The author makes critical use of official statistics on the rapidly growing school-age and adolescent population in America, on the increasing population in the older decades, on the projected future needs of the country for physicians and surgeons, and on the predictable future supply of medical students. From these data he calculates the discrepancy between the most conservative estimates of America's future need for practitioners of psychodiagnosis and psychotherapy and the most optimistic estimates of the future supply of medically trained psychiatrists. The author assumes further that for many decades the early use of psychodiagnosis and psychotherapy will continue to be our major preventive device. The conclusion is inescapable that the existing discrepancy is destined to become even larger. To fill this gap the author proposes that a new profession of doctors in medical psychology should be trained under the joint auspices of medical schools and universities, in close association with physicians, surgeons, and psychiatrists, to be licensed to practise psychodiagnosis and psychotherapy, but again only in clearly defined association with physicians. He views the development of such a profession as the only means of closing the gap; and urges that such a programme be launched in a series of small pilot tests, which should limit themselves at first to the training of teachers. The programme would begin to yield results for science and for the community as a whole in about twenty-five years.
In addition to these logistical arguments, the author presents philosophical and scientific reasons for believing that appropriately trained behavioural scientists who represent the various allied disciplines will make essential contributions to the science of psychiatry, as well as practical sociological and clinical contributions to the community.
As outlined by the author, the minimal basic training for such non-medical behavioural scientists would consist of: (a) scientific methodology in general; (b) the use of statistical devices; (c) basic
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sciences, both exact and biological (comparable to the course in the basic medical sciences, now offered at the Harvard Medical School, for men who intend to do medical research but not to practise medicine); (d) normal and pathological physiology; (e) medical and psychiatric social work; (f) the social and individual psychology of organic as well as psychological illness. This would include practical experience as attendants and clerks in medical, surgical, and psychiatric wards and out-patient departments, plus full training in psychometric and projective techniques for the psychological testing of all such patients; (d) full indoctrination in medical traditions of therapeutic responsibility and of therapeutic scepticism and self-critique; (h) specific training in the techniques of psychiatric anamnesis, psychodiagnosis, and psychotherapy, including psycho-analysis.
As projected, this training would begin in medical and surgical wards and out-patient departments, progressing thence through the social service departments to psychiatric wards and out-patient departments. The entire curriculum would take six to seven years after graduation from college; or approximately one-half of the time now required to complete the training of a medical psychiatrist. It would equip the non-medical behavioural scientist to meet the challenges of psychodiagnosis and psychotherapy as maturely as does the best trained young medical psychiatrist of today. The author emphasizes repeatedly that the first step in any such programme must be the training of a corps of teachers; and that the yield in trained practitioners would not begin until twenty to twenty-five years after the initiation of the programme.
The author considers also such problems as the organization of the teaching faculty; the relationship between the medical school, the department of medical psychology, and the university department of general psychology; the choice of specially mature students for training as teachers; the later selection of the general run of students; the initial need for foundation financing; the establishing of safeguards against the possibility of overlooking organic ailments; the problems of examination, licensing, and certification. Many difficulties and objections are also discussed, as well as problems of timing and strategy. These details must be studied in detail by anyone interested in exploring this new approach to an ancient deadlock.
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(1956). Texas Reports on Biology and Medicine XII, 1954, Pp. 692–737. Int. J. Psycho-Anal., 37:512-513