The Decline and Fall of the American Psychological Association

George W. Albee, Ph.D.

Editor’s Note: The move to expand prescription authority occupied much of the limelight at the 2005 APA convention, but the author of this paper, an honored past president, took a dissenting position in a session entitled, “Prescription Privileges – Serving Society?”

The decision by APA’s Council to proceed to seek prescription privileges for practicing psychologists is the final straw. We are doomed.

The slow-acting poison pill was ingested just after World War II when the field of clinical psychology accepted the medical/psychiatric model of causation of emotional disorders and sent clinical graduate students to Veterans Administration hospitals and clinics and other medical settings for their practicum training.

Generous public financial support for clinical graduate training led to continuing expansion of the field. Graduate study in psychology had long been focused on scientific, mostly laboratory, research. Pre-World War II clinical work had been largely studied in schools, but also in child guidance clinics and institutions for the “feeble-minded” and epileptic. It was not a sought-after career.

Academic psychologists knew little or nothing about psychopathology in 1946. The APA chose David Shakow, a research psychologist at Worcester State Hospital in Massachusetts, to lead and shape the direction and training of this new clinical field. The development of a graduate training model was shaped at a conference in Boulder, Colo., in 1946. This “Boulder Model” required research training as well as clinical training in the new Ph.D. programs. But it did not question the medical/psychiatric model of diagnosis and treatment.

This fatal flaw (Albee, 2000) led inevitably to a system of reimbursement for psychologists’ therapy requiring the use of the successive Psychiatric Diagnostic and Statistical Manuals and funding for “medical” treatment. It meant swearing allegiance to an invalid and unreliable system. But the pay was good. (Albee, 1969).

Relying on the Boulder Model for training had restricted the number of clinical psychologists completing their doctorates. So APA changed its bylaws (a dissertation that slowed production was no longer required). New free-standing professional schools appeared quickly and began churning out people (mostly Psy.D.’s) largely prepared to be psychotherapists in independent practice.

Then after a rosy period the roof fell in. Insurance companies and HMO’s found that psychotherapy went on for months, even years. Drug companies began beating the drums for new drugs that quickly reduced anxiety in the walking nervous, sometimes lifted depression and even masked severe symptoms like delusions and hallucinations in psychotics. Psychologists/psychotherapists lost income when they had to limit their clients to six sessions of psychotherapy.

Following Reagan’s election the explanation for mental disorders changed decisively from social stress and toxic relationships to brain disease. The National Institute of Mental Health (NIMH) stopped funding research on the effects of poverty, unemployment and child abuse and focused on brain pathology. New directors of NIMH were “wet brain” researchers. Soon, they promised, the pathologies of the brain would explain all deviance.

The pharmaceutical industry became top earners. They spread funds generously into organic psychiatry, brain research, training and public education. They sponsored drug research, wrote the results for the researchers, funded their journals and put everyone on as paid consultants.

Clinical psychology is a quick study. The only way to continue to earn a living is to get prescription privileges. The push is under way. Adding members in practice from every Canadian province, U.S. commonwealth and colony enlarged the APA Council. Practice votes now control Council. “Health service providers” now occupy 76 percent of all Council seats. “Research and other sub-fields” occupy 20 percent. Psychology’s scientists have fled to other organizations (American Psychological Society, Psychonomic Society, etc.) though some retain nominal memberships to get journals at member rates. In 2003 new members of APA Council included one comparative psychologist, one physiological psychologist, four experimentalists and three generalists. Members of the old “scientific divisions” are aging and are not being replaced. These divisions will disappear.

Let us not misunderstand. Psychologists will get the legal authority to prescribe. They have the strong support of the powerful pharmaceutical industry. Psychologists can and will learn to be competent prescribers. But it will finally stamp us as an integral part of the invalid, unreliable medical explanation of emotional distress. Writing prescriptions for “drugs for the mind” will cement us into a system from which there is no escape (Albee, 1998).

To get along (and get reimbursed) clinicians must go along (accept the brain disease model and invalid DSM diagnostic system). APA has joined the chorus demanding parity for mental disorders—arguing that they are “diseases” just like other diseases and those afflicted must not be stigmatized; they must command equal treatment funds and social acceptance. The best people say so (Albee & Joffe, 2004).
The first DSM, in 1952, named 60 psychiatric disorders. The current edition (DSM-IV) has about 300, including “diseases,” such as oversleeping and borderline disorders and many new ones affecting children, such as arithmetic learning disorders and attention deficit disorders. The history of modern psychiatry does not inspire confidence.

For years serious mental conditions led to the use of therapeutic convulsions, caused by the deliberate use of insulin and other drugs and by electric shock to the brain. The brain operation called lobotomy destroyed thousands (though its inventor, E. Moniz, received a Nobel Prize). Psychologists accepted all these treatments as valid – the field’s leaders supported them.

Being part of the system means supporting the system. So we must close our eyes, hold our noses and agree that half of all Americans will have a mental illness caused by a brain defect at some time in their lives. If judged incompetent they can be forced by law to take their pills.

In spite of years of seeking, no organic pathology has been found that causes mental disorders and diagnoses for these conditions are unreliable and hence invalid. Organic (drug) treatment does not cure mental disorders. But to work in the field it is necessary to support all these myths and dishonesties. The media embrace the endless stream of new drugs promising new successes. The media are especially entranced with “celebrity sufferers,” such as Mike Wallace (depression), Brooke Shields (post-partum), Leonardo DiCaprio (obsessive compulsive) and John Forbes Nash Jr. (schizophrenia). Great copy.
A few competent and informed journalists could expose the flimsy and invalid evidence on which the current model depends. We need more like A. Deutsch (1948) who, in The Shame of the States, brought attention to the horrible inhumanity of the state hospitals. R. Whitaker (2002) has made a start, but he cannot compete with the powerful citizens’ groups such as the National Alliance for the Mentally Ill (NAMI), mostly relatives of seriously disturbed people.

NAMI fiercely defends the brain diseases model and goes ballistic to any suggestion that social conflicts could play any role in causation. the National Alliance for Research on Schizophrenia and Depression holds formal balls to showcase its upper-class contributors but denies the clear evidence that schizophrenia is not a disease (Boyle) and that depression is unknown in many cultures (Albee, 2003).

There was a time when professional psychology boasted that it was the only mental health profession with sophistication and broad experience and support in research. This unique qualification is being dissipated as APA’s sturdy research base disintegrates with qualified researchers abandoning membership in APA.
Poorly prepared professionals steadily gain control of APA’s governing Council and Board of Directors. The transition is insidious but ongoing. There are still strong and viable islands within psychology that are committed to a research foundation – groups like Society for the Psychological Study of Social Issues, Counseling, Behavior Therapy, Women’s Issues, Minority Issues, Gay and Lesbian Issues – but Council is firmly in the hands of the medical model/drug-prescribing practice group that is killing APA.

References:

Albee, G.W. (1969) Who Shall Be Served? My argument with David Shakow, Professional Psychology, 1, 4-7.

Albee, G. W. (1998) Fifty years of clinical psychology, Selling our soul to the devil, Applied and Preventive Psychology, 7, 189-194.

Albee, G. W. (2000) The Boulder Model’s fatal flaw. Section Editor: L. Benjamin. American Psychologists, 55, 2, 247-248.

Albee, G.W. (2003) Contributions of Society, Culture and Social Class to Emotional Disorder. Chapter in: T.P. Gullotta & M. Bloom (editors), Primary prevention and health promotion. Pp. 97-104. L. Kluwer/Plenum.

Albee, G.W. & Joffe, J.M. (2004) Mental Illness is NOT an illness like any other, Journal of Primary Prevention. 24 (issue 4). ISSN: 0278-095X. Pp. 419-436.

Boyle, M. (1990) Schizophrenia – A Scientific Delusion? London: Routledge.

Deutsch, A. (1948) The Shame of the States. New York. Harcourt Brace.

Whitaker, R. (2002) Mad in America: Bad Science, Bad Medicine and the Enduring Treatment of the Mentally Ill. New York. Perseus Publications.
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George W. Albee, Ph.D., is professor emeritus of psychology at the University of Vermont, courtesy professor at the Florida Mental Health Institute and a past-president of the APA.

This article appeared in The Natitional Psychologist, Volume 14, Number 5, September/October 2005, p. 7. It is reprinted with permission from The National Psychologist, 6100 Channingway Blvd., Suite 303, Columbus, Ohio 43232; 614/ 861-1999. Subscriptions are available.