letters

Rediscovering trauma

THE ARTICLE 'OLDER VETS just now feeling pain of war' (May Monitor) describes the occurrence of post-traumatic stress symptoms among aging veterans who had never before displayed such symptoms.

It is interesting to note that I found similar evidence of resurging PTSD in my interviews of 190 Jewish escapees who were able to leave a Nazi-occupied country before the 'Final Solution' was implemented. In 'The Uprooted?A Hitler Legacy,' I suggested some reasons for the recurrence of anxiety and preoccupation with the past: 'The passage of time itself stirs up memories. With age, there is more time to reminisce. There is no more struggle to build a career, no busy hours with small children. The daily worries are reduced. Nor is the youthful optimism there?the belief that all losses can be filled with other pleasures and that ?time heals all wounds.? The limited years ahead seem to focus the glance backward. The value of life seems enhanced, and losses are recognized more clearly.'

Among the many comments I received on this issue, one man, whose optimism carried him through years of struggle after his escape from Hitler, reflected: 'I am given to musing too much about my childhood days and school friends [murdered by the Nazis]. I am now retired and in a position to be able to think more about events from my past. I am more emotionally affected now than I have ever been.'

The similarity in reactions between the two aging populations, the veterans and the Jewish escapees, is more than coincidence.

Dorit B. Whiteman, PhD
Hollis Hills, N.Y.

I HAVE SOME COMMENTS TO offer to the subject of delayed post-traumatic stress phenomena referred to in 'Older vets just now feeling pain of war' (May Monitor).

First, in the 19 years that I have been assessing and treating usually honest persons who have committed a variety of acts of theft and whom I have termed 'atypical theft offenders,' some of them have indeed been persons who years or decades earlier had experienced war-related trauma.

As I have reported in my book 'Why Honest People Shoplift or Commit Other Acts of Theft: Assessment and Treatment of ?Atypcial Theft Offenders?' (Tagami Communications, 1997), many of these atypical theft offenders experienced much earlier losses or trauma, and their stealing was usually precipitated by a much more recent event or situation (such as loss of a spouse or job). The operative word here is 'loss,' so much so that we articulated a 'loss substitution by stealing' hypothesis, where the offender virtually never realizes that the bizarre theft behavior is related to anticipated or just experienced personally meaningful loss.

In most cases that either I have dealt with or were described in your article, the operative term should surely be 'chronically suppressed' rather than 'repressed' memories. In most instances, those who have experienced wartime or other traumatic experiences are only too aware of them, but have avoided thinking about them in conscious awareness for much of their lives, by keeping themselves exceedingly 'busy' and thereby distracted. When folks retire or slow down or stop running, the unresolved earlier material that they had avoided looking at are right there, often in only too vivid color, and too loud sounds.

Will Cupchik, PhD
Toronto, Ontario

More emphasis on teaching

The article 'Rules for earning tenure are different at smaller institutions' (April Monitor) sent me back to an October 1997 article, 'Job interviews 101: the keys to success.' Both articles offer advice to prospective or beginning faculty, but their recommendations could hardly be more different.

The earlier piece talks almost exclusively about research. Candidates are urged to inform themselves about the publication records of their future colleagues and to have ready a brief presentation about their own research 'that you can give any time someone asks about you.' Only one brief phrase mentions teaching ('Consider bringing samples of syllabi for courses you designed'), despite the fact that teaching is a primary responsibility of faculty in all universities, even those that claim to be 'research-intensive.'

Perhaps the picture portrayed in the 'Job interview 101' reflects the reality in most psychology departments: that despite calls for a greater emphasis on teaching, only research counts. Yet Robert Boice?s study of new faculty showed that concerns about teaching were a major impediment to career progress, causing problems in the classroom as well as with research productivity.

Teaching undergraduates is the main reason that most universities exist. Let?s start to take it seriously by preparing new faculty for their teaching roles, and selecting people at least partly on the basis of teaching competence. Lee Shulman?s idea that job candidates should be required to give a sample class and a 'teaching colloquium,' in addition to a presentation on their research, has much to commend it.

Christopher Knapper, PhD
Ontario, Canada

No evidence for Gerson therapy

'Alternative medicine: much promise, little data' (May Monitor) is yet another example of the use of hype without regards to the facts. It amazed me that the APA could run such an article. One is left with the impression that Gerson technique is the best thing in the world. We?re told of a specific case, and of the wonders of the treatment. The only problem: No scientific evidences the treatment works. In 'Questionable Cancer Therapies' Stephen Barrett, MD and Victor Herbert, MD, JD discuss Gerson Therapy, finding among other things that: (1) The National Cancer Institute (NCI) reviewed 10 cases selected by Dr. Gerson himself and found his report unconvincing; (2) A committee appointed by the New York County medical Society reviewed records of 86 patients, examined 10 actual patients and found no evidence that the Gerson method had value in treating cancer; (3) An NCI analysis of Dr. Gerson?s book 'A Cancer Therapy: Results of Fifty Cases' concluded in 1959 that most of the cases failed to meet the criteria (such as histologic verification of cancer) for proper evaluation of a cancer case; (4) Lastly, it was reported that in 1986, investigators learned that patients were not monitored after they left the facility. In 1983, 21 patients were tracked over a 5-year period (or until death) through annual letters or phone calls. At the 5-year mark, only one was still alive (but not cancer-free); the rest had succumbed to their cancer.

Jeremy A. Margolis
Hattiesburg, Miss.

Too harsh on the Unabomber?

Extraordinary care should be taken before psychological knowledge is applied to the courtroom. Drew Westin in his article 'Should we have second thoughts about Kaczinski? (March Monitor) foolishly opines that if Ted Kaczinski, the Unabomber, suffers from schizophrenia then a mental health rather than a criminal justice solution should have been rendered by the court.

Every legal test of insanity in this country necessitates that a link be established between a sufficiently severe mental disorder and a cognitive and/or volitional impairment.

Having profiled the Unabomber for the Secret Service and the FBI, I can assure the readership that the three killings and maiming of two dozen innocents over 18 years was perpetrated with extraordinary deliberation, planning and self-control. The three-part test of insanity was not met, even assuming Kaczinski was schizophrenic.

Westin?s lack of forensic expertise also carries the danger that we can simplistically apply our hard-fought knowledge to questions of sentencing versus treatment. In expert testimony in over 100 murder and manslaughter trials, I find the courts bend over backwards to protect the rights of the defendant and to provide treatment when necessary. Both the courts and society are not forgiving, however, when one intentionally chooses to kill with impunity for no good reason.

Harold V. Hall, PhD
Kamuela, Hawaii

Leave prescribing to others

As an APA student affiliate about to embark on a graduate program in clinical psychology, I have followed the debate surrounding prescription privileges for psychologists with great interest. While the efficacy of drug therapy in certain situations is undeniable, I strongly oppose APA?s endeavor to acquire the right to prescribe these medications. There are a number of professions, such as medicine and dentistry that apply the physical and biological sciences to the treatment of human suffering. This application requires individuals to be viewed in terms of their component parts?that is, in terms of cells, tissues, organs and organ systems.

I propose that the approach of the practicing psychologist should be fundamentally different from that of the medical professional. The psychologist should view individuals not in terms of their component parts, but rather in terms of those systems of which the individual himself represents a component part: the relationship with self, with significant individuals and with the ultimate facts of human existence; and the dynamics of family, society and culture. The psychologist, therefore, must leave physical and biological science to the scores of professionals already on the scene, and instead stake out his own territory by clinically applying the behavioral and social sciences. The practicing psychologist should apply sociology or anthropology, for example, in the same way that the physician applies chemistry or physics. Only by focusing on higher levels of organization will clinical psychology distinguish itself from psychiatry to become a full-fledged member of the health-care community.

Joseph E. Moldover
Philadelphia

A lesson from psychiatry

PSYCHIATRISTS DESERVE OUR respect for their efforts to preserve their distinctive scope of practice. After all, this is something that we, as psychologists, have never had any success with.

We have defined our profession as being a doctoral-level one, but have continued to allow individuals with master?s degrees to practice psychology independently. APA has accredited doctoral programs in psychology, but some licensure boards have continued to allow individuals from 'related fields' to become licensed. APA has proclaimed clinical neuropsychology to be an 'official' specialty, but we have continued to allow individuals without specialized training and without doctoral degrees to practice it independently. We have equated ourselves solely with psychotherapists, rather than 'marketing' our distinctive assessment skills. We have not secured our assessment instruments, and so have allowed nurses, speech therapists, occupational therapists and physicians to 'do testing.'

Not surprisingly, the consum-er?s view of professional psychology seems to include the perception that advanced education and training are optional. Let?s not take on prescription privileges until we can demonstrate the ability and the willingness to regulate what we already have.

Carol Chambers Mills, PsyD
Kevin Lawlor, PsyD
Ann Genetta, PsyD
Kenneth Stefano, PsyD
Mechanicsburg, Pa.

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