Whole health care

RONALD LEVANT is to be congratulated for leading APA into health-care reform and his focus on the whole person (May Monitor President's column). While the biopsychosocial model that he mentions is an important step in the direction of replacing the biomedical model, it falls short. The biopsycho- sociospiritual model is broader in scope and is congenial to the APA aims.

Transforming how we think about promoting health and preventing disease should include new models as well. There are many people at the George Washington University and other universities who are also working hard to help transform health and health care in the United States and worldwide and will be pleased to look at the work of APA's Health Care for the Whole Person Task Force.

The George Washington University

Impulsiveness in adolescence

IN THE ARTICLE "ADOLESCENT development and severity of criminal punishment" (June Monitor, page 28), Dr. Laurence Steinberg was quoted saying that the standards of criminal conduct to which people are held should depend upon people's ability to control their impulses and consider the future consequences of their behavior.

Dr. Steinberg's statement seems to imply that the incarceration of people who injure others should be reduced for people who cannot control their impulses. The practical consequence of this principle would be to increase the number of people who are injured by people who do not control their impulses. I would suggest that Dr. Steinberg's message should be expanded to say that people who cannot control their impulses should be given less freedom in order to protect innocent people from being injured by impulsive behavior. In the absence of a common, effective way to determine in advance which people will control their impulses, people are given the opportunity to act impulsively, and they are restricted after the fact to prevent further misbehavior. It would be nice if this determination could be made in advance, but at present that seems impractical. I admire Dr. Steinberg's compassion for people who cannot control their impulses, but I would like to be protected from harmful impulsive behavior regardless of the offending person's ability to resist the impulse.

Emporia, Kan.


THE LAW ALREADY ESTABLISHES that crimes committed impulsively are punished less severely than crimes that are premeditated, and, to some extent, also establishes that individuals who are inherently less able to control their impulses (such as those with severe mental illness or profound mental retardation) may also be punished less severely as a consequence. It is true that this poses a dilemma for society: In some regards, those people who can't control their impulses pose the greatest risk to society. Generally, however, this argument, when applied to adults, is invoked only in extreme cases, and most individuals with chronic problems with aggression or impulse control are likely to be sanctioned in a way that is intended to protect the community. This is one reason that repeat offenders are punished more severely than first-time offenders.

I think that adolescence creates a special case, however, which was the point of my talk. Problems in impulse control during adolescence more often than not are problems that individuals will grow out of as they mature. To the extent that this is a transient problem, I think the way in which we view and punish criminal behavior in adolescence should differ from the way we view and punish comparable behavior among adults. One reason for having a separate juvenile system, in which individuals can be held only until a certain age, is that there is a good chance that by time a juvenile is released, he or she may have matured sufficiently to no longer pose a danger to the community.

Red Lake response

IN REGARD TO THE "HELPING Red Lake Heal" article by Zak Stambor in the May Monitor, I think it is important for readers to know that many groups of people have been helping the community to heal. The Indian Health Service sent in care teams for two-week tours for 8 weeks, a group from UCLA has been there, as well as a team from Columbine, Colo.

The article implied that the people of the Red Lake Nation would find the resilience and strength to recover, but failed to mention that recovery takes a long time. The Red Lake Nation continues to struggle and grieve. My partner is currently serving in the schools as a psychologist and is struggling to see when this nation will return to balance. As we all know, violence in any community takes time to sort out and the path to healing can take years.

Gallup, N.M.

Kenneth Clark's legacy

THE AMERICAN PSYCHOLOGICAL Association is capable of behaving judiciously and sympathetically in matters of psychological debasement, as evident in our Council's recent action in support of same-sex marriage and parenting (August 2004).

It is therefore the height of irony that Kenneth B. Clark, following his recent death, is now being lionized and beatified by APA when, following the heady days of the Court's 1954 historic decision declaring the prevailing but flawed "separate but equal" doctrine unconstitutional, he was given the silent treatment by APA. The Clarks' contribution to this momentous decision of the Court should have been celebrated as a great "win" for psychology and psychological science. But instead APA went about its business without the slightest recognition of the Clark tour de force.

There was not a single word in the archival minutes of APA's Board of Directors or Council of Representatives honoring the decisive Clark testimony. The complete and utter silence of psychologists is chronicled by Benjamin and Crouse (2002, p. 43): "There was apparently no formal or official recognition from APA for any of the psychologists participating in Brown. There were no commendations from the APA board or APA council, no letters of congratulation or commendation from the office of the APA executive secretary."

We are not here to assign blame, or to scold today's psychologists, most of whom were not yet born in 1954. We wish to urge, instead, that in the future we not sit idly by while courageous acts of psychologists move the field to new heights. There is nothing commendable about APA waiting decades to acknowledge the great Clark accomplishment.

University of Pittsburgh
Brown University

Monitor advertising policy

I WAS VERY SURPRISED TO SEE A clearly discriminatory U.S. Navy recruitment ad printed on page 108 of the May Monitor. The ad states that law and policy that prohibit homosexual acts or acknowledgement of sexual orientation by those the recruiting organization accepts. It notes that American law supports the discrimination.

I think the response of APA and the Monitor regarding discrimination, whether legal or not, should be "so what" and refusal to run such an ad. The issue should be clearly one of not printing discriminatory material regardless of source and what laws may support it. One could imagine a pre-apartheid South Africa running a recruitment ad saying "whites only," stating that their laws support that. I can't imagine that APA would print that!

I'm not American, and understand that sexuality is particularly sensitive in the United States. That does not justify printing this sort of advertisement. If the APA policy does specify material such as this ad as inappropriate for publication, it should. Period.

Saskatoon, Saskatchewan, Canada

Editors' note: A 2004 action by the APA Council of Representatives removed any prohibition against U.S. military recruitment advertising in APA publications and requires the following disclaimer statement: Eligibility for military service requires certain physical abilities and attributes including age, height, weight, and physical ability requirements. Furthermore, U.S. law prohibits service members from engaging in homosexual acts and prohibits lesbian, gay, or bisexual service members from stating their sexual orientation.

Inmate suicide watches

IN THE June Monitor, K. Kersting described a study in Psychological Services that found the following benefits in using inmates to conduct suicide watches: less hours for inmates on watch, prosocial development for inmate watchers and significant financial savings for the institution. Correctional institutions and agencies should carefully weigh these "benefits" with the ethical and legal costs of using inmates to conduct suicide watches. According to the National Commission on Correctional Health Care, "When any actively suicidal inmate is housed alone in a room, supervision through continuous monitoring by staff should be maintained."

While inmate peers informally may provide important social support and an extra set of eyes for inmates in crisis, the institution and its staff are solely responsible for the treatment, management and monitoring of suicidal inmates. As Lindsay Hayes, the nation's foremost authority on correctional suicide prevention, concluded: "Despite promises to the contrary, use of other inmates to conduct suicide watch results in relaxation of both correctional and mental health staff responsibilities for inmate safety and treatment....observation aides are simply a budgetary rationalization for inadequate staff coverage."

Winfield, Pa.