Letters

Sexual arousal

AS THE AUTHOR, more than 20 years ago, of one of the most sophisticated theoretical models of female orgasm in the published literature to date (e.g., "The Role of the Muscle Spindle in Women's Orgasm" in B. Graber's Circumvaginal Musculature and Sexual Function), I believe I have an informed opinion. It was most disappointing to see Etienne Benson repeat the tired feminist assertion that studies regarding female sexual arousal have been "much rarer" than those on men (April Monitor ). In the last 30 years there have been more published studies on women's sexual arousal than on men's. The lack of acknowledgement of Beverly Whipple's research on the G-spot, research that has had enormous heuristic value, is also disappointing.

Finally, Deborah Smith's piece on female sexual dysfunction completely failed to address an enormously important issue, that of differentiating difficulty experiencing orgasm from difficulty experiencing orgasm during intercourse. The former is rightly a dysfunction whereas the latter is not.

DOUG MOULD

Benton, Kan.

Training beyond mental health

DR. CYNTHIA BELAR'S PSYCHOLOGY education column in the March Monitor was a concise summary of why professional psychology needs to hasten its transformation from a "mental health" to "health" profession. Dr. Belar outlined several competency training areas essential to the improvement of quality in health care. These included being able to translate scientific information from one's own discipline for practical use in others (informatics), working in interdisciplinary environments and implementing evidence-based care. Transformation of health care from an acute to chronic-illness care model demands that behavior change--ranging from primary prevention to behavioral management of chronic illness--becomes a central element. Clinical psychology is potentially ably suited for this role. This is not news to many. However, judging from CVs and interviews with applicants for postdoctoral training in behavioral medicine and primary care, few training programs appear to be adequately preparing psychologists for 21st century health care.

Continuing to train clinicians in behavior change practices aimed principally at psychiatric illness in exclusion of the broad health-care context does not meet public health demands. By continuing training in outmoded assessment techniques and treatments, providing few interdisciplinary experiences and graduating students ineligible for licensure, clinical psychology could indeed be a good case study of planned obsolescence.

ROBERT J. FERGUSON, PHD

Dartmouth Medical School

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