letters

Worthy of honor?

Within the past month there has been considerable attention given to Judith Rich Harris for her work 'Do Parents Matter?' Finally, psychological theory has been taken to task for pointing the finger at parents as the culprits for all of our childhood difficulties. But does that now mean that we should frame parental influence as insignificant, pale in comparison to genetics and peer influence?

Harris purports that, all other things being equal, nice children tend to be hugged because they are nice, and unpleasant children tend to be beaten because they are unpleasant. At the heart of [a client?s] distress, at the heart of many abused children?s distress, is the quiet voice inside that says, 'What if they?re right? What if it was me that made my father throw me against the wall, beat me when he was drunk, molest me because?.'

A new theory comes down the journalistic pipeline every week. But my concern has more to do with the APA honoring this work with an award, thus raising its credibility with the public. Granted, psychology has historically acted as barometer and voice piece of the culture. But, aren?t we also charged to use care in applauding theories that come into the mainstream? I wish we had been a bit more careful anticipating the impact of this one on the clients whom we treat.

Patricia Gianotti, PsyD
Portsmouth, N.H.

It?s what you make of it

I am writing in response to the September article on isolation and Internet use. This topic raises many interesting issues about 'Internet life,' but it is important to keep in mind that the Internet is what one makes of it. I have seen the ill effects as described in the article occur to many friends of mine. In one case a friend became a lonely hitch-hiker on the information super-highway. He became reclusive and his only desire was to be online 24 hours per day. On the other hand, I have also observed the Internet having positive effects on people, but these positive effects can quickly lead to obsession if one does not get out of the house once in a while.

Fred Mayhew
Erie, Pa.

Of course depression is biochemical

In the 'president?s column' in the Monitor?s September issue, Dr. Seligman poses a misleading question: 'Is depression biochemical?' The brain is an electrochemical system, and no matter how it is altered, it remains an electrochemical system. The brain can be altered directly through surgery, electrical stimulation, and chemical stimulation, and it can also be altered indirectly though learning and experience. The brain of a depressed individual is in a certain state, and when depression is relieved?and no matter how that depression is relieved?the brain is now in a different state. In that undeniable sense, all depression is biochemical.

I believe that what Dr. Seligman is really concerned about is whether or not talk psychotherapy is more effective than psychotropic medication in the treatment of depression. In other words, which intervention produces the appropriate biochemical changes (and, of course, the associated mood and behavior changes) faster or better? In principle, the ideal biochemical intervention should be able to produce the same changes as the ideal talk therapy. Alas, since neither exists, the value of biochemical and experiential interventions, used separately or in combination, must be evaluated on a case-by-case basis.

Robert Epstein, PhD
Cardiff by the Sea, Calif.

In his column 'Is depression biochemical?' (Monitor, Sept. 1998) President Seligman asks why CNN, Newsweek, managed-care organizations and the American public do not recognize the strong evidence for cognitive causation of unipolar depression.

I had an experience that suggests one reason. Two items came in the mail one day. One item was an edition of The Scientific American (December 1996) with an article, 'Why Freud Isn?t Dead,' pointing out the value of psychotherapy and criticizing drug therapy. Dr. Seligman was quoted. The other item was an invitation sent to all my mental health colleagues to a free supper at an expensive local restaurant. The supper would be accompanied by a presentation regarding a new antidepressant medication marketed by the sponsor of the supper. The playing field is not level.

Charles L. Walter, PhD
Johnson City, Tenn.

Response from Dr. Seligman:

The brain is not only an 'electrochemical system.' It is also a system of proteins, a system of atoms and a system of subatomic particles?in just the same sense. The scientific question, as opposed to the philosophical question, is whether the account of the phenomena of depression (note the plural, 'phenomena'; there is no implication that depression is one thing or has one cause) is most usefully cognitive, electrochemical, protein synthesis, atomic or subatomic. I claimed that the usefulness and explanatory power of the causal account of the 'electrochemical' model is considerably overstated and oversold?given what is actually known. And that, in contrast, the psychological explanation is quite robust.

Forget anyone?

I read your story 'Psychologists, social workers and psychiatrists: too many or not enough?' with great interest. I looked carefully for any mention of the thousands of therapists who practice under a master?s level license, such as 'licensed professional counselor' or 'marriage and family therapist.' However, the Monitor has ignored the existence of these therapists.

Although the American Counseling Association has worked cooperatively with the APA in several efforts, the profession of counseling continues to be ignored by the Monitor. You contended that we are all vying 'for position in the next decade,' but yet I see little movement to come together as a mental health profession, no matter what our licenses and degrees may read.

It?s a time for unity, not division. It is ironic that many psychologists, probably APA members, are working in educational institutions in programs that prepare counselors?yet one never sees this mentioned in the Monitor.

Rosemarie Scotti Hughes
Virginia Beach, Va.

An otherwise illustrative and well-crafted article fails to recognize the scope of involved professionals in the behavioral health-care field. I am referring to Rebecca Clay?s September article, 'Mental health professions vie for position in the next decade.' Ms. Clay outlines the marketplace shifts among competing professionals who practice psychotherapy. Psychiatry is out, social workers are in, and psychologists want to write prescriptions. Nowhere is mention made of licensed professional counselors who specialize in behavioral health care and who are attracting attention from managed-care providers and mental health agencies across the country. Virtually every state in the nation (45, to be precise) has in place a licensure board for professional counselors that sets standards and confers licensed status. Combined with the impetus for counselor education programs to attain the American Counseling Association?s CACREP (Council for Accreditation of Counseling and Related Educational Programs) accreditation or at least to adopt CACREP curricula and training requirements, counselors are more than adequate to the task of competition in managed-care markets alongside psychologists and social workers. Keeping a finger on the pulse of ascending or descending fates of branches of behavioral health care professionals blunts the focus needed for more pressing concerns. Professional publications ought to be obliged to take up the more critical issue of how these four disciplines will put away their jockeying for position and take up a consolidated stance to curb managed behavioral health care excesses in the denial of services and provision of inadequate services.

Patricia A.D. Kennington, PhD
Marietta, Ga.

An activist agenda

The report in the September Monitor 'Volunteers find satisfaction' about Michael Sullivan as well as the members of the Michigan Psychological Association who offer pro bono services to union members suffering hardship from a lengthy strike is astounding.

Unions call strikes! They can end their hardships, which they bring on themselves, by going back to work. The psychologists could solve the problem immediately by convincing the union leadership to instruct the members to return to work.

What about the company and the many hardships the managers and owners suffer as a result of the union striking them? They are the victims in a strike. That?s who should receive the pro bono counseling. Oh, wait. Silly me. I forgot. They?re psychologists and have an activist liberal social agenda.

Neil P. Lewis, PhD
Marietta, Ga.

Voicing frustration

I continue to be frustrated with the content of the Monitor, although perhaps there is some solace in thinking that it does not reflect what really goes on at APA. If it does, then I?m concerned about the political action activities I am supporting with my dues. Taking positions on whether certain groups can have access to health insurance is something I can take to my congressional representatives who represent my views before the legislature.

When I see that I am about to be assessed again to support practice activities, I want to see that as the focus of APA. I am unwilling to have my practice assessment fund political actions or use it to support blue ribbon committees that APA uses to avoid honoring its heritage. What about seeing some action, maybe a blue ribbon committee, to look into joining a union? The social workers? national organization did just that when it felt their progress had been limited against the managed-care machine. Let?s see some articles on using my assessment money for that.

Gordon C. Sauer, Jr., PhD
Irving, Texas

More on Rxp

I write in response to Dr. Russ Newman?s column, in the September Monitor, which stated that an article appearing in the July/August issue of the National Psychologist provided 'inaccurate information' on the process whereby APA endorsed prescription privileges. As a member of APA?s Council of Representatives that participated in the process, I can affirm that Henry Saeman?s article in the National Psychologist was quite accurate (except for one minor point). Dr. Newman was correct in reporting that in 1986, Council did approve a resolution that the practice of psychology 'includes both physical as well as purely psychologic interventions.' Nowhere in that resolution was prescriptive authority specifically mentioned.

In August 1995, APA Council voted to suspend its usual rules and consider immediately a new business item endorsing prescription privileges. This action eliminated the process of referral of the item to all APA boards and committees interested in reviewing the concept and providing feedback to Council before it voted. After suspending its rules, Council then approved the prescription privileges policy. As reported by Dr. Newman, the August 1995, Council did subsequently set up groups with broad organizational representation to develop model legislation and training plans for prescription privileges. However, the decision to pursue prescriptive authority had already been made.

The only error in the National Psychologist article involved the date: APA Council voted in August 1995, not August 1996, to approve prescription authority for psychologists.

Garland (Gary) Y. DeNelsky, PhD
Cleveland, Ohio

Correction

A September cover story on Internet use incorrectly listed Viktor Brenner?s institutional affiliation as Marquette University. Brenner formerly worked at Marquette but now is with the Wisconsin School of Professional Psychology.

In the August issue, a chart that listed the sites of various school shootings over the past seven years misidentified Parker Middle School in Edinboro, Pa. The school was listed as Andrew J. Parker Middle School.

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