SINCE THE psychologists and trainers in our practice provide threat assessment and training to organizations struggling to cope with violence as a work and school issue, I read the July/August piece "Road rage, air rage and now 'desk rage'" with much interest.
Two quotes by Drs. Spector and Burroughs demand my comment. When Dr. Spector states that, "The media influence can be good," it goes against what we have seen during our post-incident work at Columbine and Santana high schools, at the Oklahoma City bombing and at many workplace violence shootings. Our reality suggests that the TV media succeeds in two ways: creating a climate of fear at workplaces and schools, and encouraging, by proxy, copycat behavior. Post-incident headlines that scream, "Are You Really Safe At Work?" help people feel anxious about the rarity that is fatal workplace violence or school-based homicide. For the disturbed worker or student who is considering targeted violence, the TV and print media trumpeting can provide the impetus to "solve my problems like that shooter did."
Dr. Burroughs' suggestion that Intranet cyber-venting might be useful forgets the fact that anonymous postings of "electronic graffiti" create a fearful environment. The angry worker who types threat-laced rants about "blowing up this place and certain people in it," causes immediate anxiety in those who read them. In our era where many verbalized threats are rationalized as "I didn't really mean it," we don't need more anonymous outlets to make other people feel afraid to come to work or stay there.
Psychological assessments compared to medical tests
THE JULY/AUGUST MONITOR article, "Psychological assessments shown to be as valid as medical tests," is stimulating and, as far as it goes, probably accurate. However, the article seems misleading in several ways that are important to gauging the relative value of medical and psychological techniques (when such alternatives are available). First, juxtaposing MMPI Ego Strength scores with ultrasound examinations of pregnant women (in the graph) is like pairing the squishiness of bananas with the fuel consumption of airliners. To be realistic, the presentation should have compared medical and psychological techniques for predicting the same conditions.
Secondly, you did not mention the time required to take psychological and medical tests. Especially in the area of neuropsychology, most psychological methods take literally hours to administer. Meanwhile, most medical tests take only a few minutes.
As you know, in many areas of health-care practice, life may hang in the balance, and it is critical to make sound inferences in a short time--even if the patient cannot participate meaningfully in the process. However, with most psychological tests, for results to be valid, the patient must participate with optimum alertness, effort and interest.
Your article was engaging, but I feel--to be really helpful--the topic should be readdressed and comparisons between psychological and medical tests put on an equal footing, i.e., contrasting their accuracy for aiding the same types of decisions.
MILTON R. RAVENSBORG, PHD
Port Charlotte, Fla.
RESPONSE FROM THE STUDY AUTHORS: We appreciate Dr. Ravensborg's thoughts. Although it may not have been clear in the Monitor report, the article to which it refers explains how the 144 test effect sizes emerged from a survey of meta-analyses that validated each test with appropriate criteria. While tests are used for many distinct purposes, their effect size magnitude provides a meaningful frame of comparison. For instance, even though Pap smears should detect cervical abnormalities better than depression and vice-versa for the MMPI, knowing the validity for each test-criterion relationship is enlightening. The Monitor and full article also noted several instances when the same criterion validated medical and psychological tests (e.g., dementia detected by MRI or neuropsychological tests). The results did not suggest superiority for one type of test.
Second, we agree cost-benefit considerations are important, though they must extend beyond testing speed. The most important factor is the cost of not using tests and reaching erroneous conclusions. Lives hang in the balance in the psychological arena also, and we documented the serious limitations associated with circumscribed evaluations derived from a single source of information (e.g., interview). On the whole, we doubt that it is really more expensive to use tests when obtaining sound information about psychological functioning than physical functioning.
Finally, we fully agree that psychological tests cannot be performed on patients but must be done with their willing engagement. Collaborative/Therapeutic Assessment models make this a central requirement of the process and it is part of what makes assessment much different from testing.
GREGORY J. MEYER, PHD, STEPHEN E. FINN, PHD, LORRAINE D. EYDE, PHD, GARY G. KAY, PHD,
ROBERT R. DIES, PHD, ELENA J. EISMAN, EDD, TOM W. KUBISZYN, PHD, GEOFFREY M. REED, PHD
A sterile account
THE "PRESIDENT'S COLUMN" IN THE JULY/AUGUST Monitor offers a tepid and sanitized account of the controversy sparked when the former editor of the American Psychologist, Richard McCarty, also former head of the APA Science Directorate, withdrew a previously accepted manuscript entitled "Bonfire of the Vilifiers" by Scott O. Lilienfeld. The president quotes the Ethics Code covering the authority of journal editors, but ignores the question of the editor's conflict of interest, given his office at the time of APA's craven response to congressional pressures stemming from adverse publicity over the Rind, et al., review. Nor does she address the shortsightedness of McCarty's editorial reversal. Did McCarty imagine that Lilienfeld would not submit elsewhere?
At a time when professional organizations are under fire for self-interest and a reluctance to police themselves, what would have been the consequences had his manuscript appeared in, say, the New Yorker or the Atlantic Monthly?
The president laments the appearance of the debate on the Internet, because it has "no rules of conduct," but misses the point that the editor's conduct is precisely what gave rise to its displacement to the Internet in the first place! As "an open forum," the Internet is fully accessible to opposing views. The "Bonfire" flap arose in the wake of the editor's initial support and subsequent effort to silence Lilienfeld's alternative voice. Who is kidding whom? This controversy came to general attention from an article in the May 23 issue of the Chronicle of Higher Education, not from the Internet. Where was the Monitor?
DAVID S. NICHOLS, PHD
Don't forget prevention
IN THE JUNE SUBSTANCE ABUSE special issue, when prevention is mentioned, the overwhelming focus is on education. These foci are appropriate for clinicians but neglect the responsibilities of psychologists as scientists and citizens. Moreover, they implicitly play into the blame-the-victim, pro-drug campaign being financed by two or three very rich people (except where Monitor writers stipulated harmful effects of substances).
The introduction to the issue alludes to another prevention approach: legally restricting substances of abuse, but that approach is treated as controversial. Contrary to myth and propaganda, the literature has well-established facts that involve social action. Specifically, Prohibition of alcohol in the United States, 19181933, was quite successful. With hardly any enforcement, drinking dropped by two-thirds or more. Despite advertising and another spate of media efforts, pre-Prohibition alcohol consumption rates were not reached again until the early 1970s.
The myth of a 1920s crime wave is based on bad journalism and anachronistic movies, not historical facts. Con-trary to exceptional cases played up by the media then and now, people breaking prohibitory laws represented general criminals, and arrests for alcohol/drug offenses simply were a convenient way to reduce general anti-social behavior.
The literature shows that prohibitory laws do work. Psychologists should join their colleagues in public health in endorsing all forms of prevention as well as treatment. And it might help to whisper--without discouraging the brave workers in the field--that disappointing sustained success rates of cure programs have left a large social gap.
JOHN C. BURNHAM, PHD
Ohio State University
More lifestyle balance
I JUST READ EILEEN O'CONNOR'S article about Robert Brooner, PhD, in the June Monitor. I was impressed by Brooner's achievements in the field of drug treatment, but the description of how he lives his life made me shudder.
His "typical day" begins with problem-solving for numerous treatment agencies; no matter how challenging the problem, "Brooner finds the answer." Then, while most of us mortals are taking time to eat lunch, he is meeting with researchers and staff. Next, he sees patients until 8:00 p.m., while also grabbing "a few moments to try to write." Eventually he goes home and makes an effort to spend time with his wife and children, followed by more writing and editing until 3 a.m. On a typical weekend he unwinds by working only six to eight hours. The result: "Brooner's hard work has paid off."
As psychologists, many of us try to help clients come to terms with the impossibility of doing all, being all and having all. But the admiring tone of the article about Brooner betrays the possibility that, while we often decry our society's multitasking, we still buy into it on some level.
ANNE WINCHELL, PHD
RESPONSE FROM DR. BROONER: The letter by Dr. Winchell reflects considerable dismay and disapproval over the "positive spin" in the article describing my "typical" day. The article accurately describes a busy and demanding set of responsibilities. These responsibilities include providing answers to numerous questions that require definitive action on behalf of one or many people. Making decisions about complex questions is a critical aspect of my job. Professional success is often a springboard for increased opportunities. Many people manage this challenge by devoting more hours to the work schedule. This practice is neither unusual nor necessarily damaging or destructive. Like many of my colleagues, I decided years ago to devote considerable time to the development of my career. As noted prominently in the article, I decided recently to reduce the scope of my professional responsibilities. These decisions were thoughtfully considered and both were good choices. In condemning the article as a poor example of "success," Dr. Winchell misses the point that most decisions in life are amenable to reconsideration and change. Helping people both realize and exercise this principle is perhaps more central to the work of psychologists and other mental health experts than is telling people what they cannot or should not seek to accomplish in their lives.
ROBERT BROONER, PHD
AS CHAIR OF THE APA WORKING Group on Assisted Suicide and End of Life Decisions (19982000), which developed the resolutions on end-of-life care and assisted suicide that were passed with minor revisions by the Council of Representatives, I am writing to clarify some misperceptions about the assisted suicide resolution--in particular that it does not take a definitive position. In fact, it does!
By neither endorsing nor opposing assisted suicide, this resolution honors and respects individual and cultural differences in attitudes toward death and dying. Further, it avoids a premature APA stance on issues that as yet have insufficient empirical data and, along with its companion resolution, paves the way for psychology to contribute to our knowledge base and advance quality of care at the end of life.
People have strong differences of opinion: In several studies approximately 80 percent of psychologists have supported the possibility of rational or assisted suicide, and the public and various professional groups show a range of 35 to 65 percent in favor. Even more significant in today's age of advanced biomedical technology is the reality that the timing of at least 70 percent of all deaths is orchestrated in some manner, meaning that a majority of dying patients and their families face difficult end-of-life decisions. APA's commitment to health and well-being throughout the life span should include the end of life for the dying and their loved ones. The resolutions do just that, by promoting training, research, counseling, advocacy, policy development and interdisciplinary collaboration.
JUDITH R. GORDON, PHD
DIVERSE OPINIONS ABOUT, AND methods of, approaching death are emerging in the United States. Requests for physician-assisted death raise substantial issues not only for the medical community, but also for psychologists who may be asked to participate in assessing the patient's capacity to consent to such an intervention or to assist in the decision-making process.
The Oregon Death with Dignity Act enables a mentally competent, terminally ill adult to request a medication from a physician that can be self-administered to hasten death. This law substantially differs from that found elsewhere in the United States. In many other jurisdictions, on a de facto basis, aggressive palliative care can hasten death "unintentionally." Psychologists play nominal roles in such decisions that have been shown by the empirical research to be susceptible to the effects of undue influence and coercion. Abusive practices are best exposed and healthy policy change achieved by the development of a comprehensive examination of the practice, policies and empirical knowledge surrounding this topic. I am very proud of the APA for developing and passing the resolutions on end-of-life care and assisted suicide. Both recognize that insufficient empirical data exist and call for psychology to contribute to our knowledge base and advance quality of care at the end of life.
Psychologists can find a comprehensive discussion of the implementation of Oregon's law, the assessment of patient decisional competency under the law, and a review of existing research findings and implications for future research within a special issue about hastened death in the APA journal Psychology, Public Policy, and Law (Vol. 6, June 2000, delayed in publication until June 2001).
G. ANDREW H. BENJAMIN, JD, PHD