letters

Lesson from the Capitol shootings

IT SURPRISES AND CONCERNS me that despite the outrage, fear, and disgust that are felt following incidences such as the recent shooting in the Capitol building by a schizophrenic man who was not receiving adequate psychiatric care, our communities and representatives do not lobby more strongly in support of mental health-related matters. Psychiatric illnesses, like most other major health problems, require effective treatment and monitoring by qualified mental health professionals including psychologists, psychiatrists and social workers.

Unfortunately, however, it is often difficult for patients to receive such treatment because of insurance limitations, restrictions from managed-care organizations and inadequately funded community mental health clinics for those individuals who cannot afford health insurance. We should not allow our outrage, fear and disgust to fade when we look for answers to these problems.

Michael Heitt, PsyD
Baltimore

Clarity on the ADA

THE JULY MONITOR ARTICLE 'Mental disabilities no barrier to smooth and efficient work' conveyed an effective and appropriate approach to complying with the Title I provisions of the Americans with Disabilities Act (ADA). However, some statements in the article were incorrect or misleading.

The article?s sidebar states that the ADA covers rehabilitation from drug use or addiction. Actually, the ADA affords protection only to rehabilitated drug addicts who are not currently using drugs. A person who has used drugs illegally in the past, but did not become addicted, is not protected under the ADA.

The article implies that employers have overstated the negative impact of the EEOC guidance document 'Enforcement Guidance on the Americans with Disabilities Act and Psychiatric Disabilities.' On the contrary, it is difficult to ascertain what impact these guidelines will have since judges have generally based their decisions without reliance on the guidelines. Until courts begin to rely extensively on the EEOC?s guidance?and they may not?such conclusions are unfounded.

Finally, the article states that the ADA 'has had little financial and legal impact for employers, especially in the area of psychiatric disabilities.' This view is obviously not shared by the thousands of employers who have expended extensive financial resources ensuring ADA compliance. There have been approximately 10,000 ADA claims based on emotional/psychiatric impairments during the last four years. Although some cases were brought to redress obvious employer wrongs, many were without merit.

I concur that the ADA is a well-intentioned and appropriate statutory mechanism. However, recognition of the facts contained herein provides a more realistic perspective of the ADA.

David W. Arnold, PhD, JD
Chicago

Been there, done that

THE JULY ARTICLE 'MORE clinical psychologists move into organizational consulting,' mentions practitioners filling an alleged 'gap between clinical psychology and industrial/organizational psychology.' The gap was filled years ago by counseling psychology?the branch of our profession that has always focused on the adjustment problems of a more healthy population. Counseling psychologists deal with people?s adjustment problems, work environments, career development and interpersonal relationships. It has proven to be a perfect preparation for what I describe to my corporate clients as 'management psychology'?a blend of insight and advice that builds from my training in counseling psychology. When our clinical colleagues begin to explore the world of work adjustment, they would be wise to consult the literature of Div. 14 (Industrial/Organizational).

William S. Beery, PhD
Darien, Conn.

Dangerous v. healthy self-esteem

IN THE JULY ISSUE, DR. SELIGMAN called attention to America?s violence crisis, and he is commended for this. However, he suggested building self-esteem is linked to violence and a disregard for responsibility and achievement, when in fact, 'high' self-esteem (e.g., Rosenberg, 1979) indicates a person feels neither worse nor better than others. The accurate interpretation of valid 'high' scores is 'healthy' self-esteem. Healthy self-esteem, which is earned, is different than dangerous self-esteem, which is falsely inflated. The Baumeister et al. (1996) article that linked teens? violent gang behavior with high self-esteem is often misinterpreted. Offenders? 'high' self-esteem was actually clinical narcissism or unstable and inflated self-esteem.

Predicting violence is very complicated. It is safer to suggest that when violent offenders and school yard bullies report inflated feelings of self-worth, they are defending against fears of inadequacy. This is an important issue because psychologists are arbiters of mental health. When our culture becomes confused enough to resist and 'blame' healthy self-esteem movements in the schools, then a cornerstone of mental health is compromised. Empathy and love for others develops with empathy and love for self?likely antidotes to violence.

The apparent backlash against self-esteem is ironic: Society is more at risk when children don?t feel just as good as others. The rest of the 'I am special' mantra that Seligman oversimplified is, 'Johnny and Aisha are just as special too.' Psychologists must help discriminate between pathological narcissism and healthy self-esteem. Please join us in promoting 'healthy' self-esteem when communicating with the public and professionals.

Mary Polce-Lynch, PhD
John R. Lynch, PhD
Ashland, Va.

More on the ?President?s column?

I WAS PLEASED TO READ THE president?s column in the June Monitor. Having just taken the clinical psychology ABPP exam, I too have been impressed with the need amongst psychologists to review 'prosocial' ethical behaviors. While I consider myself to be honest and ethical in my personal and professional life, I found myself clarifying my thinking on a variety of issues in preparing for the ABPP exam. In particular, reviewing Koocher & Keith-Spiegel?s 1998 edition of 'Ethics in Psychology' helped me to sort out the 'better path' when confronted with the 'grey zones' of ethics. Perhaps the Monitor, along with state psychology organizations and APA divisions, could address these issues by including ongoing ethics columns in their publications/newsletters?not to present egregious violations of ethical behavior, but to provide interesting examples of ethical dilemmas, followed by responses from a variety of psychologists (preferably not all from academic settings). The 'Clinical Child Psychology' newsletter episodically includes such a section, which is quite informative to read.

Mary A. Fristad, PhD
Columbus, Ohio

Misunderstanding of hypnosis?

IT IS DIFFICULT TO RECONCILE your careful coverage of hypnosis in the May issue with the note written by B. Murray in the June 'Newsline' regarding an article by Brandon et al. Because of space constraints, I just mention two glaring misstatements. First, Murray described hypnosis as one of a number of dangerous 'memory-recovery techniques,' and Brandon et al. quoted the work by McConkey & Sheehan (1995) to support their warning against hypnosis. What did McConkey & Sheehan actually conclude? '(M)emory distortion is neither unique nor specific to hypnosis...distortion is probable enough in the normal waking state' (p. 210, 214). This is not to say that hypnosis cannot be used incompetently or inadequately, or that false memories do not occur inside or outside of the hypnotic context, but these possibilities do not justify a general warning against the use of hypnosis. Second, Brandon et al. concluded that 'There is no evidence to support the wholesale forgetting of repeated experiences of abuse, nor of single episodes of brutality or sadistic assault....' They based their conclusion on a rebuttal of three studies. In contrast, D. Brown et al. (1998) have reviewed dozens of retrospective and prospective studies on childhood or physical abuse, combat, torture, etc., that show consistently that a substantial minority of individuals forget single or repeated instances of trauma. Professor Cheit keeps a web page on legal cases that also refute Brandon et al. Readers of the Monitor deserve comprehensive and balanced coverage on such an important issue.

Etzel Cardeña, PhD
Gaithersburg, Md.

Thanks for the wake-up call

Stan Lipitz?s column on downsizing of clinical psychology is an excellent though sobering wake-up call. For those of us working in the trenches, his words ring very true.

Tom Bergquist, PhD
Urbana-Champaign, Ill.

Psychologists and managed care

I PROPOSE THAT ANY PSYCHOLOGIST in the salaried employ of any managed-care organization be required to provide full disclosure of that relationship when aspiring to positions of governance and practice advocacy.

Further, this proposed requirement should be part of the bylaws of APA and all state psychological organizations. The damage done to this profession by the advocates of the managed-care industry is already so extensive as to need no further assistance from psychologists who believe they can serve two masters.

A. Richard Tomanelli, PhD
Greenwich, Conn.

REQUIRING A PSYCHOLOGIST to conduct psychotherapy through managed-care standards, is like forcing Rembrandt to paint by number.

Franklin S. Helsinger, EdD
Huntingdon Valley, Pa.

Shyness in our culture

IN RESPONSE TO THE 'NEWSLINE' 'New book spotlights an overlooked anxiety disorder' in the June Monitor, I would like to object to the medicalizing of a cultural value. As an educator and psychologist, I have found no evidence that students who speak out in class do better than those who do not. In fact, it is often the more reticent students who have done the most reflection. In addition, some people who are shy or 'socially phobic' as the article would term it are perfectly happy to avoid 'being in front, dealing with people.' It is interesting to note, too, that assertiveness, which is so highly prized by the dominant group in the United States, is seen as childish and lacking discipline in many other cultures that value social harmony and reticence (shyness). Is social phobia really only a thin disguise for cultural hegemony? The author of the article may take exception to my comments by asserting that social phobia would only be diagnosed in those whose shyness is causing them severe life adjustment problems. I would counter by noting that this is the same argument used in conversion therapy for homosexuals. As in that case, rather than examining the effects of a society which discriminates against those who don?t fit in, and their subsequent internalization of that discrimination which may lead them to seek help, we view the problem as a 'mental disorder.' Another case of blaming the victim. Thanks, but I?d rather emain a happy social phobic, than a victim of drug therapy, 'social skills training,' or 'cognitive restructuring.'

Valerie Pruegger
Calgary, Alberta

Prescription privileges

Voluminous research has shown that an understanding of human biology is inseparable from that of human behavior. Psychology?s first pioneers explored new theories and treatments to help their patients. Yet, some psychologists seem unwilling to tolerate the change represented by the move to gain prescription privileges for psychologists. A recurring argument against prescription privileges focuses on opinions about 'what is best for the profession.' What about the patient? Professional image, malpractice insurance and costs of training aren?t the heart of psychological treatment. Doctoral-level psychologists practice with a strong foundation in clinical theory and research. This background, unique among mental health professionals, prepares psychologists to deliver quality therapeutic treatment.

Current research, however, strongly suggests a need to broaden that training and also raises questions about the legalities and ethics of continuing as treatment providers without functional knowledge of the biological and psychopharmacological aspects of the therapeutic process. Some, who don?t want prescription privileges for themselves, feel that no psychologists should have them. This display of self-interest is thinly disguised protectionism and opposes the fundamental goals of our society. Must we battle for freedom of choice here, too?

To ensure quality, we need to focus on developing rigorous education programs and professional standards, not blocking progress. Concerns about professional image are red herrings?not long ago psychologists? rights to practice psychoanalysis was legally restricted. In addition, gaining prescription privileges will not make it mandatory for all psychologists anymore than gaining the right to practice psychoanalysis did.

I applaud APA?s support of the prescription privileges effort. As psychologists, we should be the first to recognize the importance of change.

Pamela Rutledge
The Fielding Institute

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