REGARDING "When health fears hurt heath" (July/August Monitor), there is another aspect to the development of dental phobias that was not examined in the excellent article. The usual injected dental anesthetic contains both Novocaine (for numbness) and epinephrine (to constrict blood vessels to both keep the Novocaine in the immediate area and minimize bleeding). Epinephrine typically increases the heart rate and other signs of physiological arousal. When this is added to the level of arousal that the patient is already feeling, the patient can really feel panic. The next time the patient has to go to the dentist, the feeling of that arousal is anticipated and worsens the level of fear.
Novocaine is available without the epinephrine and should be requested and also documented on the patient's chart. There will be a bit more bleeding, and the pain management may need to be repeated, but the racing heart and panic will be absent or minimal. This is very important, given the amount of self-monitoring that is part of the phobic reaction. In addition, the act of taking charge of some aspect of the dental procedure lessens the anxiety. Empowerment to the people!
KAREN GREENE, PHD
New York, N.Y.
Psychologists at Guantanamo Bay
THE NEW ENGLAND JOURNAL OF Medicine (Vol. 353, No. 1, pages 6-8) has reported about cases where psychologists and physicians were involved in preparing inmates of the Guantanamo jail for interrogation. Information about specific psychological disorders (like fear of darkness) were used by the officers. In reply to accusations, the U.S. government argues that these psychologists and physicians were not part of the therapeutic team but were doing research in Guantanamo. In my opinion, it is unethical for psychologists to take part in measures of torture whatever the function of psychologists or physicians may be. The U.S. government interprets torture only as a measure, which leads to a certain amount of pain or injury. The scientific literature shows that prevention of sleep, enduring cold temperatures, etc., have the same effect as traditional torture. The use of specific psychopathological information about inmates for interrogation is in contrast to the ethical standards of APA.
I expect some clear words by the APA to condemn such behavior and some proposals about how to prevent such incidents in future.
MATTHIAS REISS, PHD
Helping men to help themselves
I FOUND IT IRONIC THAT THE first piece of advice offered to therapists when working with men ("Keeping them hooked in," June Monitor), was "First and foremost, don't stereotype," yet the lead article in this section ("Helping men to help themselves") opens with a stereotype--the "Marlboro man" who "wouldn't admit to needing help...wouldn't talk about his emotions [and] might not even recognize that he has emotions." If half the population is, as the article suggests, too "tough, independent and unemotional" for psychotherapy, then maybe the fault lies with traditional forms of psychotherapy, not with the male half of the population. Would we want an article in the Monitor about why women seek therapy more often than men to begin with a stereotype that depicts women as weak, dependent and overly emotional?
JAMES E. MADDUX, PHD
George Mason University