No time to become a psychoanalyst? Try training in "psychoanalytic psychotherapy"

Stat News

"Approximately 1 in 5 adults in the US will experience mental health issues, yet psychoanalysis is rarely covered by insurance — or considered a viable treatment option.

“There’s much more emphasis on medication,” said Lisa Deutscher, vice president of the 106-year-old New York Psychoanalytic Society & Institute. “Even in a rather privileged stratum of society, there are shifts away from the idea that it would be useful to spend your time doing therapy. There are greater pressures, like the fact people are on call for their jobs 24/7. It makes other commitments in life that much harder.”

It can even be hard for would-be analysts to find the time to train. They can’t start until they’ve earned an MD, a PhD, or a license to practice clinical social work. After that, they must complete four years of coursework in psychoanalysis and 200 hours of clinical training.

On top of all that, they have to undergo analysis for at least two years — for at least four sessions per week.

“They’re requirements that fit the 1950s, when every psychologist wanted to be an analyst,” said Jamieson Webster, a psychoanalyst with a private practice in downtown Manhattan. “If you’re doing a MD or a PhD or an LCSW, the conditions of starting a private practice and having a job don’t fit with analytic training anymore. Candidates find their analytic voice at 50. That’s nuts.”

It may also help explain why 52 percent of members in the American Psychoanalytic Association are between 60 and 80 years old.

“We are an aging organization,” said Smaller, who runs the school program in Illinois. “When I became president-elect at age 62, it was scary that I might have been considered a Young Turk.”

To bring in a new generation of analysts, training centers have embraced a mode of treatment called “psychoanalytic psychotherapy.” It incorporates Freudian ideas about motivation and the unconscious, yet requires only two years to learn, making it an easier and cheaper route for new candidates to join the profession."

Nightmares as predictors of suicide

Nightmare. Henry Fuselli (1781)

Nightmares as predictors of suicide.

Tanskanen, Antti; Tuomilehto, Jaakko; Viinamäki, Heimo; Vartiainen, Erkki; Lehtonen, Johannes; Puska, Pekka

Sleep: Journal of Sleep and Sleep Disorders Research, Vol 24(7), Nov 2001, 844-847.

Examined the relationship between the frequency of nightmares and the risk of suicide. A prospective follow-up study in a general population of Finland starting in 1972. A total of 36,211 Ss (17,700 men and 18,511 women aged 25–64 yrs at baseline. The study included self-administered questionnaire (mainly questions on socioeconomic factors, medical history, health behavior, and psychosocial factors) and health examination at the local primary healthcare center. The frequency of nightmares was estimated. The Ss were followed until Dec. 31, 1995, or death. Information on deaths caused by suicide or other self-inflicted injury was obtained from the National Death Register by computerized record linkage using the national personal identification code assigned to every Finnish resident. Using the Cox proportional hazards regression model we controlled for several potential confounding factors. The frequency of nightmares was directly related to the risk of suicide. Among Ss having nightmares occasionally the adjusted relative risk of suicide was 57% higher, and among those reporting frequent nightmares 105% higher compared with Ss reporting no nightmares at all.

Most Doctors Don't Listen to Patients

"Dr. Martin" is the vignette below is in all likelihood a clinical psychologist. We rule.


NYT

"HARRISBURG, Pa. — BETSY came to Dr. Martin for a second — or rather, a sixth — opinion. Over a year, she had seen five other physicians for a “rapid heartbeat” and “feeling stressed.” After extensive testing, she had finally been referred for psychological counseling for an anxiety disorder.

The careful history Dr. Martin took revealed that Betsy was taking an over-the-counter weight loss product that contained ephedrine. (I have changed their names for privacy’s sake.) When she stopped taking the remedy, her symptoms also stopped. Asked why she hadn’t mentioned this information before, she said she’d “never been asked.” Until then, her providers would sooner order tests than take the time to talk with her about the problem.

...

[C]ommunication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.

A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms."

Wittgenstein's Forgotten Lesson -- Ray Monk (1999)

Prospect Magazine

"One of the crucial differences between the method of science and the non-theoretical understanding that is exemplified in music, art, philosophy and ordinary life, is that science aims at a level of generality which necessarily eludes these other forms of understanding. This is why the understanding of people can never be a science. To understand a person is to be able to tell, for example, whether he means what he says or not, whether his expressions of feeling are genuine or feigned. And how does one acquire this sort of understanding? Wittgenstein raises this question at the end of Philosophical Investigations. “Is there,” he asks, “such a thing as ‘expert judgment’ about the genuineness of expressions of feeling?” Yes, he answers, there is.

But the evidence upon which such expert judgments about people are based is “imponderable,” resistant to the general formulation characteristic of science. “Imponderable evidence,” Wittgenstein writes, “includes subtleties of glance, of gesture, of tone. I may recognise a genuine loving look, distinguish it from a pretended one… But I may be quite incapable of describing the difference… If I were a very talented painter I might conceivably represent the genuine and simulated glance in pictures.”

But the fact that we are dealing with imponderables should not mislead us into believing that all claims to understand people are spurious. When Wittgenstein was once discussing his favourite novel, The Brothers Karamazov, with Maurice Drury, Drury said that he found the character of Father Zossima impressive. Of Zossima, Dostoevsky writes: “It was said that… he had absorbed so many secrets, sorrows, and avowals into his soul that in the end he had acquired so fine a perception that he could tell at the first glance from the face of a stranger what he had come for, what he wanted and what kind of torment racked his conscience.” “Yes,” said Wittgenstein, “there really have been people like that, who could see directly into the souls of other people and advise them.”

“An inner process stands in need of outward criteria,” runs one of the most often quoted aphorisms of Philosophical Investigations. It is less often realised what emphasis Wittgenstein placed on the need for sensitive perception of those “outward criteria” in all their imponderability. And where does one find such acute sensitivity? Not, typically, in the works of psychologists, but in those of the great artists, musicians and novelists. “People nowadays,” Wittgenstein writes in Culture and Value, “think that scientists exist to instruct them, poets, musicians, etc. to give them pleasure. The idea that these have something to teach them-that does not occur to them.”"

Free-Standing Graduate Schools in Clinical Psychology: Caveat Emptor

WSJ

Colorado Attorney General John Suthers in December reached a $3.3 million settlement with Argosy University, after alleging that the Denver school deceived students in a doctoral psychology program. The state said Argosy misled students by telling them they would be eligible to become licensed psychologists and that the program was on track to be accredited by the American Psychological Association when that wasn't the case.

In the Colorado settlement, 40-year-old Heather McQueen of Denver is getting more than $107,000 of her student loans repaid by Argosy. She left the program and got her degree from a nonprofit school in San Francisco after discovering that the Argosy program didn't meet several Colorado requirements for psychologists.

Argosy and its Pittsburgh-based parent company, Education Management Corp., denied the attorney general's allegations. A spokesman said it "was important for us to cooperate" with the state and declined to comment on Ms. McQueen's case.

Everyone's carrying the same things

Custom officials search through baggage recovered from the Hindenberg disaster (1937)

WSJ


Peggy Noonan, yet again:

I had a lot of jobs in a somewhat knockabout youth...The best was waitressing...At the Holiday Inn on Route 3 in New Jersey, long-haul truckers on their way to New York would stop for breakfast. They hadn't talked to anyone in hours. I'd pour coffee and they would start to talk about anything—the boss, the family, politics.

I learned from them what a TSA agent told me many years later: "Everyone's carrying the same things." I had asked the agent what she'd learned about people from years of opening people's bags and seeing what was inside. She meant her answer literally: Everybody's carrying the same change of clothes, the same toiletries. But at the moment she said it we both understood that she was speaking metaphorically too: Everyone's carrying the same burdens, the same woes one way or another. We have more in common than we know.

Which reminded me of this, from Herodotus:

“But this I know: if all mankind were to take their troubles to market with the idea of exchanging them, anyone seeing what his neighbor's troubles were like would be glad to go home with his own.”

That might be the best summation of what I have learned as a psychotherapist: Everyone's suffering, and the suffering is compounded by the misapprehension that suffering is abnormal and that happiness and contentment are the norm. One major personal benefit I have gained from practicing psychotherapy is this: I don't envy anybody.

I used to think that this was from Philo of Alexandria, but apparently it is more recent:

"Be kind, for everyone you meet is in the midst of a great struggle."

Major New Development in the Treatment of Depression!

NYT

I had a queasy feeling as I read that headline. I was pretty sure I was going to read about some Dr. Frankenstein sticking electrodes into Area 25 of someone's brain, or about some drug trial involving glutamate enhancers (or antagonists, take your pick). But no, it's just this:

The therapy that Dr. Manber, Dr. Carney and the other researchers are using is called cognitive behavior therapy for insomnia, or CBT-I for short. The therapist teaches people to establish a regular wake-up time and stick to it; get out of bed during waking periods; avoid eating, reading, watching TV or similar activities in bed; and eliminate daytime napping.

The aim is to reserve time in bed for only sleeping and — at least as important — to “curb this idea that sleeping requires effort, that it’s something you have to fix,” Dr. Carney said. “That’s when people get in trouble, when they begin to think they have to do something to get to sleep.”

This kind of therapy is distinct from what is commonly known as sleep hygiene: exercising regularly, but not too close to bedtime, and avoiding coffee and too much alcohol in the evening. These healthful habits do not amount to an effective treatment for insomnia.

In her 2008 pilot study testing CBT-I in people with depression, Dr. Manber of Stanford used sleep hygiene as part of her control treatment. She found that 60 percent of patients who received seven sessions of the talk therapy and an antidepressant fully recovered from their depression, compared with 33 percent who got the same drug and the sleep hygiene therapy.

Yup, CBT-I really is that simple, as are most cognitive-behavioral interventions. Here's the sickening part -- most doctors who prescribe antidepressants don't discuss sleep with their patients -- hell, they don't even ask if they are thinking about killing themselves. The doctor prescribing your antidepressants is only seeing you for 11 minutes, during which you will have the luxury of speaking to your doctor for 4 minutes. The typical doctor interrupts a patient after listening to them for 12 seconds.

No wonder people value psychotherapy, and no wonder it works so well. Most people have never had the experience of being listened to and feeling understood.

By the way, I do "CBT-I" with all of my depressed patients, and I have for done so for over a decade. I don't call it CBT-I, though; I call it caring enough about your patients to think about how small improvements in their lives might positively affect their mental health. I would have assumed that any psychotherapist worth his salt would already be doing this intervention as a matter of course, but then again most people are not terribly good at what they do.

I wouldn't advise going to bed while wearing so much make up.

"Universal Health Care Isn't Worth Our Freedom" -- Thomas Szasz

WSJ

The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion. Rich and educated people not only receive better goods and services in all areas of life than do poor and uneducated people, they also tend to take better care of themselves and their possessions, which in turn leads to better health. The first requirement for better health care for all is not equal health care for everyone but educational and economic advancement for everyone.

Our national conversation about curbing the cost of health care is crippled by the vocabulary in which we conduct it. We must stop talking about "health care" as if it were some kind of collective public service, like fire protection, provided equally to everyone who needs it. No government can provide the same high quality body repair services to everyone. Not all doctors are equally good physicians, and not all sick persons are equally good patients.

If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a "compassionate" government that will provide the same low quality health care to everyone.

Henry David Thoreau famously remarked, "If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life." Thoreau feared a single, unarmed man approaching him with such a passion in his heart. Too many people now embrace the coercive apparatus of the modern state professing the same design.

Dr. Szasz is emeritus professor of psychiatry at Upstate Medical University in Syracuse, New York. He is author of "The Myth of Mental Illness," among other books (HarperCollins, 1961).

 

 

 

Photo copyright by jennyphotos.com (posted with permission)

 

 

 

Hermann Rorschach's (Belated) 129th Birthday

Time

Today’s Google Doodle [November 8, 2013] honors the 129th birthday of Swiss psychiatrist Hermann Rorschach (1884-1922), who, in 1921, introduced the inkblot test, which has been used to diagnose schizophrenia and borderline personality disorders, among other conditions. He would hold up cards and ask people what the drawings look like, and the idea behind the test is that people will project their feelings onto “ambiguous stimuli”. Now Googlers can take a version of it and share their interpretations of the inkblots on Facebook, Twitter, and Google Plus — though you’ll have to go to a real doctor to get a diagnosis.


In a 1962 article, TIME magazine summed up the pros and cons of the method — first published in Rorschach’s book Psychodiagnostics — at a time when University of Texas psychologists developed inkblot sets to rival the Rorschach ones:

Though some critics dismiss the Rorschach as an exercise in “clinical liturgy.” most psychiatrists and psychologists still give it high marks for uncanny ability to reveal the innermost secrets of a test subject’s personality and emotional problems. But it has one drawback: interpretation of the results is a difficult job in which even experts often disagree. Rorschach testers often have to ask questions to draw out more than one response to each blot, and judgment may be colored by the interplay of personality between tester and tested.

 

Source: Neurocritic

 

 

 

 

Fragment 124 -- Heraclitus

Christ in the selpulchre, guarded by angels (William Blake, 1757-1827)

 

 

 

Even sleepers are workers and collaborators in what goes on in the universe.

 

Heraclitus

 



Freudian Dream Interpretation

Here's a link to the best online introduction to Freudian dream analysis that I have seen. If you really want to get into it, a beautiful new version of Freud's Intrepretation of Dreams is available. From the site:

"I had a dream in which I was at a party with my sister and a friend. My sister had sex with a guy right next to me while I was passed out asleep because I was drunk. I slept for a few hours and then woke up and went back to the party. There was a guy there who had two visor hats over his face and everybody was afraid of him. We then started driving and racing. Everybody pulled over for him to pass them, except for me. He was really mad that I wouldn’t pull over and was getting violent. He tried to crash into me, but I pulled ahead and got away. Then there was an accident behind me with two other cars."

Personal interpretation: 

Perhaps I am feeling resentment for a family member or friend and view them as having more than me, as I am currently not in a relationship and not having sexual relations. Maybe the scary man represents men in general and me being intimidated by them and not being able to trust in order to date. If I did date someone at this time, it might be a mistake, causing an "accident."

Freud might say:

The dreamer is asserting strength and independence against problems known (sister issues, which may be in a completely different form than in the dream) and unknown (the visored male driver). The latent associations for the visor and threatening drivers should be explored. This may be the desire of the female to have control over the masculine influence in her life, or a generally threatening influence.

I would add: Let's not forget that Freud thought that all dreams were disguised wish fulfillments. What are this dreamer's latent wishes, as symbolically revealed in the dream? Voyeurism, perhaps, in her sister having sex right next to her. But if the sister is actually a displaced version of herself, then the wish could be to take the passive role in sex, to not have to initiate sex but to simply receive it, while completing giving in to her desires ("passing out").

The two-visored man is interesting, but I agree that it is up to the dreamer to figure out who or what he represents. If she means a man with a motorcycle helmet with two visors, then I would suggest that wearing a motorcycle helmet would add a bulbous quality that might make him look like a walking penis, and hence a pretty obvious phallic symbol.

Racing dangerously suggests the unconscious desire to give in to one's instincts. "To crash into me" seems like a pretty clear sexual penetration symbol in this female dreamer. Perhaps the wish is to lead a man on to the point of his losing complete control of himself, to cause a man to become so sexually desirous of her that he destroys himself (and whomever else he was near). Freud would call that sexual sadism.

Freud never said that you would like what you find out about yourself in your dreams. There's a reason that the material is disguised and distorted, and a reason why you have dreams about these dark impulses rather than act them out during the day.



 

The "devastatingly effective myth" of psychopharmacology

The New Yorker

[P]sychopharmacology...is...deeply indebted to...a remarkable series of accidental discoveries made in the fifteen or so years following the end of the Second World War.

In 1949, John Cade published an article in the Medical Journal of Australia describing his discovery that lithium sedated people who experienced mania. Cade had been testing his theory that manic people were suffering from an excess of uric acid by injecting patients’ urine into guinea pigs, who subsequently died. When Cade diluted the uric acid by adding lithium, the guinea pigs fared better; when he injected them with lithium alone, they became sedated. He noticed the same effect when he tested lithium on himself, and then on his patients. Nearly twenty years after he first recommended lithium to treat manic depression, it became the standard treatment for the disorder.

In the nineteen-forties and fifties, schizophrenic patients in some asylums were treated with cold-induced “hibernation”—a state from which they often emerged lucid and calm. In one French hospital, the protocol also called for chlorpromazine, a new drug thought to increase the hibernation effect. One day, some nurses ran out of ice and administered the drug on its own. When it calmed the patients, chlorpromazine, later named Thorazine, was recognized in 1952 as the first drug treatment for schizophrenia—a development that encouraged doctors to believe that they could use drugs to manage patients outside the asylum, and thus shutter their institutions.

 

In 1956, the Swiss firm Geigy wanted in on the antipsychotics market, and it asked a researcher and asylum doctor, Roland Kuhn, to test out a drug that, like Thorazine, was an antihistamine—and thus was expected to have a sedating effect. The results were not what Kuhn desired: when the schizophrenic patients took the drug, imipramine, they became more agitated, and one of them, according to a member of the research team, “rode, in his nightshirt, to a nearby village, singing lustily.” He added, “This was not really a very good PR exercise for the hospital.” But it was the inspiration for Kuhn and his team to reason that “if the flat mood of schizophrenia could be lifted by the drug, then could not a depressed mood be elevated also?” Under the brand name Tofranil, imipramine went on to become the first antidepressant—and one of the first blockbuster psychiatric drugs.

American researchers were also interested in antihistamines. In 1957, Leo Sternbach, a chemist for Hoffmann-La Roche who had spent his career researching them, was about to throw away the last of a series of compounds he had been testing that had proven to be pharmacologically inert. But in the interest of completeness, he was convinced to test the last sample. “We thought the expected negative pharmacological results would cap our work on this series of compounds,” one of his colleagues later recounted. But the drug turned out to have muscle-relaxing and sedative properties. Instead of becoming the last in a list of failures, it became the first in a series of spectacular successes—the benzodiazepenes, of which Sternbach’s Librium and Valium were the flagships.

By 1960, the major classes of psychiatric drugs—among them, mood stabilizers, antipsychotics, antidepressants, and anti-anxiety drugs, known as anxiolytics—had been discovered and were on their way to becoming a seventy-billion-dollar market. Having been discovered by accident, however, they lacked one important element: a theory that accounted for why they worked (or, in many cases, did not).

...

Despite their continued failure to understand how psychiatric drugs work, doctors continue to tell patients that their troubles are the result of chemical imbalances in their brains. As Frank Ayd pointed out, this explanation helps reassure patients even as it encourages them to take their medicine, and it fits in perfectly with our expectation that doctors will seek out and destroy the chemical villains responsible for all of our suffering, both physical and mental. The theory may not work as science, but it is a devastatingly effective myth.

Whether or not truthiness, as one might call it, is good medicine remains to be seen. No one knows how important placebo effects are to successful treatment, or how exactly to implement them, a topic Michael Specter wrote about in the magazine in 2011. But the dry pipeline of new drugs bemoaned by Friedman is an indication that the drug industry has begun to lose faith in the myth it did so much to create. As Steven Hyman, the former head of the National Institute of Mental Health, wrote last year, the notion that “disease mechanisms could … be inferred from drug action” has succeeded mostly in “capturing the imagination of researchers” and has become “something of a scientific curse.” Bedazzled by the prospect of unraveling the mysteries of psychic suffering, researchers have spent recent decades on a fool’s errand—chasing down chemical imbalances that don’t exist. And the result, as Friedman put it, is that “it is hard to think of a single truly novel psychotropic drug that has emerged in the last thirty years.”

Despite the BRAIN initiative recently announced by the Obama Administration, and the N.I.M.H.’s renewed efforts to stimulate research on the neurocircuitry of mental disorder, there is nothing on the horizon with which to replace the old story. Without a new explanatory framework, drug-company scientists don’t even know where to begin, so it makes no sense for the industry to stay in the psychiatric-drug business. And if loyalists like Hyman and Friedman continue to say out loud what they have been saying to each other for many years—that, as Friedman told Times readers, “just because an S.S.R.I. antidepressant increases serotonin in the brain and improves mood, that does not mean that serotonin deficiency is the cause of the disease”—then consumers might also lose faith in the myth of the chemical imbalance.

PTSD and Medal of Honor recipient, Ty Carter

 Stars and Stripes:

On Oct. 3, 2009, more than 300 Taliban fighters descended on Combat Outpost Keating, a soon-to-be-abandoned site near the Afghanistan-Pakistan border, in a well-coordinated ambush. Eight U.S. soldiers would be killed in the daylong battle, and 22 wounded.

When the fighting began — a hail of bullets from above, almost immediately overwhelming the 54-man force inside the COP — then-Spc. Carter was asleep. He rushed into battle wearing a tan T-shirt and PT shorts but did manage to grab his body armor.

 ...

He watched two friends die in the early assault and two more die trying to support his position. Another, Spc. Stephan Mace, was gravely wounded by a rocket-propelled grenade and left stranded in the middle of the kill zone.

Carter’s commanding sergeant forbade him from attempting rescue after the explosion, saying it was a suicide mission. Over the next agonizing hours, Carter watched Mace slowly dying just out of reach.

“A good man was lying there wounded, begging for my help,” he said, swallowing hard as he fought back tears. “But [Sgt. Brad] Larson knew that if I went out there, I’d be dead too. For that, I owe him my life.”

...

Still, Carter was focused on Mace. As the firefight began to shift in their favor — thanks to the efforts of Romesha across the base and aerial support — Carter pressed Larson again to let him try to rescue Mace.

Larson relented.

Carter ran onto exposed ground to pull the almost lifeless Mace to safety. He had to make two trips — out to stabilize the fallen soldier, back to coordinate cover fire with Larson, out again to drag Mace across the kill zone back to relative safety.

 ...

Carter didn’t attend Romesha’s Medal of Honor ceremony, saying the 4-year-old battle still felt too raw for him. He talks about the nine losses his troop suffered in that battle — fellow soldier Ed Faulker Jr. battled PTSD and took his own life a year after the attack.

He has been open about his own struggles with PTSD, and said he hopes to use the new honor as a forum to talk about the stress of war and the stigma of seeking mental help. He deployed again to Afghanistan last year and has been in counseling to help him handle the battlefield horrors he can never unsee.

Stars and Stripes:

Carter was singled out for the award for his efforts to save Spc. Stephan Mace, who was mortally wounded and stranded in the kill zone before Carter selflessly sprinted to his position. 

“I lost some of my hearing in that fight,” Carter said, “but I’ll hear the voice of Mace, and his pleas for help, for the rest of my life.”

 

The president also noted that Carter’s courage extended past the battlefield. In recent months, he’s become a self-made spokesman for troops suffering with Post-Traumatic Stress Disorder, openly speaking about his own struggles after returning from the fight.

Obama called him an inspiration for the military in its struggle to end the stigma of seeking mental health treatment.

“Look at this soldier,” he said. “Look at this warrior. He’s as tough as they come, and if he can find the courage and the strength to not only seek help but also to speak out about it, to take care of himself and to stay strong, then so can you.”

Carter said he is “eager” to represent the troops fighting the invisible wounds of war. He addressed “the American people” at the end of his press remarks, asking for more understanding and empathy of post-war mental health issues.

“Know that a soldier suffering from post-traumatic stress is one of the most passionate, dedicated men or women you’ll ever meet,” he said. “Know that they are not damaged. They are simply burdened with living what others did not.”

Maybe combat veterans with PTSD aren't "damaged," but they sure can be destroyed by their experiences. And if they're not "damaged," they sure can be disabled, which is why the U.S. government paid out $4 billion dollars in disability payments to veterans with PTSD in 2012. MoH
recipient Sgt. Dakota Meyer (USMC) tried to kill himself about a year after his combat deployment, but before he received the MoH. I wonder if the DoD would have awarded it to him posthumously?

It's amazing to me how many people, especially military personnel (not combat veterans, I might add), think that PTSD is a consequence of moral weakness or cowardice (and that they, of course, are therefore somehow immune to the psychological injuries associated with combat). Well, one in five Americans think that the sun revolves around the Earth, so I guess there's no helping some folks.

Here's a nicely done Public Service campaign by Medal of Honor recipients who encourage recent veterans to get help for PTSD and "don't let the enemy defeat you at home."


By the way, one of the eight MoH recipients from the Afghan War was a college graduate, and he majored in psychology.

The Girl on the Ferry with the White Parasol -- Citizen Kane

 

 

"A fella'll remember a lot of things you wouldn't think he'd remember."

 

 

 

 

John Rosemond license -- Just what makes a psychologist, anyway?

The Kentucky Board of Psychology has asked John Rosemond, a parenting advice columnist, to stop identifying himself as a "psychologist" in his byline. Mr. Rosemond is currently licensed as a "psychological associate" in the state of North Carolina. It looks to me that "psychological associate" is the term used in North Carolina for someone with a masters-level degree, which Rosemond has. In North Carolina, such people are allowed to call themselves "psychologists." The problem is that in Kentucky, you have to be doctoral-level (e.g., Ph.D.) to call yourself a psychologist.

It seems like this problem would go away if Rosemond would simply stop identifying himself as a psychologist. People seem to want this case to be about free speech but it is about professional identity. Many people give "legal advice" and it is not against the law to do so. For example, I warn my students that when a police officer is talking to you, he is gathering evidence which he hopes will be used by the state's attorney to convict you. He is not "just trying to find out what happened here." He is talking to you because you are the one he is about to arrest and he wants you to make a self-incriminating statement before he has to remind you of your right not to make self-incriminating statements. If you have been arrested, you are not going to get yourself unarrested by blabbing to the police. Now, my right to offer such advice is protected by the First Amendment. However, the First Amendment does not entitle me to call myself an attorney.

Any schmo off the street can offer parenting tips or other psychological advice, for free or for pay, in print or face-to-face. But in Kentucky, and in many other states, there are many conditions concerning who gets to call himself a "psychologist." Rosemond doesn't qualify, so, in my amateur legal opinion, he should knock it off.

Excerpts from a piece by Rosemond's lawyers in the Wall Street Journal:

"Can occupational-licensing laws—which require the government's permission to work—trump free speech? Some government licensing boards, which function increasingly as censors, certainly think the answer is yes.

Consider the facts of this particular case, which involves an advice columnist named John Rosemond, who is also a licensed family psychologist based in North Carolina and the best-selling author of more than a dozen books on parenting. Since 1976, Mr. Rosemond has written a column on parenting that is syndicated in more than 200 newspapers across the country, including some in Kentucky.

In February, Mr. Rosemond wrote a column responding to a question from parents about their 17-year-old son, whom they described as a "highly spoiled underachiever." Mr. Rosemond, who believes that children need clear boundaries and discipline, wrote that their son was in "dire need of a major wake-up call" and advised that they suspend his privileges until he shapes up.

The day after Mr. Rosemond's column ran in the Lexington Herald-Leader, a retired Kentucky psychologist contacted the Kentucky Board of Examiners of Psychology to complain. Astonishingly, the Kentucky attorney general and the board sent Mr. Rosemond a letter ordering him to stop publishing his column in the state.

Kentucky's theory is that one-on-one advice about parenting—even if it is published in a newspaper—is the practice of psychology. Because Mr. Rosemond is licensed in North Carolina, but not Kentucky, the state government thinks his advice constitutes the unlicensed practice of a profession and is not protected by the First Amendment. The state also told Mr. Rosemond that it is illegal for him to call himself a psychologist in the byline of his column—even though he is one—because he is not a Kentucky-licensed psychologist."

Here's the North Carolina Board of Psychology's definition of the practice of psychology:

Practice of psychology. -- The observation, description,

evaluation, interpretation, or modification of human behavior by

the application of psychological principles, methods, and

procedures for the purpose of preventing or eliminating

symptomatic, maladaptive, or undesired behavior or of

enhancing interpersonal relationships, work and life adjustment,

personal effectiveness, behavioral health, or mental health. The

practice of psychology includes, but is not limited to:

psychological testing and the evaluation or assessment of

personal characteristics such as intelligence, personality,

abilities, interests, aptitudes, and neuropsychological

functioning; counseling, psychoanalysis, psychotherapy,

hypnosis, biofeedback, and behavior analysis and therapy;

diagnosis, including etiology and prognosis, and treatment of

mental and emotional disorder or disability, alcoholism and

substance abuse, disorders of habit or conduct, as well as of the

psychological and neuropsychological aspects of physical

illness, accident, injury, or disability; and psychoeducational

evaluation,, therapy, remediation, and consultation.

Psychological services may be rendered to individuals,

families, groups, and the public. The practice of psychology

shall be construed within the meaning of this definition

without regard to whether payment is received for services

rendered.
If Kentucky's definition is similar (which it probably is), then Rosemond certainly does seem to be "practicing psychology" in Kentucky without a license to do so. He evaluated human behavior for the purpose of eliminating undesired behavior, to use their terms. It will be interesting to see how this plays out in court. Where does advice-giving end and the provision of state-regulated clinical services begin? "Portability" of licensure across state lines is a whole different mess and one that probably won't be fixed with this case.

I am all for strict rules that regulate who can call himself or herself a psychologist. I think that North Carolina does the profession a disservice by allowing masters-level practitioners (who have less than half the education and training of doctoral-level practitioners) to call themselves psychologists. Personally, I think that only clinical psychologists who provide direct clinical services need be licensed by state boards of psychology. It seems silly to license organizational/industrial psychologists who work for corporations. Also, academic psychologists are unlikely to harm the public during the course of their work. But there are a lot of bozos out there offering quasi-psychological services to the public who are a real danger. Licensure is one way for the public to discern the docs from the quacks.

I think that Rosemond's byline should read, "Mr. Rosemond is a licensed psychological associate." (Mine would read, "Dr. Sullivan is a licensed clinical psychologist.")

Escape from Freedom -- Erich Fromm

"Most psychiatrists take the structure of their own society so much for granted that to them the person who is not well adapted assumes the stigma of being less valuable. On the other hand, the well-adapted person is supposed to be the more valuable person in terms of a scale of human values. If we differentiate the two concepts of normal and neurotic, we come to the following conclusion: the person who is normal in terms of being well adapted is often less healthy than the neurotic person in terms of human values. Often he is well adapted only at the expense of having given up his self in order to become more or less the person he believes he is expected to be. All genuine individuality and spontaneity may have been lost. On the other hand, the neurotic person can be characterized as somebody who was not ready to surrender completely in the battle for his self. To be sure, his attempt to save his individual self was not successful, and instead of expressing his self productively he sought salvation through neurotic symptoms and by withdrawing into a phantasy life. Nevertheless, from the standpoint of human values, he is less crippled than the kind of normal person who has lost his individuality altogether."

 

 

A lot of people use Orwell's 1984 in order to try and explain the modern age. In my opinion, Fromm's Escape from Freedom would be a far more appropriate book to turn to. And if you are like me and have never admired Martin Luther or John Calvin, you are in for a treat.

 

That's quite a blurb from the Washington Post on the front cover: "Fromm's thought merits the critical attention of all concerned with the human condition and its future."

 

 

 



Nicholas Cummings -- Time for Psychotherapy to Take on Pharmacotherapy

An impassioned plea from former APA President Nicholas Cummings. This one line really grabbed me: "How long has it been since you have seen a patient who came to you who had not already been medicated by the primary care physician or a psychiatrist?" This is such a striking observation that you don't realize it at first because it is so "normal." That is, it is normal for a primary care physician to begin "treating" a patient for anxiety or depression even before a thorough psychological assessment has been made by a mental health specialist. They write the prescription and then they refer for psychotherapy (if they refer at all, which they rarely do).

"We are seeing in the second decade of the 21st Century two forces converging that create both an imperative and a golden opportunity for psychology. The first is the continued steady decline of psychotherapy which has been largely replaced by psychotropic medication. How long has it been since you have seen a patient who came to you who had not already been medicated by the primary care physician or a psychiatrist? Antidepressants are ubiquitous, prescribed not only for the Monday morning blues or any degree of sadness, but also for such off-label conditions as erectile dysfunction, smoking cessation, obesity, obsessive compulsion, and even bereavement, with the latter practice unfortunately interfering with and severely prolonging nature’s healing process. It did not used to be that way prior to the medicalization of mental health. Rather, the patient first saw a psychologist, psychotherapy was the first line intervention, and in those instances when the psychologist determined medication was necessary, it was arranged through a cooperating psychiatrist. But the psychologist’s evaluation always came first. 

 

Psychotherapy was not only effective, numerous researches over decades repeatedly revealed it saved medical/surgical dollars. There was a high regard for our services among the general public, which was heralded in the media, movies and government sponsored programs such as the community mental health centers. It was usual for highly sought psychotherapists to have long waiting lists of those who clamored but patiently waited for their services, not only because of need, but also for self-improvement. Psychiatrists medicalized because they wanted tobe “real doctors.” They abandoned psychotherapy, and became essentially a prescribing and hospitalizing profession, thus making psychology the booming, preeminent psychotherapy profession. The American Psychiatric Association cleverly responded by joining Big Pharma with its grants, subsidies, and other goodies, and then captured the National Institute of Mental Health (NIMH) with a sweeping “changing of the guard” at the highest levels. The DSM threw out all psychopathology to fit into the new theories of serotonin and dopamine receptor imbalances in the brain. It promised to cure mental illness through a rapidly evolving series of psychotropic meds. On the basis that medication would thus solve the problem, our state hospitals were deinstitutionalized by releasing hundreds of thousands of schizophrenics with nowhere to go and only a supply of medication. Overnight the street and the prison became our de facto mental hospitals and remain so to this day in spite of new generations of highly touted antipsychotics.

 

 

The second force is the rapidly developing backlash among the public resulting from mounting and often serious side-effects, the over-prescribing of medication for minor conditions and especially for children, revelations of tampering with clinical trials by throwing out studies with negative or neutral findings, and, worst of all, psychiatrists conducting the research and those promoting various drugs have been subsidized or even directly hired by the pharmaceutical companies. Additionally, the cherished “brain chemical imbalance” theories are being called into question by numerous studies and are chronicled in two best-selling books published in 2010. The DSMs have successively abandoned any validity to actual brain diseases, becoming arbitrary collections of symptoms that are grouped into syndromes given clinical-sounding names, and with every syndrome needing a medication or class of medications. Psychotherapy is disdained as ineffective and even irrelevant “talk therapy.”

 

 

But now Big Pharma has never had a lower public image, giving us an opportunity made in heaven for us to make a comeback. This is the time to mount an extensive campaign to educate the American public on the effectiveness of psychotherapy and to restore it as the first line intervention in behavioral health. Such a campaign would not only be directed through the media, but it would involve the most recent communication innovations such as YouTube. Can we afford to do this is not the question. Rather, it is, “Can we afford NOT to do this?” If we miss this golden opportunity psychotherapy will continue to decline and psychology as a direct service profession will become a relic that someday economic paleontology can unearth and dissect, seeking to answer why the most admired profession of the 20th Century died in the 21st."

 

 

References

Carlat, D.J. (2010). Unhinged: The trouble with psychiatry - A doctor's revelations about a

profession in crisis. New York: Free Press.

Whitaker, K. (2010). Anatomy of an epidemic. New York: Crown.

(Reprinted by the author from The National Psychologist, 20(1), p. 8, January/February 2011.)

 

 

 

 

 

Acquainted with the Night -- Robert Frost

The internet has a lot to answer for, including the unfortunate promulgation of poetry "analyses." Contrary to what you might have learned in high school English class, poems aren't written to be analyzed.

I have been one acquainted with the night.
I have walked out in rain -- and back in rain.
I have outwalked the furthest city light.

I have looked down the saddest city lane.
I have passed by the watchman on his beat
And dropped my eyes, unwilling to explain.

I have stood still and stopped the sound of feet
When far away an interrupted cry
Came over houses from another street,

But not to call me back or say good-bye;
And further still at an unearthly height,
A luminary clock against the sky

Proclaimed the time was neither wrong nor right.
I have been one acquainted with the night.      

Cognitive therapy for whining (with Albert Ellis)

Given the choice, would you rather have had Albert Ellis, Aaron Beck, or Martin Seligman as your personal psychotherapist? My pick is Ellis, hands down. I love his sense of humor and no-b.s. attitude. With his New York accent and eyeglasses, I also get a positive transferential reaction between Ellis and my dad. Further, I agree with Ellis that many contemporary cases of"anxiety" or "depression" stem from people whining about not having been given everything they want as quickly as they want it.

The Yale Whiffenpoof song is not as famous as it was when the film clip was recorded, so here it is if you are interested (Ellis starts singing the parts from 1:18 on):

Turing Tests -- Blade Runner

If this is what the future of psychological assessment looks like, count me in.

This is supposed to resemble a Turing Test for artificial intelligence.

I wonder what the False Positive rate is for this test? How many humans couldn't "pass" a Turing-like test but would resemble automata?