Psychiatric training for future responsibilities.

Abstract

The developmental trends of psychiatric practice have, over the past year or so, become an increasing concern for both psychiatrists and community. The British Mental Health Bill, the U.S.A. Joint Commission Report on Mental Health, the Mental Health Services report of the Canadian Mental Health Association and the various psychiatric briefs to the Royal Commission on Health Services, have all given expression to changing need, new patterns of action, and increasing responsibilities in the field of mental disorder. Although many conditions and circumstances will determine the effect of the new thinking and new arrangements, the essential ingredient vitalising the whole is the psychiatrist. Psychiatrists, from a logistic point of view, must be available to the Canadian scene in sufficient numbers and in appropriate distribution. The problems of the university graduate divisions to increase numbers are by no means simple. To raise the ratio of psychiatrists to population from the present 1 in 25,000 to 1 in 15,000 over a decade requires the tripling of present programmes. The creating of well-distributed posts for the increased numbers is an urgent issue at the community level of health organization. Although psychiatry may be thought of as a body of knowledge the applications of that knowledge are various. The heterogeneous nature of psychiatry is more apparent than real: the variegated appearance is due to the differing modes of application of psychiatric knowledge. The educational or training problem is to develop a fundamental body of knowledge in the graduate student and from that base to bring about a concentration of studies in one or other area of application. To allow the graduate students incorporation of a fundamental body of knowledge, the educational matrix must include, in near equal degree, both biological and behavioural ingredients. In each, both structural and functional aspects will require consideration, thus providing an emphasis on relations with both organic medicine and social medicine. Concentration studies, limited to techniques of psychotherapy, will be outmoded. The expansion of learning theory and sociological theory will modify both interrelationship therapy and group therapy. Maturation and development will be better understood in terms of biological and adaptive mechanisms capable of control. As these expansions come about neglected areas—juvenile delinquency, mental retardation, alcoholism etc.—will more definitely be allocated to psychiatry. The embryo psychiatrist, involved in a scene where basic knowledge is growing and focussed studies are clearing, will of necessity become more identified with technical competence in smaller areas. His interest in and sympathy for that kind of research, which first delimits problems before attempting to solve them, will be enhanced. The educational and training programmes will reveal those men who are, not only curious, but also willing and able, to discipline a ranging curiosity in the interest of research discovery. Greater numerical strength, more appropriate distribution, wider ranging basic studies, more focussed concentrations, more specific research endeavours are each and severally the objectives of the developing training programmes. Movement in respect to these objectives will be the greater the more ideas are interchanged across the barriers of provincial boundaries, the cleavage of bilingualism, the entrenchments of status, and the defences of sectarian departments. One of the more important functions of our national Psychiatric Association is to facilitate such interchanges.