APA: Keep up the inspiring work
Does your APA have a reciprocal membership relationship to my APA? After reading your cover story in the October issue on "Curbing Climate Change," I'm most impressed and jealous. While the American Psychiatric Association has been silent on climate change, the American Psychological Association boldly broadcasts the contributions psychology and behavior can make to address the risks.
One of the bullet points in the article was that "it's not clear exactly how climate change will affect people psychologically, but it's likely to be devastating." Recently, I reviewed that data for Physicians for Social Responsibility. That group shared the Nobel Peace Prize in 1985 for addressing the risks of nuclear proliferation; now we think global warming is as big a future risk to humanity. The fact sheet on the mental health risks is on its Web site.
The only other suggestion I have is for psychology to reconsider the terminology we are using. "Climate change" seems so benign psychologically speaking, as the change can be for the better or worse. Applying it to our own field, how about "climate instability" (like "mental instability," something that needs to be helped)? And global warming is also too benign. Here in Wisconsin, we would like a little warming this winter. More effective might be "global boiling."
Keep up the inspiring work.
H. Steven Moffic, MD
Medical College of Wisconsin
Clinical utility and the DSM-V
"Improving diagnosis worldwide" in the October Monitor describes the goals of the World Health Organization in developing the International Classification of Diseases and Related Disorders and the important role psychologists are playing—especially in the chapter on mental and behavioral disorders.
The article provided a good assessment of the need for clinical utility in establishing diagnostic criteria, but it was misleading when it implied a diminished role for the Diagnostic and Statistical Manual of Mental Disorders (DSM) because ICD-11 codes will be required in reporting mortality and morbidity data to WHO as well as for the Health Insurance Portability and Accountability Act. Actually, this is not a change. ICD codes have always been used for these purposes. The fact is the DSM-IV codes are compatible with ICD-9-CM and ICD-10, as DSM-V will be compatible with ICD-10 and ICD-11. Codes in the DSM will continue to be "crosswalked" to the appropriate ICD codes so clinicians can continue to use DSM descriptors and diagnostic criteria for many purposes, including medical records, quality assessment, medical review, consultation and patient communications.
The development of the DSM-V has been the most inclusive in the history of the manual—involving an international team of researchers and clinicians from various mental health disciplines. Harmonization with ICD is a high priority. As a psychologist on the DSM-V Task Force and chair of the Sexual and Gender Identity Disorders Work Group, I can tell you that the overriding goal in developing DSM-V is to create an evidence-based manual that is useful to clinicians. One of the biggest changes expected in the new edition of the DSM is the increased use of dimensional measures, which will assist clinicians in evaluating the severity of symptoms while improving their ability to assess symptoms across diagnostic categories.
Kenneth J. Zucker, PhD
DSM-V Task Force, Chair, Sexual and Gender Identity Disorders Work Group
Electronic health records
While the "Smart charts" article in the October Monitor highlighted electronic health record benefits, clinical practitioners should be aware of problems experienced by physicians in small group or individual practices. For psychologists working in hospitals or medical centers where the organization provides hardware, software and training, the shift from paper to the electronic health record may be stressful, but will not be costly. However, psychologists in small group or individual practices may find shifting from paper records to electronic health record to be financially overwhelming and clinically problematic.
Electronic health records are not yet widely used; fewer than 10 percent of U.S. hospitals have fully functioning electronic health records, partly because of the time and cost of integrating all hospital departments into the system. Small group medical practices and clinics have been slow to adopt such systems because of the costs. Physician income drops for several years because of the investment costs for an electronic health record system; $50,000 per physician plus ongoing system maintenance is not unusual. Plus, because physicians spend more time getting information into the system, they see fewer patients per day, and their reduced income may not recover for several years.
Interoperability among different electronic health records is a major problem. Because the software is proprietary, health information created in one system often cannot be read by another. Psychologists thinking about electronic health records must analyze their interoperability needs and decide whether they can afford a system compatible with that of other practitioners, referral sources, medical practices, hospitals, etc.
Mark Hochhauser, PhD
Golden Valley, Minn.
A letter on a letter
Dr. Carl Ward's letter to the editor in the October Monitor states an unpleasant fact. He writes: "Does the board (APA's Board of Directors) really believe that psychologists and psychiatrists just started consulting in PsyOps and interrogation strategies with the Bush administration?" He goes on to state that he disapproves of the board's attempt to create policy for psychologists who may be in the military or in police or intelligence work. Dr. Ward advances the argument that the board cannot know the circumstances under which psychologists assist these groups in their struggle to defeat our enemies and, therefore, its pronouncement about what is and is not ethical may very likely be irrelevant, at best.
First of all, the board's authority extends only to members of APA. Second, expulsion from membership is its only sanction. Finally, it has not only the right, but the duty to specify what is appropriate ethical behavior for its members. Dr. Ward's argument sounded like, "The ends justify the means."
William A. Myers, PhD
Cape Coral, Fla.
The importance of history
The March Monitor contains a letter by Dr. Annie Lee Jones of Hollis, N.Y., under the heading "Whitewashing history?" Dr. Jones's letter is in response to the January Monitor's feature "Time Capsule," regarding the birth of American intelligence testing. According to Dr. Jones, this feature whitewashes Henry H. Goddard's influences on intelligence testing and various social engineering policies that have impact to this day. Goddard translated Binet's intelligence test into English. (Alfred Binet died in Paris in 1911. Goddard died in the United States in 1957.)
According to Jones, Goddard was a long-term advocate of several early forms of the eugenics movement. She suggests that rather than praising Goddard for his pioneering translation of the Binet, a full examination of psychology's past role in court-ordered compulsory sterilization of the poor, "feebleminded" or not, in an effort to demonstrate such individuals' inheritability might serve us better than praising Goddard. But there is more to this history of Goddard's career. To be fair, we must note Goddard's chagrin when he learned how his famous Kallikak Family (a popular work) was used by Hitler and Nazi Germany to advance racism and Aryan superiority. This probably led Goddard to modify and reject many of his earlier views.
Interestingly, Goddard's concepts and popular reactions by many fellow professionals are strikingly similar to what happened to my long-term good friend Raymond Cattell, (who incidentally, is related to neither McKeen Cattell nor Psyche Cattell). Raymond Cattell and I were both born and educated in the United Kingdom.
Cattell was an outstanding scholar and researcher who made seminal contributions to personality and intelligence theory. His meticulous research led him to a hereditary view of intelligence and the conclusion that intelligence, as he conceptualized it, is largely a matter of genetics.
Over the years, I knew beyond doubt that Cattell was a data-based scientist and never a racist. Around 1997, when Cattell was nominated by the American Psychological Foundation for its highest Lifetime Achievement Award, several prominent psychologists objected—a controversy I learned from Cattell himself. Cattell explained to me how some of his ill-advised statements of youth had been taken out of context and misinterpreted, and indicated that he sent a detailed open letter of explanation to the APF. He died a few months after writing this letter, leaving this controversy unresolved.
Thus, for both Goddard and Cattell, history was more in the facility of the pen than so-called facts, whitewashed or otherwise. Regardless, these more recent events do not seem to reflect well on the history of psychology.
Cyril M. Franks, PhD
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