Letters

Questionable grounds for exclusion

In their "Judicial Notebook" column ("Expert testimony in insanity cases," November Monitor), Mercado and Bornstein, without naming me, referred to Justice David Souter's citation of my work in his troubling Clark v. Arizona decision. Souter based his opinion partly on a mischaracterization and misapplication, in an amicus brief, of my two decades of documentation of the inadequate use of science in the creation of diagnostic categories.

How did Justice Souter hear about my work? A Church of Scientology group, calling itself the Citizens Commission on Human Rights (CCHR) and not mentioning Scientology, submitted that brief, using an argument irrelevant to the case but, surprisingly, used by Justice Souter. They cited my work and claimed that disagreement about the scientific basis of diagnoses causes confusion in criminal cases. What was actually at issue was whether therapists should be allowed to testify that Mr. Clark, who had killed a policeman, was delusional. He believed that aliens disguised as police had invaded Earth and were trying to kill him. Justice Souter ruled that psychiatrists' and psychologists' testimony about a criminal defendant's state of mind can be excluded because, as the CCHR said, diagnoses are unscientific. To exclude their testimony, however, is patently absurd. Furthermore, problems with validity of categories (symptom clusters) do not justify excluding testimony about individual symptoms relevant to the crime, which are easier to document and have face and content validity for this case.

The way my work was misused raises two larger questions: (1. Do Supreme Court and other appellate judges regularly investigate the identity of authors of amicus briefs they don't recognize, like the CCHR? (2. Do they regularly investigate the validity of what is presented as "science" and whether the writer has represented and appliedit responsibly? The answer to both questions, as I learned researching the article at www.counterpunch.org/caplan10022006.html, is "no."

I hope no one will assume that anyone raising questions about the mental health system is allied with the Church of Scientology. For most of us questioners, nothing could be further from the truth.

Paula J. Caplan, PhD
APA Fellow

 

Psychotherapy beyond faiths

In his thoughtful and client-sympathetic column, "Psychotherapy and Faith" (November Monitor), APA Past President Gerald P. Koocher seeks to comfort six-year-old Joey, who is doomed to die from an incurable brain tumor, by...focusing upon and believing his parental bromide that they love him dearly and that his upcoming sojourn in heaven will be enhanced when his parents join him there. I agree that Koocher's homoletic, magisterial and well-intentioned attempt to alleviate Joey's anxiety should be offered...but...I fault Koocher in stopping at that point.

He might have solicited from Joey's family, friends, neighbors and teachers specific, documented...incidents preceded by this statement by Koocher to Joey: "Joey, you are a remarkable little boy, a human being whose kindnesses and courage have made this a better world. You should be very, very proud of how you changed the world and made it a better place, by deeds...which I am told you brought about, deeds that others might well learn from you as they follow your example in making life happier and more joyous for so many people. Here, then, Joey, is a sample of the fantastically wonderful parade of things that you did for making life better for little animals and for people."

I hope that when in the future Dr. Koocher is called upon to help grieving parents come to grips with their misfortunes he will go beyond, perhaps in the way I have suggested above, the bland and essentially truthless dependence on the glories and fruits of a mythical heaven.

Robert Perloff, PhD
University of Pittsburgh

 

RESPONSE FROM GERRY KOOCHER:

What Dr. Perloff regards as a "truthless dependence on the glories and fruits of a mythical heaven" may well constitute the sincere, highly valued and reassuring spiritual beliefs of others. I may not share another's belief system, but in my role as psychotherapist I will not seek to destroy or disparage such beliefs. I will never attempt to impose beliefs and preferences. Rather, I will try to speak to my clients with an empathic understanding of their frame of reference, while addressing both their spoken and unspoken emotional concerns.

In response to Gerald Koocher's sensitive and thoughtful November column, I, too, believe that I would be completely at a loss if faced with a child unexpectedly responding to his father's attempt to be comforting by saying, "I don't know God." However, the child's comment may be answered in the same manner as one would answer a question from a child just told that he would have to go away for a long time to live with an unknown relative, thus, "Joey, God is a loving and kind person who will take care of you just like daddy and mommy does."

In Koocher's follow-up conversation with Joey, I like his answer about not having to hang out with Aunty Helen in heaven because there are other kids there to play with. Joey obviously is thinking about heaven using a child's point of view. In view of how he thinks, part of my response also might be, "Did you know that when kids get to heaven, they don't have anything wrong with their bodies because God gives them a new body that's perfect so you can play all day long without getting a headache or having trouble hearing."

I also hope that I would also have said something similar-what Koocher said about "all of us, the medical team, your family and me, feel angry and sad about what is happening." This statement is sure to help Joey access the strength and support of his family, Koocher and his medical team.

John Burke, PhD
CITY AND STATE TK

 

Psychotropic concerns

As reported in the Monitor, the [working group] findings appear to be molded by psychologists who are not in favor of psychologists prescribing, especially for children. The two premises are that we should not use treatments that do not have solid, EBT-type research grounding and we should use treatments with the least risk.

The fact of the matter is that with medication, society will not condone the kinds of sound research [for children] that they condone for adults. We will always be extrapolating adult findings to children. So to suggest that we wait for better research is to suggest that we never use medication. To say that medications have higher risks for side effects than no medication is a blinding glimpse of the obvious. They make no mention of the risks associated with psychosocial interventions, such as treatment failures and the individual and societal costs of elaborate, at times more labor intensive, multisystemic interventions.

I fear the article was far too biased against medications with children and even far too biased against psychologists prescribing in general. Given the shortages of well trained child psychiatrists, children may well be the next "underserved population" that psychologists will wish to help treat psychopharmacologically. [The working group] should rightfully point out that the work will surely be challenging, pioneering and, yes, somewhat risky. But at the same time, it should be pointed out that prescribing may well hold the promise for being helpful in areas that we as psychologists have not been able to be helpful in before.

John R. Thibodeau, PhD
Albany Medical College

 

RESPONSE FROM RONALD T. BROWN:

The APA Working Group on Psychotropic Medications for Children and Adolescents appreciates your kind attention to our report and wishes to clarify our position as delineated in the report. First, with regard to prescribing medication by psychologists, the working group did not address this issue in the report. Rather, we are of the notion that the prescribing of either psychopharmacological or psychosocial treatments should be based on the training and competence of the provider, whether it be a physician, nurse practitioner or a psychologist. Second, indeed you are correct in your interpretation indicating that only empirically based treatments, whether psychopharmacological or psychosocial, should be used for pediatric populations.

Clearly, a thesis in our report is that the prescribing of psychotropic medication for children and adolescents, particularly as of recent, has exceeded any data that are available with regard to both the efficacy and safety of these agents, with the exception of possibly the short-acting stimulants.

With current practice of off-label prescribing for children that are based on clinical trials conducted for adults, we believe that children are at significant risk with these current practices. We clearly advocate for clinical trials conducted with children and adolescents that meet the standard of adult clinical trials. The working group's preference is research that is conducted expeditiously, where various treatments are rigorously evaluated and tested.

Until such research has been conducted, indeed we recommend caution in the prescribing of any of pharmacological or psychosocial treatments. We are of the notion that children and adolescents deserve the best of what we have to offer them in treatments that are definitively researched and established to be safe.

 

Ronald T. Brown, PhD
Temple University
APA Working Group on Psychotropic Medications for Children and Adolescents

Milgram and the CIA: Tortured allegations?

Truth is sometimes a casualty of heated debate. A case in point is Gary Walls' letter in the November Monitor claiming that Stanley Milgram's obedience research was sponsored by the Office of Naval Research (ONR) and the CIA to advance their torture program, an allegation premised on Alfred McCoy's book, "A Question of Torture" (Metropolitan Books, 2006). But the book presents not a shred of evidence that Milgram received CIA funding. The reason is, I believe, that none exists. In my research for a biography of Milgram, "The Man Who Shocked the World" (Basic Books, 2004), I studied thousands of documents at five different archives and spoke to more than 80 people. Yet I never came across the slightest suggestion of a CIA-Milgram link.

Ironically, "A Question of Torture" bases its speculative claims about Milgram on an essentially irrelevant event described in the biography: that ONR was among three agencies (the others were the National Institute of Mental Health and the National Science Foundation-NSF) Milgram sent inquiries to about possible support for his planned obedience research. Subsequently, Milgram only made a formal application to-and received a grant from-NSF. But, in "A Question of Torture," Milgram's negligible contact with ONR turns into "his close ties to the ONR," and "Milgram's intelligence connections." And because, according to the book, the CIA used other federal agencies as conduits, the book suggests, without any evidence and using "guilt by association," that Milgram's funding also originated from the CIA.

"A Question of Torture" uses some questionable presentational devices to advance its claims about possible CIA funding. These include time compression to forge dubious connections, selective use of information from my biography of Milgram, and, to my knowledge, misstatements of fact. Examples of these tactics can be found in my rebuttal to the book's allegations available at www.stanleymilgram.com.

 

Thomas Blass, PhD
University of Maryland Baltimore County