The New Freedom Commission's proposed mental health overhaul ("Reforming mental health care," October Monitor) worries me, and Dr. Levant's optimism (President's column, October Monitor) doesn't reassure. The trouble is, mental illness is not "…just like any other illness." The pathogens are quite different from those which cause most physical disease, and they often have moral components (e.g., child abuse/neglect). Mental illness, quite unlike infections, organ disease, autoimmune disease, cancers, etc., is most often diagnosed from behavior in a cultural context. While we want to reduce or eliminate mind-body dualism and recognize the constant important mind-body-behavior interactions in all our activities and experiences, I doubt that considering mental illness to be just like physical illness will benefit the mentally ill or the emotionally disturbed. And it absolutely does commit clinical psychology to the medical model, which is inappropriate for much of what we do. For example, a person shouldn't haveto be diagnosed (pronounced ill) in order to receive psychotherapy.
Parity is desirable if it means that mental illness is just as worthy of treatment as "physical" illness (sorry for the dualism), but it shouldn't mean it's the same, because it isn't.
Linda Waters, PhD
Levant is correct that psychology has much to contribute to those who experience severe distress, whether they be Hurricane Katrina survivors, those who have gone through rape, war or other trauma, those who may be depressed or anxious, or those with an Axis II personality style.
However, missing from our current president's equation is the fact that environmental issues such as poverty, racism and traumatic experiences are equally present-and more likely predominant in many clients. We see in his statement an image of the profession localizing problems or "disorders" in the client, thus providing many with an excuse to avoid pertinent issues of environmental stress or cultural oppression.
There is not such thing as post-traumatic stress "disorder." It took Vietnam veterans to teach us that we needed a new diagnosis of post-traumatic stress. It was clear that that the crazy-making experiences of Vietnam were the cause; but medicine and psychiatry took their observations and soon added the "D" to PTS and placed the "disorder" in the patient. Let us re-redefine post-traumatic stress as a logical response to extreme environmental challenges.
Those who face racism, heterosexism, ageism and other forms of oppression need not be termed "mentally ill." Our profession needs to extend its present commitment and address the inequities being played out in human and economic terms throughout the nation rather than falling into the "illness" trap.
Allen E. Ivey, EdD
University of Massachusetts, Amherst
First, the issue is not "the Cartesian dichotomy between the 'mental' and 'physical.'" The real issue is whether people can learn to behave abnormally with a normal brain. The current model insists that all "mental illnesses" are brain diseases that must be treated with drugs. But if the behavior is learned through normal biophysiological processes, then they can be unlearned-and even prevented-with drug-free social-environment interventions. Prescription authority for psychologists is irrelevant. Forced drug treatment is wrong.
Second, the unreliability of psychiatric diagnoses is well established. A quarter century ago there were 80 psychiatric diagnoses. Now there are 300. Are one quarter of Americans afflicted? Will half of all Americans really be "mentally ill" at sometime in their lives? With a brain disease? This is psychiatry's official position. Parity will only reinforce this folly.
Third, psychiatry has a long history of not only being wrong, but dangerous. Bleeding, ice-baths, cruelty, chemical and electric shock, lobotomy and social isolation were all inhumane failures. Current drug treatments have long-term damaging effects.
Fourth, psychology could indeed be leading the way to a more humane and effective model of emotional disturbance by focusing on the causative role of social injustices like poverty and such discrimination as sexism, racism, classism, homophobia and ageism. Let's have a scientific debate!
George W. Albee, PhD
Longboat Key, Fla.
I am pleased to see that my column has stimulated such interest. We clearly do not have all the answers in regard to long-term mental illness. I agree with some of the points made by the commentators. May the dialogue continue.Supporting psychologist troops
In reference to C.A. Totton's letter in the October 2005 Monitor, there seems to be some misunderstanding that military psychologists are somehow supportive of the current Department of Defense (DoD) policy on homosexual acts or acknowledgment of lesbian, gay or bisexual orientation. This policy has been established by Congress, not military psychologists. In this time of national crisis, the U.S. military desperately needs military psychologists who are willing to be public servants for our country and to deploy to dangerous locations around the world to provide psychological support and treatment for our troops.
Banning advertising in the Monitor has no impact on changing the law, it only limits the military's ability to recruit psychologists and psychology interns who want to voluntarily join the military and make an important contribution to our country. There is no evidence, scientific or anecdotal, that military psychologists feel any different about the current DoD policy than do civilian psychologists. If you oppose the policy, address it to Congress or your local legislators. Oppose the law, but support our military psychologist troops.
Alan L. Peterson, PhD
Assuming we believe that the military services should obey laws rather than ignore them, does it follow that APA should deny psychological services to military personnel because they are fulfilling their oath to support and defend the constitution? I don't think so.
It seems to me that our approach should be positive; rather than punishing the victims, we should be trying to change the law-an approach endorsed by both Div. 19 (Society for Military Psychology) and Div. 44 (Society for the Psychological Study of Lesbian, Gay and Bisexual Issues). One final note, lest we head off into a series of Red/Blue finger pointing: The law in question was passed by a Republican Congress, but signed by none other than Bill Clinton.
William J. Strickland, PhD