Psychiatrists step up attack on psychologists

Dear Colleagues,' the letter began. 'I labored over whether and how to write you.' Addressed to psychologists, social workers and master?s-level counselors in Key West, Fla., the psychiatrist?s letter goes on to say that nonphysician therapists must stop making medication recommendations or face prosecution. Citing a recent article in the Florida Psychiatric Society?s newsletter, the letter writer claims that medication recommendations from anyone but a physician endanger patients? safety.

He concludes with a threat to turn in anyone he deems to be practicing medicine without a license.

That letter represents just one example of an antipsychology campaign that seems to be gaining momentum as APA fights to win prescriptive authority for psychologists. Psychiatrists in Hawaii and other states have also launched letter-writing crusades. And the American Psychiatric Association?s web site is peppered with references to psychologists as 'wanna-be' physicians. The site also offers strategies for fighting any expansion of their scope of practice.

'The attack on psychologists? ability to make medication recommendations is part and parcel of psychiatry?s efforts to retaliate against psychology for its pursuit of prescriptive authority,' says Russ Newman, PhD, JD, executive director for practice at APA.

In Hawaii, the backlash from organized psychiatry has already had an impact. When psychologists in the state managed to get a prescribing privileges bill introduced in the state legislature, opponents launched a letter-writing campaign to block the bill. The bill?s author was so intimidated by this barrage of letters that he pulled his support, says Kathleen M. McNamara, PhD, an APA board member from Honolulu.

'The letters from consumers basically said, ?Please don?t let psychologists prescribe and mess with my mind,?' says McNamara.

It?s unclear whether psychiatry effectively generated the 'consumer' letters that Hawaii legislators received, says Elizabeth Cullen, director of legal and regulatory affairs for APA?s Practice Directorate. On the other hand, psychiatry certainly is employing a variety of tactics in an attempt to derail prescriptive authority for psychologists, she says.

'State psychological associations should anticipate and be prepared to deal effectively with letter-writing campaigns and similar initiatives by organized psychiatry,' Cullen says.

Alan R. Gruber, PhD, of Neurobehavioral Associates in Hingham, Mass., is puzzled by these attacks on psychologists. And he has a ready response when people suggest that he go to medical school if he wants to recommend medications for his patients: He already has. Gruber invested three years in medical school before deciding his real commitment lay with psychology.

In fact, Gruber believes that psychiatry should actually view prescribing psychology as a model for its own future. 'Prescribing psychology and psychiatry would really be much more like each other than different,' says Gruber, who has a dual doctoral degree in social work and psychology, another in clinical psychology and medicine and a postdoctoral fellowship in neuropsychology. 'Psychiatrists often think of themselves as psychiatrists and not physicians. I?m not interested in being a physician, either. I?m interested in helping people who have mental health and behavioral difficulties.'

?Rebecca A. Clay