letters

Promoting mental health

As a health psychologist that has been working in the field of primary prevention for the last 20 years at Rambam Medical Center (general hospital) in Haifa, Israel, I am delighted that APA President Martin Seligman is bringing again in focus the mission of psychology in promoting mental health. It is worthwhile noting that in September 1983 APA established a Task Force on Promotion, Prevention and Intervention Alternatives in Psychology. Members of the task force included Richard H. Price (chair), Emory L. Cowen, Raymond P. Lorian and Julia Ramos-McKay. The result of the mission of the task force was the selection of 14 model programs in primary prevention out of 300 programs reviewed. The 14 model programs identified, representing a reasonable coverage of the individual?s life span, were assembled in a book entitled '14 Ounces of Prevention. A Casebook for Prac-titioners.' The book was published by the APA in 1988. I would suggest that the new task force recognize the work that has been already done in this field in order to enhance the impact of a prevention alternative.

Ciporah S. Tadmor, PhD
Haifa, Israel

On the ?President?s column?

I applaud Dr. Seligman?s column in the January 1998 APA Monitor calling for psychologists to shift their emphasis away from pathology, weakness, damage and illness to 'study of strength and virtue,' 'nurturing what is best within ourselves,' competence and prevention of disorders. I agree we need 'a new science of strength and resilience' and ways of 'making high human potential actual.' This has been the agenda of humanistic psychology and this journal for over three decades.

Given what you wrote, my puzzlement and concern are that you use the phrase 'mental illness' six times in your column and then paradoxically say 'pathologizing does not move us closer to the prevention of serious disorders.' I would add that medicalizing serious disorders and problems of living in the absence of pathognomonic physiology is also not useful and tends to encourage strategies of medical treatment rather than community-based prevention and psychologically facilitated growth. Psychology seems increasingly medicalized these days. I hope you will lead APA to counter the trend.

Thomas Greening, PhD
Los Angeles

In his January 'President's Column,' Dr. Seligman wrote that there have been 'at least 10 disorders previously intractable have yielded their secrets and now can be cured or considerably relieved.' This is great news. What are they?

J.B. Goebel, PhD
Orlando Park, Ill.

Response from Martin : E.P. Seligman: In descending order from 'almost curable' to 'mild relief,' I?ll make it 15 rather than 10 to keep up with developments: panic, specific phobia, premature ejaculation, male erectile disorder, female sexual arousal disorder, social phobia, agoraphobia, unipolar depression, obsessive-compulsive disorder, paraphilia, bulimia, anger, everyday anxiety, post-traumatic stress disorder and substance abuse.

I take this from M. Seligman, 'What You Can Change and What You Can?t' (New York: Ballantine [1993]), which reviews the large outcome literatures for psychotherapies and medications for each of these problems.

Global needs

How timely it was to read the March Monitor?s 'Ethno-political warfare' and 'Quelling ethnopolitical strife is the goal of new initiative,' which emphasize psychologists? involvement in and contributions resolving ethno-political conflicts. I agree with APA President Martin E.P. Seligman, PhD, that 'American psychology can no longer remain insular, preoccupied only with domestic problems.'

Surely, psychologists can also contribute toward the improvement of interethnic relations, have a positive impact on the successful resolution of ethnic conflicts and on the prevention of ethnopolitical warfare.

Already, a conference has been organized, and an institute to train 'scientist-practitioners' is being planned. The need is indeed global.

As APA will not have any affiliation with the training institute(s) and psychologists from other countries and cultures will also be involved with the new initiative, I would like to suggest that:

? A center be established to coordinate the activities of the new specialists and those who have the necessary contextual experiences, cultural knowledge and sensitivity, and special skills (i.e., consultants, advisers).

? A directory of cross-disciplinary and interdisciplinary community of scholars (interested in ethnopolitical conflict and warfare) from around the world be prepared.

? Up-to-date information be disseminated through efficient means of communication to all those with necessary training and area expertise who are affiliated with the center.

? Occasional regional roundtable discussions and conferences be held with the participation of scientist-practitioners and experts from different governmental agencies and humanitarian organizations.

Hagop S. Pambookian, PhD
Portsmouth, Ohio

There?s a link

I would like to suggest that there is a link between the often-lamented 'dearth of behavioral research [grant] applications' (from the APA Monitor article by Beth Azar, 'Are psychologists shooting themselves in the foot,' March 1998) and the dismal lack of tenure-track positions in psychology that has been highlighted in previous issues of the Monitor. Many recent psychology PhDs who toil in the nontraditional vocations we have been urged to seek out?as if there were a choice?would welcome the opportunity to submit grant applications to these various agencies. We simply cannot by virtue of our nontraditional, hard-money jobs that do not, and should not, permit it. As such, if we wish to work in the field of psychology, we must make arrangements with our colleagues in psychology to put us on grant proposals in an 'in-kind' (read: unpaid) capacity. Psychology as avocation in other words.

Mark R. Somerfield, PhD
Abingdon, Md.

On Theodore Kaczynski

In the March Monitor, Dr. Drew Westen grossly misled psychologists and the public by implying that Theodore Kaczynski was found to have a brain disease when a psychiatrist labeled him 'paranoid schizophrenic.'

The psychiatrist who interviewed Kaczynski did not find any brain disorder to confirm what is called the 'diagnosis of schizophrenia.' 'Schizophrenia' is a medical-sounding label, but there is no underlying biological disease that has ever been scientifically established in connection with it. 'Schizophrenia' is a label given to denote the perceived illogicality of a person?s words and behavior. Look in medical texts written by pathologists, physicians who insist that disease be documented in the body, and not be a metaphor about 'pathological ideas' or 'sick minds.' There is no disorder of bodily tissue or of the brain that has been discovered that is 'schizophrenia.' Read carefully what the National Institute of Mental Health writes in its brochures. There are no medical tests for 'schizophrenia' because decades of biological research have not substantiated any biological theories about why people believe things that others think are foolish, deluded or irrational.

Without evidence of actual brain damage or neurological impairment, Dr. Westen?s argument about Kaczynski?s lack of responsibility for his crime could undermine our system of justice. We should not grant psychiatric clinicians the power to decide who will be held responsible for their crimes in cases where there is no finding of literal medical disease. Such abdication of difficult determinations of justice could lead us down a slippery slope.

Richard Shulman, PhD
West Hartford, Conn.

Irresponsible

When a scientist free associates about his or her results the Monitor should not make a headline of it! In February the Monitor reported on a study by S. Marc Breedlove, that showed that sexually inactive, castrated, androgen-dosed male rats had larger spinal cord motor neurons than did sexually active males.

How could this study have any bearing on sexual experience playing 'an important role in developing a homosexual or heterosexual identity'?! It is especially irresponsible in an area where so many are hurt by strongly held prejudices.

Nancy K. Montagna, PhD
Silver Spring, Md.

The Cattell award

I have reluctantly decided to end my nearly 30-year association with APA. I cannot remain a member after the way Raymond Cattell was treated. Cattell was selected by the American Psychological Foundation to receive the Lifetime Distinguished Contribution Award. A few weeks before APA?s 1997 Annual Convention in Chicago, APA received objections to Cattell?s award because his early work was said to be racist and anti-Semitic. Because Cattell was in poor health, it is my understanding that negotiations were conducted between APA and Cattell?s daughter. The fear of demonstrations at the conference and concern about the charges led to the withholding of the award at the convention. To his credit, Cattell attended the conference and even held a reception for friends, though he did not attend the award ceremony. After the convention, a blue-ribbon panel was appointed to study the charges and decide if Cattell should be given the award.

Cattell died recently. It is my understanding that his daughter withdrew his name from further consideration for the award, and the blue-ribbon panel was disbanded.

APA and APF have caused the career of a distinguished scientist to end under a dark cloud. Though parts of Cattell?s work were controversial, when taken in context none was racist or anti-Semitic in my opinion. Further, the controversial work was clearly flagged in the application for the Distinguished Contribution award so the committee knew about it when his application was judged. I am sure history will treat Cattell more kindly than APA has.

Douglas K. Detterman
Cleveland

Editors? note: It was Dr. Cattell?s decision to withdraw his name from consideration for the award. In addition, the American Psychological Foundation Awards Committee did not know about Dr. Cattell?s early writings when it first selected him for the award.

Letters about letters

Dr. Robert Neufeld states that psychotherapy is dead and managed care killed it (Letters, APA Monitor, March issue). He then describes the type of therapy that many of us practiced for many years, and many still do?a 'meandering, evolving, interesting, complicated journey.' That form of therapy is not related to reimbursement by managed care as it is not related to health insurance, appropriately interested in symptoms and solutions. Actually, many who practice brief therapy, and did before the advent of managed care, question the value of such a journey, but if that is what you want to do, do it. Just help your client realize that such a journey is of as much value as a new car or boat and worth consideration in their personal budget?not that of their health-care insurance company. I agree that being wiser, calmer and more realistic is a wonderful goal and as a REBT practitioner, I fully share that goal, as do my clients. It also is worth more to them when they make the decision to pursue it on the basis that it has personal value and monetary worth to them. We will only let this transformation happen if we agree that the only value we have to offer must be covered by health-care insurance. I tend, due to my orientation, to look upon therapy as an educational process. Perhaps that is why I can see therapy as having value beyond the 'health benefit,' which is symptom oriented.

Allan F. Demorest
Des Moines, Iowa

Regarding Dr. Martin Haydon?s letter in the March Monitor, as Dr. Haydon supports prescription privileges, it is disappointing to note that his letter contained misinformation that can be used to discredit efforts to gain those privileges. For example, Dr. Haydon asserts that 'psychologists who confine themselves within the bounds of psychotherapy deprive their clients of essential services the deprivation can constitute malpractice.' Nonsense. Lack of prescription privilege doesn?t 'confine' a competent psychologist, who refers patients as necessary for medication evaluations by physicians. Knowledge of appropriate circumstances for referral is already an essential part of our scope of practice. Dr. Haydon then asserts that 'training in psychopharmacology provides essential knowledge. Ignorance of psychoneuro-immunology limits the psychologist in making an adequate assessment of neuropsychological impairments.' Psychopharmacology, psychoneuroimmunology and neuropsychology are distinct, albeit related, disciplines, and training in psychopharmacology will not provide the basis for making 'adequate assessment of neuropsychological impairments' or any expertise in psychoneuro-immunology. The use of the terms as synonyms is absurd.

Finally, Dr. Haydon says that 'it is well established that severe, persistent depression or anxiety is the cause of neural impairment' simply makes no sense. There are multiple neurological and neuropsychological impairments, and their causes are diverse. Promiscuous and erroneous use of technical terms with 'neuro-' prefixes suggests a need to master a bit more of the psychological literature before racing off to annex others? specialties.

Jon Richard, PsyD
Denver

All letters to the editor must be 250 words or fewer. Mail them to APA Monitor, 750 First St., N.E., Washington, DC 20002-4242. Letters may be edited for clarity or cut for space reasons. The Monitor regrets it cannot run all the letters it receives.