Are medications necessary?

In response to your February cover story, I question the standard practice of using alleviation of DSM-based symptoms as a measure of the effectiveness of antidepressant drugs. Such practice assumes that depression is a bad thing, an experience to be avoided at all costs. I don't think that is the case. I think most depressions are states of being that are essentially functional and that can be very useful to people.

Perhaps a better measure of effectiveness would be the degree to which patients are able to use all of their faculties--including the ability to feel bad when faced with difficult dilemmas and life crises.

Al Galves, PhD Las Cruces, N.M.

Inspired by Woody Allen?

It's fascinating that, according to the Professional Psychology study reported in the February Monitor ("Spirituality's importance to practicing psychologists"), the percentage of clinical psychologists who prayed last year is higher than the percentage who believe in God. (The reverse is true for the general U.S. population.) Indeed, it's reassuring that clinicians are drawing inspiration from Woody Allen, who famously observed, "I don't believe in the afterlife, although I am bringing a change of underwear."

Michael Morris, PhD West Haven, Conn.

More balance on RxP

In regard to the articles on psychopharmacology, the Monitor could have provided a more objective and balanced discussion about why so little progress has been made in securing prescription privileges for psychologists. It would have been helpful, for example, if the Monitor had noted that:

  • Some psychologists, including APA members, have been quite vocal in their opposition to RxP.

  • No other health-care profession supports psychologists gaining RxP.

  • An article in the American Journal of Law and Medicine, "Fool's Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority," exposes the logical flaws underlying APA's prescriptive agenda and questions the APA's training model and practice models for RxP. For example, despite completing almost 40 percent more education and training than that recommended by psychologists to write prescriptions, no state allows physician assistants to prescribe independently of a physician; no wonder no other professional group supports RxP.

  • After years of vigorous advocacy by supporters of RxP, and who knows how much money spent by the APA, only two states have passed RxP bills. The leadership of APA consistently discusses as evidence of the power and tenacity of the foes of RxP. A more balanced assessment of limited success would include consideration of the insufficient support for RxP, including among the membership of APA, who have reason to be wary and skeptical of it.

Richard Sethre, PsyD Minneapolis

It's strain, not stress

Norman Anderson's February column on work stress shows that psychologists are in a full-blown state of co-dependency, urging working people to feel like weak victims who need help from compassionate rescuers. I feel embarrassed to be in a health-care profession that is more than 30 years out of date in its understanding of the artificial, consensus reality called "work stress."

When Dr. Hans Selye, the physician who created the concept "biological stress" retired, he apologized for making a serious mistake. In his 1977 memoirs he explained that "stress" was not the term he should have used to describe his research findings. He said that when he came from Europe he did not understand the English language or physics terms very well. He said he should have named his research findings the "strain syndrome."

Anderson's column documents how psychologists are pandering to the inclination of many workers to blame a situation for their reaction to it. This, even though we all know that there is no objective way to measure workplace stress because "work stress" experiences are subjective. The issue isn't the situation, it's how each person handles it that counts. If we truly want to help workers, it is far more useful to teach them how to monitor their inner feelings of strain, find their optimum strain level, and learn how workplace strains can make them stronger and more resilient.

Lawrence A. Siebert, PhD Portland, Ore.

RESPONSE from the Society for Occupational Health Psychology

In our view, it is inaccurate and irresponsible to blame workers for their adverse reactions to poorly managed workplaces. Occupational health psychology (OHP) literature has identified many organizational practices and conditions (i.e., stressors) that create strain. Examples include long hours, downsizing, violence, abusive leaders, night work and poor compensation. Several decades of OHP research has established (using multiple data sources) that measures of these stressors are distinct from measures of strain. A consistent theme in this literature is that some situations are more conducive to health problems than others (i.e., those with higher levels of stressors).

Of course, enhancing workers' resilience and coping are important aspects of promoting worker health. However, OHP advocates a preventive approach that emphasizes improving management practices and working conditions. For instance, psychologists can help organizations design work schedules that create less strain rather than encouraging workers to try to "handle" unhealthy schedules. To learn more, we encourage APA members to visit the Society for Occupational Health Psychology (SOHP) Web site (www.sohp-online.org), read the Journal of Occupational Health Psychology, and attend the biannual "Work Stress and Health" conference (which Dr. Anderson mentioned). These sources provide many empirically supported insights about how to improve management practices to reduce employee strain.

Robert R. Sinclair, PhD Portland State University, SOHP president

Janet Barnes-Farrell, PhD University of Connecticut, SOHP secretary/treasurer

Peter Y. Chen, PhD Colorado State University, SOHP past president

Leslie B. Hammer, PhD Portland State University, SOHP past president

More research needed

The February article "The two faces of oxytocin," discussing oxytocin as an emotional "bonding" agent, did not offer much of a critique of the cited studies on human beings. The Fries et al. study of Eastern European adoptees is an important case in point, as this nonrandomized design could not ascertain whether children placed for adoption had pre-existing characteristics, involving both hormone levels and social responsiveness, which made their placement more probable. Like other mammals, humans experience hormonal effects of emotion, but human social behavior develops through a complex, nonlinear dynamic action system, and uncritical reporting does not help readers understand this.

Jean Mercer Pomona, N.J.

What's in a title?

I had to chuckle as I read Dr. Breckler's "Science Directions" column in the February Monitor regarding what he perceived to be a distancing from the title "psychologist."

This column appeared after Dr. Phil McGraw was described by media outlets as a psychologist. Despite the concern noted by Dr. Breckler that "some ... deliberately seek to shed their identities as psychologists," I would argue that the cadre of media entertainers that includes Dr. Phil has not distanced itself enough from this title and, in fact, lowers the public understanding of the term "psychologist" when it fails to correct media outlets who call them such.

Calling Dr. Phil a psychologist demeans the very nature of this protected title and implies that he is licensed and governed by a state board, which he is not. It also serves to confuse the public about the role and behavior of true (i.e., licensed) psychologists.

Samantha L. Wilson, PhD East Providence, R.I.