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Independent Practitioner/Summer 2005 |
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Editorial and Opinion |
Letters to the Editor |
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Praise to Ed Lundeen for his upright stance against the massive movement to promote psychologists' prescription privileges ("Independent Practitioner", Spring '05). His cogent theses express the views of many of us who are critical of the clamorous "pro bandwagon". My 36 + career years in medical schools and centers introduced me to the complexities of neuroleptics and allied medications. These medicines affect the entire corpus, have unanticipated consequences and interact with the patients nutritional and total health status. A few academic pharmacology courses plus unsophisticated clinical practice do not, per se, serve the medical requirements of needful patients. Alexander Pope said it well: "Fools rush in where angels fear to tread". This is my personal opinion. Should Psychologists Prescribe? A Response I have read, with considerable interest, the articles in the Spring '05 Independent Practitioner concerning prescription privileges for psychologists. A friend sent me this issue because I was mentioned in the discussion. The position taken by Ed Lundeen, the Editor, struck me as compelling. We are, as he argued, committed to non-invasive care. The change this would be to change fundamentally our theoretical orientation, which is a re-learning orientation. Whether we are psychodynamic or behavioral, Freudian or Skinnerian, or some variant of these, our interventions are oriented toward external efforts at fostering change – in behavior, self-evaluation, relationships, and feelings about self and others. To prescribe drugs as treatment changes fundamentally our orientation as a profession. We now become part of a group that sees emotional behavioral disturbance as biological defect or glandular irregularity to be corrected with chemicals. Our long history of research into the damage done by toxic relationships in the past, and the ways these can be mended by re-learning, is abandoned. Let me give two examples: At the 1999 White House Conference on Mental Health the Keynote Speaker, H. Koplewicz, argued that "childhood psychiatric disorders" are brain diseases. He denied any role for social-environmental factors. He said "It's hard to believe that until 20 years ago we still believed that inadequate parenting and bad childhood traumas were the cause of psychiatric illness in children. And in fact, even though we know better today, that antiquated way of thinking is still out there, so that people who wouldn't dream of blaming parents for other types of disease, like their' child's diabetes or asthma, still embrace the notion that somehow absent fathers, working mothers, over-permissive parents are the cause of psychiatric illness in children. [No one says this!] And the only way we can change that is through more public awareness. I mean, essentially, these are no-fault brain disorders. These diseases are physiological, the respond to medicine Rosalynn Carter was once on the side of those of us who argued that most emotional disorder resulted from the stresses of toxic social experiences. On the dust jacket of our 1981 Vermont Conference Volume "Prevention Through Political Action and Change", she wrote. It is clear that the impact of poverty, racism and discrimination in all its forms adversely affects the mental health of millions...Too often, the pressing need for services distracts our efforts from those primary prevention activities which in the long run can have far greater impact on the mental health of our people. Seventeen years later, on July 17, 1998, in the NBC Evening News, Rosalynn Carter was asked about her long-standing interest in the field of mental health. She now lined up with the new position of the national mental health leadership. She said "We now know that mental illnesses are due to problems in the brain. We can treat brain disease". Of course psychologists can learn to prescribe drugs as well, or far better, than those who now prescribe. We could also learn to give shock treatments and to do lobotomies. The problem is not acquiring the easily learnable skills. It is with all the horrors that support the skills that we would have to embrace. Nowhere in the arguments for prescriptions privileges have I found discussion about the necessity of using the DSM as justification for using drugs. This intellectual monstrosity, now required for psychotherapy insurance reimbursement, can be ignored by using some innocuous category like Simple Adult Maladjustment. But will this cover any and all drugs. Or will we have to pretend to be serious about this unreliable and invalid diagnostic system. Finally, Glen Ally, in his discussion, quotes me correctly: I do indeed think we have sold our soul for money in accepting the medical model of emotional disorder. I fear we are now so embedded and immersed in this model that we cannot escape. But I applaud those brave rebel souls who rebel, who object to selling their birthright for a handful of pills. |
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