The Last Thing We Need…

April 3, 2010 at 9:48 am 5 comments

Somehow the push for psychologists to gain prescription privileges has thus far flown under my radar. As soon as I became aware of it, a host of fairly obvious thoughts ran through my head. As any return readers might have guessed, not in favor of such a move. Now that we’ve broadened the range of thought and emotion caught up in the net that is psychiatry’s drug craze, we’re moving toward increasing the number of people casting such nets. In a  culture where powerful and often deadly (but highly salable) drugs are the accepted answer to each of life’s concerns, the last thing we need is more prescribers. Needless to say, I’m not alone in these concerns and a recent article on Psych Central’s World of Psychology essentially echoes my thoughts on the matter.

If psychology wants to remain a science based upon the understanding of human behavior — both normal and abnormal — and helping those with the “abnormal” components, it would do well to avoid going down the road of prescription privileges. But perhaps it’s already too late…

It never ceases to amaze me that people can speak to a psychiatrist, present them plainly with the source of their emotional troubles, walk their doctor through their problem from onset to complete breakdown and be told they have a biological illness and given a prescription. Psychology as a profession is still in a position to offer real care for very real problems that result from life’s many stumbling blocks. The question is, is that enough?

The fundamental problem with psychologists gaining prescription privileges is the inevitable decline over time in the use of psychotherapy by those same psychologists. This is precisely what happened to psychiatry — they went from the psychotherapy providers of choice, to the medication prescribers of choice. Now it’s hard to find a psychiatrist that even offers psychotherapy…

By switching to a heavily prescription-based practice, a psychologist will be able to nearly double their salary. Can you imagine any other field where you can double your salary with an additional 2 years’ worth of training? Are proponents actually suggesting that money has little or no significant impact in helping a person make career decisions? (We only have a few decades’ worth of research to demonstrate how money does indeed influence our decision-making process.)

Back when prominent psychiatrist Loren Mosher resigned from the American Psychiatric Association (APA),  it was for just this reason. He saw his field’s practitioners getting all too cozy with drug makers — and then from cozy to dependent. It began with the blending of psychiatry and psychopharmacology in the early seventies and continued into what we see now — a field whose approach is virtually devoid of any connection between life and trauma, favoring instead to label everything a chemical imbalance with a chemical cure. It has become the goal of many psychiatrists not to pinpoint and address peoples’ actual sources of distress but, as a sales force for psychotropic drugs, to capitalize on their patients’ struggles with an endless but ever-changing and supposedly improving parade of pharmaceuticals. From his resignation letter:

After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. Luckily, the organization’s true identity requires no change in the acronym…These psychopharmacological limitations on our abilities to be complete physicians also limit our intellectual horizons. No longer do we seek to understand whole persons in their social contexts — rather we are there to realign our patients’ neurotransmitters. The problem is that it is very difficult to have a relationship with a neurotransmitter — whatever its configuration.

When you look back to the late sixties and early seventies, when psychiatrists were seeing the vast majority of psychotropic prescriptions filled by general practitioners in a trend of declining credence in psychiatry, todays push seems all too familiar. That’s when psychiatrists started to flesh out the chemical imbalance theory as an exclusive (at the time) answer and a justification of their field, positioning themselves as the sole experts on the topic of biological cause to emotional struggles. It was never backed by objective scientific discovery or even verifiably observed in study but it sold well and justified the existence of psychiatry as an institution and a higher authority on the matter than GPs. The APA and its congregants could hold up the theory disguised as fact and point out that it was they and not GPs who came up with this exclusive supposed answer.

Is that where we are with psychology? In a time where we — as patients and consumers –are conditioned to think our emotional troubles and extreme states of mind are rooted not in our environment but in our chemistry, psychologists offer little in the way of addressing the chemical cause we’ve been sold. They are sitting back watching psychiatrists sell theories and pills in a monopoly while they are increasingly regarded as new age hucksters selling psychobabble. If they are going to remain socially relevant and commercially viable, they need to market themselves as better stewards of the same keys. It would appear, by the early actions of proponents of prescription privileges, that they would do this by taking on the legitimacy offered by psychopharmacology and the balance and apparent of purity of intentions offered by addressing factors like stress,abuse and emotional damage. You can already see them holding themselves up as not having gone down the road of greed and corporate influence but if they’ve taken the high road, it’s largely because the low road has been closed off to them. Sure, there is a great number of psychologists who truly believe in and act on the ability to relate emotional discharge to environmental input but if their era sunsets, the new blood will be trained in the new paradigm and it will be a lucrative one. I’m sure we can scarcely imagine what that will do to the notion of choice in mental health care.

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5 Comments

  • 1. Marian  |  April 3, 2010 at 2:52 pm

    IMO, psychology in general already has reduced itself to be nothing much more than another hammer in the tool box of biological psychiatry (that by and large doesn’t contain anything else but hammers of different types and sizes). Psychologists obtaining prescription privileges is a mere formality. The vast majority of them today doesn’t practice much else than delivering “the slightly more sophisticated” version of psycho-education anyway, drumming the message about imbalanced neurotransmitters and the importance to take their “meds” into their client’s head, and teaching them coping strategies – to cope with the chronic, biological brain disease they allegedly suffer from. Every now and then, one can witness them point this out themselves: “We/CBT/DBT, whatever, can strengthen insight and compliance.” If you’re lucky, you’re allowed to mention this or that traumatic event in your life in passing. Only to get to know that you have to forgive and let go, and that, btw, it certainly has nothing to do with your present emotional problems. So, it’s actually not of any further interest, and certainly not of the same interest as the question whether you remembered to take your “meds” during the past week, and what kind of strategies might help you remember it in case you forgot.

    More often than not, the first thing a psychologist will ask you to do the moment you walk into their office, is go and get a prescription, from your GP or a shrink, for “something”. It’s not a long way from asking someone to get a prescription from somebody else to writing the prescription oneself. The underlying view of human nature in general, and emotional distress in particular, without doubt is the same.

    Psychology has sold its soul a long time ago. Greed is one of the reasons. Low self-esteem and fear of losing territory and influence are others.

  • 2. Marian  |  April 3, 2010 at 3:04 pm

    P.S.: Actually, IMO, psychology sold its soul the day Freud dismissed his seduction theory, and came up with the Oedipus complex-bs, blaming the victim.

  • 3. markps2  |  April 6, 2010 at 3:25 pm

    Drugs will just screw people up more, as manipulating ones feelings with legal drugs is pretty much the same as illegal drugs.
    Dose and lethality.
    Its cheating and probably wont work in the long run.
    But there are lots of successful alcoholics and nicotine addicts, so anything is possible.
    However, exploiting the naive with drugs, in the name of science and medicine is a crime IMO.

  • 4. Susannah  |  November 23, 2010 at 2:56 pm

    Totally agree Mark

  • 5. Susannah  |  November 23, 2010 at 3:03 pm

    “It never ceases to amaze me that people can speak to a psychiatrist, present them plainly with the source of their emotional troubles, walk their doctor through their problem from onset to complete breakdown and be told they have a biological illness and given a prescription.”

    It is outrageous.


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