Letters

Male suicide overlooked

I WAS DELIGHTED TO SEE THE Monitor cover Surgeon General Satcher's suicide prevention initiative (November Newsline). This is clearly an important area in which psychologists can and should have much to contribute.

On behalf of Div. 51 (Society for the Psychological Study of Men and Masculinity) Task Force on Men and Depression, I would like to highlight an important aspect of this issue that was missing in the report. Being male is a greater risk factor than either risk factor mentioned in the article (being adolescent or Native American). Death by suicide is a significant mortality risk for boys and men of all ages and all races, particularly those with exacerbating conditions such as alcoholism, drug addictions and antisocial behavior patterns.

Yet, barriers persist to our efforts to assist men in getting help that would enable them to more effectively manage depression and suicidal behaviors. This is unfortunate since available therapy outcome studies indicate that men respond positively to both interpersonal and cognitive-behavioral psychotherapies. In addition to these empirically verified treatments, newer, innovative therapies designed specifically for men hold great promise.

We hope that one outcome of this initiative will be to enhance the likelihood that more men will find their way to our consulting rooms.

SAM V. COCHRAN, PHD
Iowa City, Iowa

Acknowledging others' contributions

AS A LONGTIME APA MEMBER and Monitor reader, I was disappointed to find that the November articles regarding the disAbility community reflected the Monitor's tendency to fail to recognize the efforts, validity and even presence of nonpsychologist-dominated services and providers. For over 20 years, a nationwide network of Centers for Independent Living (CILs) has looked very closely at and worked toward the resolution of many of the issues addressed.

CILs are federally funded to provide "core services" including advocacy and independent living skills training; many offer a broader continuum, including training in hiring personal assistants. CILs are customer-driven, in that at least 51 percent of the Board of Directors of each are individuals with disAbilities, as are many of the staff. As the assistant director of a CIL, I challenge you to learn more about CILs and recognize their work when addressing the issues of individuals with disAbilities.

TERRY DEROCHER LERMA, PHD
Port Huron, Mich.

To prescribe or not to prescribe?

THE NOVEMBER MONITOR showcases psychology's involvement with drug companies, promises a glamorous makeover of the Monitor for more appeal to drug advertising and minimizes the problem of conflicts of interest. The Monitor postures for prescription privileges. But what about the data? The theory underlying drug treatment is based more in science fiction than in fact; drug studies are flawed and yield results equivalent to placebo; and conflicts of interest abound.

First, empirical support for the underlying mechanism of emotional complaints, the biochemical imbalance, simply does not exist. Ditto for drug efficacy. Consider antidepressants: Studies are fatally flawed because of compromises to the double blind. Antidepressants are no more effective than placebo when a credible placebo (that mimics side effects) is used and when clients rate their own outcomes.

Moreover, when clients' ratings and long-term follow-up are considered, therapy is more effective than antidepressants. Psychologists have a respected heritage of empirical scrutiny and moral integrity. Do we want to sell these for bankrupt science and corporate collusion? We need to face the data and consider the risks before jumping on the prescription bandwagon.

BARRY L. DUNCAN, PSYD
Jupiter, Fla.

SCOTT D. MILLER, PHD
Chicago

AS EVIDENCED BY THE TOWN hall meeting at APA's Annual Convention, the movement to gain prescription privileges has continued to gain momentum, and significant efforts and funding are being used by the APA and state psychological associations in order to achieve this goal.

Although it is important for practicing psychologists to be trained in basic psychopharmacology, the pursuit of prescription privileges is a misguided attempt to improve psychology's tenuous position in the current healthcare market. For our profession to survive we must, at a minimum, be able

to distinguish ourselves from other practitioners. However, prescription privileges would only further blur professional boundaries. As it is unlikely that prescription privileges would come without physician oversight, we would become analogous to nurse practitioners and physician's assistants who already have such physician-dependent privileges. Rather than increasing status and autonomy for psychology, prescription privileges will likely reduce both.

Since psychology is at an important crossroads facing an uncertain future, our time and resources must not be wasted fighting a lengthy and costly battle that will result in a greater loss of identity. Instead, we must focus our efforts on reinforcing, marketing and lobbying for ownership of the skills that define us as a profession and differentiate us in the already confusing and overcrowded healthcare market.

GREGORY M. FLISZAR, PHD