Stigma and the military

As both a psychology graduate student and the wife of an Army combat soldier, I have a strong appreciation for the need to quickly de-stigmatize mental health care within the military (June Monitor). Many soldiers whom I have spoken with about mental health care, my husband included, believe there is no confidentiality between a military psychologist and a soldier, and that anything discussed in a session could potentially reach the soldier's commander. I have also heard from other young military couples that they would never go to marital counseling offered through the military for fear that their domestic disputes would become grist for the base's rumor mill. In the civilian world, confidentiality only excludes suicidal and homicidal ideation, but in the military it is perceived to exclude almost everything. Not only is this an unfair practice toward soldiers and their families, but it is also unfair to the psychologists and counselors who are unable to reach a large number of potential patients.

If the military wants to end mental health-care stigma once and for all, it needs to start by correcting confidentiality misperceptions within the ranks, as well as re-examining the limits of confidentiality in military psychology.

Lauren M. Vines
Louisville, Ky.

Where are the psychologists?

I should like to write and say how unfortunately I can resonate with, and daily find evidence for, Dr. Bray's sentiments expressed to us in his June column, "Where have all the psychologists gone?" A case in point is the recent article in the June 22 issue of that reported on how the forefront of mental health should be in prevention. The article makes the valid points that it makes sense to detect mental illness early and to put treatments on board early so as to avoid future suffering and future higher cost mental health care. Where was psychology in this article? Nowhere. The star of the article, pictured looking eerily like Sigmund Freud, was psychiatrist William McFarland. Other researchers mentioned by name were William Beardslee and Thomas McGlashin, both MD psychiatrists. All were referred to as "Dr." of course. Would psychologists be called "Dr." in a article? The only reference to psychology in the entire article was the mention of the journal which reported on verbal learning, verbal memory and processing speeds in schizophrenics. Most likely, lay readers of the article will assume it is a "medical journal" because it begins with "neuro." Even when describing treatments received by patients in the prevention studies, it mentions only social workers, "therapists," psychiatrists and nurse practitioners.

I think there is a definite reason we are not included. tips its hand when it reports that "virtually everyone enrolled in [the prevention programs] is prescribed psychiatric medications." In reporting the effectiveness of the prevention programs, it reports that the prevention program with a "therapy" arm is significantly better than a prevention program with just medication alone. The main concern, it seems to indicate, is getting medications that are given early to be more effective.

The reason psychology is not mentioned at all is that we are not yet visible enough as or vocal enough about being prescribers. Because we are not identified as dispensers of "psychiatric medications," we are and will continue to be marginalized as mental health providers.

As much as I respect the intelligence, skills and talents of all of those who do not wish to prescribe themselves, I do believe that in order for all of us to get the respect we deserve, a certain visible number of us should become medicalized to the point that we can safely and effectively prescribe psychotropic medications.

John R. Thibodeau, PhD
Longwood, Fla.

Dr. Bray's June column speaks to psychologists becoming "generic mental health practitioners" and goes on to lament the fact that many patients do not understand the difference between psychologists and other mental health providers. I cannot blame patients for this misunderstanding. While APA has been steadfastly pursuing prescription privileges, the organization has all but forsaken our psychotherapy roots. I would also like to know what the difference is between psychologists and other mental health providers.

Anyone can under the guise or title of psychotherapist provide psychotherapy, or psychological services for that matter, provided they use another name other than "psychological service." In my area, we have counselors, social workers, even nurses all providing psychotherapy. Even licensed professional counselors can administer, score and interpret psychological tests. The term "psychological services" really speaks to the credential of the provider rather than the type of service being rendered.

APA needs to do a much better job of defending and strengthening our identities as psychotherapists before we are relegated to becoming generic mental health providers.

Efforts to gain hospital privileges, better insurance reimbursement for therapy and psychological testing and dealing with the internship crisis would all be much more worthy pursuits to protect psychology.

Kris Stankiewicz, PsyD
Franklin Park, N.J.

The reason non-clinical psychologists don't identify themselves as such is that the wider culture—and even some clinical graduate students of my acquaintance—presume all "psychologists" are clinicians. As a social psychologist, I sometimes describe myself as a sociologist, since I find that creates an impression much closer to my actual interests and research. Saying "psychologist" instantly produces five minutes of conversation to establish "no, not kind," and even then, many people refuse to believe I can't help them manage their relationships.

Michael J. Donahue, PhD
Arlington, Va.

What dream for psychologists?

As I gazed at the vibrant young couple on the cover of the July/August Monitor I wondered, if they were psychology students, would their "new American dream" be, "We've just gone through five years of psychology graduate study and we can't get an internship. Now all we can afford is a steering wheel."

Andrew Meyers, PhD
Memphis, Tenn.

'Eye for an eye'

The June 2009 article "Revenge and the people who seek it" was marred by a common and unfortunate misinterpretation of the "eye for an eye" verses. The article implied that they were a prescription for revenge, but the truth is quite the opposite. These verses most likely were written to prescribe what actions were (and were not) permissible during violent feuds, thereby preventing the escalating process of revenge and retaliation. This concept eventually became the basis for meting out fair and just punishments in courts of law.

This misinterpretation is a favorite example of mine—along with the infamous 1994 McDonald's coffee lawsuit and the notion that we use only 10 percent of the brain—when teaching about critical thinking and the importance of examining and challenging one's assumptions and beliefs.

Richard Alexander
Muskegon, Mich.