The Training of the Neurologist and the Psychiatrist
Reprinted from the Archives of Neurology and Psychiatry. New York. 1934-35.
Nine papers, originally published serially in the Archives of Neurology and Psychiatry, have been collected together under one cover with an Editorial peroration. The series deals with the training of the Neurologist and the Psychiatrist and is of an international character. Contributions by Dr Brouwer of Amsterdam, Dr. Lhermitte of Paris and Dr Walshe of London, convey something of European opinion, while American points of view are diversely presented in the remainder. The general practitioner receives small consideration in these papers which are preeminently concerned with the consultant neurologist and psychiatrist. This is a serious omission since it is the early relatively unspecialised training such as the general practitioner receives, which decides in a specialised direction, and a critical authority at that time is a protection against obscurantism and warring sectarianism.
All the writers appear to be in fair agreement concerning the fundamentals of specialist training. These lie in the study of anatomy, physiology, psychology, pathology, etc. Sound experience in general medicine with a long apprenticeship in the special clinics is reaffirmed. Experience is still the mother of efficiency and Dr Walshe and Dr. Meyer particularly stress this, in keeping with the best traditions of British Medicine.
Differences arise in considering the scope of specialist practice. The argument of training is the argument of limitation of scope in practice. Specialised branches of medicine are becoming more interdependent with the growth of knowledge. In Psychiatry alone, the problems of Mental Disorder have become linked with those of the Biochemist, Endocrinologist, Geneticist, etc. Since this is so, it would appear arbitrary to impose a limit on interests and consequently a limit on practice. Yet this is what some would seek to do.
The main reason for this attitude would appear to be an economic one. An encroachment on specialist preserves involves a monetary loss to someone, and that someone is likely to object. The grounds of the objection are only adequate if the encroachment is to the detriment of the patient. Such an encroachment should certainly be obstructed until the bona fides and talents of the newcomer are demonstrated, but the obstruction should be in the interest of the patient, not of the doctor.
In Neurology, the doubtful territories are the Neuroses and Psychoneuroses, Neurosurgery, and certain infections such as cerebrospinal fever usually dealt with by the Paediatrician. These represent a therapeutic spread of neurological interest and impose a responsibility which can only be dealt with by special training.
The doubtful territories of Psychiatry are Neurology and certain aspects of Paediatrics met with in Child Guidance. To deny the interests of these subjects to the Psychiatrist implies an insularity of interest and training which cannot hold.
The Editor, summing up, states the position plainly. Were the Neurologist and the Psychiatrist each trained to the satisfaction of the other, they would form a united front in the interests of public health against cultists, quacks and others. The great goal ahead is the medically and surgically intelligent ” neuropsychiatrist ” who will be the physician to treat patients with nervous and mental disease. A B S
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