Let me begin by saying that I was unsure if I should publish this column. Not because I doubt its content or sit concerned with retort. No, it was because of Glenn Ally I wasn’t sure. Glenn is a spearhead of the Psychologist Rx movement and was instrumental in seeing this enacted in Louisiana. He is a fine human being and he nearly changed my opinion on this issue. Nearly. And he made one really fine point that swayed me. He hoped that opponents to the Psychologist Rx issue would not use our own writings against us when opposing our efforts in the legislatures. I honestly hope so too, though even if it appears duplicitous I am still going to say what I believe below. But if you ever meet Glenn, shake his hand because he’s earned it.

Re. Rx privileges and why I still think we as psychologists should not seek them. And my hope is that I am elucidating for others what they may have considered as well on this subject. Even though this replicates some of what I published a few years ago, I believe it bears repeating and further explication.

Psychiatrists started out doing therapy too. They were well-intended and did what they could with what they had. They have fallen prey to the glitter and promise of medication, just like most of the public and many of our own colleagues. If they are indeed corrupted it is because corruption is endemic to systems that operate on the principles medication does -- quick fix, no pain, easy money.

WHY OH WHY do we insist on believing that WE are nobler than that. That in 30 years (less, more?) we won’t be the same thing as psychiatrists. Why are we better, more ethical than they are/were? “We’ll do it better!” Why can we not see that as simply institutional narcissism that will fall by the wayside? Again, not everyone will fall, as all psychiatrists have not given way to the ease of medication – recall there remain many analysts who are purely psychiatrists. Please, if we’re going to use the emotional plea of “we’ll still listen” let’s check ourselves and ask if we can really promise that we are above it all. “We’re the good revolutionaries -- power won’t corrupt us”. Cripes folks, just look at history and the thousands of groups who have said just the same. The revolutionaries are always going to change things, and then turn out like their original oppressors. Power motives are built into human being -- to try to pretend that psychologists are above evolutionary epigenetic principles is, well, bad psychology.

There are lots of other ways to achieve the end we want, without picking up an Rx pad. But those few seem rarely discussed. What other options do we have regarding Rx for patients?  That is IF we assume that it is important to see to it that our patients get access to Rx’s for their psychological problems.  Because the precursor point is that maybe it is NOT important for us to get more patients on medication.  Perhaps medications claims are fully overblown, their efficacy much more questionable than television would tell us, their status as “the medical solution” perhaps a serious mistake.  Must we indeed prescribe at all or be concerned that others can?  Must we jump on the medication bandwagon?  No, I’m not suggesting that medication has not been useful for some -- it has proven tremendously useful in many cases.  But we are not forced to accept it is absolutely necessary for us as profession to see to it that we improve patient access to medication. Chiropractors e.g. are completely ANTI-drug and their profession is thriving and growing.  

But IF we assume that it is important for psychologists and APA to get behind seeing to it that as many patients as possible have access to psychoactive medication, there remain at least 3 other very viable ways to see to or aid this process.  These are my alternative proposals -- the list is hardly exhaustive, but is the limit of my cogitation thus far.  

1. Psychologists can make a nationally organized push to coordinate with primary care physicians to see to it that these physicians offer patients who are deemed in need the right sort of psychoactive meds.  We can make as our largest priority to collaborate with medical practitioners.  In this regard we can train ourselves to be knowledgeable and we can collaborate.  I can go on about this one, but I just want to make the point, not sell it for now.  
2. Psychologists who wish Rx privileges, and the APA in assistance to this, can seek their Rx’ing licenses in other medical fields.  Psychologists can become Nurse Practitioners or Physician’s Assistants.  They can add this skill to their clinical repertoire as independent of their psychology license -- related but separate.  This has been done, with great success (e.g. by Mike Enright in Montana).  The training is surely no longer than that which we propose for our own profession to be certified and simply side-steps the whole question of “should our profession do this?”  I would fully support APA in assisting my colleagues interested in this endeavor.  Be aware that such a tactic nearly completely avoids the battleground of psychiatry and medicine and even the likes of me and the others who agree that psychologists should NOT seek Rx privileges.  If we don’t encroach on turf directly, the battle is never started.    
3. APA and individual psychologists who are interested in seeking increased access to medications for patients can investigate other methods for dispensing such medications.  E.g. in Brazil, medications are largely dispensed by a pharmacist -- the patient tells the pharmacist what they are being troubled by, the pharmacist makes a suggestion for what might offer relief and the PATIENTS CHOOSE WHAT THEY MAY OR MAY NOT TAKE.  There is no parental regulation of what patient’s take to ease their ailment. 

Note, the above example is only one, and others may immediately condemn it as stupid or dangerous.  I simply note it as illustrative that if APA and psychologists are so gravely concerned about seeing to it that patients receive medicine, then why haven’t we considered reforming the whole system of how medication is dispensed.  To my knowledge this has never been discussed.  Complex issue?  Of course.  But if we are claiming such humanitarian status that we can’t watch patients suffer, then why aren’t we taking every avenue to help them.  

To those who say we are trained differently and THAT is why we will do it better.  If we join the ranks of medical professionals pro forma, why is it we WON’T simply more and more morph into what they think?  If the argument is that we are “different” (and this argument is always forwarded), then how do we maintain that difference once we become part of the medical model.  Again, this smacks of a kind of professional narcissism that says “we won’t be corrupted because we’re different”. 

Another point:  I encounter many patients who are divorcing or in the legal system, as do most of us.  And often, I find that their lawyers do a less than superior job of representing their needs in the legal system.  And I think I could probably do a better job if I had the privilege to do so.  Thus, it would be legitimate for me to argue and expect my colleagues to seriously consider that I wish to add the working privileges of attorneys to the practice of psychology.  After all, we’re very smart, we could come at the law from a different angle and we could do it much better.  This is tantamount to the same argument as Rx privileges I suggest.  Don’t dismiss it -- logically these do not represent different positions.  Shall we now pursue privileges with the all the State and Provincial Bars?

Robert Resnick, ex-APA president, to whom I offer great respect, once opined re. Rx. privileges: “It should never be the case where I don’t want them so you can’t have them.”  My retort however respectful is “Like fun it shouldn’t be!”  This is MY profession as much as those who are pro-Rx privileges.  I’ve just told everyone at least 3 possible ways they can have what they want WITHOUT forcing me to go along for the professional ride -- you see, if you take MY profession and give IT Rx privileges, that means ALL of us.  My money goes to the effort just like yours, and the public lumps my name into the debate alongside yours.  I say again, we are changing the fundamental nature of our design to do this. 

I’ve heard the “there have always been dissenters to change” argument several times too.  So what?  Because something may or may not have worked for the best of our profession in the past, does not make all current progress intelligent.  That is simply not a philosophically or debate based point that is interesting.  It appeals to emotional pleas, and subtly attempts to paint dissent as “anti-progress”.  There is nothing Phillistinic about not wanting certain things to change in certain ways -- not all progress is the right choice. 

Like it or not, believe in transference or not, prescribing medications for patients will forever change our profession in negative ways.  Try on this scenario.  “No Mr/Mrs. Jones, I don’t want you to take Prozac because it will dull your affective reactions and I believe will impede your ability to work through your emotional pain that you don’t yet understand”.  Mr/Mrs Jones may have a large number of reactions, but, in my opinion many of them will be negative and will hurt the therapeutic process.  It’s one thing to encourage Mrs. Jones NOT to take meds, but to be able to give them and withhold them will be seen as sadistic.  On many occasions, Mr./Mrs. Jones will simply leave and go to Dr. X (the “Prescribing Psychologist” in town) who will surely give her what she wants, even if he says she still needs to work through her pain in therapy.  And if not Dr. X., Dr Y. will.  Or Dr. Z.  In an infinite regress.  

We’re not morally superior people.  We have a bell curve of morality in our profession like any other.  And there will be those practitioners who WILL give patients whatever they want, and they will formulate pressure for others in their profession to comply as well.  There will be outliers, like me, but we will fade. It’s simple folks.  Power corrupts.  The power to NOT do something is a fallacy that never works.  If one CAN do something they generally come to do it.  

At present, this is a States rights issue; however APA has continued to place money into these endeavors at the State level which to me continues to make this a national issue. As always, perhaps even more on this issue than any other, the IP welcomes replies to this column, especially those designed to refute the above views. This is an issue on which complete education for all psychologists seems critical, and Division 42 is an excellent source for pursuing this end.