On Zimbardo's column

I FELT VERY uplifted after reading Dr. Zimbardo's article, "A psychology filled with joy, pride and passion," in the December 2002 issue.

In my senior year at my undergraduate institution, I am in the process of applying to graduate programs. After taking many psychology courses, I finally have to pinpoint which route in psychology that I want to direct me toward my future. Loving research, I have aspirations of being the psychologist that Dr. Zimbardo describes: one dedicated to "research, teaching and applying psychological knowledge." Of course, I am always confronted with uncertainties. Is this really my calling? Will I maximize my potential in another profession? After reading the article, I now know that I am on the right track. He is truly an inspiration.


Wesleyan College

Macon, Ga.

WHILE I CONGRATULATE DRS. Zimbardo, Beutler and Bonger for taking the initiative to head the National Center on Disaster Psychology and Terrorism, I can't help but wonder what has happened to all the years of discussions in APA about the importance of including diversity in major undertakings of this organization. For over 20 years I have watched as APA members discussed the substantial differences in viewpoints and perspectives between women and men. We have watched as numerous issues related to mental health take on different perspectives depending upon a person's religious, ethnic, racial, economic and overall experiential background. So, when leading a center to examine "motives, values and ideology" of people, wouldn't it be worthwhile to include a diverse range of leaders with a diverse range of motives, values and ideology to better synthesize ideas and plan strategies for dealing with the issues? How can we still be seeing leadership in the year 2002 on such important issues as terrorism and trauma overtly excluding gender and ethnic/racial diversity? Are we still just talking the talk?


Rochester, N.Y.

Response from Zimbardo:

YOU ARE RIGHT ON IN YOUR essential point of the necessity to broaden all APA-related activities with appropriate diversity representation. It has been one of my goals as APA president and a long-held personal value to honor multiplicity of perspectives, to respect the vitality of views that flow with opening the playing field to all who can contribute to the game.

However, the center on disaster psychology reported in the Monitor is not an APA organization, but one that I and my two colleagues (Bruce Bongar and Larry Beutler) formed recently and independently to deal with a variety of mental health, research and educational issues arising from human-induced disasters. There is no question that we will include representative input across gender, race, ethnicity and other important domains. At this point, we are just starting out, seeking funding and engaging in many dialogues about future directions that psychologists can take in formulating constructive proactive responses to terrorism and human disasters.


Palo Alto, Calif.

Smoking politics

I WAS DEEPLY DISTURBED TO note in an apparent innocuous paragraph buried at the bottom of page 17 of the December 2002 Monitor a report of APA's foray yet another time into the political arena. Apparently APA has signed on to a resolution that urges states to raise excise taxes on cigarettes because, per the announcement, research shows that smoking behavior decreases when cigarette prices are raised. The paragraph further goes on to report that some studies show that teenagers may be particularly sensitive to price (apparently quoting Geoffrey Mumford, PhD, director of science policy in APA's Public Policy Office.)

Let me state my biases at the outset. I gave up cigarettes some six months ago after having smoked two packs a day for 40 years. (I recently lost a kidney due to renal cancer and also developed peripheral vascular disease.) I thus had considerable noneconomic incentive to quit smoking but would likely never have stopped had not my health been so imminently threatened.

As an adult, one may choose to smoke and drink and so poison one's body, and it is perfectly legal to do so; tragic, perhaps, but legal. The APA may have the most splendid objectives, but it has no business in the political arena with my dollar and without my consent. If I wish an organization to lobby for my political beliefs, I will join such an organization. The imposition of selective taxes and the lobbying for such impositions are naked political activities.


Tallahassee, Fla.

I WONDER IF APA REALLY thought through its endorsement of raising the price of cigarettes. While I find it doubtful that it will help reduce teen-age smoking much at all, it will necessarily reduce significantly the access many, many elderly people have to one of the very few pleasures to which they have access.

I don't smoke, don't like smoking, but I spend almost all of my clinical time delivering psychological services to elderly clients in nursing homes, the majority of whom have thirty dollars a month of discretionary money. Spend a day in an average nursing home, and it gives a different perspective on life. There is not much edifying or life-affirming about living in one, and for many of these individuals the single most rewarding aspect of their day is their cigarettes.


Benton, Kan.

Seconding Tomes

I VIGOROUSLY APPLAUD DR. Henry Tomes for his wonderfully appropriate and respectful article in the December Monitor titled "Recognizing Kenneth B. Clark's legacy."

On a professional level, I, too, was very disappointed, puzzled, surprised, but most of all, angry when I first viewed the list and noticed that Kenneth Clark's name was not included among the top psychologists of the 20th century. Many of us, especially minority psychologists, echo Dr. Tomes' question, "How could such a distinguished psychologist be omitted from such a list?" I am sure that a panel consisting of CEOs from the companies that manufacture dolls would certainly put Dr. Clark's name high on their list of people who had an impact on their industry (I say this with tongue in cheek, of course).

Although I cannot prove it, I am sure the notion of creating dolls to look like their consumers was a result of his research and helped to boost sales on a national and international level. Dr. Clark's pioneer work and efforts throughout his lifetime had a profound impact on the reshaping of our schools and, ultimately, on our country during one of its most tumultuous eras. Furthermore, his book, "Dark Ghetto," remains a must read in social psychology courses.

Dr. Tomes is absolutely right, Kenneth Clark and his work deserve better.


New York, N.Y.

Managed-care concerns

I HAVE BEEN A PRACTICING clinical psychologist since 1976 and am pleased with the advances in the mental health parity laws on a state level ("Success in the states," December 2002 Monitor). I would like to see the issue of managed mental health care addressed in this debate as well. In return for "unlimited outpatient visits with a limited copay" we now have a "mother may I?" system of mental health care with drastic reductions in payments to participating psychologists and onerous treatment report reviews. I previously saw numerous federal employees who could easily afford the 50 percent payment per visit. And if they began therapy late enough in the year, they could have virtually 40 visits with no treatment plans and reimbursement of my full fee. Those patients now pay about $15 per visit and the managed-care company requests a treatment plan every five visits. I would welcome the author of the article to specifically address this issue as well.


Gulfport, Miss.

On the paranormal

DR. RICHARD MILLER'S COMMENTS (November 2002 Monitor, page 44) regarding the need to alter students' beliefs in the paranormal were disappointing. They reveal a biased assumption that such beliefs are wrong and must be reprogrammed during the classroom experience. He remarks that "the number of students who are persuaded to abandon their beliefs...is distressingly small"--as though there were something abnormal about these beliefs, and they therefore require indoctrination into a true line of thinking. To say that it is distressing that more people cannot be converted to one's beliefs speaks poorly of a representative of the profession and the dogmatic and arrogant tone implicit in those comments.

He argues that critical thinking is needed to offset paranormal beliefs. However, authentic critical thinking means examining the social, political and moral assumptions implicit in psychological theories and practices (Prilleltensky, 1994). What we have here, on the part of Dr. Miller, is an apparent failure to scrutinize the ideological repercussions of his form of theorizing, which is to declare that a part of reality many of us feel exists is nothing more than foolishness. Dr. Miller's assumptions violate the assertion that psychology is a value-free, unbiased science. This violation suggests that the scientific method is the sole means of knowing reality, and that it is also responsible for constructing reality. Personal experience has little to no legitimacy in this process. Sadly, assumptions such as these do nothing more than limit psychology's understanding of the full breadth of the human experience.


Greeley, Colo.

IN REGARD TO "REDUCING student belief in the paranormal," I find it disturbing that the assumption that belief in the paranormal indicates a deficit in critical thinking--that is itself accepted uncritically. Half a century ago, the leading critic of parapsychology concluded that because there were dozens of well-controlled experiments that supported the experience of psi phenomena, the investigators must be lying. Today, with hundreds of methodologically sound studies as evidence, we are either seeing the results of the most successful, long-running conspiracy of all time, or perhaps, genuine phenomena. The only argument contemporary critics can muster is that parapsychological phenomena cannot be produced on demand. As this critique applies equally to the efficacy of psychotherapy, we dwellers in this "glass house" should keep a more open mind, as do most physicists and chemists.


Santa Rosa, Calif.

Defining PMDD

PAULA CAPLAN IN "IS PMDD real?" (October 2002 Monitor), is quoted as stating that the decision to accept Sarafem as a treatment for PMDD just "furthers the misleading and dangerous assumption that the condition even exists," leaving women's real underlying problems, such as depression and abuse, untreated.

Unpacking this tortuous reasoning, we seem to get the following: Sarafem (a brand of fluoxetine currently marketed to women who report symptoms of depression during the period between ovulation and menstruation) is dangerous and should not be used, because doctors will treat women with this antidepressant instead of providing what they really need--i.e., treatment for their depression. Thus it might be all right to treat them with Prozac-brand fluoxetine for depression, but it would be dangerous to treat them with Sarafem-brand fluoxetine for PMDD.

It would appear that, in Dr. Caplan's view, it is acceptable for women to be depressed because they have been abused or victimized (presumably by men), but it is politically anathema to consider that something in their femaleness itself might be causing them to feel badly. Caplan ends up having to take the curiously paternalistic view that women who think they are only depressed for a week or ten days before their periods don't really know what they are talking about--they must be victims, even if they themselves don't know it.


Franklin Village, Mich.

Response from Caplan:

ERARD'S CLAIM THAT I DISBELIEVE women is strange, given the actual content of the Monitor article and given my decades-long commitment to respecting what women say. Depressed women should be diagnosed as depressed, and the real causes of their depression (abuse or anything else) should be addressed. His bias is crystal-clear in his claim that "femaleness" itself is or causes psychopathology, though it has long been known that various forms of discrimination and prejudice are upsetting to their targets.

Erard's portrayal of me as claiming that abuse, especially by men, is the only cause of women's depression is based on nothing I have ever said, not even my comments in the Monitor article.

The Society for Menstrual Cycle Research questioned FDA approval of Prozac for "PMDD" because of the lack of evidence that a premenstrual mental illness even exists; and ample research shows that women labeled with "PMDD" have more histories of abuse or current abusive or otherwise terrible situations than do other women. Many patients report that Prozac/Sarafem and related drugs "don't get rid of my problems but allow me to experience them as from a distance." And there is compelling evidence that for many women diagnosed with "PMDD," it's focusing in therapy on the harrowing aspects of their histories that helps.

Anyone should have the option to take medication, as long as they are told up front that the therapist considers them depressed and as long as the therapist and drug company disclose the full range of positive and negative effects they might experience and the full range of other treatments that have been helpful, as well as the fact that, since "PMDD" has not been proven to exist, any treatment based on that diagnosis is experimental treatment. But that rarely happens.

When their patent on Prozac was about to expire, Eli Lilly got FDA approval to market it for a woman-only condition, so other drug companies couldn't yet sell cheaper, generic versions. And an FDA letter to Lilly instructed them to pull or modify their Sarafem ads because they were "misleading" by "broaden[ing] the indication" for the drug and "minimizing important risk information" ( www.pharmcast.com/WarningLetters/November2000/EliLilly1100.htm). This debate is not about helping women but about the billions of dollars made from pathologizing women.


Providence, R.I.