The Decline and Fall of the American
George W. Albee, Ph.D.
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
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
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
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.
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.
Boyle, M. (1990) Schizophrenia – A Scientific Delusion? London:
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.
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.
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.