Since graduation from medical school in 1982, I have witnessed some very stormy times, starting with the AIDS epidemic and followed by the assault on medicine by lawyers, insurance companies, HMOs, managed care, and now "prescription privileges for psychologists."

A psychologist recently told me that he had enrolled in the new "clinical psychopharmacology master’s program" at Nova University in Fort Lauderdale, describing a two-year degree in which psychologists attended classes a half day every other week for two years. "Then we will get the laws changed and start prescribing," he said. He noted that the Department of Defense’s psychologist prescription training program had been a huge success, and "any day now, Louisiana will be the first state to change the laws." Then, he added, "it will be a falling house of cards from there on."

The pronouncement reminded me of a horror story my wife and I experienced last year, when our 4-year-old daughter developed generalized edema due to an allergic reaction to penicillin. She was received in the pediatric emergency room of a Miami private hospital by a nurse practitioner who, without ordering labs, bent the child over, making her touch her nose to her knees. Our daughter let out a scream, and the nurse practitioner said, "It’s probably meningitis. I’ll do a lumbar puncture." After my temper tantrum abated and a doctor finally appeared and began to implement the correct treatment, I learned that the residents had been removed from the E.R. because it was cheaper to have nurse practitioners doing the job. So, back to prescription privileges for psychologists. . . .

One of the most frightening findings about this master’s in psychopharmacology program is how, without a medical background, one can become an expert on the "psychopharmacology of the brain." This reminds me of a 1950s horror movie that I saw on late-night television titled "The Head," in which a woman’s talking head is kept alive, in a bell jar of a mad scientist’s laboratory, through the help of electrodes connected to her scalp. Bizarre and absurd, this image of the "talking head" seems an appropriate metaphor for the absurd notion that a person can become a prescribing physician-psychiatrist "of the head only" by taking a two-year, part-time course on basic concepts of the central nervous system.

It is very disturbing that the issue of prescription privileges for psychologists is not being examined by a panel of health experts, but instead is being decided by state legislatures through lobbying of self-interested parties. It’s demoralizing to discover that everything is for sale if the price is right, even medical licenses. The American Psychological Association has already invested greatly in this project.

It is equally disturbing and paradoxical that, as we learn more about the biological basis of nervous disorders with the help of neuroimaging techniques, our specialty is under serious threat of becoming demedicalized. Also paradoxical is the fact that, just as the Institute of Medicine has published a national report alerting the medical community to the need for more safeguards to protect patients from medical errors, state legislatures seem to be willing to vote on licensing nonmedical professionals to prescribe drugs that affect not only the central nervous system, but the entire organism.

The best safeguard of good practice in mental health care is through use of the biopsychosocial paradigm. For this, psychiatrists are unquestionably the most qualified professionals.

Psychologists insist that giving them prescribing privileges would make mental health services cheaper for the public. I wonder what kind of liability insurance a nonphysician would be forced to carry in order to prescribe psychotropics to humans.

Another complaint by psychologists is that mental health care is too fragmented. Their solution is to "unify it" by practicing medicine without medical training and thus endangering the public.

What can we do about this impending medical nightmare? We have to fight the battle "where it’s at," and that is in the state legislatures and in the federal government.

The battle, however, needs to be fought through the district branches. We need to become proactive members of our district branches by educating our local legislators about the issues and the public about the distortions regarding our profession. Above all, we must be alert to any psychologist-prescribing bills that are introduced at the state level. By doing so, we can react quickly to protect the health of our patients, the quality of the mental health care we deliver, and the future of our professional identity.