Have we forgotten what a psychologist ought to be? Vocationally, the difference between a psychologist and a psychiatrist is immense. The psychiatrist is a trained physician who is most prepared to treat patients who suffer from illnesses which are likely to have a substantial biological basis. As typical clusters of symptoms that respond to psychotropic medication, the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (published by the American PSYCHIATRIC Association) are likely caused or maintained by known or unknown biological factors. By contrast, a psychologist is presumably trained to help clients manage or cope with the psychological sequalae associated with stresses and somatic symptoms. While the methods overlap to a certain extent, the difference is largely one of hardware and software, with psychologists helping clients adjust their attitudes in ways that relieve distress, remove psychological obstacles to adjustment, and optimize mental health by re-organizing the elements of one's personality into an integrated and effective unit. While medication may often be necessary to restore functions fundamental to thinking and attention, psychologists do not possess the training required to make pharmacological decisions and no psychologist true to his or her vocation treats the pharmacological agent as a centerpiece of patient health and healing. And yet many psychologists do.

Market Forces

Underbid by social workers for therapy positions traditionally allocated to higher-priced and better-trained psychologists, psychologists have been forced to redefine their role in the mental health delivery system. Acutely attuned to market trends, many for-profit professional schools now turn out assessment specialists, psychologists with a near-Ninja training in the construction, evaluation, administration, scoring, interpretation, and reporting of intelligence batteries and personality inventories. However, as supply of these services greatly outweighs demand, psychologists have altered their training to graduate second-rate psychiatrists.

Second-Rate Psychiatrist

Clinical psychology training reflects a disproportionate orientation by the Diagnostic & Statistical Manual of Mental Disorders, published by the American Psychiatric Association. The programs turn out savants specializing in the treatment of special populations diagnosed with a particular class of DSM disorders (e.g., Anxiety Disorders) and toward that end, manualized therapies are published to guide the psychologist through the diagnostic and therapeutic interviewing of these patients. Pressures from sources of third party reimbursement (i.e. managed care companies) contribute to the practice of targeting a disorder or source of maladjustment. Consequently, the broad psychologistic education, and psychologists's disposition and ability to address the whole of the person (including their case conceptualization skills), have significantly eroded over a series of training generations.

Thus the lobbying for prescription privileges among a growing minority of psychologists both reflects and perpetuates a dummying down of psychologists with respect to an understanding of (and interest in) the human condition. And granting agencies like the National Institute of Mental Health feeds this trend by making funding contingent on research that uses DSM diagnostic constructs, solidifying this canon and narrowing our view of psychopathology in a discipline whose preoccupation with abnormal psychology has all but banished normal psychology into a realm of near-paranormal impertinence. This trend is not to be underestimated, as grants determine what research is performed, what phenomena gets attention, who is the preferred candidate among the 100 applicants for the 1 tenure-track teaching position, and by extension, who defines Psychology and assumes responsibility for shaping the academic and professional communities.

But what really furrows my brow is how the American Medical Association and the American Psychiatric Association could have been so thoroughly outsmarted, so outmaneuvered and outnetworked, by the American Psychological Association. The Psychological Association evolved into quite the political juggernaut with considerable real estate holdings. In addition to three psychologists serving in Congress, the American Psychological Association cultivated relationships to Congressional legislators with mind-blowing meticulousness. Its Science in the Public Interest [nicknamed "SPIN"] listserv and Public Policy Advocacy Network [PPAN] created a tool whereby members across APA listservs are e-mailed a policy action alert complete with links to Congress (see APA One Click Away from Capitol Hill) oiling the herd for a slick stampede of Congress. The policy action alerts often assume allegiance and uniformity, failing to provide details about the issue, and encouraging members to copy and paste the response provided in an e-mail to their district representative or committee chair.

And lastly, the support of prescription privileges reflects a metaphysical materialism among a growing number of psychologically unsophisticated and intellectually insouciant professionals. Psychologists have been complicit in the propaganda that panders to the public perception of treatment as pills for rogue neurotransmitters (see Dream Research Most Reveals Psychology's Impurities) for a humorous take on the managed neglect and distortion of dreaming by sleep lab research.

Surely, psychologists could not have money on the brain. Or could they? The students read the annual financial report of salaries for mental health professionals – which was assigned reading at my professional school – with more involvement than any book or trade publication. Most of all I remember the rancor and bitterness with which the students rail at trends that favor social workers, nurses, or psychiatrists. I remember the "they're catching up" complaint uttered by psychology students who noticed the average salary for social workers increased $1,000 more than the average salary for psychologists in their area.

So the only question that remains is this: what marks the death of Psychology? Will it be the day psychologists are granted privileges to prescribe psychotropic medications? Or WAS IT the day a poll revealed that a critical minority of psychologists decided they favored them? Probably the latter. But still more damage to the industry – and to the collective psyche – can be done. Psychologists have already co-opted the DSM. What remains for them to do to become psychiatrists IF they were win such privileges (and they have already won them in New Mexico and Louisiana)? How about medical school? I apologize if I should seem a bit cynical, but I have met far too many psychologists who went into the field precisely because it offered all the title ("doctor") for a fraction of the work as that required for an M.D.

Psychologists do have their problems. But believe me -- their problem is not that they lack authorization to use a prescription pad. It is that they want one.