TEACHING OF PSYCHIATRY

553 TEACHING

OF

In

PSYCHIATRY

England

Now

THE approach to the psychological and social aspectsA Running Commentary by Peripatetic Correspondents of disease has changed profoundly in the last twenty SOME of your correspondents seem to me ignorant of years ; and the change is reflected in the two interimthe facts of .life, as applied to their profession. There of to the Physicians was the one who maintained that we are " Royal College reports just presented probably the by their committees on psychological, and on social best educated, most intelligent, most altruistic and most and preventive, medicine. The implications of the latter group in England today." No Sir, I am worldly-wise in our leader (p. z46) ; the psychoare discussed report afraid we are neither well educated nor particularly logical report, which is complementary to it, recognises intelligent. The old tradition still holds good that if that psychiatry has grown beyond the stage at which parents are in doubt how to dispose of their more stupid the student’s needs could be served by a dozen lectureoffspring, the only profession in which they can be demonstrations at a mental hospital : his training in it assured of a guaranteed job is medicine. Any exmust now rank among the most important parts of the perienced teacher will agree with me that the student curriculum. who cannot pass a qualifying examination in medicine is The report suggests that every teaching school should mentally deficient. Those members of the profession have a department of psychiatry for outpatients and inwho have outstanding intellectual ability are, with a few patients with an adequate teaching staff-"as a minimum, obvious exceptions, to be found in the ancillary sciences a psychiatrist, a psychiatric registrar, a resident, a such as physiology and biochemistry. Speaking genernumber of clinical assistants, a psychologist trained in there is no intellectual satisfaction to be obtained intelligence testing, psychiatric social workers and ally in the practice of medicine (or surgery)-emotional secretarial assistants." Psychiatry would thus be yes, and even spiritual satisfaction for some, represented by a complete unit. The committee, more- satisfaction, but the doctor who tries to run his practice on a rational over, look forward to the day when there will be a proand logical basis will soon find himself in the workhouse. fessorial chair of psychiatry in every medical school. Then, to talk as if a state medical service means the end The clinician attached to the department of social and preof all personal initiative and freedom, while the present ventive medicine should work in cooperation with the system of practice is a valhalla of complete freedom, has of as well ’as with the other department psychiatry no relation to reality. What freedom does the average departments of the hospital. GP or consultant possess ? What consultant dare refuse The student, they consider, should take a course in a call, even at the most inconvenient moment ? What normal psychology towards the end of his second preGP dare ignore a summons from a patient ? No, the clinical year, and an introductory course in the psychiatric present archaic system is the acme of slavery and serfdom. aspects of clinical work at the beginning of his first year Either from financial reasons or simply in order to build in the wards. Throughout the clinical period he should up a reasonable practice the practising doctor of today take a systematic course in psychiatry. The syllabus has no semblance of liberty of action. cannot be rigidly laid down since it must be flexible * * * enough to suit different hospitals, but they feel that the If it must be Sicily or North Africa give me Sicily course of lectures and demonstrations should be amplified every time. Nobody seemed to be taking much notice by seminars and discussion groups covering the whole of us as we tripped up the beach from our invading craft. range of mental disorder and mental deficiency. The That nonchalant air which characterises the British course would include meetings in the outpatient departsoldier as he steps out on a foreign strand, and which ments and wards of the hospital, at local psychiatric you have doubtless noticed in the news reels, is quite centres or admission wards in mental hospitals, and visits genuine. It seems the most natural thing in the world to mental deficiency institutions, child guidance clinics to trail away into Sicilian Tommy Atkins that he should " and psediatric outpatient departments. The student as though he were on orange groves and " brew up should spend three months as a clerk in his own hospital Salisbury Plain. I don’t know whether it was the custom psychiatric department during his first or second clinical in the last war, but when a meal or a hot drink is ready year, combining the post with work in one of the other for serving, the cookhouse staff set up the cry, " Tea special departments-preferably the department of up " ; or in the case of a set meal, " Come and get it," neurology. He should examine and make case notes and the invitation is accepted with alacrity by all. But on at least 6 psychotic and 20 neurotic patients. if we were casual in our demeanour as invaders, the conA suggested systematic course covers principles of diagquered people were even more so. True there were no " tears of joy," but there was not the slightest sign of nosis, general causes and pathology of mental illness, principles of prevention and treatment (physical, psychological, resentment; and many of the peasants gave us a smile and the V sign with their fingers as they passed by on and social), toxic and organic syndromes, affective syntheir carts and buggies. The flight of Mussolini and his dromes, schizophrenia, psychopathic personality, hysteria, obsessional syndrome, other psychological aspects of physical gang of thugs was a matter of great satisfaction to them, disease, children, mental deficiency and forensic psychiatry. and many anti-fascists had seized the opportunity to deface the silhouette of Il Duce which appeared It is suggested that during the last clinical year a short resident period in a mental hospital or a clinical clerkship in an on nearly every white wall in the villages we passed observation ward might form part of training, coupled with through. Sicily, at all events, seems to have had a raw deal from the fascist administration. The villages, in the of a visits social worker. company domiciliary psychiatric The committee attach much importance to the teaching of picturesque and bizarre when seen in the distance, are mental deficiency and advise that six of the lecture-demontawdry and squalid on closer inspection. Sanitation is strations in the systematic course should be on this aspect primitive in the extreme, and the dwellings emit a disof psychiatry and that at least two of them should be congusting smell which drifts well beyond the boundaries of the place. On the other hand, the picture postcards ducted at an institution for mental defectives. are exceedingly attractive. Furthermore, the inhabitFinally the committee propose that the student’s ants are fortified by high-sounding extracts from Mussoknowledge of normal psychiatry should be tested by lini’s speeches plastered on the walls of nearly every examination at the end of the preclinical period, and that Exroom of the schools and other public buildings; in the finals there should be a separate examination in hortations to work, to multiply, to suffer, and if necessary psychiatry, to be taken either at the end of the clinical to fight and conquer, have evidently served as political period or earlier. blood-transfusions for a poverty-stricken population for nearly two decades. Having reached the new location in which the Unit is to function, one settles down to the job of helping to BRITISH P1EDIATRIC ASSOCIATION.-The September issue of the Archives of Disease in Childhood contains two reports by make the wheels go round, and quickly becomes detached from the foreign background. The avalanche of patients this association, one on the early diagnosis of tuberculosis in childhood, and the other on arrangements for newly born descends on the establishment. The familiar rhythm of working, eating and sleeping is re-established. Etna babies in maternity hospitals. Copies of these reports may be and its wisp of volcanic smoke fade into the background ; obtained from the acting honorary secretary, Dr. Donald the horizon is limited by a broken ring of " GS Doubles " Paterson, 27, Devonshire Place, London, W.I. ,

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