Misunderstood?
Regrettably, Dr. Jerry Wiener (Psychiatric News, June 19) has misunderstood several points in my letter published in the May 15 issue. I shall try to remedy that situation:
- Dr. Wiener claims that I asserted that he conceded "that members of a specialty could designate themselves as sub-specialists." I did no such thing. I merely reflected his statement that "in every profession there are those who by virtue of training and experience are recognized as experts in one or another aspect of practice. . . ." The idea that this should amount to nothing more than self-designation was neither stated nor implied in my letter.
- I used the word "nefarious" with full awareness of its definition. I was referring to Dr. Wiener's hypothesis that some psychiatrists may call themselves psychopharmacologists in order to gain economic advantage in the managed care environment, despite the fact that their collaboration with psychotherapists, in his view, "does not constitute optimal treatment." Sure sounds like a nefarious motive to me! (Unfortunately, Dr. Wiener may be right about some psychiatrists.)
- Dr. Wiener previously expressed the opinion that separating the provision of psychotherapy from that of pharmacotherapy amounts to "splitting off mind from brain." He now objects to my assertion that his conceptualization ratifies mind/brain dualistic fallacies, and in fact he believes the opposite to be true. His belief is predicated on the common misconception that psychotherapies are "mind treatments," in contradistinction to pharmacotherapies, which are seen as "brain treatments" or "biological treatments." There are many reasons to reject that notion. (See, for example, Baxter LR et al.: Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Archives of General Psychiatry 1992; 49:681-689, and Kandel ER: A new intellectual framework for psychiatry. American Journal of Psychiatry 1998;155:457-469.) In fact, Dr. Wiener's statement in his article that the biopsychosocial model "proposes that brain and mind cannot be divided off from each other" is an inaccurate construal of that model. For a cogent explanation of why the biopsychosocial model, despite intentions to the contrary, inescapably entails and necessitates acceptance of mind/body dualism, see Goodman A: Organic unity theory: The mind-body problem revisited. American Journal of Psychiatry 1991; 148:553-563.
G. Scott Waterman, M.D.
Burlington, Vt.
