I am reluctant to respond to Dr. Muskin’s letter in the November 5 issue on my article "An Apple A Day," which appeared in the Residents’ Forum in the September 17 issue of Psychiatric News. However, his letter is a perfect example of why psychiatrists don’t speak out on issues that concern them. Dr. Muskin, rather than responding to the content of the column, chose to respond to what he believes is my unconscious motivation for writing it. He writes, "Humor often conceals anger and frustration," and then goes on to say, "There is nothing that would suggest that Dr. Schulman’s attack on the pharmaceutical industry’s provision of trinkets, grand rounds, or purchase of textbooks is grounded on anything but her anger at the failings of her own training program."

Though I certainly respect opposing viewpoints and appreciate Dr. Muskin’s free psychoanalysis, I cannot allow this comment to go unchallenged. The reason I felt free to write a column that parodies the situation at many residency programs is that my program is one of the best in the country at teaching psychotherapy along with psychopharmacology. Along with our course material in different styles of psychotherapy, including psychoanalytic psychotherapy, interpersonal psychotherapy, and cognitive-behavioral therapy, we have mandatory year-long training in family therapy and group therapy. I have three psychotherapy supervisors (currently one analyst, one cognitive-behavioral psychologist, and one general psychiatrist), as well as separate supervisors for psychopharmacology, substance abuse, and child/adolescent psychotherapy.

In my column, I did not mean to suggest that drug companies directly decide what course material is taught. Of course, residency directors are the ones who decide how much training relates to psychotherapy. However, it is naïve to think that drug companies do not work hard to bias residents toward using medications. Dr. Muskin writes, "If other therapies work along with medications, the drug companies still sell their products." That is correct. However, when I successfully treat a patient with panic disorder with behavioral therapy alone, as I have done, the drug company does not sell its products. The free book I received last year was on the pharmacologic treatment of anxiety disorders; it did not cover the use of any treatment without the concomitant use of medications. It is not unusual to find a resident’s office filled with these books.

Humor does indeed conceal anger and frustration. The point of the column was simply to raise these issues for discussion and thought, and I am pleased to see that it has provoked a response in a way that I suspect only a humorous column could.

Julie K. Schulman, M.D.

New York, N.Y.