LETTERS

Psychology and cancer

THANKS YOU SO MUCH FOR the recent coverage of psychological issues of cancer. As a psychologist who works with many people dealing with cancer, I found the information quite applicable to my practice.

Unfortunately, it seems that much research and applied psychology is targeted for those recently diagnosed or undergoing treatment. The psychological impact of long-term survival does not appear to be adequately researched. Many of my clients are a decade or two from diagnosis, yet continue to suffer from significant anxiety symptoms. Based on face validity, it doesn't appear that time heals these wounds.

At a recent three-day conference at the H. Lee Moffit Cancer Center and Research Institute in Tampa, Fla., psychosocial issues of long-term survival as observed by facility clinicians were presented. The presenters, mental health professionals with years of experience in psycho-oncology, reported that they too saw significant anxiety in long-term survivors, many times taking on a PTSD-like presentation. As a long-term cancer survivor myself, it was quite validating, as it is much easier for us to be objective with our clients than it is to be with ourselves. Cancer survivors many times find themselves discriminated against due to their histories, no matter how many years postdiagnosis.

Finding it difficult to obtain health and/or life insurance is a common experience for those who survive cancer. I, myself--12 years post-treatment, am unable to obtain insurance even through the APA Trust. My physician has supplied ample proof that I am of no higher risk than a person who has never had cancer, yet I am still denied coverage. A colleague, a psychologist nearly 10 years post-treatment for breast cancer, was refused liability insurance as she was viewed as too-high of a risk. Statistically, one can see that many psychologists are cancer survivors themselves, and suffer the same psychosocial issues that many of our clients must endure. I do hope to see an interest in our profession for examining issues of long-term survival. I am sure that many psychologist could better serve their clients with the knowledge obtained through this type of research.

James L. Harlow, PsyD
Sarasota, Fla.

Division 4.0: Psychologists with Prostate Cancer

WHEN THE FIVE OF US learned we shared this diagnosis through a prostate cancer listserve, we jokingly proposed a new APA division: Division 4.0, Psychologists with Prostate Cancer. A score above 4.0 on the prostate specific antigen (PSA) blood test often triggers further diagnostic tests for prostate cancer versus prostate infection or enlargement. Conveniently, there is no Division 4 in APA.

Unfortunately, Division 4.0 would have many members. The American Cancer Society (ACS) reports a higher incidence of prostate cancer in men than any other cancer, with incidence and mortality roughly equal to breast cancer in women. Yet federal funding for research recently was $1.62 billion for AIDS, $550 million for breast cancer, but only $80 million for prostate cancer. Our colleagues with breast cancer and AIDS deserve every penny of this funding. But when prostate cancer strikes you, underfunded prostate cancer research seems more personal and unjust.

The ACS recommends that men get annual checkups and tests for prostate cancer after age 50, and earlier at age 40 if you have a family history of prostate cancer or are African American. Two of us were diagnosed in our late 40s, and two more in our 50s! Two-thirds of the cancers detected by

PSA are still confined to the prostate and have the best chance for cure. The five of us chose three different forms of treatment for our prostate cancers (surgery, radiation, hormones), but annual checkups gave us knowledge to help us make this choice. Contact us at MiddleNeal@aol.com if we can help you.

Rick Bolnick, PsyD
Illinois
Lorel Lindstrom, PhD
California
Dan Schultz, PhD
Indiana
Will Shadish, PhD
Tennessee
Dick Weber, PhD
Minnesota

The aging family system

THE JUNE MONITOR HAD AN excellent article ("Reaching out to families of cancer patients") I intend to share with my colleagues. In our geriatric practice, we have learned the benefits of applying a template combining the clinical course of cancer with family development stages.

Certainly, the first stage of a family intervention would consist of understanding the family organization. This includes uncovering family myths, rules, and themes. Next, it is necessary to understand how the family responds to change. High risk family groups exhibit a significant level of denial; pivotal-person syndrome; anger-guilt response; and the appear-and-demand syndrome.

In assessing the aging family system, it is important to remember that delirium is the second most common psychiatric diagnosis among the elderly. For the clinician, it is imperative to differentiate diagnostically between early dementia and the normal stress reactions to the diagnosis of cancer.

Joe Roberts
Winona, Miss.

Faulty logic

THE STATEMENT IN THE April Monitor in the article "Bullying behavior may be genetic," that since "Identical twins were more likely than fraternal twins to share a tendency towards aggressive antisocial behavior, indicating a role for genes in the behavior," is logically untrue. Correlation does not indicate causation.

Being genetically identical raises profound identity issues and stresses for identical twins that it doesn't for fraternal twins. For example, they are frequently treated differently than fraternal twins are treated both by culture and by parents. They are more likely to be dressed identically, and treated as if they were alike than fraternal twins are treated. The way that they are treated may well influence subsequent behavior.

APA needs to be more careful in evaluating articles, especially in these times when there is such a distorted overemphasis on biological and genetic bases for so much social behavior.

Lawrence Tirnauer, PhD
Washington, D.C.

Ethics and Yugoslavia

WHILE OUR GOVERNMENT
is bombing Yugoslavia, I don't see psychologists encouraging the development of social policy that serves the public (principle F from APA ethics code, social responsibility).

Do not psychologists respect the rights of individuals to...self-determination and autonomy? (Principle D, respect for people's rights and dignity.)

It appears that by not making public their knowledge...to contribute to human welfare (principle F again), psychologists are acting unethically.

The goal of psychology is to apply knowledge...to improve the condition of...society (preamble). How does bombing another country improve society? Just because the ethics code does not have the force of law and supposedly does not apply to the private lives of psychologists, does that let us off the hook? Are psychologists merely small, obedient cogs within the wheels of U.S. society, or do we have higher standards for our behavior?

Dave Hennerman, PhD
Glendale, Calif.

Fighting cultural stereotypes

IN THE APRIL ISSUE OF THE Monitor, an article highlighted the unfortunate continuation of stereotypical conceptions and representations of Native Americans as we approach the year 2000. All we need to do is to look around and see if other cultures are portrayed on currency, as mascots and toys, and used as team names.

The answer is few if any, and the reason may be that other groups have inspired or command the show of respect. Let us continue to work together to improve sensitivity to, understanding of and appreciation of for cultural diversity as we enter the new millennium.

Sigmund Hough, PhD
Boston

More on humor

THE ARTICLE ON HUMOR IN therapy in the March issue, and even more the response letters in the May issue, remind me of a saying that I think goes back to Alan Watts: "The Western Mind" has largely lost the ability to engage in genuine play. Before he can play, he has to be convinced of the measurable benefits of playing, at which point the play is no longer playful but just another task to get done.

In the May letters section, Naji Abi Hashem writes, "They need to be very careful regarding the style, content and timing of the laughter or humor they introduce." And Alan E. Kazdin writes, "the last thing the field needs is another untested idea of what to do in psychotherapy."

These are sad commentaries indeed. I contest that the last thing the field needs is to turn humor into another carefully calculated, rehearsed, regulated and predictable "intervention." Perhaps after years of training they have forgotten how to be human. Whatever happened to the idea of psychotherapy as a genuine encounter between two or more human beings?

Eberhard Scheiffele
West Chester, Pa.

E.O. to speak?

YOU COULD HAVE KNOCK-ed me over with a feather! The Monitor reports that APA--that bastion of politically correct zealots--invited E.O. Wilson to speak at the APA. Can it be? Are different points of view going to be finally allowed to be voiced? Incredible! What next? Will Professional Psychology journal publish opposing views? My, my.

One more point. Your article didn't mention that he was physically attacked for his theory of sociobiology, the first time in America that a scientist has been physically attacked for voicing a theory. The attackers were a small mob of politically correct hoodlums. I hope something similar doesn't happen during his APA lecture.

Armando Simon
Live Oak, Texas

A call for volunteers

IN THE APRIL APA MONITOR letters, I read with interest and alarm of the financial struggle for most graduate students in public and private institutions, whether working part time, or on assistantships or on scholarships. It took me back many years to my graduate school days and the remembrance that the GI Bill covered many of my costs, after being drafted into the Army for two years.

The success of that program suggests to me that a broader based one might even be more useful, that of asking students to give two years of public service to the community and the country. These students would get experience in hospitals, schools, nursing homes, retirement communities, with the police or day-care centers. They could not only gain educational credits but also be entitled to further education paid for by the government. It is already being done to some extent with the Peace Corp and Americorp.

It would attract the middle class and the poor of our diverse population to mingle and learn together, and give the country their energy and involvement in much needed services.

As it stands now, only those who volunteer for the professional armed services can get their college education paid for. All fields of human services are equally important to this country. These experiences would give our youth the pride of having served their country, as well as an adventurous two years.

For those who feel this would involve big government in another grand bureaucracy paid by taxes, I can only point out that our current military spending, plus the cost of past wars in VA medical services, disability compensation and military pensions, now comes to well over half our national budget. National service giving training and education in positive preventive work vital to the country is as patriotic as national defense.

Frank Trotta, PhD
Philadelphia

In Memory of Harold Greenwald

PSYCHOLOGY HAS LOST AN unforgettable friend who contributed much to his patients and students. I first met Harold, as he preferred to be called, when he was my mentor at the American Institute of Psychoanalysis and Psychotherapy in New York in early 1963 where his seminars were heavily attended. In fact at every psychological meeting in which Harold appeared, there was standing room only. Ingeniously, he made his points through humor. We were tickled while we learned. He could have been a stand-up comedian. I knew him throughout my professional life both as a teacher and dear friend.

Harold taught at Hofstra University, the University of Bergen in Norway as a Visiting Fullbright Fellow, and at United States International University in San Diego where he became a Distinguished Professor in 1975. He served as president of the Academy of Psychologists in Marital and Family Therapy and as president of the division of Humanistic Psychology of APA. His contribution of Direct Decision Therapy is well regarded. He is best known as an expert on the psychology of prostitutes, which stemmed from his doctoral dissertation. Despite his professional status, Harold lacked arrogance. Pomposity was not part of his character. He was natural, down to earth, compassionate and kind. A real mensch.

As a humanist, Harold officiated at my daughter's wedding, showing great sensitivity to her Jewish identity. He and his delightful wife Ruth attended my wedding where she led the dancing of the "Hora." Harold was always there for me, professionally and personally. He never lost his sense of humor.

He shall remain always in the hearts of all he has deeply touched.

Sandra Levy Ceren, PhD
Del Mar, Calif.

Statistical matters

I WAS DELIGHTED TO LEARN from my May Monitor that the excellent and needed recommendations by the APA's Task Force on Statistical Inference will be published later this year in the American Psychologist. Readers who understand what null hypothesis significance testing actually does should then be able to understand how it does not facilitate the accumulation of accurate findings in our literature.

But a basic understanding of hypothesis testing cannot be assumed, judging from your article. The article included the statement that "a result is significant, so the theory goes, if it reaches or is less than the level of .05, which indicates that the chances of the finding being random is only five percent or less." This statement embodies a misunderstanding that generations of instructors of statistics clearly have failed to eradicate.

Roger Bakeman, PhD
Atlanta

THE ARTICLE ON SIGNIFI-cance tests and 'results-blindness' by Joseph J. Locascio, PhD, (May Monitor) caught my attention. While I agree with his main points, I would like to highlight the statistical theory on which they are based.

First, Locascio fails to distinguish between R.A. Fisher's model of "significance testing" and the Neyman-Pearson approach. The latter was referred to simply as "hypothesis testing." Indeed, it is this mistaken conception of a unified theory of statistical inference that may be the cause of the largest of problems in the history of null hypothesis statistical significance testing (NHST). For instance, the definition of NHST quoted by Locascio is the Neyman-Pearson definition--originated for making decisions about two hypotheses, largely in an industrial context The purpose was to minimize the frequency of errors in the long run, not to accumulate scientific knowledge about a phenomenon.

Second, I agree with the author that more importance should be invested in the degree of interest in the problem, rather than whether a given study reaches an "arbitrary" significance level. Third, when arguing for an unbiased body of published "statistically significant" and "nonsignificant" findings, the author echoes what Fisher implicitly recommended in 1935. Fisher hinted that a comparison between "positives" and "negatives" should be made, and that a ratio of the two should then be calculated so as to ascertain the presence of a phenomenon. I encourage every psychologist to relearn what the Master originally prescribed for a "scientific" model of NHST.

Daniel J. Denis, PhD
North York, Ontario

ONE GOOD REASON TO heed the recommendation of the APA's Task Force on Statistical Inference that we de-emphasize significance testing in our research is that so few psychologists seem to understand what statistical significance means. Sadly, the May Monitor article on the Task Force recommendations only contributed to further widespread confusion.

According to the article, obtaining finding at a .05 significance level "indicates that the chances of the finding being random is only 5 percent or less." Wrong! A .05 significance level indicates that, given that there is no non-random effect (Ho is true), if the same study were performed 20 times, an obtained chance result of this magnitude would be expected to occur only once. We assume that the null hypothesis is true so that we can then estimate the probability of the obtained result. This is quite the reverse of determining the probability of the null hypothesis itself.

While a significant result at a given p level counts as indirect evidence that there is a non-random effect (H1 is true), estimating the actual probability that the result was random (Ho is true) is an entirely different matter. The logical difference may seem subtle, but it is real and significant. No doubt it would be very useful to be able to report the odds that a given result is in fact random, but we cannot compute odds form a significance test.

Fortunately, Joseph Locascio's, thoughtful, lucid column on Significance and Test 'Results-blindness' offered careful readers a "corrective educational experience" for those laboring under the common misconception reinforced by the earlier article.

Robert Erard, PhD
Franklin Village, MI

On the labor pool

IN THE JUNE ISSUE RAY Marshall is quoted, "The economy works well for people in the top paid 25 to 30 percent of the work force...But for the 40 percent at the bottom they are worse off than they were in 1970." These facts are true. How do we explain them? If the supply of labor goes up in excess of the demand for its services, then average wage rates must decline until equilibrium is attained.

The postindustrial U.S. economy has tremendous demand for high- not low-skilled labor, hence the discrepancy of income gains. Raising the minimum wage beyond the supply/ demand equilibrium point is a false solution. So what is the solution?

Reduce the supply of low- skilled labor, thereby forcing employers effectively into a bidding war for this labor. Education works effectively to this end, making workers more valuable, but cannot be utilized by many of those of lesser talent who tend to make up the bottom of the labor pool.

The only way to significantly raise the income of American workers at the bottom of the pay scale, without increasing unemployment, is to dramatically reduce immigration. The solution is simple, but never discussed in the popular media, although the polls show that over 70 percent of the population is in favor of this.

James Nolvany, PhD
Racine, Mo.

The value of membership

REBECCA CLAY'S ARTICLE "Rx for keeping members: accountability and value" in the May issue of the Monitor stimulated some new thinking about the need for concerted efforts on the parts of APA and the 50 state associations to be more responsive to the needs of their constituencies. In this regard, I find the fact that only 50 percent of colleagues belong to state associations both alarming and diagnostic.

It is alarming because it indicates that too many psychologists have chosen to disassociate themselves from organized membership and diagnostic in that it suggests that they see no benefit to keeping their memberships active. This assumes even greater poignancy when the threat to the profession posed by managed care is fully perceived.

APA should continue its support of state associations' lawsuits against managed care organizations. This is just one of the very important actions which encourage the membership to maintain its loyalty. Too many of us feel that we have been abandoned to face the managed-care industry alone.

APA has demonstrated a huge commitment to state associations by actively supporting these lawsuits. Perhaps our colleagues who are not members of their state associations will encourage more of these actions by joining now.

Further, APA 's Practice Directorate should encourage psychologists to use their state associations as referral channels for potentially actionable managed care-cases. Utilization of coordinated state and national web sites to enhance the flow of relevant information would be of value to all of us.

Perhaps readers of this letter will come forward and contribute their own suggestions to APA.

A. Richard Tomanelli, PhD
Greenwhich, Conn.

Ageism at APA?

I AM WRITING TO TAKE issue with the obvious and ironic ageism expressed in the May Monitor. In the article, "Templeton positive about largest psychology award," an APA award program is announced that "is meant to support and reward ground-breaking research in the area of positive psychology."

I strongly agree with the goals of the award program. As I am 55 (and 25 years out of graduate school), you can imagine how I blanched when I read "candidates must not be more than 40 years of age or, if over 40, must not be more than 12 years beyond receipt of the doctoral degree." This sentence so strongly smacks of "back of the bus" thinking that I am almost at a loss to express the depth and breadth of my concern. To add salt to this wound, Sir John Templeton, the philanthropist who initiated this award, is 86!

How can we, the nation's most powerful and prestigious organization of psychologists, practice such blatant ageism and still look ourselves in the mirror in the morning? It is, after all, against the law to use age, sex, race or even sexual orientation as disqualifying criteria for career advancement in many states/organizations. We should be ashamed to have allowed this example of a not-so-hidden prejudice to have appeared in our organization's newspaper. I can almost hear future psychologists clucking their collective tongues. Tsk. tsk.

Raymond Reed Hardy, PhD
De Pere, Wis.



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