h o p a t h o l o g y as a unified a n d d y n a m i c science is a c o n t i n u a t i o n of a tradition in A m e r i c a n p s y c h i a t r y g o i n g
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z.j.
L~rOWSKl
b a c k to a p i o n e e r i n g p a p e r b y V a n C,ieson '; p u b l i s h e d in 1898. Its revival a n d return to a central position in p s y c h i a t r i c e d u c a t i o n m a y give s u b s t a n c e to tile prediction of the late F r a n z A l e x a n d e r ~: " I - s e e t h e d e v e l o p m e n t s of the next ten years: in a g r o w i n g integration of the biologic, p s y c h o d y n a m i c a n d sociologic a p p r o a c h e s , a n d the e m e r g e n c e of c.omprehensive p s y c h i a t r y w h i c h no longer a t t e m p t s to solve the g r e a t m y s t e r y of h u m a n b e h a v i o r from one single r e s t r i c t e d p o i n t of view." It is useful, for heuristic reasons, to m a k e a distinction b e t w e e n g e n e r a l a n d special p s y c h o p a t h o l o g y . T h e f o r m e r deals w i t h basic principles, relationships, conceptions, methods, a n d theories; the latter constitutes pathology" of the specific s y n d r o m e s a n d is m o r e c o n v e n i e n t l y dealt w i t h in the context of clinical psychiatry. The p r o p o s e d contents of the courses of lecture.s a n d seminars on g e n e r a l p s y c h o p a t h o l o g y can n o w be s u m m a r i z e d . First Year: ( 1 ) I n t r o d u c t i o n : clefir~ition a n d scope of p s y c h o p a t h o l o g y . (:2) T h e role a n d m e t h o d s of observation, description a n d classification; the conc e p t of n a t u r a l history of disease. ( 3 ) G e n e r a l survey of a|)nornmlities of cognition, perception, p s y c h o m o t o r behavior, emotions, a n d conammaication ill the light of clinical observation a n d c u r r e n t psychological conceptions. ( 4 ) Critical r e v i e w of the key concepts in p s y e h o p a t h o l o g 3, such as a b n o r m a l i t y , reality testing, conflict, anxiet3~, defenses, disorganization, psychological stress, b o d y i m a g e a n d its disorders, c l o u d i n g of consciousness, etc. ( 5 ) Illustrations of p a t h o l o g i c a l states o b t a i n e d from a u t o b i o g r a p h i c a l aceolmts a n d literar.~" \vorks. S e c o n d }'ear: ( 1 ) T h e c o n c e p t of etiology a n d a review of the multifactorial d e t e r m i n a n t s of a h n o r m a l b e h a v i o r a n d experience. E m p h a s i s on the d y n a m i c interplay of the etiological factors in p r o d u c i n g various forms of psychological m a l a d j u s t m e n t . (2.) G e n e r a l principles of p s y c h o s o m a t i c interrelationships a n d conceptions of the b o d y - m i n d p r o b l e m . (:3) E x p e r i m e n t a l p s y c h o p a thology. A s u r v e y of the current r e s e a r c h m e t h o d s in tlm field with special emphasis on recent techniques such as variation of sensory inpnt, d e p r i v a t i o n of sleep a n d d r e a m s , m o d e l psychoses, hypnosis, stressfld interviews a n d films, animal research, etc. T h i r d Year: (1) Critical survey of psychological, biological, p s y c h o d y n a m i c , a n d sociological e x p l a n a t o r y h y p o t h e s e s a n d theories. ( 2 ) P s y c h o p a t h o l o g i c a l m e t h o d o l o g y ~ i . e . , application of the conceptions of t h e philosophy of science to the m e t h o d s , language; a n d t h e o r y formation. (.3) ]-]istory of p s y c h o p a tholog3~. T h e p r e c e d i n g outline is not, of course, m e a n t to b e either c o m p l e t e or final, h u t is offered h e r e as a basis for discussion. Psychiatric literature is replete with generalizations a b o u t an ideal c u r r i c u l u m , but concrete proposals are g e n e r a l l y lacking a n d a p r o p o s e d scheme, such as the one given here, m a y at last lead the discussion from the g e n e r a l to the particular. T h e writer also believes t h a t in v i e w of the c u r r e n t u n c e r t a i n t y r e g a r d i n g the subject m a t t e r of p s y c h o p a t h o l o g y a m o r e d e t a i l e d consideration of its t e a c h i n g was in order. To this tripartite core should b e a d d e d brief courses on biological a n d social sciences, d e p e n d i n g on the availability of t i m e a n d teachers.
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I~OSTCIIADUATE TI:~A1NIN(; IN I'SYCII1ATt~'~" ] ' I t E TEACt~IEllS
W h o s h o u l d teach these courses a n d h m v ? A discussion of t e a c h i n g In¢,tnotas w o u l d fall o u t s i d e t h e scope of this p a p e r . O n t h e q u a l i t y of t h e t e a c h e r s such a m o d e l c u r r i c u l u m s t a n d s or falls. T h e r e m u s t be a d e l i b e r a t e a n d o r g a n i z e d a t t e m p t to train p s y c h i a t r i c t e a c h e r s w h o s h o u l d f i r s t a t t e m p t i n t e g r a t i o n of t h e m a t e r i a l in their o w n m i n d s b e f o r e t r y i n g to t e a c h it. T h e w r i t e r p r o p o s e s the f o r m a t i o n of an advanced i~stitute a t t a c h e d to a w e l l ' d i v e r s i f i e d p s y c h i atric c e n t e r w h e r e m e n w i l l i n g to d e d i c a t e t h e m s e l v e s to t e a c h i n g a s a c a r e e r could s p e n d some m o n t h s or even y e a r s of t r a i n i n g in t e a c h i n g t e c h n i q u e s . T h e t e a c h i n g of p s y c h o p a t h o l o g y s h o u l d not b e left to w e l l - m e a n i n g a m a t e u r s . A t r a i n i n g i n s t i t u t e s h o u l d p r o v i d e t]m i n t e l l e c t u a l c l i m a t e o f free d i s c u s s i o n a n d a l l o w for d e m o n s t r a t i o n lectures a n d s e m i n a r s before; Critical a u d i e n c e s . A similar p r o p o s a l h a s b e e n m a d e b y /~ueseh, ~4 a n d its i m p l e m e n t a t i o n is an u r g e n t m a t t e r . T r a i n i n g t h e t e a c h e r s is not t h e c o m p l e t e a n s w e r : h o w e v e r . T h e r e a r e also p e r s o n a l q u a l i t i e s whiela d i s t i n g u i s h good from b a d teat:hers. 3qae m o s t i m p o r t a n t is p e r h a p s tim a p p r o a c h to t e a c h i n g not u n l i k e that of a c r e a t i v e c r a f t s m a n to his c h o s e n craft. I can d o n o b e t t e r t h a n q u o t e an o]d professor in one of C h e k h o v ' s g r e a t s h o r t stories: "No k i n d of sport, no kind of g a m e or diversion, h a s ever g i v e n m e such e n j o y m e n t as l e c t u r i n g . O n l y at lectures h a v e I b e e n able to a b a n d o n m y s e l f e n t i r e l y to p a s s i o n , a n d h a v e u n d e r s t o o d t h a t i n s p i r a t i o n is n o t an i n v e n t i o n of t h e poets, b u t exists i n real life... "" ~'~ Is it n o t h i g h t i m e to s t a r t a s e a r c h for a n d offer t h e besi t r a i n i n g to p s y c h i a t r i s t s m o v e d - b y this i d e a l a n d b o l d e n o u g h n o t to be d e t e r r e d b y the diflqculties i n h e r e n t in t h e task of i n t e g r a t i n g our k n o w l e d g e ? SU,X t ~AY/Y
T h e e x p a n d i n g scope of the scientific basis of p s y c h i a t r y as well as t h e m o u n t i n g social p r e s s u r e for p s y c h i a t r i c services call f o r a r e e v a h m t i o n of t h e c u r r e n t p o s t g r a d u a t e t r a i n i n g curricula. T h e r e is a n e e d for an o p e n discussion of b o t h t h e g e n e r a l goals a n d the p a a ~ c u ] a r c o n t e n t s of t h e p o s t g r a d u a t e courses. T h e clinical t e a c h i n g is of crucial i m p o r t a n c e for t h e i m p a r t i n g of d i a g n o s t i c a n d t h e r a p e u t i c skills. It m u s t b e s u p p l e m e n t e d b y formal theoretical courses c o n s i s t i n g of lectures a n d s e m i n a r s e x t e n d i n g over at le.ast t h r e e years. T h i s p a p e r p r e s e n t s a t e n t a t i v e m o d e l of such a d i d a c t i c course to be b u i l t a r o u n d t h r e e core s u b j e c t s : g e n e r a l p s y c h o p a t h o l o g y , n o r m a l h u m a n d e v e l o p m e n t , a n d clinical p s y e h i a t ~ , . It is felt t h a t such a c u r r i c u l u m could a d a i e v e t h e i n t e g r a t i o n of t h e b a s i c sciences of p s y c h i a t r y a n d p r e p a r e t h e s t u d e n t p l w s i c i a n s #or a n y t y p e of clinical, r e s e a r d a , or t e a c h i n g c a r e e r in t h e field. It is p r o p o s e d t h a t £onaaation of an a d v a n e e d i n s t i t u t e for the t r a i n i n g of t e a d a e r s in p s y e h i a t ~ , is u r g e n t l y n e e d e d . REFERENCES l.
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A l e x a n d e r , F. : T h e next ten year~ in psychiatry'. A m e r . J. P s y c h o t h e r . 12: 4 3 8 - 442, 1958. Cameron, D. E. : T i l e psye]fiatric t r a i n i n g networi~ of ~lcGiil U n i v e r sity. A m e r . J. p s y d a i a t . 1 2 0 : 1 0 3 9 ,
1044, 1964. :3. C a m e r o n , D. E . : T r a i n i n g of p s y d l i a trists. ComDr. Psychi nt , 6 : 2 2 7 - 2 3 5 , 1965. 4. F r e y h a n , /:. A.: A r e v i e w of Traini~g
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Needs. Amer. J. Psychiat. 122: 718719, 1965. Freyhan, F. A.: On the psychopathology of psychiatric education. Compr. Psychiat. 6:221-:2926, 1965.. Gieson, I. Van: Correlation of the sciences in the investigation of nervous and mental disease. Arch. Neurol. Psychopathol. 1 ::295-262, 1898. Grinker, R. R., Sr.: A struggle for eclecticism. Amer. J. Psychiat. 121: 451-457, 1964. C;rinker, 11. R., St.: Psychiatry rides madly in all directions. Arch. Gen. Psychiat. 10:228-237; i964~ Hendrick, I.: Psydfiatry Education Today. New York, International Universities Press, Inc., 1965. Hoch, P. 1t.: Comments on graduate psychiatric education. Compr. Psychiat. 5:133-136, 1964.
11. Kubie, L. S.: A school of psychological medicine within tile framework of a medical school and university. J. Med. Educ. 39:,17%480, 1964. 12. Lipowski, Z. J.: Psychopathoh)gy as a science. Compr. Psyehiat. 7:175-182, 1966. 13. Rado, S.: Fundamental seientillc goals of psychiairie education: Compr. psychiat. 6:3-5, 1965. 14. Ruesch, J.: Adwmced training for psychiatric teaching and research. J. Ncrv. Ment. Dis. 128:115-124, 1959. 15. Sheptlerd, M.: Psychiatric education in the United States and United Kingdom: similarities and contrasts. Compr. psychiat. 6:246-254, 1965. 16. Tchehov, A.: Select Tales. London, Chatto and Windus, 1954, p. 482. 17. Training the Psychiatrist to Meet Changing Needs. Washington, American Psychiatric Association, 1963.