Letters

Past presidents' remarks
I WAS ALARMED that George Albee, at the last APA convention, said that psychologists must work to "get rid of organized religion," largely because he sees it as a major source of social injustice (page 20, December Monitor). I always thought psychologists were ethically obligated to respect the diversity of others, and to use their resources and expertise to build up communities, not tear apart one of their most valuable segments.

There is no question that organized religions do adhere to particular beliefs that seem problematic, even offensive, but Albee might do well to remember that organized religions also spend much time advocating their constituents to be moral, charitable and kind. What other cultural organization (despite its imperfections) leads this charge?

His recommendation to "get rid of" religion is an archaic notion, a throwback to psychologists of old, who made no attempt to understand religion, but ignored, dismissed and sometimes trod on the cherished beliefs of its memberships. Despite some clear ideological differences, today many psychologists and members of organized religions are working hard to accomplish good things together, to foster more mutual understanding, respect and, most importantly, serve the needy.

Perhaps Albee has simply been unaware of these endeavors.

JIM GUINEE, PHD
Conway, Ark.

GEORGE ALBEE MAKES IT CLEAR he is a foe of organized religion. Are we to assume that he is a proponent of disorganized religion?

CHARLES L. WALTER, PHD
Johnson City, Tenn.

I HEARD ROBERT PERLOFF speak in San Francisco. Your article in the December Monitor proves his point. He really said, "The APA is too goddamn politically correct, too goddamn bureaucratic and too goddamn obeisant to special interests." Funny, but the word "goddamn" never made it into your article. Were the PC police on patrol? Scared of stepping on some toes? Shame on the APA! Censorship is a terrible practice. Print what the man said, then leave it up to the readers to react as they see fit.

BRIAN JONES
San Diego

Evolutionary theory
IN HIS PLENARY ADDRESS (December Monitor), Frans B.M. de Waal discussed the potential evolutionary theory for providing a unifying framework for understanding behavior and simultaneously cautioned against its simplistic application. While I concur with his general premise, as the author of the study that he criticized, I find the Monitor article problematic for several reasons.

It appears from the article that Dr. de Waal's criticism is based entirely on the first line of the abstract, which is quoted in the Monitor without context. It was not noted that the research was published in the leading peer-reviewed journal in the field of evolutionary psychology and included a thorough evolutionary analysis based on standard biological assumptions. In fact, Darwin himself postulated that facial hair may have evolved through sexual selection.

Evolutionary theory suggests that genetic characteristics that develop after the reproductive years are not subject to evolutionary pressures. Consequently, Dr. de Waal's analogy of male pattern baldness (which is sexually dimorphic and appears at sexual maturity) to Alzheimer's disease is gratuitous. The inexact representation of any research is a disservice to Monitor readers. Further, there is no indication from the Monitor article of how Dr. de Waal differentiates between simplistic and non-simplistic uses of evolutionary theory in social science research. Dr. de Waal suggests that there are a priori reasons for rejecting some avenues of study but does not indicate what these are. His position may discourage innovative use of evolutionary theory and its application to understudied behaviors.

FRANK MUSCARELLA, PHD
Barry University

Speaking on prescription privileges
I WAS SURPRISED AND DISTRESSED to see my quotes in the "Soundbites from APA's Annual Convention" in the December Monitor: The Monitor incorrectly reported that I was speaking "against" prescription privileges. In fact, the title of my paper was "How can we preserve psychological practice after prescription privileges?"

Since APA went on record approving prescription authority for psychologists, I have not spoken against prescription privileges for psychologists in any public forum. Rather, I have warned of dangers associated with prescriptive authority and made several recommendations to help ensure that our field does not become overwhelmed with and distorted by the forces inherent in prescribing. This need for vigilance if and when psychology obtains prescriptive authority is what I was referring to when I stated, "The very essence of psychological practice is at stake."

As a democratic organization, APA made the decision to pursue prescription privileges, and although I argued against it at the time, I believe it essential that all APA members not openly oppose official APA policy. I find it pathetic and most unproductive, for example, when members of APA testify against official positions APA has taken on this (and other) issues in their state legislatures--few actions are more damaging to our field and to us as psychologists. On any complex issue such as prescription privileges there are bound to be those on the winning side and those on the losing side. If psychology is to survive, especially in these formidable times, each of us must pull together with a common voice even when our position on an issue turns out to be in the minority.

GARLAND Y. DENELSKY, PHD
Solon, Ohio

Psychology's response to terrorism
IN MID-NOVEMBER, 35 PSYCHOLOGISTS from the Boston area met to discuss what we might do--as teachers, researchers, scholars, practitioners--in the aftermath of the Sept. 11 tragedy. The immediate stimulus for our meeting was the statement of the APA Board of Directors' Subcommittee on Psychology's Response to Terrorism, which was circulated by the Council of Representatives. We were dismayed by its self-serving emphasis. The primary aim seemed to be enhancing opportunities for clinical practice through media campaigns to persuade the public that "it is an act of patriotism to be as resilient as one can to defeat the purpose of the terrorists" and that psychologists are the experts to turn to for "stress and anxiety management." Of course, psychologists have a contribution to make to the treatment of trauma, grief and mourning. But it trivializes the deep and widespread suffering in the United States and other countries to use Sept. 11 as an opportunity to expand psychology's turf and "position psychology as a key national resource, perhaps as significant as the repositioning that occurred after World War II."

The narrow focus on individual functioning in the subcommittee's statement and the exclusion of any reference to the political and historical contexts of the Sept. 11 attack not only prevent an adequate understanding of its sources and consequences, but also exclude any critical analysis of our government's response. Pleased to have "requests for assistance" from "mission critical governmental departments such as Defense, State, the FBI, etc." the statement ignores such ethical issues as the bombing of innocent civilians, the detaining of ethnically-profiled suspects without judicial review, the erosion of civil liberties through the anti-terrorism act; and it fails to address relevant theoretical and empirical questions about, e.g., the effects of conformity and the suppression of dissent, the impact of racism and stereotypes, the long-term consequences of chronic violence and oppression. Our concerns about these issues are reinforced by the resolution on terrorism adopted by the APA Board of Directors at its early December meeting. Although it differs in details, it essentially reaffirms the narrow perspective of the subcommitee statement.

Finally, rather than isolating ourselves on grounds of our special expertise and looking out primarily for our own interests, we think it is important to work with others in our communities and institutions to find out what we have to offer that is useful to our collective struggle for a less violent and more just and humane world. In this way, we might find our way back from a view of psychology as a manual of techniques to a deeper understanding of it as an area of inquiry and a social practice with both an ethical and a scientific mandate.

BOSTON-AREA PSYCHOLOGISTS FOR PEACE AND
JUSTICE
Letter signed by 46 psychologists in the Greater
Boston area

RESPONSE FROM RONALD F. LEVANT: The APA Board of Directors Subcommittee on Psychology's Response to Terrorism was formed just a few days after the Sept. 11 attacks. During the last few months, as we have spent many hours responding to colleagues who requested information or wanted to offer their services, we have been awed at the generosity and responsiveness of psychologists to this crisis. Although we have attempted to reach out to many colleagues to get diverse input by attending the meetings of many APA boards and committees during the fall consolidated governance meetings, it is clear that we have not been able to hear from all of the groups that might wish to comment, such as the Boston Area Psychologists for Peace and Justice. I hope that we have opportunities to expand the dialogue over the coming months.

I do wish to make one corrective comment. The subcommittee did not ignore issues of ethnic profiling, erosion of civil liberties and racism. We state quite clearly in the memo: "We are also looking at what psychologists might contribute to addressing the rising number of anti-Islamic and anti-Middle Eastern hate-crime incidents, racial profiling and the erosion of civil liberties." Furthermore, we state in the resolution: "Be it further resolved that the American Psychological Association...condemns prejudice leading to harassment, violence and hate crimes."

To view the full resolution, visit www.apa.org/governance and look for the minutes of the December 2001 Board of Directors meeting.

Sometimes aggression may be necessary
IN SANDRA REINHOLD'S LETTER in the November Monitor ("What message are we sending?"), she wrote that "our country is failing to exercise impulse control and conflict resolution skills" as NATO forces retaliate against the al-Qaeda. She draws a metaphor for how this is contrary to her work with children and adolescents. I acknowledge that encouraging "impulse control, anger management and conflict resolution" is an approach I use with children exhibiting acting-out behavior. However, to make her metaphor more accurate would be to say that one of her clients was being relentlessly pursued by homicidal zealots who had mercilessly killed members of her client's family (on several different occasions) and vowed openly to continue to do so in the name of God. Surely we would not suggest to our clients that their rage was inappropriate or recommend they approach such individuals to attempt conflict resolution. I would suggest that my clients obtain help from law enforcement and be prepared to fight for their lives if necessary. To promote passivity when their enemy's intent is murder would be to encourage victimization.

We should help clarify for our clients that these decisions are not straightforward and that they may seem antithetical to their beliefs. We should help our young clients understand that sometimes aggression may be necessary. We can help them recognize that when talking will not protect them from more violence, when walking away will only perpetuate future brutality and when their rage is justifiable, giving the other guy a bloody nose (however repugnant) may be the only way to curtail future aggression.

STEVEN KENNELLY, PHD
Princeton, N.J.

End-of-life issues
WE WERE PLEASED TO SEE THAT APA is taking the lead in addressing end-of-life issues (October issue), but we were disappointed by the inaccurate clich├ęs that were apparently dispensed in the July 18 congressional briefing.

We are referring to Barry Rosenfeld's unsubstantiated claims that most depressed terminally ill patients are not being treated because physicians are reluctant to prescribe antidepressants. Rosenfeld's own research found that whereas only 17 percent of terminally ill patients were depressed, 40 percent of all patients in his sample were receiving an antidepressant. Our work finds that a third of breast cancer patients are receiving an antidepressant. That includes 75 percent of all patients with major depression, but many more patients who have never been depressed. Nonspecific prescription of antidepressants without adequate follow-up or demonstrated benefit is part of the problem of end-of-life care, not the solution to unmet needs. Rates of prescribing of antidepressants now exceed the prevalence of depression, particularly among the elderly. Casual dispensing of antidepressants has become an expedient alternative to a sensitive eliciting and humane addressing of patients' needs, not only at the end of life, but throughout medical care. We hope that the next time APA seeks to inform Congress about end-of-life issues, it will come armed with accurate data.

JAMES C. COYNE, PHD, AND STEVEN PALMER, PHD
University of Pennsylvania Comprehensive Cancer
Center

RESPONSE FROM DR. ROSENFELD: Drs. Coyne and Palmer point out an important discrepancy and, unfortunately, a continued source of concern in the clinical treatment of medically ill individuals. I certainly share their concern regarding the "casual" dispensing of psychotropic medications and hope that my comments would not serve to justify the continued or expanded prescription of antidepressants unnecessarily. I would, however, caution against over-interpreting the statistics offered, since many medically ill individuals are prescribed antidepressant medications for reasons other than severe depression (e.g., neuropathic pain, insomnia). But perhaps more importantly, my comments (which were summarized into a single sentence for the Monitor but obviously encompassed a wider range of issues and "data") were not intended to suggest an expanded role for psychotropic medications among the terminally or medically ill. Rather, I am more concerned with the difficulties in accurately identifying depression in the context of a medical or terminal illness. Thus, while it is perhaps heartening that Drs. Coyne and Palmer found that 75 percent of the individuals with a major depression in their study were receiving antidepressant medications, it does not address what proportion of depressed patients were actually identified as depressed (which my own research suggests is likely to be a modest fraction of the total). When patients are identified as suffering from depression, clinical resources available are often more than adequate (including psychotherapeutic interventions, not just antidepressant medications), but without an adequate assessment, the risk of failing to diagnose depression when it exists or over-prescribing antidepressants for those who are not genuinely depressed rises. This was the thrust of my comments in Washington, not the need to expand antidepressant prescribing practices.

Sexual harassment in schools
I STRONGLY SUPPORT THE SUGGESTIONS given in the September Monitor article "Harassment in the hallways" that call for psychologists to "help create school environments where sexual harassment isn't ignored." Helping students become aware of the policies and how to report harassment along with getting parents and the community involved are key to attacking harassment issues. The unity of parents and the community is a powerful force in this world. Their unity has enough power to change board of education policies--even government policies. However, it must first be realized. Once the parents and community are made aware of the harassment issue they will likely place pressure on schools to create a sexual harassment policy.

This article emphasized the importance of children being made aware of sexual harassment policies and the importance of staff training on those policies. In my own view, parental involvement is a key in creating schools that will and do carry out school training. Finally, as an example of the kind of training that is not mentioned in the article, I suggest that psychologists can help parents by training them about how to react when their child has been sexually harassed. In my personal experience of being harassed as an elementary school student, my mother contacted the boy's guardian to discuss the issue. This turned out to have several positive consequences, and in retrospect I see it as an excellent example of how parents can and should be involved in the area of sexual harassment.

CRYSTAL A. BOST
Auburn University

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